职业噪声暴露与石油工人肾功能损伤的关系
Relationship between occupational noise exposure and renal function impairment in oil workers
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摘要:
背景 石油工人的工作性质决定其存在职业噪声暴露。在没有有效防护的情况下，噪声会对工人身体各方面机能造成影响，包括通过作用于肾上腺皮质系统，引发肾功能受损。
目的 探讨噪声暴露及累积暴露量与石油工人肾功能损伤之间的关系。
方法 选取某医院集体体检的石油工人作为研究对象。依据GBZ/T 189.8—2007《工作场所物理因素测量 第8部分：噪声》对石油工人工作现场进行3次噪声暴露强度测量，取平均值获得累积噪声暴露量（CNE）。采用问卷调查研究对象的一般情况，包括社会人口学特征、家族史、生活行为史以及职业史等，并检测空腹状态下的血生化指标水平，根据肾小球滤过率判断肾功能损伤情况。对存在噪声暴露的工人使用受试者工作特征曲线图分析CNE与肾功能的关系。
结果 共纳入2 917名研究对象，其肾功能损伤率为14.2%。单因素结果提示，是否患有高血压、性别、年龄、婚姻状况及吸烟、饮酒等生活习惯不同者之间，其肾功能损伤率的差异有统计学意义（P＜0.05）；尿酸、总胆固醇、甘油三酯、高密度脂蛋白及空腹血糖异常者肾功能损伤率高于正常者（P＜0.05）；按照等效声级≥80 dB(A)的标准共有1 565人（53.7%）存在噪声暴露，存在噪声暴露的工人其肾功能损伤率高于不存在噪声暴露的工人（P＜0.05）。多因素研究结果显示，女性（OR=2.811，95%CI：1.960~4.030）、年龄31岁及以上（OR31~40=3.502，95%CI：1.402~8.751；OR41~50=4.255，95%CI：1.759~10.291；OR≥51=7.179，95%CI：2.864~17.996）、尿酸异常（OR=5.932，95%CI：4.486~7.843）、患有高血压（OR=1.593，95%CI：1.230~2.063）、饮酒（OR=2.648，95%CI：1.346~5.212）、吸烟（OR=1.816，95%CI：1.133~2.911）者发生肾功能损伤风险更高。暴露于噪声者发生肾功能损伤的风险是非暴露者的1.351倍（95%CI：1.073~1.702倍）。与接触噪声的肾功能正常组相比，接触噪声的肾功能损伤组的噪声暴露强度和CNE均更高（P＜0.05）。以CNE≤95.85 dB(A)·年为参考，当CNE＞95.85 dB(A)·年时，工人发生肾功能损伤的风险升高（OR=2.583，95%CI：1.956~3.411）。
结论 接触噪声、噪声暴露强度和CNE可能与石油工人发生肾功能损伤有关。当石油工人CNE超过95.85 dB(A)·年时，肾功能损伤风险增加。
Abstract:Background The current oil production determines oil workers’ occupational noise exposure. Without effective protection, noise will affect various aspects of worker’s body functions, including acting on the adrenal cortex system and resulting in renal function damage.
Objective To evaluate the associations of noise exposure and its cumulative exposure level with renal function impairment of oil workers.
Methods Oil workers from a collective medical examination in a hospital were selected as the study subjects. In accordance with the national standard Measurement of Physical Agents in the Workplace Part 8: Noise (GBZ/T 189.8—2007), noise exposure was measured three times at the oil workers' work site, and their average value was calculated to obtain the cumulative noise exposure (CNE). A questionnaire survey was conducted to collect general information such as socio-demographic characteristics, family history, lifestyles, and occupational history. All blood biochemical indicators were measured in the fasting state. Renal function impairment was judged based on the glomerular filtration rate. The relationship between CNE and renal function was analyzed using receiver operating characteristic curve (ROC) for workers with noise exposure.
Results A total of 2 917 subjects were included in the study and their prevalence of renal function impairment was 14.2%. The univariate analysis results suggested statistically significant differences in the prevalence of renal function impairment among the oil workers grouped by having hypertension or not, gender, age, marital status, marital status, smoking, and alcohol consumption (P＜0.05); the prevalence of renal impairment was significantly higher in those with abnormal values of uric acid, total cholesterol, triglycerides, high-density lipoprotein, and fasting glucose than in those with normal values (P＜0.05); the oil workers with noise exposure n=1565, 53.7%, equivalent sound level ≥80 dB(A) showed a higher prevalence of renal function impairment than those without (P＜0.05). The results of multiple logistic regression analysis showed that being female (OR=2.811, 95%CI: 1.960-4.030), age at 31 years and above (OR31-40=3.502, 95%CI: 1.402-8.751; OR41-50=4.255, 95%CI: 1.759-10.291; OR≥51=7.179, 95%CI: 2.864-17.996), showing abnormal uric acid (OR=5.932, 95%CI: 4.486-7.843), having hypertension (OR=1.593, 95%CI: 1.230-2.063), alcohol consumption (OR=2.648, 95%CI: 1.346-5.212), and smoking (OR=1.816, 95%CI: 1.133-2.911) had higher risks of developing renal function impairment; besides, those exposed to noise had 1.351 times (95%CI: 1.073-1.702) higher risks of developing renal function impairment than non-exposed individuals. Noise-exposed oil workers in the renal impairment group had higher noise exposure intensity and CNE compared to the noise-exposed oil workers in the normal renal function group (P＜0.05), and the workers had an increased risk of renal function impairment when the CNE was >95.85 dB(A)·year versus CNE ≤ 95.85 dB(A)·year ( OR=2.583, 95%CI: 1.956-3.411).
Conclusion Exposure to noise, higher noise exposure intensity, and higher level of CNE may be associated with developing renal function impairment in oil workers. Oil workers with CNE above 95.85 dB(A)·year are at an increased risk of renal impairment.
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