个体噪声防护的职业接触人群听力损失的剂量-反应关系研究

目的准确评价工作场所中使用个体听力防护的噪声接触人群的听力损失。方法对50家企业的3 432名接触噪声工人进行纯音听力测试并对50家接触噪声企业进行职业卫生调查。结果50家噪声接触企业进行职业流行病调查显示噪声强度(92.1±4.9)dB,累积噪声暴露量(CNE)为(103.43±6.66)dB(A).年;在3 432名接触噪声作业人员的听阈检查中,高频损失1 272人(37.06%),语频损失133人(3.88%);高频和语频损失的发生率随累积噪声强度的增大而增大,其发生率与CNE存在剂量-反应关系(P<0.01)。结论高频和语频的发生率随累积噪声强度的增大而增大,呈剂量-反应关系。     

噪声性耳聋易感基因研究的进展

噪声性耳聋 (noiseinducedhearingloss,NIHL)是常见的职业疾患。以往的研究结果显示 ,相同噪声暴露下不同个体NIHL严重程度具有相当大的差异 ,说明NIHL存在个体易感性差异。一般认为NIHL易感性与遗传有关 ,近年的研究结果也显示一些与NIHL易感性相关的基因改变。然而整体而言NIHL易感基因研究尚处于起步阶段 ,面临着相当多的困难。笔者回顾近年该领域的研究进展 ,并对研究中存在的困难及相应策略进行初步分析 ,现综述如下。一、噪声性耳聋存在个体易感性差异人群研究结果表明 ,NIHL和噪声暴露量呈正相关 ,噪声愈强、暴露时间愈…     

个人行为方式对噪声性听力损失的影响

目的 探讨个人行为方式对噪声性听力损失的影响,为其预防策略和措施提供依据。方法 采用腾讯问卷收集广州市某汽车生产厂职工的基本信息、个人行为方式等信息,对其进行纯音听阈测试和噪声强度检测。采用两独立样本t检验、Pearson χ2检验和非条件logistic回归模型分析个人行为方式对噪声性听力损失的影响。结果 控制噪声强度、年龄等混杂因素后,进食奶豆及其制品为噪声性听力损失的保护因素（P = 0.002）,即一周内进食奶豆及其制品3～5 d者、6～7 d者罹患噪声性听力损失的风险分别为不进食者的0.609倍、0.424倍（P = 0.035、0.001）;吸烟＞10支/d者罹患噪声性听力损失的风险为不吸烟者的1.638倍,差异有统计学意义（P = 0.021）。结论 提高进食奶豆及其制品频率、减少吸烟频率（＜10支/d）可降低罹患噪声性听力损伤的风险。     

Transcultural adaptation of an instrument to evaluate hearing handicap in workers with noise-induced hearing loss

The noise-induced hearing loss (NIHL) is a chronic and irreversible disease resulting of the exposure to noise in high levels at work. Even in the beginning, this hearing loss can damage in many degrees the worker's quality of life. Before this study, there wasn't an instrument, in Portuguese, to evaluate the psychosocial disadvantages of workers with NIHL. The aim of this research was to make a transcultural adaptation of an especific instrument to evaluate the hearing handicap from the original language to Portuguese, and check the reliability and legitimacy. The selected instrument passed by a process of semantic equivalence that was conducted in five stages: translation, back translation, critical appraisal of the versions, pre-test and a final review by a multi-professional group to develop a consensual version of the instrument for current use in Brazil. The instrument called "Inabilities Scale and Hearing Handicap" had, in general, acceptable psychometric measures, considering the little size of the sample and the fact that workers' hearing loss weren't too significant. Therefore, the Portuguese version of this instrument needs to be further tested in a representative sample of Brazilian workers with NIHL to ratify its utility in order to evaluate hearing handicap in this population.     

肌动蛋白结合蛋白TRIOBP与噪声性听力损失易感的相关性研究

目的 分析肌动蛋白结合蛋白TRIOBP基因的多态性与噪声性听力损失的关系，探索人群发生噪声性听力损失的遗传学机制。方法 通过病例对照研究设计选取2020年1—12月汽车制造工厂接受职业健康检查的噪声暴露工人，将双耳高频听力阈值超过25 dB的工人作为高频听力损失组，根据年龄、噪声接触情况和工作岗位等变量进行匹配，选择双耳任一频段（500、1 000、2 000、3 000、4 000、6 000 Hz）的听力阈值低于25 dB的工人作为对照组，每组234人。收集受试者的一般信息、职业史、个人史、既往史、体检结果和空腹全血样本，对两组工人的血样进行TRIOBP基因单核苷酸多态性测序，采用条件logistic回归分析TRIOBP的遗传变异与NIHL（噪声性听力损失）易感的相关性。结果 单因素分析显示，高频听力损失组比对照组有更多的工人接触过混合溶剂，睡眠时间延长（P <0.05）；对照组比高频听力损失组有更多的工人有听觉系统症状、ALT异常和LDL-C异常（P <0.05）。条件logistic回归分析显示，TRIOBP基因的5个SNP均不是NIHL易感性的影响因素（P>...     

