焦炉工人高血压发病队列研究

摘要

目的：通过焦炉工人自身队列研究分析，焦炉工人焦炉作业暴露水平及暴露时间与高血压发病的关系，探讨焦炉工人高血压发病的危险因素。方法选取山西某焦化厂焦炉作业工人128人为暴露组，同厂辅助工种32人为对照组，分别于2009年和2014年2次对工人进行调查，通过调查表收集个人信息，定点采取作业场所空气样本，高效液相色谱法测定空气样本中苯并（a）芘[B（a）P]和研究对象尿1-羟基芘（1-OHP）的浓度，电子血压计测定血压，采用1999年世界卫生组织/国际高血压联盟（WHO-ISH）制订的高血压诊断和分级标准进行诊断。结果与2009年相比，2014年作业场所空气中B（a）P浓度及研究对象尿1-OHP浓度差异无统计学意义。暴露组新增发病率（23.4％）显著高于对照组（9.4％）（P<0.05）。以在2009年基础上将2014年暴露工人高血压诊断级别上升级数作为因变量进行有序Logistic回归，结果显示，焦炉作业为高血压评级升高的危险因素， OR（95％CI）为5.37（1.79，16.04）。进一步对暴露组各因素进行分析，结果显示，暴露组中尿1-OHP的浓度及蓄积量均与血压升高呈正相关，r分别为0.354，0.397（P<0.05）。接焦工龄、尿1-OHP的浓度及蓄积量均为血压升高的危险因素（P<0.05）。结论焦炉作业可导致暴露工人高血压发病率升高，病情加重，多环芳烃暴露及其蓄积水平是主要危险因素。%Objective To investigate the risk factors of hypertension in coke oven workers through a cohort study on the correlation between the exposure level and time of coke oven operation and the incidence of hyperten-sion. Methods A total of 128 coke oven workers of a coking plant in Shanxi province were included in the exposed group, and 32 assistant workers in the same factory were included in the control group. All workers were surveyed in 2009 and 2014, respectively, and the personal informations were collected through the questionnaire. Air sampling of the workplaces was taken at the designated locations. The concentrations of benzo (a) pyrene [B(a)P] in the air samples and urinary 1-hydroxypyrene (1-OHP) in the subjects were determined by high performance liquid chromatography (HPLC). The blood pressure was measured by electronic sphygmomanometer. The diagnostic and grading criteria for hypertension developed by the World Health Organization/International Society of Hypertension (WHO-ISH) in 1999 were used for the diagnosis. Results There was no significant difference in the air B(a)P concentration in the work-place and urinary 1-OHP concentration in the subjects in 2014 compared with those in 2009. The incidence of the new onset in the exposed group (23.4%) was significantly higher than that in the control group (9.4%) ( P<0.05). On the basis of 2009, the increased diagnostic level of hypertension in the exposed workers in 2014 was used as the de-pendent variable for the ordered Logistic regression. The findings showed that the coke oven operation was a risk fac-tor for increased diagnostic level of hypertension, and the OR (95%CI) was 5.37 (1.79, 16.04). Further analysis on the risk factors in the exposed group showed that the urinary 1-OHP concentration and volume were positively correlated with the increased blood pressure, and r was 0.354 and 0.397, respectively (P<0.05). The age of coke oven workers, urinary 1-OHP concentration and volume were the risk factors of increased blood pressure ( P<0.05). Conclusion Coke oven operation may lead to increased incidence of hypertension and exacerbation of the disease in exposed workers. Polycyclic aromatic hydrocarbon exposure and its accumulation level are the main risk factors.