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。

The retrospective survey of malignant tumor in weapon workers exposed to 2,4,6-trinitrotoluene

OBJECTIVE: To investigate the occupational health risk level of workers exposed to 2,4,6-trinitrotoluene (TNT) in arms industry, so as to provide basis for revising the standard of diagnosis for chronic TNT poisoning, and making protective measures for workers. METHODS: The retrospective study about the morbidity of total malignant tumor was taken on the male workers exposed to TNT over one year from eight military factories during 1970 to 1995. RESULTS: The morbidity of total malignant tumor in male TNT exposed workers were markedly higher than that of controls, and the relative risk (RR) was 2.32. Compared with the total malignant tumor mortality of male populations in large and medium cities in 1973 to 1975 and 1990 to 1992, the standardized mortality ratio(SMR) were 71.8 and 179.6 respectively, the CI of 99% was 71.8-144.2, indicating that the morbidity of malignant tumor of male workers exposed to TNT was higher than that of normal populations. Liver cancer morbidity was 31.91% of the total malignant tumor, and its mortality was 3.97 times of the controls. Compared with the liver cancer mortality of male populations in large and medium cities in 1973 to 1975 and 1990 to 1992, SMR were 150.5 and 381.6 respectively, these data were significantly different, and CI of 99% was 59.3-184.0. The average death age of the TNT exposed workers (51.7 years old) was younger than that of the same factory control(54.1 years old) and male populations(55.6 years old) in large and medium cities. The incidence of liver cancer was closely related to the length of service, the kinds of job in a factory and the level exposed to TNT, and alcohol consumption was synergistic with TNT carcinogenesis. CONCLUSION: The morbidity of malignant tumor of male workers exposed to TNT was markedly higher than that of normal populations. Liver cancer was the most remarkable malignancy, and its incidence was closely related to the length of service and the kinds of job and the level exposed to TNT.