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自20世纪以来,苯等化学物质和X射线等放射线已得到广泛应用,其对人体的危害也备受关注。苯是目前工业使用较多的化工原料之一,其可作为油漆、黏合剂的化学溶剂和稀释剂,广泛应用于喷漆、制鞋、印刷及室内装修等行业,因此苯可通过职业接触和环境接触影响人体健康[1]。X射线在医疗和工业中的广泛应用使得X射线作业人员逐年增加。大量研究结果证实,苯和X射线均可对人体的血液系统产生一定程度的影响[2-4]。虽然有较多且深入的研究围绕苯或X射线对人体健康的影响展开,但目前关于两者联合作业人员的健康危害的报道较少。我们通过分析苯与X射线联合作业人员的职业健康检查结果,探讨苯与X射线联合作业对人体健康的影响,从而为其职业防护提供理论依据。
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X射线作业组、苯与X射线联合作业组人员的年龄均大于对照组,且差异均有统计学意义(均P<0.05),受检人员一般资料的比较结果见表1。
组别 性别(名) 年龄
( ,岁)$\bar x \pm s $ 工龄
[M(Q1,Q3),年]体重指数
( ,kg/m2)$\bar x \pm s $ 婚姻情况(名) 吸烟情况(名) 饮酒情况(名) 男 女 已婚 未婚 是 否 是 否 对照组(n=53) 45 8 27.8±4.5 4(2,15) 22.4±3.2 20 33 28 25 30 23 X射线作业组(n=52) 44 8 29.8±4.4a 5(1,12) 22.6±4.9 18 34 25 27 31 21 苯作业组(n=64) 49 15 27.9±4.5 3.5(1,15) 22.3±3.7 25 39 39 25 34 30 苯与X射线联合作业组(n=50) 47 3 30.3±3.6a 5(1,16) 23.3±2.9 30 20 21 29 27 23 检验值 χ2=6.522 F=4.878 H=6.656 F=0.829 χ2=0.369 χ2=4.370 χ2=0.571 P值 0.089 0.003 0.084 0.479 0.946 0.224 0.903 注:a表示与对照组比较,差异均有统计学意义(t=−2.015、−2.546,P=0.017、0.003) 表 1 219名职业健康受检人员一般资料的比较
Table 1. Comparison of the normal information of 219 occupational health examinees
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在219名受检人员中,X射线作业组、苯与X射线联合作业组人员的人均年有效剂量均小于规定限值20 mSv/年[14],工作场所X射线的周围剂量当量率均低于规定限值2.5 μSv/h[11];苯作业组、苯与X射线联合作业组人员的苯CTWA均低于职业接触限值6 mg/m3[15],且保持在较低水平,具体数据见表2。
组别 采样点数(个) 苯CTWA( ,mg/m3)$\bar x \pm s$ 人均年有效剂量( ,mSv/年)$\bar x \pm s$ 周围剂量当量率( ,μSv/h)$\bar x \pm s$ 对照组(n=53) − − − − X射线作业组(n=52) 7 − 0.65±0.04 0.147±0.037 苯作业组(n=64) 7 1.10±0.22 − − 苯与X射线联合作业组(n=50) 14 1.04±0.24 0.63±0.04 0.153±0.042 t值 0.471 0.687 −0.268 P值 0.646 0.505 0.793 注:CTWA为时间加权平均容许浓度。−表示无此项数据 表 2 219名职业健康受检人员工作场所职业病危害因素检测结果的比较
Table 2. Comparison of the test results of occupational disease hazard factors in workplaces of 219 occupational health examinees
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由表3可知,X射线作业组、苯作业组、苯与X射线联合作业组人员的血常规各项指标与对照组比较,均有不同程度的降低,其中,苯作业组人员的RBC计数和血红蛋白水平,X射线作业组人员的血红蛋白水平和淋巴细胞计数,苯与X射线联合作业组人员的血红蛋白水平、WBC、淋巴细胞计数和血小板计数均低于对照组,且差异均有统计学意义(均P<0.05)。苯与X射线联合作业组人员的RBC计数高于苯作业组,淋巴细胞计数低于苯作业组,且差异均有统计学意义(均P<0.01)。
组别 红细胞计数
[M(Q1,Q3),×1012/L]血红蛋白
[M(Q1,Q3),g/L]白细胞计数
( , ×109/L)$\bar x \pm s$ 中性粒细胞计数
( , ×109/L)$\bar x \pm s$ 淋巴细胞计数
( , ×109/L)$\bar x \pm s$ 血小板计数
( , ×109/L)$\bar x \pm s$ 对照组(n=53) 5.1(3.9,5.7) 156(138,168) 6.2±1.0 3.7±1.2 2.3±0.4 223.7±36.6 X射线作业组(n=52) 5.0(4.0,5.5) 148(122,159)a 5.8±0.8 3.6±0.8 2.0±0.3a 208.8±21.2 苯作业组(n=64) 4.9(3.5,5.4)a 144(115,165)a 5.7±1.0 3.7±1.1 2.1±0.6 208.3±46.4 苯与X射线联合作业组(n=50) 5.1(4.2,5.6)b 149(132,159)a 5.4±0.5a 3.6±0.8 1.9±0.3a, b 192.9±38.4a 检验值 H=10.997 H=33.260 F=6.908 F=0.203 F=7.130 F=5.832 P值 0.012 <0.001 <0.001 0.894 <0.001 0.001 注:a表示与对照组比较,差异均有统计学意义(t=25.469、57.163、62.388、46.968、−0.747、0.212、0.383、30.837,P=0.030、P<0.001、P<0.001、P<0.001、P<0.001、P=0.011、P<0.001、P<0.001);b表示与苯作业组比较,差异均有统计学意义(t=−38.298、0.230,P=0.001、0.005) 表 3 219名职业健康受检人员血常规检查结果的比较
