氯乙烯作业工人恶性肿瘤发病情况的流行病学调查

对全国12个城市的13个聚氯乙烯制造工人中5459名氯乙烯作业工人和6461名对照厂工人进行了从投产到1989年12月31日为止的恶性肿瘤发病情况的回顾性和前瞻性队列调查。结果表明,男工接触组肝癌的发病率、死亡率均显著高于对照组,男性肝癌的死亡率也显著高于我国中等城市男性肝癌的死亡率。在恶性肿瘤的分类构成中,接触组男工的肝癌居首位。接触组男工肝癌的发病年龄比对照组显著提前。     

吸烟与油毡生产男性工人肺癌死亡关系的研究

对４３２０名油毡生产工人和４１０１名对照组工人进行了吸烟与肺癌死亡关系的回顾前瞻性流行病学调查研究。结果表明，油毡生产男工吸烟组肺癌标准化死亡率为４０．８６／１０万，不吸烟组肺癌标化死亡率为２４．７３／１０万，均显著高于对照组男工肺癌的死亡率，吸烟与油毡生产男工接触沥青烟有相加作用。     

吸烟与铬酸盐生产工人肺癌发病关系的研究

对２５４５名铬酸盐生产工人和５１９７名对照组工人进行了吸烟与肺癌发病关系的回顾一前瞻性流行病学调查研究，结果表明，铬酸盐生产男工吸烟组肺癌的发病率和死亡率均为１１４．１０／１０万，均显著高于对照组男工肺癌的发病率和死亡率，可清楚看出吸与铬酸盐生产男工接触化物有协同致癌作用。为预防铬酸直生产工人肺癌的发生，必须加强不吸烟的宣传教育。     

铬酸盐生产工人肺癌发病情况的流行病学调查研究

对六个地区２５４５名铬酸盐生产工人和５１９７名对照工人的恶性肿瘤发病情况调查结果，铬酸盐生产工人肺癌高发。其男工肺癌的发病和死亡分别占全恶性肿瘤发病和死亡的３５．６３％和３７．５０％；其肺癌的发病率和死亡率分别高达８２．０８／１０万和７９．４３／１０万，均显著高于对照男工（Ｐ＜０．００１）；其肺癌的ＳＭＲ为１．９６７和２．５７１，表明其肺癌死亡率显著高于全国大城市和中等城市男性同年龄组人群的肺癌死亡率；接触铬化物较多的转炉和制造两工种肺癌的发病率分别高达１３１．２１／１０万和７７．２３／１０万，均显著高于对照男工；吸烟与接触铬化物有明显的协同致肺癌作用。     

铅对接触男工妻子妊娠结局的影响

为评价铅对接触男工妻子妊娠结局的影响,对387名接触工人和575名非接触工人进行了调查。接触组和对照组男工妻子的人工流产率,分别为20.2％和22.9％,无显著性差异(P>0.05);接触组男工妻子的自然流产率和围产儿死亡率均高于对照组,接触组分别为10.3％和37.7‰。对照组分别为4.6％和12.0‰。(RR分别为2.23和3.14),有显著性差异(P<0.05);接触组男工妻子中有自然流产史的人数所占比例亦明显高于对照组,前者为12.1％,后者为6.4％(P<0.05)。多因素分析表明:自然流产和子女出生体重与接触铅、接触工龄和婚育年龄有关。     

二苯甲撑二异氰酸酯对作业男工外周血淋巴细胞微核率的影响

目的：二苯甲撑二异氰酸酯（MDI）对作业男工（接触组）外周血淋巴细胞微核（MN）率的影响。方法：对某化工厂84名接触MDI的男工和96名对照男工外周血淋巴细胞微核（MN）及其白细胞（WBC）计数并进行检测比较，结果：MDI作为男工外周血淋巴细胞MN显著高于对照组（P＜0．01）且随着工龄的增长有递增的趋势（P＜0．01）；高浓度接触组MN显著高于中浓度组及低浓度组（P＜0．01）。结论：MDI具有一定的遗传毒性。     

