手传振动工人冷水复温率影响因素的多因素Logistic回归分析

目的检测和评估手传振动企业的手传振动危害,初步分析手传振动作业工人冷水复温率的影响因素。方法以广东省五家企业的接振工人为研究对象,现场检测振动接触水平,测定冷水复温率。通过问卷调查,了解不同岗位接振工人的一般情况。分析性别、年龄、吸烟、饮酒、高血压、接振剂量、不同岗位与冷水复温异常率的关联。结果所检测的48个接振岗位操作中有31个岗位的振动水平A(4)超过我国国家标准规定的5 m/s2,超标率64.6%。按国际上A(8)的分级标准,有28个点达到或超过Ⅰ级危险度。经单因素χ2检验,年龄、吸烟指数、高血压、接振剂量对冷水复温异常影响的差异有统计学意义(P均0.05)。Logistic回归分析发现,年龄≥40岁与冷水复温率关联的比值比(OR)=1.865(P0.05)。吸烟指数600与冷水复温率关联的OR=2.474(P0.05)。高血压与冷水复温率关联的OR=1.231(P0.05)。饮酒指数≤600与冷水复温率关联的OR=0.395(P0.05)。中剂量组、高剂量组与冷水复温率的关联的OR值分别为1.232、2.135(P均0.05)。结论所调查的企业手传振动危害严重。年龄、吸烟、高血压是影响冷水复温率异常的危险因素,饮酒指数≤600是保护因素。接振剂量与冷水复温异常无明显相关。     

手传振动工人累积暴露量及末梢血管损伤程度与血浆TGF-β水平的相关研究

目的探讨手传振动暴露职业人群血浆中转化生长因子(TGF-β)水平与手传振动接触水平、手部末梢循环血管损伤程度之间的关系。方法选取77名某金属制品厂的手传振动作业工人为振动暴露组,以30名健康男性作为对照组,现场检测手传振动接触水平并计算累积振动暴露剂量(CVEL),采用问卷调查了解研究对象的一般情况和手臂症状,采集抗凝血用酶联免疫吸附法检测血浆中TGF-β水平;振动暴露组进行冷水复温试验(CWLT)检测,记录是否出现振动性白指(VWF)。结果作业场所的CVEL为7.4~15.7(13.2±1.3)m2/s4,92.2%的振动暴露工人自诉有各种手臂症状;对照组的TGF-β水平中位数(M)为341.49(151.29~1040.41)ng/L,均在正常参考值范围;振动暴露组的TGF-β水平为1519.27(610.18~5417.46)ng/L高于对照组,差异具有统计学意义(P0.001)。校正吸烟、饮酒和年龄等混杂因素后,TGF-β水平与CVEL高水平组和有VWF症状相关(P0.05),CVEL高水平组的OR值及95%CI为15.33(1.06,221.89),有VWF亚组的OR值及95%CI为4.55(1.05,19.78)。结论接触手传振动可导致暴露人群TGF-β水平升高,TGF-β水平升高与手传振动的暴露剂量及手部末梢血管损伤程度明显相关。     

79例手臂振动病病例接触振动时间与冷水复温率相关关系分析

目的了解手臂振动病病例冷水复温率情况,探讨接触振动(简称接振)时间与冷水复温率之间的相关关系。方法收集79例手臂振动病病例资料,分析其冷水复温率水平及构成,并按接振时间进行分组,分析接振时间与冷水复温率的相关性。结果左右手冷水复温率异常检出率比较,差异无统计学意义(P>0.05),5 min冷水复温率异常与接振时间不相关(P=0.83),10 min冷水复温率异常与接振时间不相关(P=0.05),其中接振时间在≥20 001 h和5 001～10 000 h组异常检出率较高。结论接振时间与冷水复温率无直线相关关系,在疾病发展的某些阶段冷水复温实验可能存在敏感性差的问题。     

老年人吸烟、饮酒与脑卒中的流行病学研究

目的 研究吸烟、饮酒及其他危险因素与脑卒中及其分型的关系。方法 对象为北京市万寿路地区60岁以上老年人群的分层随机抽样样本。共调查2096人，分析吸烟、饮酒及其他危险因素与脑卒中的关系。结果 单因素分析时吸烟的OR值为1.17(95％CI:1.01～1.35)。饮酒在男性脑卒中及脑梗塞的OR值(95％CI)分别是0.69(0.51～0.94)、0.71(0.52～0.98)；调整其他主要因素后，吸烟致脑卒中、脑出血的相对危险性OR值(9596CI)分别为1.19(1.02～1.39)、1.53(1.03～2.27)；饮酒似为脑卒中的保护因素，OR值(95％CI)为0.78(0.61～0.99)。另外与脑卒中有显著相关的危险因素包括年龄、收缩压、高密度脂蛋白、高血压、冠心病、糖尿病、高血脂、脑卒中家族史。结论 吸烟是脑卒中的危险因素，适量饮酒对其似有保护作用。     