Evaluation of noise-induced hearing loss by reference to the upper limit of hearing

We have defined the upper limit of hearing as the maximum audible frequency measured with fixed intensity and changing frequency. We have previously established the standard upper limit ageing curves from the normal age variation in the upper limit of hearing. In the present study, we sought to clarify the effects of occupational noise on the upper limit of hearing. We measured the upper limit of hearing in 239 healthy male workers (478 ears) exposed to intensive occupational noise. Their age variation in the upper limit of hearing was compared with the standard upper limit ageing curves in males. There were statistically significant deteriorations. Even if the ears that had normal hearing levels (35 dB or less) were selected, deterioration in the upper limit of hearing was noticeable. The upper limit of hearing may serve as clinically useful information on the hearing impairment that precedes noticeable hearing impairment in conventional audiometry for workers exposed to intensive occupational noise.     

Occupational noise-induced hearing loss

Occupational noise-induced hearing loss is, at least in theory,preventable. One way to assess the problem and whether preventativemeasures are effective is to assess employees' hearing. In orderto minimize cost and time off work this can be carried out effectivelyin the workplace as long as certain conditions are met.     

钙黏素23基因多态性与噪声性听力损失易感性关系研究

目的探讨钙黏素23(CDH23)基因多态性与噪声性听力损失易感性关系。方法采用病例对照研究方法对254名接触噪声工人进行研究,聚合酶链反应-限制性片断长度多态性方法检测CDH23基因单核苷酸多态性位点rs1227049和rs1227051的多态性。结果rs1227049位点在听损组CC、CG和GG基因型频率分别为39.4%、15.0%和45.6%,等位基因C和G的频率分别为46.9%和53.1%;对照组3种基因型的频率分别为51.2%、19.7%和29.1%,等位基因C和G的频率分别为60.9%和39.1%。rs1227051位点在听损组TT、CT和CC基因型频率分别为82.7%、17.3%和0,等位基因T和C的频率分别为91.3%和8.7%。对照组3种基因型的频率分别为89.0%、11.0%和0,等位基因T和C的频率分别为87.0%和13.0%。两位点的基因型分布及其等位基因频率在听损组和对照组之间差异均无统计学意义(P>0.05)。采用多因素Logistic回归分析对个体间年龄、工龄和累积噪声暴露量等因素进行校正后,也未发现两个单核苷酸位点任一基因型的改变会引起噪声性听力损失的危险度有显著性提高(P>0.05)。结论本研究还不能认为CDH23基因rs1227049和rs1227051两个单核苷酸多态性位点是噪声性听力损失易感性的危险因素。     

噪声作业工人血糖水平与噪声性听力损失的关系

目的 探究血糖与性别之间的交互作用对噪声性听力损失(noise-included hearing loss, NIHL)的影响。方法 采用病例对照研究,询问调查噪声作业工人一般资料、职业史、既往史等资料以及职业健康监护资料,进行单因素分析,然后采用logistic回归模型分析NIHL的影响因素,再进行乘法交互作用分析。结果 调查的1 628例噪声作业工人NIHL 616人(37.84%),NIHL的危险因素有血糖偏高(OR=1.960,95%CI:1.345～2.855)、男性(OR=4.346,95%CI:2.866～6.590)、高环境噪声强度(OR=1.036,95%CI:1.016～1.056)、单核细胞计数偏高(OR=8.522,95%CI:3.054～23.776)、血小板偏低(OR=0.997,95%CI:0.994～0.999)。血糖偏高人员的NIHL风险是血糖正常的1.960倍(P<0.01),男性NIHL的风险是女性的4.346倍(P<0.01),环境噪声强度每增加一个单位,NIHL风险提高1.036倍。血糖偏高与男性对NIHL的加法交互作用有统计学意义...     