Table 3. Comparison of the blood routine test results of 219 occupational health examinees
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由表4可知,与对照组相比,X射线作业组、苯与X射线联合作业组人员的血清游离T3水平较低,血清游离T4水平较高,且差异均有统计学意义(均P<0.05)。苯与X射线联合作业组人员的血清游离T3水平高于X射线作业组,且差异有统计学意义(P<0.01)。
组别 T3水平
( ,nmol/L)$\bar x \pm s$ T4水平
( ,nmol/L)$\bar x \pm s$ 血清游离T3水平
[M(Q1,Q3),pmol/L]血清游离T4水平
[M(Q1,Q3),pmol/L]促甲状腺激素水平
( ,μIU/ml)$\bar x \pm s$ 对照组(n=53) 2.0±0.3 110.2±22.5 13.40(4.05,1.99) 5.47(3.66,24.04) 2.5±1.3 X射线作业组(n=52) 2.1±0.3 112.6±18.0 4.97(3.85,7.49)a 16.87(13.02,22.00)a 2.1±1.4 苯与X射线联合作业组(n=50) 2.1±0.4 108.3±15.2 5.37(4.15,18.93)a, b 16.12(5.65,22.00)a 2.4±1.3 检验值 F=1.411 F=0.652 H=19.627 H=16.391 F=1.069 P值 0.247 0.522 <0.001 <0.001 0.346 注:T3为三碘甲状腺原氨酸;T4为甲状腺素。a表示与对照组比较,差异均有统计学意义 (t=−18.997、−42.441、−35.119、−21.791,P=0.032、P<0.001、P<0.001、P=0.014);b表示与X射线作业组比较,差异有统计学意义 (t=−23.662,P=0.008) 表 4 职业健康受检人员甲状腺功能检查结果的比较
Table 4. Comparison of thyroid function test results of occupational health examinees
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各组受检人员外周血淋巴细胞染色体微核率的分布见表5,3组间比较,差异无统计学意义(H=1.268,P=0.530)。
组别 人数 淋巴细胞染色体微核率 0 1‰ 2‰ 3‰ 对照组 53 48 4 0 1 X射线作业组 52 50 1 0 1 苯与X射线联合作业组 50 46 3 1 0 总计 155 144 8 1 2 表 5 职业健康受检人员外周血淋巴细胞染色体微核率的分布(名)
Table 5. Distribution of chromosomal micronucleus rate in peripheral blood lymphocytes of occupational health examinees (case)
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X射线作业组人员晶状体浑浊的发生率高于对照组,且差异有统计学意义(13.5%对0,χ2=7.644,P=0.006);苯与X射线联合作业组人员的晶状体浑浊发生率高于对照组,但差异无统计学意义(8.0%对0,P=0.052)。
2016年苏州市工业园区苯与X射线联合作业人员的职业健康检查结果分析
Analysis of occupational health examination results of benzene and X-ray combination workers in Suzhou Industrial Park in 2016
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摘要:
目的 分析2016年苏州市工业园区苯与X射线联合作业人员的职业健康检查结果,为其职业防护提供理论依据。 方法 选取2016年在苏州工业园区疾病防治中心进行职业健康检查的219名受检人员为调查对象开展回顾性研究,其中,苯作业人员64名、X射线作业人员52名、苯与X射线联合作业人员50名、无职业病危害因素接触史人员53名(对照组)。通过问卷调查收集受检人员的基本情况。通过溶剂解吸-气相色谱法检测工作场所空气中的苯系物浓度,检测工作场所X射线的周围剂量当量率和受检人员的个人有效剂量,判断职业病危害因素是否超过接触限值。对受检人员进行职业健康检查,包括内科检查、血常规检查、甲状腺功能检查、淋巴细胞染色体微核率测定、晶状体浑浊情况检查等,比较不同作业人群职业健康检查结果的差异。计量资料2组间比较采用独立样本t检验和最小显著性差异法t检验,多组间比较采用单因素方差分析和Kruskal-Wallis H检验;计数资料的组间比较采用Pearson χ2检验或Fisher确切概率法。 结果 X射线作业组、苯与X射线联合作业组人员的年龄均大于对照组,且差异均有统计学意义[(29.8±4.4)岁对(27.8±4.5)岁、(30.3±3.6)岁对(27.8±4.5)岁,t=−2.015、−2.546,均P<0.05]。