男性打鼾与高血压的关系

目的 调查男性职工打鼾与高血压的关系。方法 采用整群抽样方法，抽取马鞍山钢铁企业不同车间不同工种的当班作业工人1172人，采用自填问卷法，调查打鼾、吸烟、饮酒情况，同时测量血压、血脂、身高、体重以及常规内科检查(包括心电图、胸透)。结果 钢铁企业男性职工习惯性打鼾的流行率为14．6％，偶尔打鼾的流行率为55.3％；习惯性打鼾随年龄的增长，流行率增加，随着体质指数的升高，打鼾率升高，与吸烟20支以上和曾经饮酒有关；随打鼾频率增加，高血压患病率增加，从不打鼾者高血压患病率为13．6％，偶尔打鼾为16．4％，习惯性打鼾为30．4％(OR=1．651，95％可信区间为1．307～2．085)，但在校正年龄、肥胖、高血压家族史、吸烟、饮酒、血脂等因素后，打鼾与高血压联系不强(OR=1.373，95％可信区间0．906～2．080)。结论 打鼾可能与高血压无关。     

吸烟、饮酒与食管癌p53基因改变的Meta分析

目的 探讨吸烟、饮酒与食管癌p53基因改变之间的关系。方法 应用Meta分析对有关研究吸烟、饮酒与食管癌p53基因改变的文献进行综合评价。结果 纳入Meta分析的14篇研究吸烟的文献中,吸烟与P53蛋白高表达、p53基因改变(P53蛋白高表达 p53基因突变)的合并OR值分别为1.99(95％CI:1.30～3.06)、1.64(95％CI:1.13～2.37)(P<0.05),吸烟与p53基因突变的合并OR值为1.11(95％CI:0.47～2.76)(P>0.05)。11篇研究饮酒的文献中,饮酒与P53蛋白高表达、p53基因突变和p53基因改变的合并OR值分别为1.30(95％CI:0.83～2.04)、1.13(95％CI:0.67～1.90)和1.22(95％CI:0.87～1.72),合并OR值无统计学意义(P>0.05)。结论 吸烟与p53基因改变有显著联系,饮酒与p53基因改变未见显著联系。     

银川市回族和汉族老年人群空腹血糖异常情况

目的 研究银川市回族和汉族老年人群空腹血糖(FPG)异常的流行情况和影响因素,为老年人糖尿病的防治提供依据.方法 于2011年6月,采用整样随机抽样的方法对宁夏银川市5个社区年龄≥60岁的1 113名老年居民进行问卷调查(一般情况、病史及吸烟、饮酒情况等)、体格检查和生化指标(血脂、血糖)检测.结果 银川市老年人群FPG异常率为27.8％(309/11 13).单因素分析结果显示,汉族(x2=5.343,P=0.021)、非在婚状态(x2=3.890,P=0.049)、饮酒(x2=17.884,P＜0.01)、超重肥胖(x2=12.522,P=0.002)、高血压病史(x2=10.154,P=0.001)、血清总胆固醇水平高(x2=17.692,P＜0.01)和甘油三酯水平高(x2=25.559,P＜0.0)的人群FPG异常率高.多因素非条件logistic回归分析结果显示,民族(OR=0.720,95％CI:0.521～0.995)、饮酒(OR=1.980,95％CI:1.329～2.950)、体质指数(OR=1.241,95％CI:1.026～1.501)、高血压病史(OR=1.358,95％CI:1.031～1.789)、血清总胆固醇(OR=1.301,95％CI:1.053～1.607)和血清甘油三酯(OR =1.308,95％CI:1.109～1.543)为FPG异常的影响因素.结论 银川市老年人群FPG异常率较高,民族、饮酒、体质指数、高血压病史、血清总胆固醇和甘油三酯是FPG异常的影响因素.     

