钢铁工人累积噪声暴露量对颈动脉内膜中膜厚度影响
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摘要
目的探讨钢铁工人累积噪声暴露量(CNE)对其颈动脉内膜中膜厚度(IMT)的影响。方法采用整群随机抽样方法,以某钢铁公司1 437名噪声作业工人为研究对象,根据其工作场所噪声强度计算CNE,并对其进行职业健康检查,构建噪声对IMT的结构方程模型。结果 1 437名研究对象颈动脉粥样硬化(CAS)检出率为38.3%。钢铁工人CNE越高,CAS检出率越高(P<0.01)。结构方程模型拟合效果良好,路径分析结果显示CNE可通过血压、甘油三酯、空腹血糖、同型半胱氨酸、高密度脂蛋白&载脂蛋白A、低密度脂蛋白&载脂蛋白B间接影响IMT,其总效应分别为-0.375、0.337、0.248、0.117、0.056和0.018。结论 CNE可通过作用于近端病因间接增加钢铁工人IMT。
Objective To explore the effects of cumulative noise exposure(CNE) on the intima-media thickness(IMT) of carotid artery in steel workers. Methods A cluster random sampling method was used to select 1 437 noise exposed workers in a steel company as study subjects. The CNE was calculated according to the noise intensity of the workplace, and the occupational health check was carried out to construct the structural equation model of noise to IMT. Results The detection rate of carotid atherosclerosis(CAS) in these 1 437 subjects was 38.3%. The CAS detection rates of steel workers increased with the increasing CNE(P<0.01). The structural equation model had good fitting effect. Path analysis showed CNE can indirectly affect IMT through blood pressure, triglycerides, fasting blood glucose, homocysteine, high-density lipoprotein & apolipoprotein A, low-density lipoprotein & apolipoprotein B. The total effects were-0.375, 0.337, 0.248, 0.117, 0.056, 0.056 and 0.018 respectively. Conclusion CNE can indirectly increase the IMT of steel workers by acting on the proximal cause.
Objective To explore the effects of cumulative noise exposure(CNE) on the intima-media thickness(IMT) of carotid artery in steel workers. Methods A cluster random sampling method was used to select 1 437 noise exposed workers in a steel company as study subjects. The CNE was calculated according to the noise intensity of the workplace, and the occupational health check was carried out to construct the structural equation model of noise to IMT. Results The detection rate of carotid atherosclerosis(CAS) in these 1 437 subjects was 38.3%. The CAS detection rates of steel workers increased with the increasing CNE(P<0.01). The structural equation model had good fitting effect. Path analysis showed CNE can indirectly affect IMT through blood pressure, triglycerides, fasting blood glucose, homocysteine, high-density lipoprotein & apolipoprotein A, low-density lipoprotein & apolipoprotein B. The total effects were-0.375, 0.337, 0.248, 0.117, 0.056, 0.056 and 0.018 respectively. Conclusion CNE can indirectly increase the IMT of steel workers by acting on the proximal cause.
引文
[1] 中国卒中学会,中国卒中学会神经介入分会,中华预防医学会卒中预防与控制专业委员会介入学组.急性缺血性卒中血管内治疗中国指南2015[J].中国卒中杂志,2015,10(7):590-606.
[2] SCHINKEL A F, KRUEGER C G, TELLEZ A, et al. Contrast-enhanced ultrasound for imaging vasa vasorum: comparison with histopathology in a swine model of atherosclerosis[J]. Eur J Echocardiogr,2010,11(8):659-664.
[3] BABISCH W. The noise/stress concept, risk assessment and research needs[J]. Noise Health,2002,4(16):1-11.
[4] 欧健苹,郭黎红,江锦雄,等.彩超评价噪声对颈动脉内膜厚度和肱动脉内皮功能的影响[J].广东医学,2011,32(15):2028-2029.
[5] 张东平,李晋芳,胡长林,等.重庆市中老年钢铁工人颈动脉粥样硬化的流行病学调查[J].中华流行病学杂志,2009,30(4):322-325.
[6] 李嘉辉,陶志民,黄丽丽,等.汽车制造业工人累积噪声暴露量对高血压影响[J].中国职业医学,2018,45(2):173-177.
[7] TOUBOUL P J, HENNERICI M G, MEAIRS S, et al. Mannheim intima-media thickness consensus[J]. Cerebrovasc Dis,2004,18(4):346-349.
[8] 韩丽英.职业性噪声对心血管系统影响的研究进展[J].中国城乡企业卫生,2016(2):19-20.
[9] MüNZEL T, S?RENSEN M, GORI T, et al. Environmental stressors and cardio-metabolic disease: part II-mechanistic insights[J]. Eur Heart J,2017,38(8):557-564.
[10] 傅旭瑛,杨恩明,段哲辉,等.职业性噪声接触对心血管系统影响彩色多普勒超声检查指标探讨[J].中国职业医学,2011,38(5):420-421.
[11] KERKHOF G F, DUIVENVOORDEN H J, LEUNISSEN R W, et al. Pathways leading to atherosclerosis: a structural equation modeling approach in young adults[J]. Hypertension,2011,57(2):255-260.
[12] 石磊,张星.噪声对人体健康影响研究进展[J].中国职业医学,2015,42(2):225-228.
[13] 由凤秋,董亚茹,狄政莉,等.动脉硬化性脑梗死患者血清高密度脂蛋白、载脂蛋白A1、低密度脂蛋白、载脂蛋白B水平及其比值的变化[J].卒中与神经疾病,2013,20(5):287-289.
