手传振动对作业工人上肢影响的meta分析

贾艳霞; 严茂胜; 郑浛君; 张丹英; 肖斌

doi:10.11836/JEOM21366

摘要:

背景手臂振动病是（HAVD）我国的法定职业病之一，其发病机制尚不明确。长期接触电动振动工具的作业人员可增加患HAVD的风险。

目的系统评价振动作业对工人上肢神经、血管、肌肉的影响。

方法检索和收集中国知网、万方、PubMed数据库关于手传振动对于HAVD影响的相关研究，文献发表时为1974年1月—2021年4月。使用纽卡斯尔-渥太华量表评估队列研究和病例对照研究质量，使用美国卫生保健研究和质量机构的质量评价标准评估横断面研究质量。使用RevMan 5.4.1 软件对纳入文献的结局指标（OR）进行统计分析，采用随机效应模型对有关振动性白指和神经感觉损伤文献中的效应量进行合并，纳入了腕管综合征的文献则采用固定效应模型合并效应量，并分别对其进行亚组分析和发表偏倚分析。使用Stata 16.0 软件进行meta回归探索研究的异质性来源，对纳入的文献进行敏感性分析。

结果本次从数据库共检索到716篇文献，并手动检索到18篇，排除不符合标准的文献后共34篇文献被纳入，涉及振动性白指、神经感觉损伤和腕管综合征的文献中分别有11004、7270和1722例研究对象。meta分析结果显示：与对照组相比，手传振动作业人员振动性白指合并后的OR为4.25（95%CI：2.72~6.65），神经感觉损伤合并后的OR为4.03（95%CI：2.46~6.61），腕管综合征合并后的OR为2.44（95%CI：1.61~3.71）。异质性检验发现：与振动性白指相关的原始研究存在异质性（I²=81%，P＜0.001），与神经感觉损伤相关的原始研究存在异质性（I²=90%，P＜0.001），与腕管综合征相关的原始研究的异质性可忽略（I²=23%，P＜0.001）。敏感性分析显示合并后的效应量（OR）结果较稳定、可靠。从meta回归的结果中可以看出影响振动性白指、神经感觉损伤的文献间高异质性因素分别是文献的发表时间（t=−2.10，P=0.049）、作业工人的工龄（t=−2.40，P=0.032）。

结论手传振动是作业工人发生振动性白指、神经感觉损伤和腕管综合征的危险因素。

Abstract:

Background Hand arm vibration disease (HAVD) is one of the legal occupational diseases in China, and its pathogenesis is not clear. Operators exposed to electric vibration tools for a long time have an increased risk of HAVD.

Objective To conduct a systematic evaluation of the effects of vibration operations on workers' upper limb nerves, blood vessels, and muscles.

Methods Relevant studies on the effects of hand-transmitted vibration on HAVD were searched and collected from the China Knowledge Infrastructure, Wanfang, and PubMed databases, and the literature was published from January 1974 to April 2021. The quality of cohort and case-control studies was assessed by the Newcastle-Ottawa Scale (NOS), and the quality of cross-sectional studies was by the evaluation criteria recommended by the Agency for Healthcare Quality and Research (AHRQ). Statistical analyses of outcome indicators (OR) in the included literature were performed using RevMan 5.4.1 software, effect sizes in the literature on vibration-induced white finger and neurosensory impairment were combined using a random-effect model, those that included carpal tunnel syndrome were combined using a fixed-effect model, and subgroup and publication bias analyses were also performed. To explore sources of study heterogeneity, meta-regression was performed using Stata 16.0 software, and sensitivity analyses were performed on the included literature.

Results A total of 716 papers were retrieved from the databases, and 18 articles were retrieved by manual searching. A total of 34 papers were included after excluding those not meeting the criteria. Of the papers, 11004, 7270, and 1722 subjects related to vibration-induced white finger, neurosensory impairment, and carpal tunnel syndrome, respectively. The results of meta-analysis showed that compared with the control group, the combined ORs of hand-transmitted vibration exposure were 4.25 (95%CI: 2.72−6.65) for vibration-induced white finger, 4.03 (95%CI: 2.46−6.61) for neurosensory impairment, and 2.44 (95%CI: 1.61−3.71) for carpal tunnel syndrome. Heterogeneity was identified in the original studies related to vibration-induced white finger (I²=81%, P < 0.001) and neurosensory impairment ( I²=90%, P < 0.001), except carpal tunnel syndrome ( I²=23%, P < 0.001). The results of sensitivity analysis showed that the combined effect sizes ( ORs) were stable and reliable. The results of meta-regression showed that the factors contributing to high heterogeneity of combined vibration-induced white finger and neurosensory impairment were time of publication (t=−2.10,P=0.049) and working age (t=−2.40,P=0.032), respectively.

Conclusion Hand-transmitted vibration is a risk factor for vibration-induced white finger, neurosensory impairment, and carpal tunnel syndrome in operators.

手传振动对作业工人上肢影响的meta分析

Effects of hand-transmitted vibration on upper limbs of workers: A meta-analysis