某化工厂恶性肿瘤死亡的回顾性队列研究

目的：了解职业因素对化工厂工人恶性肿瘤死亡的影响。方法：采用流行病学队列研究方法对该厂接触毒物工人疾病死亡原因进行29年回顾性分析。结果：硫酸、磷肥两车间肝癌死亡明显高于对照组（P＜0．05或0．01）;磷肥车间全癌死亡也明显高于对照组（P＜0．05）。此外,磷肥车间累计接毒工龄15－20年（或年龄40－50岁）全癌死亡、累计接毒工龄20年以上（或年龄50岁以上）肝癌死亡标化相对危险度（SRR）明显高于对照组（P＜0．05或0．01）;硫酸车间累计接毒工龄20年以上（或年龄50岁以上）肝癌死亡SRR也明显高于对照组（P＜0．05或0．01）。结论：本研究表明,某化工厂癌症发生可能与其生产环境中存在的铁金属矿尘、磷矿石粉尘以及氟化物等职业危害因素的综合作用有关。     

硝化作业工人肝胆系统损伤的调查研究

本文结合现场人接触剂量监测结果对77名接触DNT和NT的硝化作业工人及40名非硝化作业工人的有关肝胆系统指标进行了研究,结果表明接触组工人自觉症状发生率显著高于对照组（P＜0．05）,;B超检查结果接触组肝大检出率高于对照组,差异有显著性（P＜0．05）,且随接触时间的增加而加重,尤其工龄在20年以上的硝化作业工人肝脏毒性作用更为明显,接触组HBsAb检出率明显高于对照组。     

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。     

氯乙烯作业工人恶性肿瘤发病情况的研究

本文对某聚氯乙烯树脂厂氯乙烯接触者４０５名工人（男３１９名，女８６名）和不接触任何毒物的某建筑部门４１１名工人（男３４２名，女６９名）对照组，进行了恶性肿瘤发病情况的对比研究。结果表明，作业环境空气中氯乙烯浓度为０．５～５６９６．６ｍｇ／ｍ３，男性接触氯乙烯者恶性肿瘤和肝癌死亡率分别为１５４．３１／１０万和６８．５６／１０万，略高于对照组，未见显著性差异；全肿瘤、肝癌死亡年龄比对照组显著提前；接触组发现１例肝血管肉瘤。     

丙烯腈对作业工人健康的影响研究

目的：探索长期接触丙烯腈（Acrylonitrile,ACN)对职业人群健康状况的影响。方法：对275名ACN作业工人（接触组）和275名不接触ACN职工（对照组）的健康状况进行流行病学调查分析。结果：（1）ACN作业人群头痛,头昏,失眠,记忆力减退,疲乏无力,胸闷,胸痛、心悸及恶心症状比例高于对照组（P＜0．05）;（2）接触组Hb(男性）,WBC水平高于对照组（P＜0．05）;（3）接触组ALT异常率高于对照组（P＜0．05）;（4）肝脏B超检查显示接触组脂肪浸润比例较对照线高,其差异有显著意义（P＜0．05）。结论：低浓度ACN对接触人群仍会产生一定影响。     

水泥制造工人神经行为功能调查

使用WHO神经行为功能核心测试组合对某水泥制造厂矿山、生料、制成、烧制四个车间的作业工人共131名及后勤行政对照40名进行神经行为功能测试。结果显示,接触组工人的情感状态除有力－好动项外,积分均明显高于对照组工人,差异有显著性（P＜0．05,P＜0．01）;各行为功能指标（生料、制成组的数字译码项除外）积分均明显低于对照组,差异有显著性（P＜0．05,P＜0．01）,表明水泥制造作业环境对作业工人的神经行为存在有害影响。     

