职业应激与高血压的关系

目的 探讨职业应激对高血压的影响.方法 采用整群抽样的方法,对某热电厂工龄>2年的498名在职工人进行横断面调查,有效样本446例;排除了继发性高血压、糖尿病史、肝肾病史等后,确诊高血压病例84例(男58例,女26例),血压正常者362例.使用付出一回报失衡模式问卷、工作紧张模式问卷和职业应激测量工具对职业应激因素、个性特征、缓解因素和职业应激反应进行测评;调查高血压的常见危险因素,常规法测定血清中甘油三酯、总胆同醇及空腹血糖水平;应用多因素logistic回归分析和χ~2检验进行相关统计学处理.结果 (1)将研究中包括的所有因素引入方程进行多因素logistic同归分析,结果显示,父母高血压史、体质量指数(BMI)、血清中甘油三酯浓度、饮酒及对人负责、内控性、宏观决策、社会支持对高血压存在影响.(2)将付出一回报失衡模式的主要因素和其他相关冈素等同时引入以高血压发生与否为应变量的同归分析,结果显示,除父母有高血压史、饮酒、BMI、甘油三酯浓度和内控性对高血压的发生存在影响外,外在付出和付出-回报失衡比值(ERI)也对高血压的发生影响较大(OR分别为1.71和2.43).(3)将工作紧张模式主要因素和其他相关因素同时引入回归分析,结果显示,除父母有高血压史、饮酒、BMI、血清中甘油三酯浓度和内控性进入回归方程外,上级支持也进入了方程,且对高血压的发生有保护作用,工作需求和决定自由度等未能进入方程.(4)男性高、低应激水平组间高血压患病率比较,差异有统计学意义(OR为3.13,P<0.01);而女性不同应激水平组间高血压患病率比较,差异无统计学意义(P>0.05).结论 职业应激与高血压的发生有关;付出-回报失衡模式对高血压的预测作用大于工作紧张模式.

Effect of occupational stress on hypertension

Objective To explore the effect of occupational stress on hypertension. Methods 498 workers whose accumulative length of service was more than two years were investigated with questionnaire by method of cluster sampling from a thermal power plant in Henan province in China. 446 respondents retuned qualified questionnaire including 281 male and 165 female Han People. After the patients with secondary hypertension, diabetes patients, and patients with liver or kidney disease were excluded, 84 workers (58 males and 26 females) were diagnosed as hypertension. The occupational stressors, personalities,buffering factors and occupational strain were measured by using the Job Demand-control Model, the Effort-reward Imbalance Model questionnaires and Occupational Stress Measurement Scale. Main risk factors for the development of hypertension such as heredity, body mass index, high salt diet, alcohol use, smoking habit and lack of physical activity were investigated. 498 whole blood samples were collected from workers in field epidemiologic survey. All of the samples were detected TG, CHO and FPG by common biochemistry methods. Multivariate logistic regression analysis were used to determine the relationship between occupational stressors and prevalence rate of hypertension. The difference of morbidity of hypertension between different stress level subjects was analyzed by χ~2 test. Results (1) Logistic regression analysis of the hypertension by all occupational stressors and risk factors of hypertension indicated that not only some common factors such as parents' hypertensive history, BMI, alcohol use and TG.but also responsibility for person, work locus of control and social support were significantly correlated with elevated risks of hypertension. (2) Logistic regression analysis of the hypertension by main dimensions of effort-reward imbalance model and risk factors of hypertension indicated that parents' hypertensive history, BMI, alcohol use, TG,and effort were significantly correlated with elevated risks of hypertension. Logistic regression analysis indicated the risk of hypertension had an effect on the ER1 and effort (OR was 1.71 and 2.43 respectively). (3) For the job strain model, results indicated that parents' hypertensive history, BMI, alcohol use, TG,work locus of control and social support were significantly correlated with elevated risks of hypertension. But the main dimensions of job strain model (job demands and decision latitude)didn't enter regression equation. (4)The difference of prevalence of hypertension between high- and low stress level groups in male was statistically significant(OR=3.13, P<0.01), but the case wasn't the same in female (P>0.05). Conclusions Occupational stress might be risk factor of hypertension; The predictive power of effort-reward imbalance model for the development of hypertension would be larger than that of job strain model.