职业因素组对钢铁工人颈动脉粥样硬化影响的病例对照研究  

A case-control study on effect of occupational factor exposures on carotid atherosclerosis in steel workers

作　　者：秦真威 苏亚娇 王海涛 朱红茹 张晓同 李婵 李小明 王朝阳 袁聚祥 范红敏 Qin Zhenwei;Su Yajiao;Wang Haitao;Zhu Hongru;Zhang Xiaotong;Li Chan;Li Xiaoming;Wang Zhaoyang;Yuan Juxiang;Fan Hongmin(School of Public Health,North China of Science and Technology University,Tangshan 063210,China;Hebei Provincial Coal and Safety Key Laboratory,Tangshan 063000,China;Tangshan Hongci Hospital,Tangshan 063000,China)

机构地区：[1]华北理工大学公共卫生学院,唐山063210 [2]河北省煤矿卫生与安全重点实验室,唐山063000 [3]唐山市弘慈医院,063000

出　　处：《中华流行病学杂志》2020年第11期1836-1842,共7页Chinese Journal of Epidemiology

基　　金：国家重点研发计划(2016YFC0900605);河北省自然科学基金(H2016209058);河北省科技支撑项目(192777129D)。

摘　　要：目的探讨职业因素对钢铁工人颈动脉粥样硬化(CAS)的影响。方法采用病例对照研究方法,选取2017年2-6月经超声检查诊断为CAS的1033名工人为病例组,选择同期体检的1033名正常工人为对照组。收集工人基本情况、饮食情况、行为生活方式、血生化指标和职业史等。利用单因素和多因素logistic回归分析职业有害因素对CAS的影响,利用环境风险评分(ERS)评估多种职业有害因素对CAS的联合作用。结果高温、噪声、职业紧张、夜班天数增加罹患CAS的风险;随着高温、噪声、累积暴露量、职业紧张程度和夜班天数的增加,CAS的发生风险成上升趋势(趋势检验:χ2=37.53,P<0.01;χ2=16.98,P<0.01;χ2=13.93,P<0.01;χ2=5.59,P<0.05);与P20组比,调整协变量后,P40、P60、P80、P100组发生颈动脉危险分别为高温1.61(1.19~2.18)、1.69(1.25~2.30)、1.84(1.36~2.49)、2.43(1.77~3.34);噪声1.70(1.15~2.52)、1.68(1.20~2.35)、1.80(1.34~2.42)、2.23(1.53~3.26);职业紧张1.39(1.04~1.86)、1.41(1.06~1.89)、1.45(1.09~1.95)、1.48(1.10~1.98);夜班天数1.58(1.08~2.33)、1.66(1.12~2.47)、1.55(1.04~2.31)、1.76(1.17~2.64)。环境风险评分结果显示,随着ERS评分增加,患颈动脉硬化的风险增加(趋势检验χ2=51.61,P<0.01);RCS结果显示,钢铁工人ERS与CAS之间存在相关性(P<0.01),且呈线性关系(非线性检验P>0.05)。结论高温、噪声、职业紧张、夜班天数与CAS发生有关;ERS与钢铁工人CAS之间存在线性剂量-反应关系。Objective To investigate the effect of occupational factor exposures on carotid atherosclerosis(CAS)in steel workers.Methods A frequency matched case-control study was conducted by age and factory proportion.A total of 1033 workers with carotid atherosclerosis diagnosed by ultrasonography examination from February to June 2017 were selected as case group,and 1033 workers without carotid atherosclerosis indicated by physical examination at the same time were selected as control group.The basic information of the workers,such as diet pattern,lifestyle,serum biochemical index and occupation history,were collected.The effects of occupational hazards on carotid atherosclerosis were analyzed by univariate and multivariate logistic regression analyses.The combined effects of various occupational hazards on carotid atherosclerosis were evaluated by environmental risk score(ERS).Results High temperature,noise,occupational stress and night shift days increased the risk of CAS.With the increase of cumulative high temperature and noise exposure,occupational stress and night shift days,the risk of CAS increased(trend text:χ2=37.53,P<0.01;χ2=16.98,P<0.01;χ2=13.93,P<0.01;χ2=5.59,P<0.05).After adjustment of covariates,compared with P20 group,the risk of carotid artery in P40,P60,P80 and P100 groups were as follows:high temperature 1.61(1.19-2.18),1.69(1.25-2.30),1.84(1.36-2.49),2.43(1.77-3.34);noise 1.70(1.15-2.52),1.68(1.20-2.35),1.80(1.34-2.42),2.23(1.53-3.26);occupational stress 1.39(1.04-1.86),1.41(1.06-1.89),1.45(1.09-1.95),1.48(1.10-1.98);night shift days 1.58(1.08-2.33),1.66(1.12-2.47),1.55(1.04-2.31),1.76(1.17-2.64).The results of the environmental risk score showed that the risk of carotid atherosclerosis increased with the increase of ERS(ERS trend textχ2=51.61,P<0.01);RCS results showed that there was a linear relationship between ERS and CAS in steel workers(P<0.01).Linear dose-response relationship existed between ERS and CAS(nonlinear test P>0.05).Conclusions High temperature,noise,occupational stress and nigh

关 键 词：颈动脉粥样硬化 钢铁工人 职业因素 

分 类 号：R743.1[医药卫生—神经病学与精神病学]