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随着经济的发展和科技的进步,放射性核素、电离辐射源及核能被广泛地开发和利用,辐射对人体造成的损伤一直是放射医学界关注的问题。染色体畸变率和微核率是评估放射性损伤的灵敏指标[1],也是放射工作人员职业健康检查的必检项目[2-3]。上岗前检查是放射工作人员职业健康检查的重要组成部分,其主要目的是发现有无职业禁忌证以及建立接触职业病危害因素人员的基础健康档案。不同地区、不同城市、不同年代的人群所接触到的环境有害因素的种类和剂量不同,诱发染色体畸变与微核的本底水平也不同。近年来,国内对于放射工作人员上岗前染色体畸变率和微核率的水平及其分布特征少有报道,仅有健康人群染色体畸变和微核本底水平的调查数据,且样本量偏少,单篇文献通常只有几十至几百名调查对象,缺乏大样本量的人群数据[4-17]。我们通过分析深圳市2015—2020年放射工作人员上岗前职业健康检查的染色体畸变率和微核率结果,为放射工作人员对预期工作的适任和持续适任程度的评价提供参考,为应急照射或事故照射的医学处理和放射性疾病的诊断提供基础健康资料,也为加强放射工作人员辐射防护与职业健康管理提供科学依据。
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由表1可知,2 777名受检者的双着丝粒体+着丝粒环畸变率为(0.016±0.002)%、染色体畸变(双着丝粒体+着丝粒环+无着丝粒体)率为(0.072±0.005)%,染色体畸变细胞率为(0.068±0.005)%,以上结果均在国内文献[4-14, 18]报道的健康人群的本底水平范围内。双着丝粒体+着丝粒环畸变率随年龄的增加略有升高,但各年龄组间的差异无统计学意义(χ2=0.931,P=0.920);且各年龄组间染色体畸变(双着丝粒体+着丝粒环+无着丝粒体)率、染色体畸变细胞率间的差异均无统计学意义(χ2=1.193、0.691,P=0.879、0.952)。
组别 人数(名) 分析细胞数(个) 双着丝粒体+着丝粒环畸变率
(p±Sp,%)染色体畸变(双着丝粒体+
着丝粒环+无着丝粒体)
率(p±Sp,%)染色体畸变细胞率
(p±Sp,%)17~20岁 178 18 070 0.011±0.008 0.094±0.023 0.089±0.022 21~30岁 1 972 199 668 0.016±0.003 0.071±0.006 0.067±0.006 31~40岁 480 48 700 0.016±0.006 0.070±0.012 0.068±0.012 41~50岁 111 11 300 0.018±0.013 0.062±0.023 0.062±0.023 51~69岁 36 3 700 0.027±0.027 0.108±0.054 0.081±0.047 合计 2 777 281 438 0.016±0.002 0.072±0.005 0.068±0.005 注:p为双着丝粒体+着丝粒环畸变率或染色体畸变率或染色体畸变细胞率;Sp为标准误 表 1 2 777名不同年龄放射工作人员上岗前职业健康检查染色体畸变情况的比较
Table 1. Comparison of chromosome aberrations of 2 777 radiation workers of different ages in pre-job occupational health examination
由表2可知,各年龄组不同性别的受检者的染色体畸变(双着丝粒体+着丝粒环+无着丝粒体)率、染色体畸变细胞率之间的差异均无统计学意义(Z=−0.929~−0.059,均P>0.05)。
组别 性别(名) 染色体畸变(双着丝粒体+着丝粒环+
无着丝粒体)率(p±Sp,%)染色体畸变细胞率(p±Sp,%) 男 女 男 女 男 女 17~20岁 130 48 0.092±0.027 0.100±0.045 0.084±0.025 0.100±0.045 21~30岁 1 618 354 0.067±0.006 0.089±0.016 0.065±0.006 0.072±0.014 31~40岁 341 139 0.066±0.014 0.078±0.024 0.064±0.014 0.078±0.024 41~50岁 89 22 0.056±0.025 0.083±0.059 0.067±0.028 0.042±0.042 51~69岁 32 4 0.094±0.054 0.200±0.200 0.094±0.054 0 合计 2 210 567 0.068±0.006 0.088±0.012 0.067±0.005 0.074±0.011 注:p为染色体畸变率或染色体畸变细胞率;Sp为标准误 表 2 不同年龄、不同性别放射工作人员上岗前职业健康检查染色体畸变情况的比较
Table 2. Comparison of chromosome aberrations of the radiation workers in pre-job occupational health examination of different genders and ages
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由表3可知,2 777名受检者的微核率为(0.43±0.01)‰(在国内文献[6-17]报道的健康人群的本底水平范围内),微核细胞率为(0.40±0.01)‰,淋巴细胞转化率为(85.07±3.16)%;与17~20岁年龄组相比,其余各年龄组的微核率、微核细胞率均较高,淋巴细胞转化率均较低,且差异均有统计学意义(均P<0.05)。Spearman秩相关分析结果表明,受检者的微核率和微核细胞率均与年龄呈正相关(r=0.166、0.168,均P<0.001);而淋巴细胞转化率与年龄呈负相关(r=−0.197,P<0.001)。