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。     

上海某冶炼厂铅接触工人肿瘤死亡的回顾性队列研究

目的 了解职业铅接触工人肿瘤死亡情况,探讨职业铅接触与肿瘤的关系。方法 1985年1月1日前在本厂工人1年以上,且1985年1月1日仍存活的男性工人共6971名组成全队列,其中3344名在铅接触车间工作的工人组成的亚队列为接触队列。随访从1985年1月1日至1997年12月31日。以上海市人口的肿瘤死亡率作为标准对照,计算标化死亡比（SMR）;以本厂非接触人群作内对照计算相对危险度（RR）;估计累计接触剂量进行剂量－反应关系分析。结果 全队列6971人共观察87576人年,接触队列3344人共观察41505人年。全队列中,肺癌的SMR（95％CI）为128．0（101．1－159．7）。1965年后入厂的工人肺癌的SMR为463．7（P＜0．01）。有铅接触工作史且工龄超过20年的工人鼻咽癌的SMR＝408．0（P＜0．01）,肺癌的SMR＝156．6（P＜0．01）。肿瘤总计、恶性肿瘤总计、食管癌、胃癌、肝和胆道癌、肺癌和膀胱癌的RR（95％CI）分别为3．25（2．43－3．89）、3．28（2．54－4．32）、3．57（1．08－10．47）、2．93（1．15－4．87）、4．58（2．03－9．97）、8．58（4．82－15．11）、6．66（2．83－13．01）。将累计接触剂量分为高、中、低3个组,中、高组工人恶性肿瘤RR分别为1．62（P＜0．05）和1．70（P＜0．05）,且有随累计接触剂量增加危险性升高的趋势。中、高组工人的肺癌RR分别为2．55（P＜0．05）,和2．31（P＜0．05）。结论 工人肿瘤死亡危险性升高可能与铅接触有关,但还需要在控制其他职业有害因素接触和非职业性有害因素接触的情况下作进一步的研究。     

某农药厂有机磷农药对作业工人健康危害的调查

目的：探讨某农药厂有机磷农药对作业工人健康的职业危害。方法：监测作业环境空气中有机磷农药浓度，对农药接触组和对照组人员进行内科、眼科、皮肤科、B超、心电图、X线胸片、肝功能及神经系统的检查，对女工进行了月经、生殖情况调查及妇科病检查，对接触组人员进行全血胆碱酯酶活性测定。结果：接触组神衰综合征、肝损伤和皮炎检出率显著高于对照组，差异具有显著性（P＜0．01，P＜0．05）。接触组眼疾患检出率高达80．95％，与对照组比较，差异具有非常显著性（P＜0．01）。接触组女工阴道炎，宫颈炎检出率以及月经异常发生率与对照组比较，差异具有显著性（P＜0．01，P＜0．05）。子宫肌瘤、卵巢囊肿、自然流产检出率也高于对照组，但差异无显著性（P＞0．05），而子宫内膜异位、早产、死胎情况只有接触组女工发生。结论：有机磷农药对作业工人健康有不良影响。     

二硫化碳接触工人热应激蛋白70及其抗体水平的变化

目的：探讨二硫化碳诱导人体产生热应激蛋白70（HSP70）及其抗体水平情况。方法：用免疫印迹法（Western blot)和酶联免疫吸附（ELISA）法对职业性接触二硫化碳工人HSP70和HSP70抗体水平进行检测。结果：接触组工人中血浆HSP70抗体阳性率明显高于对照组（P＜0．05），而HSP70蛋白含量在两组间比较差异没有显著性（P＞0．05）；但据HSP70抗体是否为阳性将工人分为阳性组和阴性组后，阳性组HSP70蛋白含量低于阴性组，差异有显著性（P＜0．05）。结论：HSP70及其抗体滴度可反映二硫化碳的接触状况，对接触二硫化作业工人的健康监护有一定意义。     

氯乙烯作业工人恶性肿瘤发病情况的前瞻性流行病学调查

对全国范围内12个城市的13个大、中型聚氯乙烯生产工厂5 291名接触氯乙烯的工人,及6 276名对照工人,进行了从1982-01-01～1989-12-31为止的前瞻性流行病学调查。结果没有发现肝血管肉瘤患者,但接触组男工肝癌的死亡率显著高于我国中等城市男性居民肝癌的死亡率(P<0.05),在恶性肿瘤的分类构成中,接触组男工以肝癌居首位,而且肝癌的发病年龄比对照组显著提前。     

Incidence of cancer among vinyl chloride and polyvinyl chloride workers.

The results of a follow up study of the incidence of cancer and the mortality in a cohort of 454 male workers producing vinyl chloride and polyvinyl chloride are presented. The study population was restricted to employees with more than one year's work experience in the study plant between 1950 and 1969 and the cohort was followed up from 1953 to the end of 1979. Twenty three new cases of cancer were observed compared with 20.2 expected; one case of liver angiosarcoma was found. Five cases of lung cancer were found (2.8 expected) and four cases of malignant melanoma of the skin were observed (0.8 expected). The possibility of a causal relationship between exposure to vinyl chloride and the development of malignant melanomas is discussed.     

