某石棉矿接尘工人恶性肿瘤10年回顾性调查

目的了解接触石棉粉尘工人恶性肿瘤患病情况,为制定石棉所致肿瘤的防护措施提供依据。方法选择某石棉矿1972—1981年接触石棉粉尘1年以上工人为调查对象,同时选择该矿附近县城关镇11个村居民作为对照组,采用统一方法进行流行病学调查,研究资料进行回顾性对比分析和统计学处理。结果①某石棉矿恶性肿瘤年平均粗死亡率55.82/10万,标化死亡率(SMR)70.82/10万;②石棉接尘工恶性肿瘤相对危险度(RR12.42)与对照组(RR3.76)对比分析差异有显著性(P<0.01);③石棉接尘工和对照组肺癌SMR比两者差异有显著性(P<0.01);④肺癌患病与接尘工龄长短呈正相关(r=0.87,P<0.025);⑤肺癌死亡工种分布:选矿最高、辅助工次之,采矿第3位,包装和生产管理人员未见肺癌患者;⑥吸烟工人肺癌高于不吸烟者(P<0.05)。结论接触石棉粉尘可引起肺癌患病率升高,消化道癌患病率也可升高,肺癌患病率与接尘工龄长短呈正相关,与接触粉尘浓度高低(工种)有关,粉尘浓度越大、接触时间越长,肺癌患病率越高,石棉粉尘接触是引起石棉矿肺癌高发的原因,吸烟对石棉所致肺癌有协同作用。     

手纺温石棉女工肿瘤死亡的41年队列研究

采用历史性队列研究方法对手纺温石棉女工肿瘤死亡情况进行了研究 ,以寿命表法计算人年数 ,以观察人群人年数为基数计算死亡率 ,并以当地女性年龄别死亡率均值为对照计算标准化死亡比 (SMR)、相对危险度 (RR)和特异危险度 (AR)及其 95%可信区间 (CI)。调查发现 ,在对 1960～ 1980年间手纺温石棉 1年以上的 5681名女工 ,追访至 2 0 0 0年底 ,共死亡 858例 ,以肿瘤死亡为主 (2 13例 ,占 2 4 83 % ) ,其中又以肺癌居首位 (87例 ,占 40 85% ) ,死亡率分别为 12 7 47 10万与 52 0 6 10万 ,SMR各为 1 3 5(1 18～ 1 54)、3 88(3 14～ 4 79) ,AR各为 3 3 0 7 10万与 3 8 64 10万 ,均显著高于对照 (P <0 0 5或P <0 0 1)。结果提示 ,手纺温石棉作业能使接触人员肺癌高发 ,与“闪石理论”、“矿物油暴露理论”和吸烟无关 ,而是由于手纺作业更易产生长度大于 10 μm的石棉纤维所致     

温石棉与肺癌——二十七年追踪研究

目的 探讨单纯接触温石棉的工人恶性肿瘤,尤其肺癌是否超高。方法 采用固定队列研究方法。研究队列为515例男性石棉工人,人列条件为1972年1月1日工资在册,工龄满1年,没有明显心肺疾患者。对照队列为650例不接尘男性工人,其余条件同研究队。追踪27年（1972－1998）。结果 （1）研究队列全癌死亡50例（SMR＝144）,其中肺癌22例（SMR＝652）;．对照队列全癌死亡1例（SMR＝34）,肺癌3例（SMR＝89）。两队列间全癌和肺癌差异均有显著性（P＜0．05）。（2）不接触石棉的吸烟者肺癌RR为2．6,不吸烟的石棉接触者肺癌RR为12．2,而接触石棉的吸烟者RR高达32．1。吸烟和石棉暴露协同指数为2．2。（3）研究队列发生胸膜间皮瘤2例。结论 单纯暴露于温石棉的工人肺癌显著超高。     