组别 人数(名) 分析细胞数(个) 微核率(p±Sp,‰) 微核细胞率(p±Sp,‰) 淋巴细胞转化率( ,%)$\bar x\pm s $ 17~20岁 178 17 8000 0.24±0.04 0.23±0.04 85.84±3.29 21~30岁 1 972 1 972 000 0.37±0.01a 0.34±0.01a 85.31±3.02a 31~40岁 480 480 000 0.56±0.03a 0.52±0.03a 84.49±3.23a 41~50岁 111 111 000 0.94±0.09a 0.90±0.09a 83.00±3.13a 51~69岁 36 36 000 1.11±0.17a 0.95±0.16a 81.89±3.43a 合计 2 777 2 777 000 0.43±0.01 0.40±0.01 85.07±3.16 注:p为微核率或微核细胞率;Sp为标准误。a表示与17~20岁年龄组比较,差异均有统计学意义(Z=−2.538、−4.462、−6.981、−4.486、−2.510、−4.393、−6.940、−4.461、F=4.922、22.413、52.860、42.570,P=0.011、P<0.001、P<0.001、P<0.001、P=0.012、P<0.001、P<0.001、P<0.001、P=0.027、P<0.001、P<0.001、P<0.001) 表 3 2 777名不同年龄放射工作人员上岗前职业健康检查微核情况的比较
Table 3. Comparison of micronucleus of 2 777 radiation workers of different ages in pre-job occupational health examination
由表4可知,21~30岁年龄组、31~40岁年龄组女性受检者的微核率和微核细胞率均显著高于同年龄组的男性受检者,且差异均有统计学意义(均P<0.001);17~20岁年龄组、21~30岁年龄组女性受检者的淋巴细胞转化率均显著高于同年龄组的男性受检者,且差异均有统计学意义(均P<0.01)。
组别 性别(名) 微核率(p±Sp,‰) 微核细胞率(p±Sp,‰) 淋巴细胞转化率( ,%)$\bar x\pm s $ 男 女 男 女 男 女 男 女 17~20岁 130 48 0.21±0.04 0.32±0.08 0.20±0.04 0.32±0.08 85.45±3.44 86.90±2.61a 21~30岁 1 618 354 0.32±0.01 0.58±0.04a 0.30±0.01 0.55±0.04a 85.19±3.05 85.87±2.82a 31~40岁 341 139 0.50±0.04 0.72±0.07a 0.46±0.04 0.67±0.07a 84.36±3.27 84.83±3.12 41~50岁 89 22 0.93±0.10 0.96±0.20 0.89±0.10 0.91±0.20 83.09±3.08 82.64±3.37 51~69岁 32 4 1.12±0.18 1.00±0.50 0.94±0.17 1.00±0.50 82.00±3.51 81.00±2.94 合计 2 210 567 0.38±0.01 0.61±0.03 0.35±0.01 0.58±0.03 84.95±3.18 85.54±3.03 注:p为微核率或微核细胞率;Sp为标准误。a表示与同年龄组的男性比较,差异均有统计学意义(Z=−4.826、−4.811、−3.516、−3.607,F=6.947、14.563,P<0.001、P<0.001、P<0.001、P<0.001、P=0.009、P<0.001) 表 4 不同年龄、不同性别放射工作人员上岗前职业健康检查微核情况的比较
Table 4. Comparison of micronucleus of the radiation workers in pre-job occupational health examination of different genders and ages
深圳市2015—2020年放射工作人员上岗前职业健康检查染色体畸变率与微核率分析
Analysis of chromosome aberration rate and micronucleus rate of pre-job occupational health examination of radiation workers in Shenzhen from 2015 to 2020
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摘要:
目的 分析深圳市2015—2020年放射工作人员上岗前职业健康检查染色体畸变率与微核率的水平及其分布特征,为加强放射工作人员辐射防护和职业健康管理提供科学依据。 方法 选取2015—2020年在深圳市职业病防治院接受上岗前职业健康检查的2 777名放射工作人员开展横断面研究,其中男性2 210名、女性567名,年龄17~69(27.6±6.8)岁,将受检者按年龄分为5组:17~20岁、21~30岁、31~40岁、41~50岁、51~69岁。采用全血微量培养法制备受检者的淋巴细胞微核和染色体,应用全自动染色体扫描分析系统对每名受检者的100个淋巴细胞染色体中期分裂相进行分析,统计双着丝粒体、着丝粒环和无着丝粒体等染色体畸变类型,比较不同年龄组以及同年龄组不同性别受检者染色体畸变情况和微核情况的差异。计量资料的组间比较采用方差分析;染色体畸变和微核的分布服从泊松分布,采用非参数检验,2组间比较采用Mann-Whitney U检验,多组间比较采用Kruskal-Wallis秩和检验。受检者年龄与染色体畸变率、微核率的相关性分析采用Spearman秩相关分析。 