CASP3和CASP7基因多态性与噪声性听力损失易感性关系

目的 探讨细胞凋亡通路相关基因CASP3和CASP7多态性与中国汉族人群噪声性听力损失（NIHL）易感性之间的关联。方法 研究对象来自2014年杭州市1 549名噪声接触工人听力损失的横断面调查,采用1：1配对病例对照研究,病例组为电测听双耳高频平均听阈>25 dB（A）的工人,对照组为性别、年龄、接噪工龄、工作岗位与病例匹配且双耳所有频段听阈均≤25 dB（A）的工人,共272对。PCR-LDR法检测2个SNP位点的基因型。采用多因素条件logistic回归模型分析SNP位点与NIHL的关联,并以叉生分析计算基因-环境交互作用。结果 χ²检验分析发现,CASP3基因rs1049216等位基因（C、T）频率组间分布有统计学差异（OR=0.68,95%CI=0.50~0.93）,而基因型频率组间差异无统计学意义（P>0.05）;CASP7基因rs10787498等位基因及基因型频率组间分布均无统计学意义（P>0.05）;多因素条件logistic回归显示,CASP3基因rs1049216中,与野生基因型CC相比,突变基因型（CT+TT）为NIHL的保护因素（调整OR=0.65,95%CI=0.43~0.97）;叉生分析表明rs1049216位点与文化程度、睡眠时间存在交互作用（P≤0.001）,NIHL的危险性降低（OR值变小）。结论 CASP3基因rs1049216位点可能与中国汉族人群NIHL易感性有关,且可能与文化程度、睡眠时间存在交互作用。     

Noise exposure and permanent hearing loss of textile workers in Thailand

Hearing loss induced by noise exposure in a large scale textile mill (number of workers = 1,611) in Thailand was investigated on the basis of interviews, noise measurements, and audiometric tests. The frequency of subjective symptoms relating to noise exposure was higher in the weavers than among other mill workers and office workers. The average noise levels in the weaving sections and other sections were 101.3 +/- 2.7 dBA and 89.8 +/- 5.3 dBA, respectively. The results of the audiometric tests revealed the significantly higher noise-induced hearing loss among workers in the weaving section compared to other mill workers and office workers (P less than 0.01). Among weavers, hearing levels decreased with the longer years of work. Concerning personal noise protective devices, 38.6% of the weavers never used them. It was concluded that hearing loss status in the workers of the mill was serious. Improvements by means of integrated work organization activities were recommended.     

A study of noise-induced hearing loss and blood pressure in steel mill workers

Summary A cross-sectional study on noise-induced hearing loss and blood pressure was conducted in a steel mill company. Three hundred testees were selected by cluster sampling. They were physically examined and an audiometry was done. Only 151 workers, who had the highest hearing threshold at 4000 Hz and without any family history of hypertension or treatment of drugs on cardiovascular troubles, were selected as subjects in this study. Multiple regression analyses revealed that body mass index, employment duration, age and hearing loss explained a significant amount of variation in systolic and diastolic blood pressure (R ² = 0.16 and 0.12, respectively). There was no significant relationship between hearing loss and blood pressure. In order to adjust confounding factors, analyses of covariances were used and the results suggest that hearing loss is unrelated to blood pressure. It seems that hearing loss is not appropriate as a noise exposure index to measure the relationship between noise exposure and blood pressure.     

Prevalence of hearing loss and work-related noise-induced hearing loss in Michigan

OBJECTIVE: This study assessed the prevalence of self-reported hearing loss (HL) and work-related noise-induced hearing loss (NIHL) in Michigan. METHODS: Questions related to HL and NIHL were added to the 2003 Behavioral Risk Factor Surveillance System in Michigan, a national telephone survey-based surveillance system of health conditions among adults. RESULTS: An estimated 19% reported HL; the proportion with HL increased steeply with age. Among those with HL, 29.9% reported that their HL was related to noise at work. Associations were found between HL/NIHL and current cigarette smoking and elevated cholesterol. CONCLUSIONS: Self-reported HL is common in Michigan. Almost 30% of this loss was attributed to noise exposure at work, a preventable condition. Prevalence estimates from this study were higher than previously published estimates. Better surveillance and prevention programs are recommended.     