石棉矿工人和煤矿工人两个队列恶性肿瘤15年追踪研究

本文调查了两个队列(石棉矿工人和煤矿工人)男性共3035人,计58188人年的恶性肿瘤死亡率,追踪15年(1972.1.1～1987.1.1),结果表明石棉矿工人恶性肿瘤死亡率显著高于煤矿工人(SMR 1.43.P<0.05),肺癌SMR 5.72(P<0.01),肝癌、SMR2.39(P<0.05),消化道癌两队列未见差异SMR0.73,(P>0.05),不同年龄组比较显示40～50岁组石棉矿工人死亡率和恶性肿瘤死亡率均显著高于煤矿工人(P<0.05),且恶性肿瘤高发年龄在40～60岁组,其发病年龄较煤矿工人为早。此外,两队列的第一位死因均为呼吸道疾患,恶性肿瘤为第二位,可见加强防尘,防毒和鼓励戒炳等措施仍是矿山卫生工作的主要任务。石棉是多致癌物质,国外已早有报导,国内的调查资料未证实石棉的多致癌作用,但确认石棉工人肺癌高发,消化道癌未见增高。Jacobsen(1982)对煤矿工人死亡率追踪调查26年,死因分析表明消化道癌占第二位,国内王绵珍等(1986)报道煤矿工人恶性肿瘤居死因第二位,为了比较石棉矿工人和煤矿工人的恶性肿瘤,尤其是消化道癌的发病情况,作者对1472例石棉工人和2593例煤矿工人两个队列进行了15年追踪研究,结果报导如下。     

涞源石棉矿职工十年(1972—1981)死因回顾性定群研究

用回顾性定群研究对比涞源石棉矿接触石棉一年以上的1227名职工与涞源城关公社从未接触石棉的当地居民2754人的死因。结果:全死因标化死亡率、全恶性肿瘤标化死亡率和肺癌标化死亡率,石棉矿依次为10万分之924.3,443.6和344.4,而对照居民相应指标为838.8,62.9和14.3。肺癌危险度石棉矿高于居民3倍。接触石棉者中死于恶性肿瘤占死因首位。其中肺癌占37.5％,此外尚有3例死于在一般人群中极少见的胸膜间皮瘤,而对照组恶性肿瘤只占死因的第五位,其中肺癌只占18.8％,低于胃癌及食管癌。接触石棉同时吸烟者其肺癌的危险度为不接触石棉但吸烟的6倍。预防石棉引致肺癌的根本措施是控制作业场所的石棉浓度,在接触石棉工人中应大力宣传和作到不吸烟。     

碳素厂沥青作业工人癌症死亡十五年(1971-1985)回顾调查

对吉林碳素厂1990名从事沥青作业人员中恶性肿瘤死亡情况及该厂1590名不接触沥青工人死亡情况进行调查。沥青组发现肺癌死亡12例,对照组死亡5例,标化率比率(SRR)1.94。沥青组肺癌死亡与当地不接触沥青工厂比较,SRR为2.18。与当地居民比较肺癌标化死亡比(SMR)为2.70。认为使用沥青工种存在着肺癌死亡率增高趋势.     

单纯接触温石棉人员癌症死亡队列研究的荟萃分析

目的　用荟萃 (meta)分析探讨单纯接触温石棉人员的癌症是否高发。方法　凡满足明确是单纯温石棉暴露且为癌症死亡率队列研究的资料均被纳入研究对象 ,以直接法与随机效应模型法计算主要部位癌症的标准化死亡比 (SMR)及其 95 %可信区间 ,计算Q统计量与Z值检验研究结果异质性及其来源。结果　共有 2 6个队列符合入选标准 ,平均间皮瘤死亡百分比为 0 4 2 % ,全死因、全癌亡、呼吸系统全癌、肺癌和胃癌的meta SMR显著上升 ,分别为 1 2 8、1 2 6、2 2 4、2 2 9与1 2 7。肺癌的meta SMR在纺织 (3 6 4 )、石棉制品加工 (3 0 7)、采选矿 (2 2 4 )和石棉水泥制品加工(1 2 2 )显著升高 ,胃癌的meta SMR在石棉制品加工 (1 4 8)显著升高。其余部位癌症的meta SMR均无显著意义。结论　单纯温石棉暴露能使作业人员肺癌、间皮瘤显著高发 ,与其他部位癌症似无病因联系。     