二苯甲撑二异氰酸酯对男工性激素水平的影响

目的 探讨二苯甲撑二异氰酸酯（MDI）对作业男工体内性激素水平的影响。方法 对某化工厂84名接触MDI的男工和96名对照男工血清睾酮（T）、卵泡刺激素（FSH）和黄体生成素（LH）水平进行检测和比较。结果 MDI作业男工血清T水平显著低于对照组（P＜0．01）;FSH及LH水平显著高于对照组（P＜0．01）;高浓度接触组男工血清T显著低于中浓度组和低浓度组（P＜0．01）;而LH及FSH却显著高于中浓度组和低浓度组（P＜0．01）;MDI作业男工性功能与对照组比显著减退（P＜0．01）;吸烟饮酒可导致血清T水平显著低于未吸烟饮酒组（P＜0．01）,而LH及FS未吸烟饮酒组无明显差异（P＞0．05）,且MDI与吸烟饮酒三者存在协同作用的关系。结论 MDI具有一定的生殖毒性。     

吸烟对接铅男工血铅影响的探讨

分析了７８名接铅男工和２７名非接铅男工血铅含量与吸烟的关系。结果表明,接触组与对照组工人的血铅含量差别非常显著（Ｐ〈０．０１）;接触组中吸烟人群的血铅显著高于不吸烟人群（Ｐ〈０．０１）;在作业场所吸烟的频数对血铅的影响有显著意义（Ｐ〈０．０１）。提示：吸烟会加重铅作业工人的职业危害,铅作业工人应提倡戒烟。     

天津市木尘作业工人肿瘤回顾性调查

本文对天津市五所家俱厂、一所木材厂,一所鞋楦厂木尘作业工人1031名进行了肿瘤回顾性队列调查研究。结果表明,男工全肿瘤与主要部位肿瘤均低于居民,二者无明显差别。各厂分别统计结果也显示,各厂接触组男工全肿瘤与主要部位肿瘤死亡率和一般居民比较,差别无显著意义。     

铅对接触男工性激素的影响

为评价铅接触对下丘脑-垂体-性腺轴的影响,选取健康男性工人189人,其中接触男工97名(血铅2.12±1.39μmol/L),非接触男工92名(血铅1.10±0.56μmol/L),以放射免疫法测定其血浆睾酮及血清LH、FSH。接触组工人平均血浆睾酮浓度为561.12ng/dl,明显低于对照组的725.29ng/dl(P<0.01)而血清LH水平则明显高于对照组工人,前者为19.17mIU/ml,后者为15.19mIU/ml(P<0.05);两组工人血清FSH含量无显著性差异,分别为12.21和11.03mIU/ml(P>0.05)。多元逐步回归分析表明,血清LH及血浆睾酮水平的改变与接触者的工龄明显相关,其次与吸烟也有一定关系。提示男工接触铅后可影响下丘脑-垂体-睾丸轴内分泌功能,引起血浆睾酮及血清LH浓度的改变。     

氯乙烯作业工人恶性肿瘤流行病学调查研究

目的 为了解氯乙烯作业工人恶性肿瘤发病情况。方法 采用回顾前瞻性观察法,对921名氯乙烯作业工人进行了40年死因流行病学调查。结果 男性接触组肝癌死亡率明显高于对照组。RR为2．16（P＜0．05）;接触组恶性肿瘤、肝癌的死亡也显著高于1994年全国城市居民恶性肿瘤的死亡率及1995年全国城市居民肝癌的死亡水平。SMR分别为1．8、29（P＜0．05）。在恶性肿瘤分类构成中,接触组肝癌居首位。结论 氯乙烯作业工人肝癌高发具有职业性特征。     

