铬酸盐职业接触者健康监护指标的循证研究  

Evidence-based study of chromate exposed workers＇ health surveillance indexes

作　　者：顾永恩[1] 钱琴[1] 余善法 张济[3] 王丽[4] 赵祖昌 宋艳双[1] 陈田[1] 杨敬林[1] 王天成[6] 王云[1] 贾光[1] 

机构地区：[1]北京大学医学部公共卫生学院劳动卫生与环境卫生学系,100191 [2]河南省职业病防治研究院 [3]济南市疾病预防控制中心 [4]内蒙古科技大学包头医学院公共卫生学院 [5]河南省三门峡疾病预防控制中心 [6]北京大学第三临床医院检验科

出　　处：《中华预防医学杂志》2013年第9期848-854,共7页Chinese Journal of Preventive Medicine

基　　金：卫生部公益项目（200902006）;国家自然科学基金（81072281）

摘　　要：目的 对铬酸盐职业接触者现有健康监护方案监护指标进行循证研究,对该方案进行补充和完善.方法 于2011年12月以六价铬与肝损伤、微核、尿铬为主要检索内容,检索“考克兰图书馆（Cochran library）”、“PubMed”、“OVID Medline”、“Web of knowledge”与“中国生物医学文献数据库”等数据库.并对检索到的文献按照制定的纳入与排除标准筛选后,共计22篇；依据牛津证据分级标准,对其进行分级评价.结合作业场所现场调查及健康体检工作及卫生经济学手段,并以总成本与总存活生命年数计算成本效果比,对方案的有效性及可行性进行评价.结果 循证研究提示血清谷丙转氨酶（Alanine aminotransferase,ALT）不足以充分反映肝功损伤；尿铬与反映机体损伤的指标关联性较好；外周血淋巴细胞双核细胞微核率可反映铬酸盐接触的遗传损伤.铬酸盐制造业工人肺癌健康监护的卫生经济学评价结果：成本效果比（cost/effectiveness,C/E）为42 321.61元/年,而在普通人群中C/E ＞252 868.97元/年.结论 建议将检测血清谷丙转氨酶改为检测肝功能全项,尿铬由选检项目提升为必检项目,并增加外周血淋巴细胞双核细胞微核率作为选检项目.Objective The health surveillance proposal for chromate exposed workers was provided and analyzed on the evidence-based study and then to be improved.Method Firstly,the related literatures were searched about liver damage,micronuclei,urinary chromium and hexavalent chromium exposure in Evidence Based Medicine Reviews such as Cochran library,OVID Medline,Web of knowledge in December 2011 ; and then,these literatures were reviewed in according to inclusion and exclusion criterias; 22 articles totally were retrieved,evaluated and classified in according to the grading standard by Oxford Centre for Evidence-based Medicine.Finally,field epidemiological investigation was further adopted to confirm the efficiency and feasibility of this proposal,combined with cost-effectiveness analysis：the ratio of total cost divided survival years was used to express the cost-effectiveness.Result Only the glutamic pyruvic transaminase test could not reflect liver damage caused by chromate exposure well; Unirary chromium correlated well with the index reflecting body damage caused by chromate exposure; Binucleated cells micronucleus index in peripheral blood lymphocyte could reflect the genetic damage caused by chromate exposure.As for health economic evaluation of chromate lung cancer,the value of cost/effectiveness was ￥42 321.61 per year that was far below the value of common people（￥ 252 868.97 per year）.Conclusion It was suggested that serum glutamic pyruvic transaminase test should be replaced by liver function test,urinary chromium should be classified as a compulsory index and binucleated cells micronucleus index in peripheral blood lymphocyte should be supplied as a recommended index.

关 键 词：铬酸盐类 肝功能试验 微核试验 尿 成本效果分析 

分 类 号：R135[医药卫生—劳动卫生]