碳素工人中癌症流行病学的研究

本文对全国六家碳素厂和一家铝厂电解车间的男职工6635名进行了观察期15年的肿瘤回顾性队列研究,用间接法计算死因标化率比(SRR)。其中高暴露作业人群肺癌和肝癌SRR分别为4.30(P<0.01)和2.25(P<0.01),中暴露作业人群肺癌和食道癌SRR分别为1.52(P>0.05)和5.46(P<0.01),与生产中煤焦油沥青挥发物(CTPV)有关。     

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.     

Mortality surveillance in a large chemical company: the Union Carbide Corporation experience, 1974-1983

The mortality experience of 88,000 Union Carbide Corporation employees from 1974 to 1983 is presented using a population-based surveillance system. The study included many long-term employees, with most deaths contributed by those retired or terminated. The total population exhibited 30% lower mortality overall and 10% lower cancer mortality, as compared with the general U.S. population. Excesses of benign neoplasms and malignant melanoma of the skin were observed in both hourly and salaried males. Mortality rates for lymphosarcoma and reticulosarcoma were significantly elevated due to higher rates among hourly male employees and a cluster in one location. This same location also exhibited an excess of liver cancer associated with vinyl chloride operations. There were no other significant excesses in the hourly male workers and fewer deaths than expected due to brain cancer, respiratory cancer, and nonmalignant respiratory diseases. Salaried, and particularly hourly, women experienced favorable mortality, although for the women, time since hire was relatively short. Location-specific findings were similar to what had been observed in the company's previously conducted cohort studies. Future value lies in the development of a database that will have greater power to address possible effects of past exposures and outcomes related to more recent lower level exposures.     

焦化厂工人的癌症死亡率研究

本研究是对不同地区的10个焦化厂进行的癌症回顾性队列研究。这些工厂合成一个队列,共15,951名男职工,以1971～1981年为观察期,为期11年,共累积167,804人年。与焦化厂同时进行调查的10个钢坯初轧厂共11,004名男职工为对照人群,焦化厂中每个工作区人群分别与其比较,计算癌症标化率比(SRR)。 11年期间焦化厂共死亡825人,全死因和全部癌症的SRR分别为1.32(P<0.01)和1.45(P<0.01),肺癌为2.50(P<0.01)。焦炉工人的肺癌显示明显超出量,SRR为5.20(P<0.01),其中炉顶和炉侧分别为6.91(P<0.01)和4.20(P<0.01)。炉顶、炉侧和非焦炉作业工人的肺癌危险性呈现梯度。即:0.91>4.20>2.72。焦炉工人的肺癌SRR随就业至观察终点间隔(Latency)年数增长而增加。     

卷烟生产工人十年死亡原因回顾性调查

本文对178例卷烟生产死亡工人,以6313例当地居民死亡病例为对照进行了十年(1981年1月1日至1990年12月31日)死亡原因回顾性调查。结果发现,卷烟生产女工平均死亡年龄比当地女性居民提前5.65岁。卷烟生产女工恶性肿瘤和呼吸系统疾病的死因序位分别提前1个位次,SMR分别为170和193,与对照组比有显著性意义(P<0.05)。卷烟生产女工肠癌和乳腺癌的死因序位与居民比分别提前5和6个位次,SMR分别为512和592(P<0.05)。本次调查未发现男性卷烟工人死因与当地居民存有差异。     

鞍钢焦炉工人肺癌进一步研究

本文对鞍钢焦炉工人的肺癌,在前期回顾性队列研究基础上,作了进一步研究。队列由焦化厂4171名男性工人组成,以1971～1985年为观察期,在此15年期间共积累57153人年。与鞍钢初轧厂男职工人群比较,焦化厂炼焦工作区中焦炉和非焦炉工人的肺癌SRR分别为4.88(P<0.01)和0.50(P>0.05)。炉顶和炉侧工人的肺癌SRR分别为5.74(P<0.01)和3.52(P<0.01)。该区工人的肺癌超出量,以炉顶、炉侧、非焦炉的顺序,呈现梯度(SRR为5.74>3.52>0.50),并与相应场所空气中平均苯溶物浓度相一致。其它工作区工人的肺癌无明显超出。     

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.