CYP1A1和GSTM1基因多态与肺癌发病关系的病例-对照研究

目的 探讨肺癌易感性标记物CYP1A1及GSTM1基因多态以及吸烟等其他环境暴露因素与肺癌发生的关系。方法 采用病例-对照研究的方法，收集原发性肺癌病例91例以及非肺部疾患的住院病例(对照)91例，所有的研究对象均采静脉血进行DNA抽提，并用PCR方法检测CYP1A1以及GSTM1基因多态，同时调查研究对象吸烟等其他环境暴露因素。应用Logistic回归分析方法进行单因素和多因素的分析。结果 无论是单因素分析还是多因素分析均未显示出CYP1A1和GSTM1基因多态与肺癌发病的关联。多因素分析结果表明：化程度的OR为0．63(95％CI：0．45～0．86)，吸烟量的OR为1．56(95％CI：1．14～2．14)，无抽油烟机的OR为3．77(95％CI：1．48～9．56)，食用动物油的OR为1．67(95％CI：1.25～2．24)，常吃胡萝卜的OR为0．47(95％CI：0．22～0．98)，饮酒的OR为6．58(95％CI：1.53～28．30)，家族肺癌史的OR为3．75(95％CI：1．64～8．58)。结论 CYP1A1和GSTM1基因多态与肺癌发病无明显的关联，吸烟、饮酒、食用动物油、家族肺癌吏以及无抽油烟机是肺癌的危险因素，而高化程度和常吃胡萝卜与降低肺癌风险有关。     

公务员人群中脂肪肝患病影响因素的病例对照研究

目的 了解公务员脂肪肝患病情况及其影响因素,探讨预防发病的干预措施.方法 于2008年9～12月,采用整群抽样的方法对天津市某区公务员进行健康状况及影响因素的问卷调查.应用SPSS17.0建立Logistic回归模型,对公务员人群的脂肪肝影响因素进行分析.结果 公务员人群中脂肪肝患病率为17.86％.多因素分析结果显示脂肪肝患病影响因素有:年龄(OR=0.074,95％CI:1.050～1.105)、性别(OR =-1.207,95％CI:0.223～0.402)、体重指数(OR=0.385,95％CI:1.360～1.587)、饮酒(OR=0.990,95％CI:1.459～4.964)、吸烟(OR=0.852,95％CI:1.485～3.707)、睡眠时间(OR=-0.165,95％CI:0.723～0.995)、按时吃饭情况(OR=0.693,95％CI:1.582～2.530)、高血压(OR=1.340,95％CI:3.031～4.817)、高血脂(OR=1.431,95％CI:2.700～6.483)、腰臀比(OR=2.734,95％CI:6.098～18.920)、亚健康分值(OR=-0.048,95％CI:0.936～0.970).结论 公务员人群脂肪肝患病率较高,公务员是各种慢性病发病的高危人群,是今后开展健康管理的重点群体.     

上海市社区人群高血压危险因素聚集与患病关系的研究

目的 <\b>研究超重与中心型肥胖、家族遗传史、不适量饮酒、吸烟、血脂异常和高血糖6项危险因素的聚集与高血压患病间的关系.方法 <\b>利用2008-2011年对15 158名35 ～ 74岁上海市社区居民进行的心脑血管疾病社区综合防治研究项目数据,采用单因素和多因素统计方法,描述危险因素聚集与高血压之间的相关性,使用纵向队列进一步对因果关系进行探讨.结果 <\b>基线调查高血压总现患率为41.9％.随着高血压危险因素聚集数目的增加,与高血压患病关联的OR值(按年龄调整)增大.聚集数目为1～5项及以上的男性其OR值依次为3.157 (95％CI:2.152 ～ 4.630)、6.428 (95％CI:4.435 ～ 9.319)、11.797 (95％CI:8.135～ 17.105)、19.723 (95％CI:13.414 ～ 29.000)、33.051 (95％ CI:21.449～50.930),聚集数目为1～4项的女性其OR值依次为2.917 (95％CI:2.374～ 3.585)、6.499 (95％CI:5.307～ 7.959)、15.717 (95％CI:12.609～ 19.591)、31.719(95％CI:21.744～ 46.270).在纵向队列中,男性和女性的2年发病率分别为1.9％和1.6％.同无危险因素人群相比,聚集数目较多的人群2年发病率较高,女性中当聚集数目为2及3项时其RR值分别为2.111(95％CI:1.024 ～ 4.350)、3.000(95％CI:1.287 ～ 6.995),差异有统计学意义.结论 <\b>随着危险因素聚集数目的增加,高血压患病风险升高,应对危险因素进行综合防控.     