1991～2004年烟台市芝罘区居民恶性肿瘤死亡分析

[目的]分析居民恶性肿瘤死亡情况及死因顺位,为今后采取相应的预防干预措施提供依据.[方法]对烟台市区全国疾病监测点居民1991～2004年各种恶性肿瘤死亡进行统计分析.[结果]恶性肿瘤死亡627例,年平均恶性肿瘤死亡率1.47‰,仅次于心脑血管疾病(925例),居全死因的第2位.不同年份间发病率的差异无统计学意义(P>0.05).肺癌、肝癌、胃癌死亡数占恶性肿瘤死亡数的64.75%(407/627).60岁以上死亡的433例中,肺癌占29.79%(129例),胃癌占18.71%(81例),肝癌占17.09%(74例).627例恶性肿瘤死亡中,男性388例,死亡率为1.82‰;女性239例,死亡率为1.11‰,男性恶性肿瘤死亡率高于女性,差异有统计学意义(P<0.01).[结论]恶性肿瘤已成为危害市区居民身体健康的主要疾病.肺癌、肝癌、胃癌为该区癌症死因的前3位.     

石棉厂职业肿瘤回顾性队列调查

本文报告了在九个石棉厂进行职业肿瘤调查的结果。调查发现,恶性肿瘤占全死因的第一位,SMR2.19,P<0.01;肺癌又占恶性肿瘤的首位,RR8.24,SMR6.33,P<0.01,两者死亡显著地高于对照。肺癌主要发生在粉尘浓度高的工种中,发病潜伏期平均21.7年,发病年龄平均56岁。发病随工龄增加。接触石棉与吸烟在肺癌发病中呈相乘关系。     

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。     

上海石棉制品厂石棉工人40年恶性肿瘤发病情况研究

目的 探究上海石棉厂接触温石棉工人４０年来恶性肿瘤的发病情况。方法 为评估恶性肿瘤的危险程度,采用回顾性队列研究的方法,对５５１位工作于该厂的工人从１９５８年至１９９８年进行回顾研究。结果 以上海市区居民恶性肿瘤的发病率和死亡率进行比较。     

Mortality of workers manufacturing friction materials using asbestos

A mortality (1942-80) study was carried out on 13460 workers of a factory producing friction materials. The only type of asbestos used was chrysotile, except during two well-defined periods before 1945 when crocidolite was used, and over 99% of the population was traced. Compared with national death rates there were no detectable excesses of deaths due to lung cancer, gastrointestinal cancer, or other cancers; 11 deaths were due to pleural mesothelioma. A case-control study was carried out on deaths due to mesothelioma; this showed that eight workers had been exposed to crocidolite and another was possibly exposed intermittently to crocidolite. The other two had been employed for most of their working lives outside the factory, and their mesotheliomas could not be definitely attributed to exposure to chrysotile. Limiting the study to cases and controls who had exposure to 5 fibres/ml of chrysotile asbestos it was found that five of the six cases compared with two of the 10 controls had also been exposed to crocidolite. The probability (1:36) of this occurring were there no association with crocidolite is most unlikely. A case-control study was also carried out on deaths due to lung cancer and gastrointestinal cancer to investigate the dose-response relationships between these tumours and exposure to chrysotile. Measured and estimated fibre concentrations were available for the different jobs over the period of the study. No dose-response relationships were observed, but the exposures were low with only 5% of men accumulating 100 fibre-years/ml. The experience at this factory over a 40-year period showed that chrysotile asbestos was processed with no detectable excess mortality.     

Mortality of workers manufacturing friction materials using asbestos.

A mortality (1942-80) study was carried out on 13460 workers of a factory producing friction materials. The only type of asbestos used was chrysotile, except during two well-defined periods before 1945 when crocidolite was used, and over 99% of the population was traced. Compared with national death rates there were no detectable excesses of deaths due to lung cancer, gastrointestinal cancer, or other cancers; 11 deaths were due to pleural mesothelioma. A case-control study was carried out on deaths due to mesothelioma; this showed that eight workers had been exposed to crocidolite and another was possibly exposed intermittently to crocidolite. The other two had been employed for most of their working lives outside the factory, and their mesotheliomas could not be definitely attributed to exposure to chrysotile. Limiting the study to cases and controls who had exposure to 5 fibres/ml of chrysotile asbestos it was found that five of the six cases compared with two of the 10 controls had also been exposed to crocidolite. The probability (1:36) of this occurring were there no association with crocidolite is most unlikely. A case-control study was also carried out on deaths due to lung cancer and gastrointestinal cancer to investigate the dose-response relationships between these tumours and exposure to chrysotile. Measured and estimated fibre concentrations were available for the different jobs over the period of the study. No dose-response relationships were observed, but the exposures were low with only 5% of men accumulating 100 fibre-years/ml. The experience at this factory over a 40-year period showed that chrysotile asbestos was processed with no detectable excess mortality.     

