接触噪声工人听力损失预警模型的研究  

Research on early warning model of the hearing loss of workers exposed to noise

作　　者：齐海汇 杜奕熠 田宇 王永伟[1] 全立明[1] 周鼎伦[1] Qi Haihui;Du Yiyi;Tian Yu;Wang Yongwei;Quan Liming;Zhou Dinglun(West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西公共卫生学院/四川大学华西第四医院,成都610041

出　　处：《中华劳动卫生职业病杂志》2023年第1期47-51,共5页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：四川省卫生健康委员会科研课题(19PJ230)。

摘　　要：目的探讨接触噪声工人听阈变化规律,建立基于个体的听力损失预警模型,以期精准化和差异化管理接触噪声工人的健康。方法于2019年9月,收集某企业561名接触噪声工人自入职以来所有体检资料,收集较好耳高频平均听阈值、较好耳4000 Hz平均听阈值和较好耳语频平均听阈值指标,利用广义估计方程(GEE)调整性别和年龄,建立各指标的预警模型,根据ROC曲线面积(AUC)和约登指数筛选敏感指标和预警模型。结果561名接触噪声工人中,有26人出现听力损失(4.6%);敏感指标为较好耳语频平均听阈值≥20 dB、较好耳高频平均听阈值≥30 dB和较好耳4000 Hz听阈值≥25 dB,各指标AUC分别为0.602、0.794和0.804,约登指数分别为0.204、0.588和0.608;GEE听力损失预警模型中较好耳高频平均听阈值≥20 dB和较好耳4000 Hz平均听阈值≥25 dB为最优模型,AUC均为0.862。结论个体水平的听力损失预警模型可较为准确评估接触噪声工人个体听力损失的发生风险。Objective To explore the change of hearing threshold of workers exposed to noise,establish an individual-based hearing loss early warning model,accurately and differentiated the health of workers exposed to noise.Methods In September 2019,all physical examination data of 561 workers exposed to noise from an enterprise were collected since their employment.Three indicators of average hearing threshold of the better ear,namely,at high frequency,4000 Hz and speech frequency,were constructed.The generalized estimating equation(GEE)was used to adjust gender and age and establish the warning model of each indicator.Finally,sensitive indicators and warning models were screened according to AUC and Yoden index.Results Among the 561 workers exposed to noise,26(4.6%)workers had hearing loss.The sensitivity indicators were the average hearing threshold at speech frequency≥20 dB,high frequency≥30 dB and 4000 Hz≥25 dB.The AUC of each index was 0.602,0.794 and 0.804,and the Youden indexes were 0.204,0.588 and 0.608,respectively.In GEE of hearing loss warning models,high-frequency hearing threshold≥20 dB and 4000 Hz hearing threshold≥25 dB were the optimal models,with AUC of 0.862.Conclusion Combined with the changes of individual hearing threshold over the years,can accurately assess the risk of individual hearing loss of workers exposed to noise.

关 键 词：噪声 职业性 听力损失 广义估计方程 预警模型 

分 类 号：R135.8[医药卫生—劳动卫生]