X射线作业组、苯与X射线联合作业组人员的人均年有效剂量以及工作场所X射线的周围剂量当量率,苯作业组、苯与X射线联合作业组人员的苯时间加权平均容许浓度均低于规定限值。苯作业组人员的红细胞(RBC)计数和血红蛋白水平,X射线作业组人员的血红蛋白水平和淋巴细胞计数,苯与X射线联合作业组人员的血红蛋白水平、白细胞计数、淋巴细胞计数和血小板计数均低于对照组,且差异均有统计学意义(t=−0.747~62.388,均P<0.05);苯与X射线联合作业组人员的RBC计数高于苯作业组,淋巴细胞计数低于苯作业组,且差异均有统计学意义(t=−38.298、0.230,均P<0.01)。相较于对照组,X射线作业组、苯与X射线联合作业组人员的血清游离三碘甲状腺原氨酸(FT3)水平较低,血清游离甲状腺素(FT4)水平较高,且差异均有统计学意义(t=−42.441~−18.997,均P<0.05);苯与X射线联合作业组人员的血清FT3水平高于X射线作业组,且差异有统计学意义(t=−23.662,P<0.01)。对照组、X射线作业组、苯与X射线联合作业组人员外周血淋巴细胞染色体微核率间的差异无统计学意义(H=1.268,P>0.05)。X射线作业组人员晶状体浑浊的发生率高于对照组,且差异有统计学意义(χ2=7.644,P<0.01)。 结论 苯联合X射线对作业人员的血常规指标、甲状腺功能指标、淋巴细胞染色体微核率及晶状体浑浊情况有一定程度的影响,且两者可能表现出一定的联合效应,应加强对苯与X射线联合作业人员的辐射防护及健康监护。 Abstract:Objective To analyze the results of occupational health examinations of benzene and X-ray combination workers in Suzhou Industrial Park in 2016 and provide theoretical basis for occupational protection. Methods A total of 219 workers who underwent occupational health examinations at the Suzhou Industrial Park Centers for Disease Control and Prevention in 2016 were selected and retrospectively analyzed. Workers included 64 benzene workers, 52 X-ray workers, 50 benzene and X-ray combination workers, and 53 people without history of exposure to occupational disease hazard factors (control group). The basic information of inspected personnel was collected through questionnaires. Benzene concentrations in the workplace were detected by solvent desorption-gas chromatography, and the X-ray ambient dose equivalent rate around the workplace and the individual effective dose of the inspected personnel were determined to judge whether occupational disease hazard factors exceeded the exposure limit. Occupational health examinations, including internal medicine examinations, blood routine examinations, thyroid function examinations, lymphocyte chromosomal micronucleus rate determination and lens opacity were carried out. The occupational health examination results of different working groups were compared. The measurement data were compared between two groups by independent-samples t test and least significant difference t test, and the comparison between multiple groups was by one-way analysis of variance and Kruskal-Wallis H test. Pearson χ2 test or Fisher's exact probability method was used in the comparison of enumeration data between groups. Results The ages of workers in the X-ray and benzene and X-ray combination groups were significantly higher than those of workers in the control group [(29.8±4.4) years old vs. (27.8±4.5) years old, (30.3±3.6) years old vs. (27.8±4.5) years