男性青年噪声作业人员高频噪声性听力损失风险预测模型研究  

Risk prediction model for high frequency noise-induced hearing loss in young male workers exposed to noise

作　　者：白卢皙[1] 李燕茹[1] 段丹萍[1] 丘丛玺[1] 张海[1] 刘移民[1,2] BAI Lu-xi;LI Yan-ru;DUAN Dan-ping;QIU Cong-xi;ZHANG Hai;LIU Yi-min(Guangzhou Prevention and Treatment Hospital of Occupational Diseases,Guangzhou,Guangdong 510620,China;不详)

机构地区：[1]广州市职业病防治院,广东广州510620 [2]广州医科大学,广东广州511400

出　　处：《中国职业医学》2022年第3期241-247,共7页China Occupational Medicine

基　　金：广东省医学科学技术研究基金项目(A2020340);广州市卫生健康科技项目(20201A010034);广州市高水平临床重点专科建设项目(穗卫函[2019]1555号);。

摘　　要：目的探讨男性青年噪声作业人员的高频噪声性听力损失(NIHL)影响因素,建立NIHL风险预测模型。方法采用回顾性队列研究方法,以某汽车生产企业2016—2018年新入职且听力正常的从事噪声作业的男性青年人群为研究对象,进行随访调查,采用多因素Cox比例风险回归模型分析其发生NIHL的影响因素,并采用偏回归系数构建预后指数(PI)模型。根据PI值将研究对象分为低风险组(PI<0.00者)和高风险组(PI≥0.00者),采用Kaplan-Meier法分析其发生NIHL的风险。结果截至2020年,研究对象NIHL发生率为33.4%(167/500),均为单纯高频NIHL者,无检出语频NIHL者。Cox比例风险回归模型分析结果显示,发生高频NIHL的风险在职业性噪声接触水平超标者是合格者的2.03倍(P<0.01),饮酒者是不饮酒者的1.62倍(P<0.05),居住环境嘈杂者是不嘈杂者的1.69倍(P<0.05)。根据上述3个影响因素的偏回归系数构建的PI模型为:PI=-0.44+0.71 x_(职业性噪声接触水平)+0.49 x_(饮酒)+0.52 x_(居住环境嘈杂)。高风险组人群上岗后12、24、36、48和52个月发生高频NIHL的概率(3.9%、12.3%、19.4%、30.4%、51.1%)均高于低风险组人群(2.3%、8.3%、10.7%、15.3%、27.5%),特别是在上岗后第3年开始发生高频NIHL的概率上升幅度较大。结论职业噪声接触水平超标、饮酒、居住环境嘈杂均是男性噪声作业人员发生高频NIHL的危险因素;所构建的PI模型可较好地预测听力正常的男性青年从事噪声作业5年内发生早期NIHL的风险。ObjectiveTo investigate the influencing factors of high-frequency noise-induced hearing loss(NIHL)in young male workers exposed to noise,and to establish a risk prediction model for NIHL.MethodsThe young males who were newly recruited and with normal hearing in noise operations in an automobile manufacturing enterprise from 2016 to 2018 was selected as research subject using a retrospective cohort study.A follow-up survey was conducted.Multivariate Cox proportional hazards regression model was used to analyze the influencing factors of NIHL,and the partial regression coefficient was used to construct the prognostic index(PI)model.According to the PI value,the subjects were divided into low-risk group(PI<0.00)and highrisk group(PI≥0.00).Kaplan-Meier method was used to analyze the risk of NIHL.ResultsBy 2020,the incidence of NIHL was 33.4%(167/500),which was pure high-frequency NIHL,and no speech frequency NIHL was detected.Cox proportional hazard regression model analysis showed that the risk of high-frequency NIHL was 2.03 times higher than those with occupational noise exposure level exceeding the standard(P<0.01),1.62 times higher in those with drinking than in those without drinking(P<0.05),and 1.69 times higher in those with noisy living environment than in those without drinking(P<0.05).The PI model constructed according to the partial regression coefficients of the above three influencing factors is PI=-0.44+0.71 x_(occupational noise exposure intensity)+0.49 x_(drinking)+0.52 x_(noisy living environment).The probability of high-frequency NIHL(3.9%,12.3%,19.4%,30.4%,51.1%)in the high-risk group at 12,24,36,48,and 52 months after taking office was higher than that in the low-risk group(2.3%,8.3%,10.7%,15.3%,and 27.5%),especially in the third year after taking office.ConclusionExcessive exposure to occupational noise,drinking and noisy living environment are risk factors for high frequency NIHL in male workers exposed to noise.The constructed PI model can predict the risk of early NIHL among male youth with

关 键 词：噪声 听力损失 影响因素 风险 预测模型 生存分析 

分 类 号：R135.8[医药卫生—劳动卫生]