Effects of exposure to vinyl chloride. An assessment of the evidence

This paper reviews the possible effects of vinyl chloride on the mortality of occupationally exposed men and the carcinogenic effects that might be observed in the general population as a result of environmental pollution with vinyl chloride. The results of four studies fulfilling the criteria of providing substantial numbers of observations more than 25 years after first exposure and covering a period long enough for more than 10% of the workers to have been expected to die constitute the basis for the assessment of the occupational hazards. Other studies provide only supplementary information. The data permit two conclusions. First, men occupationally exposed to vinyl chloride have experienced a specific hazard of angiosarcoma of the liver. Second, any other occupational hazards that may have existed have been small. No positive evidence of a hazard of any nonmalignant disease or any type of cancer other than angiosarcoma of the liver has been found except possibly for a small hazard of lung cancer when exposure was heavy. More definite conclusions might be reached if those who have studied exposed employees could present their results in appropriate and comparable ways. A very small risk of angiosarcoma may have occurred as a result of vinyl chloride escaping into the environment around plants handling vinyl chloride in the past, but the evidence indicates that the current risk to the general public (if any) must be negligible.     

Angiosarcoma of the liver in Great Britain in proximity to vinyl chloride sites.

OBJECTIVES: To study the incidence of angiosarcoma of the liver in England and Wales 1979-86 and Scotland 1975-87. To investigate whether any non-occupational neighbourhood cases occurred near a vinyl chloride site. METHODS: This is a geographical study of incident cases among the general population of Great Britain. Diagnosis of angiosarcoma of the liver was based mainly on the national cancer registry, the world register of cases among vinyl chloride workers, and the register of cases (including histological review) maintained by the Health and Safety Executive. Proximity (< 10 km) of residence to a vinyl chloride site was based on postcode of address at the time of diagnosis. RESULTS: 55 cases were ascribed to angiosarcoma of the liver in England and Wales with a further six cases in Scotland (annual incidence in Great Britain from all sources of around 1.4 cases per 10 million population). There were two cases with documented exposure to Thorotrast, and 10 cases among vinyl chloride workers. There were no vinyl chloride sites in Scotland. Among the 25 cases in England and Wales with histological diagnosis after review by a panel of pathologists, only 15 were confirmed as angiosarcoma, and one of the two Scottish cases after histological review was also confirmed. Overall, 11 cases ascribed to angiosarcoma were resident within 10 km of a vinyl chloride site; nine were vinyl chloride workers, one further case on histological review was not considered to have been correctly diagnosed as angiosarcoma, and the remaining case, confirmed as angiosarcoma, was employed at a vinyl chloride factory during the late 1950s, although not as a vinyl chloride worker. CONCLUSION: The incidence of angiosarcoma of the liver in Great Britain remains extremely rare. The one confirmed case in a non-vinyl chloride worker within 10 km of a site must nevertheless be presumed to have been exposed to vinyl chloride in the workplace. In the period of study, there were no confirmed non-occupationally exposed cases of angiosarcoma among residents living near a vinyl chloride site in Great Britain.     

Mortality experience of workers exposed to vinyl chloride monomer in the manufacture of polyvinyl chloride in Great Britain.

Identification particulars were obtained for over 7000 men who were at some time between 1940 and 1974 exposed to vinyl chloride monomer in the manufacture of polyvinyl chloride. Approximately 99% of these men have been traced and their mortality experience studied. The overall standardised mortality ratio, 75-4, shows a significant reduction compared with the national rates. Four cases of liver cancer were found. Two of these have been confirmed by a panel of liver pathologists as angiosarcoma and two as not angiosarcoma. There is no evidence to support the hypothesis that cancers other than those of the liver are associated with exposure to vinyl chloride monomer. The two cases of angiosarcoma were found in men who had been exposed to high concentrations of the monomer although the second man died only eight years after first exposure. The industry in Great Britain has expanded considerably since the second world war with over 50% of men having entered with the last decade. Conclusions drawn about the effect of vinyl chloride monomer on the mortality experience of men in this industry must consequently be tempered by the reservation that the full impact may not yet be in evidence.     