old; t=−2.015, −2.546; both P<0.05). The per capita annual effective dose of workers and the ambient dose equivalent rate of the workplace in the X-ray and benzene and X-ray combination groups, and the time weighted average concentrations of benzene of workers in the benzene and benzene and X-ray combination groups were all lower than the prescribed limits. The red blood cell (RBC) count and hemoglobin level of the benzene group; the hemoglobin level and lymphocyte count of the X-ray group; and the hemoglobin level, white blood cell count, lymphocyte count and platelet count of the benzene and X-ray combination group were significantly lower than those of the control group (t=−0.747 to 62.388, all P<0.05). The RBC and lymphocyte counts of the benzene and X-ray combination group were significantly higher and significantly lower, respectively, than those of the benzene group (t=−38.298, 0.230; both P<0.01). Compared with the control group, the X-ray and the benzene and X-raycombination groups had significantly lower serum free triiodothyronine (FT3) level and significantly higher serum free thyroxine level (t=−42.441 to −18.997, all P<0.05). The serum FT3 level of the benzene and X-ray combination group was significantly higher than that of the X-ray group (t=−23.662, P<0.01). There was no significant difference in the chromosomal micronucleus rate of peripheral blood lymphocytes between the control group, X-ray group and benzene and X-ray combination group (H=1.268, P>0.05). The incidence of lens opacity in the X-ray group was significantly higher than that in the control group (χ2=7.644, P<0.01). Conclusions Benzene and X-rayhave a certain degree of influence on blood routine indices, thyroid function indices, lymphocyte chromosomal micronucleus rate and lens opacity of workers and may show a certain combined effect. The radiation protection and health monitoring of benzene and X-ray combination workers should be strengthened. -
Key words:
- Benzene /
- X-ray /
- Radiation protection /
- Occupational health examination /
- Combined effect
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表 1 219名职业健康受检人员一般资料的比较
Table 1. Comparison of the normal information of 219 occupational health examinees
组别 性别(名) 年龄
( ,岁)$\bar x \pm s $ 工龄
[M(Q1,Q3),年]体重指数
( ,kg/m2)$\bar x \pm s $ 婚姻情况(名) 吸烟情况(名) 饮酒情况(名) 男 女 已婚 未婚 是 否 是 否 对照组(n=53) 45 8 27.8±4.5 4(2,15) 22.4±3.2 20 33 28 25 30 23 X射线作业组(n=52) 44 8 29.8±4.4a 5(1,12) 22.6±4.9 18 34 25 27 31 21 苯作业组(n=64) 49 15 27.9±4.5 3.5(1,15) 22.3±3.7 25 39 39 25 34 30 苯与X射线联合作业组(n=50) 47 3 30.3±3.6a 5(1,16) 23.3±2.9 30 20 21 29 27 23 检验值 χ2=6.522 F=4.878 H=6.656 F=0.829 χ2=0.369 χ2=4.370 χ2=0.571 P值 0.089 0.003 0.084 0.479 0.946 0.224 0.903 注:a表示与对照组比较,差异均有统计学意义(t=−2.015、−2.546,P=0.017、0.003) 表 2 219名职业健康受检人员工作场所职业病危害因素检测结果的比较