[14] 李向文,佟俊旺,杨静波,等.钢铁生产工人累计噪声暴露量与高血压关系研究[J].中国职业医学,2016,43(4):451-455.
[15] 董莉.某化工企业职业性噪声对工人健康影响的分析[D].上海:复旦大学,2014.
[16] CAI Y, HANSELL A L, BLANGIARDO M, et al. Long-term exposure to road traffic noise, ambient air pollution, and cardiovascular risk factors in the HUNT and lifelines cohorts[J]. Eur Heart J,2017,38(29):2290-2296.
[17] HUNG M J, HSU K H, HU W S, et al. C-reactive protein for predicting prognosis and its gender-specific associations with diabetes mellitus and hypertension in the development of coronary artery spasm[J]. PLoS One,2013,8(10):e77655.
[18] 李利斌,孙菊光,史江峰,等.彩色多普勒超声联合检测对动脉粥样硬化脑梗死的诊断价值[J].中国实用神经疾病杂志,2018,21(6):602-606.
[19] 杨越,赵轲,顾大东.老年无症状性脑梗死患者颈动脉粥样硬化及其血清Hcy、hs-CRP水平的改变[J].中华全科医学,2015,13(10):1635-1637.
[20] 姜怡邓,孙炜炜,马胜超,等.内皮型一氧化氮合酶基因启动子区DNA甲基化调控同型半胱氨酸致内皮细胞损伤的机制[J].中国动脉硬化杂志,2013,21(2):115-119.
[21] 李成林,李侠,高珊珊.噪声作业工人血清同型半胱氨酸及血脂水平研究[J].中国职业医学,2016,43(2):189-192.
[2] SCHINKEL A F, KRUEGER C G, TELLEZ A, et al. Contrast-enhanced ultrasound for imaging vasa vasorum: comparison with histopathology in a swine model of atherosclerosis[J]. Eur J Echocardiogr,2010,11(8):659-664.
[3] BABISCH W. The noise/stress concept, risk assessment and research needs[J]. Noise Health,2002,4(16):1-11.
[4] 欧健苹,郭黎红,江锦雄,等.彩超评价噪声对颈动脉内膜厚度和肱动脉内皮功能的影响[J].广东医学,2011,32(15):2028-2029.
[5] 张东平,李晋芳,胡长林,等.重庆市中老年钢铁工人颈动脉粥样硬化的流行病学调查[J].中华流行病学杂志,2009,30(4):322-325.
[6] 李嘉辉,陶志民,黄丽丽,等.汽车制造业工人累积噪声暴露量对高血压影响[J].中国职业医学,2018,45(2):173-177.
[7] TOUBOUL P J, HENNERICI M G, MEAIRS S, et al. Mannheim intima-media thickness consensus[J]. Cerebrovasc Dis,2004,18(4):346-349.
[8] 韩丽英.职业性噪声对心血管系统影响的研究进展[J].中国城乡企业卫生,2016(2):19-20.
[9] MüNZEL T, S?RENSEN M, GORI T, et al. Environmental stressors and cardio-metabolic disease: part II-mechanistic insights[J]. Eur Heart J,2017,38(8):557-564.
[10] 傅旭瑛,杨恩明,段哲辉,等.职业性噪声接触对心血管系统影响彩色多普勒超声检查指标探讨[J].中国职业医学,2011,38(5):420-421.
[11] KERKHOF G F, DUIVENVOORDEN H J, LEUNISSEN R W, et al. Pathways leading to atherosclerosis: a structural equation modeling approach in young adults[J]. Hypertension,2011,57(2):255-260.
[12] 石磊,张星.噪声对人体健康影响研究进展[J].中国职业医学,2015,42(2):225-228.
[13] 由凤秋,董亚茹,狄政莉,等.动脉硬化性脑梗死患者血清高密度脂蛋白、载脂蛋白A1、低密度脂蛋白、载脂蛋白B水平及其比值的变化[J].卒中与神经疾病,2013,20(5):287-289.
[14] 李向文,佟俊旺,杨静波,等.钢铁生产工人累计噪声暴露量与高血压关系研究[J].中国职业医学,2016,43(4):451-455.
[15] 董莉.某化工企业职业性噪声对工人健康影响的分析[D].上海:复旦大学,2014.
[16] CAI Y, HANSELL A L, BLANGIARDO M, et al. Long-term exposure to road traffic noise, ambient air pollution, and cardiovascular risk factors in the HUNT and lifelines cohorts[J]. Eur Heart J,2017,38(29):2290-2296.
[17] HUNG M J, HSU K H, HU W S, et al. C-reactive protein for predicting prognosis and its gender-specific associations with diabetes mellitus and hypertension in the development of coronary artery spasm[J]. PLoS One,2013,8(10):e77655.
[18] 李利斌,孙菊光,史江峰,等.彩色多普勒超声联合检测对动脉粥样硬化脑梗死的诊断价值[J].中国实用神经疾病杂志,2018,21(6):602-606.
[19] 杨越,赵轲,顾大东.老年无症状性脑梗死患者颈动脉粥样硬化及其血清Hcy、hs-CRP水平的改变[J].中华全科医学,2015,13(10):1635-1637.
[20] 姜怡邓,孙炜炜,马胜超,等.内皮型一氧化氮合酶基因启动子区DNA甲基化调控同型半胱氨酸致内皮细胞损伤的机制[J].中国动脉硬化杂志,2013,21(2):115-119.
[21] 李成林,李侠,高珊珊.噪声作业工人血清同型半胱氨酸及血脂水平研究[J].中国职业医学,2016,43(2):189-192.