结果 2 777名受检者的染色体畸变(双着丝粒体+着丝粒环+无着丝粒体)率为(0.072±0.005)%、双着丝粒体+着丝粒环畸变率为(0.016±0.002)%、染色体畸变细胞率为(0.068±0.005)%、微核率为(0.43±0.01)‰、微核细胞率为(0.40±0.01)‰、淋巴细胞转化率为(85.07±3.16)%。各年龄组间染色体畸变率、双着丝粒体+着丝粒环畸变率、染色体畸变细胞率以及各年龄组不同性别受检者的染色体畸变率、染色体畸变细胞率间的差异均无统计学意义(χ2=1.193、0.931、0.691,Z=−0.929~−0.059,均P>0.05)。与17~20岁年龄组相比,其余各年龄组受检者的微核率、微核细胞率均较高,淋巴细胞转化率均较低,且差异均有统计学意义(Z=−6.981~−2.510,F=4.922~52.860,均P<0.05);受检者的微核率和微核细胞率均与年龄呈正相关(r=0.166、0.168,均P<0.001),而淋巴细胞转化率与年龄呈负相关(r=−0.197,P<0.001);21~30岁年龄组、31~40岁年龄组女性受检者的微核率、微核细胞率以及17~20岁年龄组、21~30岁年龄组女性受检者的淋巴细胞转化率均显著高于同年龄组的男性受检者,且差异均有统计学意义(Z=−4.826~−3.516,F=6.947、14.563,均P<0.01)。 结论 深圳市2015—2020年放射工作人员上岗前职业健康检查染色体畸变率与微核率均未超过国内文献报道的健康人群的本底水平范围,但有随年龄增大而升高的趋势,需加强放射工作人员的辐射防护与职业健康管理。 Abstract:Objective To analyze the level and distribution characteristics of chromosome aberration rate and micronucleus rate in the pre-job occupational health examination of radiation workers in Shenzhen from 2015 to 2020 and to provide scientific basis for strengthening the radiation protection and occupational health management among radiation workers. Methods A cross-sectional study was conducted among 2 777 radiation workers who received pre-job occupational health examinations in the Shenzhen Prevention and Treatment Center for Occupational Disease from 2015 to 2020, including 2 210 males and 567 females with age range of 17–69 (27.6±6.8) years. The subjects were divided into five groups by age (17–20, 21–30, 31–40, 41–50, and 51–69 years old). The lymphocyte micronuclei and chromosomes of the subjects were prepared by whole-blood microculture method. Chromosomal aberrations, including dicentric, rings, and acentric segments, in the chromosomal metaphases of 100 lymphocytes of each subject were scored by the automatic chromosome analysis system. The differences in chromosome aberrations and micronuclei were compared between different age groups and subjects of different genders in the same age group. The measurement data that conformed to the normal distribution were compared between groups by analysis of variance. The distribution of chromosome aberrations and micronuclei obeyed the Poisson distribution, and nonparametric test was used. Comparison between two groups was performed using Mann-Whitney U test, and comparison between multiple groups was performed using Kruskal-Wallis rank-sum test. Spearman rank correlation analysis was used to analyze the correlation between subjects' age and chromosome aberration and micronucleus rates. Results The chromosome aberration (dicentric + ring + acentric segment) rate of 2 777 subjects was (0.072±0.005)%, and the dicentric + ring aberration rate was (0.016±0.002)%, the chromosome aberration cell rate was (0.068±0.005)%, the micronucleus rate was (0.43±0.01)‰, the micronucleated cell rate was (0.40±0.01)‰, and the lymphocyte transformation rate was (85.07±3.16)%. All of the above results were within the background level range of healthy people reported in domestic literature. No statistical difference was found in the chromosome aberration rate, dicentric + ring aberration rate, and chromosome aberration cell rate among different age groups, as well as the chromosome aberration rate and chromosome aberration cell rate among different genders in each age group (χ2=1.193, 0.931, 0.691; Z=−0.929 to −0.059; all P>0.05). Compared with the 17–20-year-old age group, the micronucleus rate and micronucleated cell rate of the subjects in the other age groups were higher, and the lymphocyte transformation rate was lower, and the differences were statistically significant (Z=−6.981 to −2.510, F=4.922–52.860, all P<0.05). The micronuclei rate and micronucleated cell rate of the subjects were positively correlated with age (r=0.166, 0.168; both P<0.001), whereas the lymphocyte transformation rate was negatively correlated with age (r=−0.197, P<0.001). The micronuclei rate, micronucleated cell rate, and lymphocyte transformation rate of female subjects in the 17–20- and 21–30-year-old age groups was significantly higher than those of the male subjects in the same age group, and the differences were statistically significant (Z=−4.826 to −3.516; F=6.947, 14.563; all P<0.01). Conclusions The chromosome aberration rate and micronucleus rate in the pre-job occupational health examination of radiation workers in Shenzhen from 2015 to 2020 did not exceed the background level range of healthy people reported in domestic literature, but they tended to increase with age. The results of this study suggested that attention should be paid to strengthening the radiation protection and occupational health management of radiation workers. -
表 1 2 777名不同年龄放射工作人员上岗前职业健康检查染色体畸变情况的比较
Table 1. Comparison of chromosome aberrations of 2 777 radiation workers of different ages in pre-job occupational health examination
组别 人数(名) 分析细胞数(个) 双着丝粒体+着丝粒环畸变率
(p±Sp,%)染色体畸变(双着丝粒体+
着丝粒环+无着丝粒体)
率(p±Sp,%)染色体畸变细胞率