Epidemiology of occupational asbestos-related diseases in China

In 1950s and 60s, asbestosis had been a major health hazard for asbestos exposed workers. In the late 1970s, lung cancers with or without asbestosis were found among asbestos workers. All cohort studies on asbestos workers and on chrysotile miners in China showed excess deaths from lung cancer. In a large scale of cohort study on asbestos workers, a synergistic effect was found between cigarette smoking and asbestos exposure in the production of lung cancer. There have been not so many cases of malignant mesotheliomas reported, so far. In the cohort of chrysotile miners, 4 cases of pleural mesothelioma were observed. In the large scale of cohort study on asbestos workers in 9 factories using only chrysotile only one case of pleural mesothelioma was detected for 10 years' observation. In another 2 cohort studies, 2 cases of peritoneal mesotheliomas were found, one in Shanghai asbestos factory where a small amount of crocidolite had been used in 1960s, and one in Anqing asbestos factory that was located near tremolite mine. Further study is needed especially for the relationship between exposure to Chinese chrysotile and malignant mesotheliomas.     

手纺石棉女工肿瘤死亡的调查研究

目的：对手纺石棉女工肿瘤发病情况进行研究,方法：采用历史性队列研究方法。结果：发现肿瘤死亡144人,以肺癌居首位（74人,占51．39％）,死亡率各为108．97／10万与56．00／10万,SMR分别为1．16、4．17,均显著高于对照,结论：手纺石棉作业也能使接触人员肺癌高发。     

Cancer mortality among workers exposed to amphibole-free chrysotile asbestos.

The issue of whether exposure to chrysotile asbestos alone, without contamination from amphibole asbestos, causes lung cancer and mesothelioma was investigated in a 25-year longitudinal study (1972-1996) in Chongqin, China. The study cohort comprised 515 male asbestos plant workers exposed to chrysotile only; the control cohort included 650 non-dust-exposed workers. The results of analysis in which the proportional hazards model was used indicated that mortality due to all causes, all cancers, and lung cancer was related to asbestos exposure; the relative risks, adjusted for age and smoking, were 2.9, 4.3, and 6.6, respectively. Fiber concentrations in the raw material section and the textile section of the plant were 7.6 and 4.5 fibers/ml, respectively. Because of differences between the study and control plants, the authors also compared various sections of the asbestos plant that had different levels of dust exposure. The adjusted relative risk of lung cancer was 8.1 for workers exposed to high versus low levels of asbestos. Two cases of malignant mesothelioma, one pleural and the other peritoneal, were found in the asbestos cohort. These results suggest that heavy exposure to pure chrysotile asbestos alone, with negligible amphibole contamination, can cause lung cancer and malignant mesothelioma in exposed workers.     

中国石棉接触人员癌症死亡队列研究的Meta分析

目的以M eta分析探讨单纯接触温石棉人员癌症是否高发。方法凡满足明确是中国石棉接触人员且为癌症死亡率队列研究的资料均被纳入研究对象,以直接法与随机效应模型法计算主要部位癌症标准化死亡比(SMR)及其95%可信区间(CI),计算Q统计量与Z值检验研究结果异质性及其来源。结果共有13个队列符合入选标准,平均间皮瘤死亡百分比为0.62%,全死因、全癌亡、肺癌的M eta-SMR显著上升(分别为1.51、1.96、4.54),单纯接触温石棉人员肺癌的M eta-SMR也显著上升(4.39),消化系统、喉、乳腺和生殖泌尿系统等其他部位癌症的M eta-SMR未见显著上升。结论单纯温石棉暴露能使作业人员肺癌、间皮瘤显著高发,与其他部位癌症无病因联系。