某汽车制造企业噪声作业工人听力损失影响因素分析

目的 了解某汽车制造企业接触噪声工人听力损失情况,探究职业性噪声听力损失的危险因素。
方法 选取某汽车制造企业暴露于职业性噪声超过一年的3 411名工人为研究对象,对噪声作业工人开展问卷调查,对工作场所进行职业病危害因素检测。
结果 该企业有509人检出有听力损失,噪声性听力损失发生率为15.7%。听力损失组的接触噪声声级、接触噪声工龄、婚姻情况和工作班制情况与听力正常组相比较,差异均有统计学意义（P < 0.05）。多因素logistic回归分析显示:年龄、接噪工龄、接触噪声声级增大,听力损失的风险增高（OR=1.09~1.54,P < 0.01）;相比三班制,单一班制和两班制是听力损失的独立危险因素（OR=2.19、2.43,P < 0.01或0.05）。
结论 汽车制造企业工作场所噪声危害不容忽视。企业应加强工作场所噪声治理,为噪声作业工人开展定期职业健康体检,实行科学健康的工作班制。
     

噪声性听力损失易感人群外周血SOD1、SOD2、T-AOC及MDA水平分析

目的分析噪声性听力损失易感人群血浆超氧化物歧化酶(SOD1、SOD2),总抗化能力(T-AOC)以及丙二醛(MDA)水平及相关关系。方法利用病例对照研究,通过比较同一噪声暴露强度噪声作业人员的左耳3 000 Hz频段听阈位移情况,筛选出听阈位移最大的10%个体作为本研究的易感人群组,共201例;听阈位移最小的10%个体作为耐受人群组,共202例;并进行相关的职业卫生调查和问卷调查。抽取易感人群和耐受人群空腹外周静脉血5 ml,用南京建成生物有限公司试剂盒测定SOD1、SOD2、T-AOC及MDA水平。结果易感人群SOD1活力〔(46.69±16.44)U/ml〕和T-AOC能力〔(9.78±2.88)单位/ml〕均显著低于耐受人群〔(65.99±16.32)U/ml〕和〔(10.53±3.23)单位/ml〕,P<0.01或P<0.05;但两组SOD2活力差异无统计学意义,P>0.05。易感人群中MDA〔(5.12±1.49)nmol/ml〕显著高于耐受人群〔(4.74±1.56)nmol/ml〕,P<0.05。血浆中SOD1活力以及T-AOC与听阈位移呈负相关关系,P<0.05,相关系数r分别为-0.218和-0.268。而脂质过氧化产物MDA与听阈位移呈正相关关系,P<0.05,相关系数r=0.304。SOD1活力以及T-AOC和MDA水平呈负相关关系,P<0.05,相关系数r分别为-0.195和-0.198。结论血浆中SOD1、T-AOC以及MDA与噪声性听力损失的易感性有关,易感人群血浆SOD1活力、抗氧化能力、丙二醛以及听阈位移间存在广泛的相关关系。     

Predictive factors of occupational noise-induced hearing loss in Spanish workers: A prospective study

The purpose of our study was to identify the main factors associated with objective noise-induced hearing loss (NIHL), as indicated by abnormal audiometric testing, in Spanish workers exposed to occupational noise in the construction industry. We carried out a prospective study in Tenerife, Spain, using 150 employees exposed to occupational noise and 150 age-matched controls who were not working in noisy environments. The variables analyzed included sociodemographic data, noise-related factors, types of hearing protection, self-report hearing loss, and auditory-related symptoms (e.g., tinnitus, vertigo). Workers with pathological audiograms had significantly longer noise-exposure duration (16.2 ± 11.4 years) relative to those with normal audiograms (10.2 ± 7.0 years; t = 3.99, P < 0.001). The vast majority of those who never used hearing protection measures had audiometric abnormalities (94.1%). Additionally, workers using at least one of the protection devices (earplugs or earmuffs) had significantly more audiometric abnormalities than those using both protection measures simultaneously (Chi square = 16.07; P < 0.001). The logistic regression analysis indicates that the use of hearing protection measures [odds ratio (OR) = 12.30, confidence interval (CI) = 4.36-13.81, P < 0.001], and noise-exposure duration (OR = 1.35, CI = 1.08-1.99, P = 0.040) are significant predictors of NIHL. This regression model correctly predicted 78.2% of individuals with pathological audiograms. The combined use of hearing protection measures, in particular earplugs and earmuffs, associates with a lower rate of audiometric abnormalities in subjects with high occupational noise exposure. The use of hearing protection measures at work and noise-exposure duration are best predictive factors of NIHL. Auditory-related symptoms and self-report hearing loss do not represent good indicators of objective NIHL. Routine monitoring of noise levels and hearing status are of great importance as part of effective hearing conservation programs.