(p±Sp,%)17~20岁 178 18 070 0.011±0.008 0.094±0.023 0.089±0.022 21~30岁 1 972 199 668 0.016±0.003 0.071±0.006 0.067±0.006 31~40岁 480 48 700 0.016±0.006 0.070±0.012 0.068±0.012 41~50岁 111 11 300 0.018±0.013 0.062±0.023 0.062±0.023 51~69岁 36 3 700 0.027±0.027 0.108±0.054 0.081±0.047 合计 2 777 281 438 0.016±0.002 0.072±0.005 0.068±0.005 注:p为双着丝粒体+着丝粒环畸变率或染色体畸变率或染色体畸变细胞率;Sp为标准误 表 2 不同年龄、不同性别放射工作人员上岗前职业健康检查染色体畸变情况的比较
Table 2. Comparison of chromosome aberrations of the radiation workers in pre-job occupational health examination of different genders and ages
组别 性别(名) 染色体畸变(双着丝粒体+着丝粒环+
无着丝粒体)率(p±Sp,%)染色体畸变细胞率(p±Sp,%) 男 女 男 女 男 女 17~20岁 130 48 0.092±0.027 0.100±0.045 0.084±0.025 0.100±0.045 21~30岁 1 618 354 0.067±0.006 0.089±0.016 0.065±0.006 0.072±0.014 31~40岁 341 139 0.066±0.014 0.078±0.024 0.064±0.014 0.078±0.024 41~50岁 89 22 0.056±0.025 0.083±0.059 0.067±0.028 0.042±0.042 51~69岁 32 4 0.094±0.054 0.200±0.200 0.094±0.054 0 合计 2 210 567 0.068±0.006 0.088±0.012 0.067±0.005 0.074±0.011 注:p为染色体畸变率或染色体畸变细胞率;Sp为标准误 表 3 2 777名不同年龄放射工作人员上岗前职业健康检查微核情况的比较
Table 3. Comparison of micronucleus of 2 777 radiation workers of different ages in pre-job occupational health examination
组别 人数(名) 分析细胞数(个) 微核率(p±Sp,‰) 微核细胞率(p±Sp,‰) 淋巴细胞转化率( ,%)$\bar x\pm s $ 17~20岁 178 17 8000 0.24±0.04 0.23±0.04 85.84±3.29 21~30岁 1 972 1 972 000 0.37±0.01a 0.34±0.01a 85.31±3.02a 31~40岁 480 480 000 0.56±0.03a 0.52±0.03a 84.49±3.23a 41~50岁 111 111 000 0.94±0.09a 0.90±0.09a 83.00±3.13a 51~69岁 36 36 000 1.11±0.17a 0.95±0.16a 81.89±3.43a 合计 2 777 2 777 000 0.43±0.01 0.40±0.01 85.07±3.16 注:p为微核率或微核细胞率;Sp为标准误。a表示与17~20岁年龄组比较,差异均有统计学意义(Z=−2.538、−4.462、−6.981、−4.486、−2.510、−4.393、−6.940、−4.461、F=4.922、22.413、52.860、42.570,P=0.011、P<0.001、P<0.001、P<0.001、P=0.012、P<0.001、P<0.001、P<0.001、P=0.027、P<0.001、P<0.001、P<0.001) 表 4 不同年龄、不同性别放射工作人员上岗前职业健康检查微核情况的比较
Table 4. Comparison of micronucleus of the radiation workers in pre-job occupational health examination of different genders and ages
组别 性别(名) 微核率(p±Sp,‰) 微核细胞率(p±Sp,‰) 淋巴细胞转化率( ,%)$\bar x\pm s $ 男 女 男 女 男 女 男 女 17~20岁 130 48 0.21±0.04 0.32±0.08 0.20±0.04 0.32±0.08 85.45±3.44 86.90±2.61a 21~30岁 1 618 354 0.32±0.01 0.58±0.04a 0.30±0.01 0.55±0.04a 85.19±3.05 85.87±2.82a 31~40岁 341 139 0.50±0.04 0.72±0.07a 0.46±0.04 0.67±0.07a 84.36±3.27 84.83±3.12 41~50岁 89 22 0.93±0.10 0.96±0.20 0.89±0.10 0.91±0.20 83.09±3.08 82.64±3.37 51~69岁 32 4 1.12±0.18 1.00±0.50 0.94±0.17 1.00±0.50 82.00±3.51 81.00±2.94 合计 2 210 567 0.38±0.01 0.61±0.03 0.35±0.01 0.58±0.03 84.95±3.18 85.54±3.03 注:p为微核率或微核细胞率;Sp为标准误。a表示与同年龄组的男性比较,差异均有统计学意义(Z=−4.826、−4.811、−3.516、−3.607,F=6.947、14.563,P<0.001、P<0.001、P<0.001、P<0.001、P=0.009、P<0.001) -
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