胸片影像学改变应用于氧化铝粉尘作业职业健康风险评估结果的验证
Application of chest imaging changes in result validation for occupational health risk assessment of alumina dust-exposed operations
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摘要:
背景 粉尘作业职业健康风险评估是职业卫生工作的重要内容，但风险评估结果缺乏客观和有效的验证方法。
目的 探讨胸片影像学改变在氧化铝粉尘作业职业健康风险评估结果验证中的应用价值。
方法 选择某磨料磨具制造企业中氧化铝粉尘作业岗位的劳动者作为研究对象。应用澳大利亚职业健康与安全风险评估方法（澳大利亚模型）和新加坡有害化学物质职业接触半定量风险评估方法（新加坡模型）进行氧化铝粉尘作业职业健康风险评估，比较评估结果的一致性。计算研究对象的累积风险值和累积风险等级。对研究对象进行后前位高千伏胸片检查和诊断，比较不同岗位风险等级和不同累积风险等级研究对象铝尘阴影检出率的差异。
结果 澳大利亚模型和新加坡模型对该企业氧化铝粉尘作业岗位的风险评估得出的平均风险比值RR均为0.49 ± 0.10，即该企业氧化铝粉尘作业岗位的职业健康风险总体处于中等水平。2种模型评估结果具有明显的一致性（kappa检验，k = 0.823，P < 0.001）。192名作业工人胸片检出铝尘阴影62人（32.3%），无尘肺病病例。铝尘阴影形态以s影为主（30.7%）；密集度以“不到0/1”为主（31.3%）；分布肺区数量以2个肺区为主（18.8%），分布肺区位置以右下肺最多（18.8%），两上肺均未见铝尘阴影。澳大利亚模型评估得出的重大风险岗位研究对象的铝尘阴影检出率（41.7%）高于中等风险岗位（22.9%）（ P < 0.01）。新加坡模型得出的中等风险岗位研究对象的铝尘阴影检出率（42.7%）明显高于低风险岗位（23.3%）（ P < 0.01）。2种模型评估得出的累积风险等级均为Ⅰ~ Ⅲ级，研究对象铝尘阴影的检出率随着累积风险等级的增加，均呈现明显增高趋势（ P < 0.05）。
结论 澳大利亚模型和新加坡模型的风险评估结果具有明显的一致性，可联合应用于粉尘作业的风险评估。胸片影像学改变应用于氧化铝粉尘作业职业健康风险评估结果的验证具有一定价值。
Abstract:Background Occupational health risk assessment of dust-exposed operations is an important part of occupational health work. However, there is a lack of objective and effective methods for validating the risk assessment results.
Objective To explore the application value of chest imaging changes in validating occupational health risk assessment results of dust-exposed operations.
Methods Alumina dust-exposed workers in an abrasive manufacturing company were selected as study subjects. The Australian Occupational Health and Safety Risk Assessment model (Australian model), and the Singapore semi-quantitative risk assessment model of occupational exposure to chemical substances (Singaporean model) were used to conduct occupational health risk assessment for the target group. Consistency of the assessment results was compared. The cumulative risk value and cumulative risk level of the subjects were calculated. The subjects were examined and diagnosed by chest radiographs, and the differences in the positive rates of aluminum dust shadows of workers at different job risk levels and different cumulative risk levels were compared.
Results The average risk ratios (RR) of selected alumina dust-exposed workers estimated by the Australian model and the Singapore model were both 0.49±0.10, indicating generally medium occupational health risk level. The evaluation results of the two models were obviously consistent (kappa test, k = 0.823, P < 0.001). Among the 192 subjects, 62 (32.3%) were found to have aluminum dust shadows on their chest radiographs, and there were no case of pneumoconiosis. The aluminum dust shadows were mainly classified by shape and size as “s” (30.7%); the profusion of small opacities was mainly "less than 0/1" (31.3%); they were mostly distributed in 2 pulmonary zones (18.8%), and mostly in the right lower lung (18.8%), and none was seen in the two upper lung zones. The positive rate of aluminum dust shadows in the high-risk workplaces (41.7%) assessed by the Australian model was significantly higher than that in the medium-risk workplaces (22.9%) ( P < 0.01). The positive rate of aluminum dust shadows in the medium-risk workplaces (42.7%) assessed by the Singapore model was significantly higher than that in the low-risk workplaces (23.3%) ( P < 0.01). The cumulative risk levels evaluated by the two models were all atⅠ- Ⅲ levels. With the increase of cumulative risk level by the two models, the positive rates of aluminum dust shadows in the subjects both showed an obvious increase trend ( P < 0.05).
Conclusion The risk assessment results of the Australian model and the Singapore model are obviously consistent for the target group. They can be jointly applied to the risk assessment of dust-exposed operations. The application of chest imaging changes is of certain value to validate the results of occupational health risk assessment for dust-exposed operations.
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