手传振动对作业人员指端末梢神经影响的meta分析

Effects of hand-transmitted vibration on fingertip terminal nerve: A meta-analysis

  • 摘要:
    背景 手传振动是最为常见的职业性有害因素之一,与指端末梢神经症状的发生密切相关。
    目的 综合分析手传振动对作业人员指端末梢神经的影响。
    方法 检索和收集在国内外数据库公开发表的关于手传振动对作业人员指端末梢神经影响的文献,结局指标为自诉手指麻木、手指刺痛等指端末梢神经症状的患病数(率),时间限定为各数据库建立至2021年12月。经筛选后,使用美国卫生保健质量和研究机构推荐的质量评价标准评估横断面研究文献质量,使用纽卡斯尔-渥太华量表评估队列研究文献质量。使用NoteExpress 3.2进行文献管理,数据收集提取采用Excel 2003。应用RevMan 5.4.1软件进行统计分析,采用随机效应模型计算合并效应的OR值,绘制森林图,以接振工龄作为亚组分析的依据。同时剔除权重最大的文献作敏感性分析,并通过绘制漏斗图对文献偏倚进行评价。
    结果 共检索到3619篇文献,最终符合纳入条件的文献39篇,其中,中文文献29篇,英文文献10篇;横断面研究文献36篇,队列研究文献3篇。共计8399例研究对象,其中接振组5673例,对照组2726例。采用随机效应模型对纳入的文献进行合并,结果显示:作业人员自诉手指麻木(OR=8.29,95%CI:5.43~12.66)、手指刺痛(OR=7.50,95%CI:4.78~11.77)、手指肿胀(OR=8.25,95%CI:4.06~16.76)、手指僵硬(OR=10.71,95%CI:3.60~31.87)、手指颤抖(OR=5.11,95%CI:2.60~10.04)、手无力(OR=11.05,95%CI:3.98~30.68)、手多汗(OR=2.70,95%CI:1.64~4.43)、手冷(OR=3.54,95%CI:2.42~5.18)的症状发生与对照组相比差异有统计学意义(P<0.01)。亚组分析结果表明,作业人员自述手指麻木、手指刺痛等合并效应的OR值均表现为在接振的早、中期(工龄<5年组、5~10年组)上升(手指麻木:OR分别为11.11、19.07;手指刺痛:OR分别为4.70、16.55,均P<0.01),而在接振后期(工龄10~15年组、≥15年组)的OR值下降(手指麻木:OR分别为9.57、2.30;手指刺痛:OR分别为5.71、6.00,均P<0.01)。敏感性分析显示合并后的效应量结果较稳定、可靠(OR=13.96,95%CI:4.85~40.13,Z=4.89,P<0.01)。漏斗图结果显示存在发表偏倚。
    结论 长期接触手传振动可引起手指麻木、手指刺痛、手指肿胀、手指僵硬、手指颤抖、手无力、手多汗、手冷的发生。

     

    Abstract:
    Background Hand-transmitted vibration is one of the most common occupational hazards and is closely related to symptoms of fingertip terminal nerve damage.
    Objective To analyze the effects of hand-transmitted vibration on the terminal nerve of fingertips.
    Methods We systematically searched literature about the effects of hand-transmitted vibration on fingertip terminal nerve at home and abroad. The outcome index was the number (rate) of fingertip terminal nerve symptoms reported by the vibration group and the control group, such as finger numbness and finger tingling, and the search period was from database inception to December 2021. The quality of cross-sectional studies was assessed using the criteria recommended by the Agency for Healthcare Research and Quality (AHRQ), and the quality of cohort studies was assessed by the Newcastle-Ottawa Scale (NOS). NoteExpress 3.2 was used for literature management, and Excel 2003 was used for data collection and extraction. RevMan 5.4.1 software was used for statistical analysis, and random effect model was used to calculate the OR value of pooled effects and to draw forest plots. Subgroup analysis was carried out according to the working years with vibration exposure. At the same time, sensitivity analysis was performed after excluding studies with the largest weight and funnel plots were generated to evaluate publication bias.
    Results A total of 3619 articles were retrieved, and 39 articles were finally included, including 29 Chinese articles and 10 English articles; 36 cross-sectional studies and 3 cohort studies. In total, 8399 subjects were studied, including 5673 cases in the vibration exposure group and 2726 cases in the control group. Random effect model was used to merge the included literature. The results of meta-analysis showed that compared with the control group, hand-transmitted vibration was significantly associated with the self-reported occurrence of finger numbness (OR=8.29, 95%CI: 5.43-12.66), finger tingling (OR=7.50, 95%CI: 4.78-11.77), finger swelling (OR=8.25, 95%CI: 4.06-16.76), finger stiffness (OR=10.71, 95%CI: 3.60-31.87), finger trembling (OR=5.11, 95%CI: 2.60-10.04), hand weakness (OR=11.05, 95%CI: 3.98-30.68), hand sweating (OR=2.70, 95%CI: 1.64-4.43), hand coldness (OR=3.54, 95%CI: 2.42-5.18) (P<0.01). The subgroup analysis showed that the odds ratios of both finger numbness and finger tingling increased in the early and middle stages of vibration exposure (<5 years and 5-10 years of exposure duration)(finger numbness: OR=11.11, 19.07; finger tingling: OR=4.70, 16.55, respectively)(P<0.01), and decreased in the late stage of vibration exposure (10-15 years and ≥15 years of exposure duration) (finger numbness: OR=9.57, 2.30; finger tingling: OR=5.71, 6.00, respectively) (P<0.01). The results of sensitivity analysis showed a stable pooled effect (OR=13.96, 95%CI: 4.85-40.13, Z=4.89, P<0.01). The funnel plot results showed positive publication bias.
    Conclusion Occupational exposure to hand-transmitted vibration can cause finger numbness, finger tingling, finger swelling, finger stiffness, finger trembling, hand weakness, hand sweating, and hand coldness.

     

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