Mortality experience of workers exposed to vinyl chloride monomer in the manufacture of polyvinyl chloride in Great Britain

Identification particulars were obtained for over 7000 men who were at some time between 1940 and 1974 exposed to vinyl chloride monomer in the manufacture of polyvinyl chloride. Approximately 99% of these men have been traced and their mortality experience studied. The overall standardised mortality ratio, 75-4, shows a significant reduction compared with the national rates. Four cases of liver cancer were found. Two of these have been confirmed by a panel of liver pathologists as angiosarcoma and two as not angiosarcoma. There is no evidence to support the hypothesis that cancers other than those of the liver are associated with exposure to vinyl chloride monomer. The two cases of angiosarcoma were found in men who had been exposed to high concentrations of the monomer although the second man died only eight years after first exposure. The industry in Great Britain has expanded considerably since the second world war with over 50% of men having entered with the last decade. Conclusions drawn about the effect of vinyl chloride monomer on the mortality experience of men in this industry must consequently be tempered by the reservation that the full impact may not yet be in evidence.     

氯乙烯职业接触评估及其健康危害调查

目的评估氯乙烯累积接触剂量与氯乙烯职业健康的危害关系。方法选取某厂接触氯乙烯工龄超过1年的211名接触人群和其他工厂212名非接触人群 ,登录该厂氯乙烯浓度监测资料和工人健康监护资料 ,比较接触组与对照组工人症状和体征方面的差异。结果发现接触组血清谷丙转氨酶(ALT)、脾脏肿大和白细胞减少的发生率均高于对照组 ,并具有显著统计意义。同时 ,在接触组随累积接触剂量的增加 ,肝功异常(ALT)、脾肿大发生率均有升高的趋势。结论肝、脾损害与接触氯乙烯有明显的关系 ,长期、高浓度接触氯乙烯对工人的健康危害值得关注。     

兵器行业三硝基甲苯作业工人恶性肿瘤的回顾性调查研究

目的：了解兵器行业三硝基甲苯（TNT）作业人员恶性肿瘤的发病情况，为修订慢性TNT中毒诊断标准、制定TNT作业防护管理措施提供依据。方法：对兵器行业8个工厂1970－1995年期间从事TNT作业1年以上的男工恶性肿瘤发病情况进行回顾性队列调查研究。结果：接触组全恶性肿瘤发病率明显高于对照组，相对危险度（RR）为2．32。用全国大中城市1973－1975年和1990－1992年男性居民全恶性肿瘤死亡专率作标准计算标化死亡比（SMR）分别为71．8和179．6，99％CI为71．8－144．2，差异有显著性（P＜0．01），表明TNT作业者全恶性肿瘤死亡率明显高于一般人群。肝癌发病率占全恶性肿瘤发病率的31．92％，死亡率为对照组的3．97倍。用全国大中城市1973－1975年和1990－1992年男性居民肝癌死亡率为标准计算，SMR分别为150．5和381．5和381．6，99％CI为59．3－184．0，差异有显著性（P＜0．01），平均死亡年龄（51．7岁）比对照组（54．1岁）提前2．4岁，比全国大中城市居民（55．6岁）提前3．9岁。肝癌发病与工龄、工种以及接触TNT程度关系密切；饮酒有协同致癌作用。结论：TNT作业男工全恶性肿瘤发病率和死亡率明显高于一般人群，肝癌居首位，其发病与工龄、工种、接触TNT程度关系密切。     

A mortality study of vinyl chloride monomer workers employed in the United Kingdom in 1940-1974

The mortality experience of 5,498 male workers employed for at least one year during 1940-1974 in the vinyl chloride industry of the United Kingdom was followed through to 31 December 1984. There was a significant excess of nonsecondary liver tumors with 11 deaths, of which seven were angiosarcomas. All the angiosarcoma deaths occurred in autoclave workers with a median latency of 25 years from date of first exposure. A strong healthy worker effect was seen. Other than that for liver cancer, no increased incidence of cancer deaths attributable to vinyl chloride monomer exposure was found. There was no evidence of increased mortality from chronic liver disease. The incidence of death from respiratory disease was low and was not affected by polyvinyl chloride dust exposure.