Subjective scaling of hand-arm vibration

The purpose of this research was to establish a scale for comfort with regard to hand-arm vibration using the category judgment method and to validate the frequency-weighting method of the ISO 5349-1 standard. Experiments were conducted using random signals as stimuli. These stimuli consisted of three types of signal, namely designated stimulus F, with flat power spectrum density (PSD) ranging from 1 to 1,000 Hz, stimulus H with PSD which became 20 dB higher at 1,000 Hz than at 1 Hz, and stimulus L that had a PSD 20 dB lower at 1,000 Hz. These stimuli were selected from the specific spectrum patterns of hand-held vibration tools. These signals were modified by the Wh frequency weighting in accordance with ISO 5349-1, and the R.M.S. values were adjusted to be equal. In addition, the signal levels were varied over a range of five steps to create 15 kinds of individual stimuli. The subjects sat in front of a vibrator and grasped the mounted handle which exposed them to vertical vibrations after which they were asked to choose a numerical category to best indicate their perceived level of comfort (or otherwise) during each stimulus. From the experimental results of the category judgment method, the relationship between the psychological values and the frequency-weighted R.M.S. acceleration according to the ISO 5349-1 standard was obtained. It was found that the subjective response scaling of hand-arm vibration can be used for design-objective values of hand-held tool vibration.     

Lessons from hand-arm vibration syndrome research

This paper addresses many of the salient issues and difficulties encountered in performing Hand-Arm Vibration Syndrome research since its discovery in the early 1900's by Alice Hamilton. The areas discussed and the resulting lessons learned include the medical, epidemiological, and control aspects of HAVS. The authors conclude with a plea to health professionals to be ever vigilant and responsive to the HAVS problem, or else it will continue unabated into the next century, an overall time span of nearly 100 years.     

New frequency weighting of hand-arm vibration

A new frequency weighting method to assess hand-arm vibration exposure is proposed in this paper. The influence of frequency components was first estimated using the method of multivariate analysis, then a simple form of the weighting curve was introduced. Compared with the frequency weighting in the current ISO 5349-1 (2001), the proposed weighting can better explain the relationship between rates of symptoms and vibration exposure among vibrating tool users. Although this new weighting is derived from limited data, it suggests that the current weighting in ISO 5349-1 should be changed to give more weight to the high frequency range and less weight to the low frequency range.     

Prevention of the hand-arm vibration syndrome

In order to determine the prevalence of the hand-arm vibration syndrome before preventive countermeasures were taken, a special health examination was carried out among 417 national forestry workers operating chain saws in the northern area of Hokkaido, Japan. Thirty-two chain-saw workers (7.7%) were diagnosed as exhibiting the vibration syndrome. The highest prevalence rates were 15.8% among the workers who had operated the saws for 11 to 15 years and 20.3% for workers in their 50s. Improved work conditions for chain-saw workers have increasingly prevented the vibration syndrome in the state forests of Japan since 1978. The present report covered the six years since 1978, and evaluated the effects of these improved work conditions on chain-saw workers from data on the recovery rates of skin temperature and the vibration sense threshold after a cold provocation test. As a result, recovery rates of skin temperature and the vibration sense thresholds at the fifth and tenth minutes after the immersion of the hands in cold water were significantly better than those six years earlier. It is suggested that adequate restrictions on the operating time of the chain saw and on the age of workers can completely prevent the vibration syndrome even if the total operating time is appreciably lengthened.     

Sensorineural stages of the hand-arm vibration syndrome

Recent work has shown that the vascular signs and neurological symptoms commonly associated with exposure of the hand to vibration may develop independently. A classification for the neurological component of the hand-arm vibration syndrome has been developed for those symptoms dominated by sensory afferent involvement, based on the results of objective tests on 634 hands. The first symptomatic stage (1SN) consists essentially of episodic finger numbness with or without tingling, the second involves, in addition, reduced sensory perception (2SN), while the most severe stage (3SN) focuses on reduced tactile discrimination and/or manipulative dexterity. Consistent implementation of this classification by means of objective tests requires one, or more, precise, quantitative measure of peripheral somatosensory dysfunction, in addition to the traditional neurological tests (fine touch, pain, and temperature). Measurements of tactile function by means of esthesiometry or vibrotactile perception appear suited to this purpose. A procedure for staging individual hands may then be based on combining numerical scores assigned to the results of the traditional neurological tests and, additionally, esthesiometer and/or vibrotactile perception thresholds.     

再谈手臂振动病的研究及建议

关于手臂振动病的研究，国外早有不少报道，笔者也发表了一些粗浅见解。特别是新近修订、发布了国家职业卫生标准《职业性手臂振动病诊断标准》（GBZ7-2002），以及国家推荐标准《手持式机械作业防振要求》（GB／T 17958-2000）和《手套掌部振动传递率的测量与评价》（GB／T 18703-2002）等，充分反映了国内这一领域的最新科研成果。