Table 2. Comparison of the test results of occupational disease hazard factors in workplaces of 219 occupational health examinees
组别 采样点数(个) 苯CTWA( ,mg/m3)$\bar x \pm s$ 人均年有效剂量( ,mSv/年)$\bar x \pm s$ 周围剂量当量率( ,μSv/h)$\bar x \pm s$ 对照组(n=53) − − − − X射线作业组(n=52) 7 − 0.65±0.04 0.147±0.037 苯作业组(n=64) 7 1.10±0.22 − − 苯与X射线联合作业组(n=50) 14 1.04±0.24 0.63±0.04 0.153±0.042 t值 0.471 0.687 −0.268 P值 0.646 0.505 0.793 注:CTWA为时间加权平均容许浓度。−表示无此项数据 表 3 219名职业健康受检人员血常规检查结果的比较
Table 3. Comparison of the blood routine test results of 219 occupational health examinees
组别 红细胞计数
[M(Q1,Q3),×1012/L]血红蛋白
[M(Q1,Q3),g/L]白细胞计数
( , ×109/L)$\bar x \pm s$ 中性粒细胞计数
( , ×109/L)$\bar x \pm s$ 淋巴细胞计数
( , ×109/L)$\bar x \pm s$ 血小板计数
( , ×109/L)$\bar x \pm s$ 对照组(n=53) 5.1(3.9,5.7) 156(138,168) 6.2±1.0 3.7±1.2 2.3±0.4 223.7±36.6 X射线作业组(n=52) 5.0(4.0,5.5) 148(122,159)a 5.8±0.8 3.6±0.8 2.0±0.3a 208.8±21.2 苯作业组(n=64) 4.9(3.5,5.4)a 144(115,165)a 5.7±1.0 3.7±1.1 2.1±0.6 208.3±46.4 苯与X射线联合作业组(n=50) 5.1(4.2,5.6)b 149(132,159)a 5.4±0.5a 3.6±0.8 1.9±0.3a, b 192.9±38.4a 检验值 H=10.997 H=33.260 F=6.908 F=0.203 F=7.130 F=5.832 P值 0.012 <0.001 <0.001 0.894 <0.001 0.001 注:a表示与对照组比较,差异均有统计学意义(t=25.469、57.163、62.388、46.968、−0.747、0.212、0.383、30.837,P=0.030、P<0.001、P<0.001、P<0.001、P<0.001、P=0.011、P<0.001、P<0.001);b表示与苯作业组比较,差异均有统计学意义(t=−38.298、0.230,P=0.001、0.005) 表 4 职业健康受检人员甲状腺功能检查结果的比较
Table 4. Comparison of thyroid function test results of occupational health examinees
组别 T3水平
( ,nmol/L)$\bar x \pm s$ T4水平
( ,nmol/L)$\bar x \pm s$ 血清游离T3水平
[M(Q1,Q3),pmol/L]血清游离T4水平
[M(Q1,Q3),pmol/L]促甲状腺激素水平
( ,μIU/ml)$\bar x \pm s$ 对照组(n=53) 2.0±0.3 110.2±22.5 13.40(4.05,1.99) 5.47(3.66,24.04) 2.5±1.3 X射线作业组(n=52) 2.1±0.3 112.6±18.0 4.97(3.85,7.49)a 16.87(13.02,22.00)a 2.1±1.4 苯与X射线联合作业组(n=50) 2.1±0.4 108.3±15.2 5.37(4.15,18.93)a, b 16.12(5.65,22.00)a 2.4±1.3 检验值 F=1.411 F=0.652 H=19.627 H=16.391 F=1.069 P值 0.247 0.522 <0.001 <0.001 0.346 注:T3为三碘甲状腺原氨酸;T4为甲状腺素。a表示与对照组比较,差异均有统计学意义 (t=−18.997、−42.441、−35.119、−21.791,P=0.032、P<0.001、P<0.001、P=0.014);b表示与X射线作业组比较,差异有统计学意义 (t=−23.662,P=0.008) 表 5 职业健康受检人员外周血淋巴细胞染色体微核率的分布(名)
Table 5. Distribution of chromosomal micronucleus rate in peripheral blood lymphocytes of occupational health examinees (case)
组别 人数 淋巴细胞染色体微核率 0 1‰ 2‰ 3‰ 对照组 53 48 4 0 1 X射线作业组 52 50 1 0 1 苯与X射线联合作业组 50 46 3 1 0 总计 155 144 8 1 2 -
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