手臂振动病与血管活性因子的关联性

Correlation between hand-arm vibration disease and vasoactive factors

  • 摘要:
    背景 手臂振动病(HAVD)是因长期接触手传振动导致的慢性进行性疾病,振动影响手指外周血管功能的机制尚不完全清楚。
    目的 研究血管活性因子与HAVD的关联性,筛选特异性指标,为HAVD早期诊断及预防提供依据。
    方法 使用判断抽样方法,分别抽取有(HAVD组)、无HAVD工人(振动接触组)及非手传振动作业工人(对照组)各60例。采用酶联免疫吸附试验检测三组人群血浆中白三烯B4(LTB4)、血管内皮生长因子(VEGF)、5-羟色胺(5-HT)、白细胞介素-1β(IL-1β)、降钙素基因相关肽(CGRP)浓度。使用logistic回归分析血管活性因子与HAVD的关联。构建多变量模型指标 \widehatY ,通过受试者工作特征(ROC)曲线筛查预测HAVD的可能指标。
    结果 HAVD组、振动接触组、对照组手部症状率分别为26.7%、66.7%、96.7%,差异具有统计学意义(P<0.05)。HAVD组LTB4、5-HT、IL-1β、CGRP浓度高于振动接触组和对照组,振动接触组高于对照组(P<0.05),三组人群VEGF浓度差异无统计学意义(P>0.05)。logistic回归结果显示LTB4(OR=1.048,95%CI:1.022~1.076)、5-HT(OR=1.011,95%CI:1.004~1.018)、IL-1β(OR=1.148,95%CI:1.071~1.230)、CGRP(OR=1.055,95%CI:1.008~1.104)浓度越高,发生HAVD的风险越高(P<0.05)。ROC曲线分析所获曲线下面积: \widehatY( 0.969)>IL-1β(0.907)>LTB4(0.876)>5-HT(0.858)>CGRP(0.836)。
    结论 LTB4、5-HT、IL-1β、CGRP浓度随手传振动作业职业暴露而发生改变,可能与HAVD有关联,尚未发现VEGF与HAVD存在关联。可联合监测各生化指标来提高早期筛查HAVD的准确性。

     

    Abstract:
    Background Hand-arm vibration disease (HAVD) is a chronic progressive disease caused by long-term exposure to hand-transmitted vibration, but the mechanism by which vibration affects peripheral vascular function of fingers is not completely clear.
    Objective To study the association between vasoactive factors and HAVD, and to screen specific indicators for its early diagnosis and prevention.
    Methods Judgmental sampling method was used to select workers with (HAVD group) and without HAVD (vibration contact group), and non-hand-transmitted vibration operation workers (control group), with 60 workers in each group. The levels of leukotriene B4 (LTB4), vascular endothelial growth factor (VEGF), 5-hydroxy tryptamine (5-HT), interleukin-1β (IL-1β), and calcitonin gene-related peptide (CGRP) in plasma of the three groups were measured by enzyme-linked immunosorbent assay. The association between vasoactive factors and HAVD was analyzed using logistic regression, and the diagnostic HAVD indicators were screened by receiver operator characteristic (ROC) curve of a multivariate model indicator \widehatY .
    Results The hand symptom rates of the HAVD group, the vibration contact group, and the control group were 26.7%, 66.7%, and 96.7% respectively, with a significant difference (P<0.05). The levels of LTB4, 5-HT, IL-1β, and CGRP in the HAVD group were the highest followed by the vibration contact group, and lowest levels were in the control group (P<0.05). There was no significant difference in the VEGF level among the three groups (P>0.05). The logistic regression results showed that higher levels of LTB4 (OR=1.048, 95%CI: 1.022-1.076), 5-HT (OR=1.011, 95%CI: 1.004-1.018), IL-1β (OR=1.148, 95%CI: 1.071-1.230), and CGRP (OR=1.055, 95%CI: 1.008-1.104) were associated with a higher risk of HAVD (P<0.05). The order of the potential indicators' area under the ROC curve from high to low was: \widehatY (0.969) > IL-1β (0.907) > LTB4 (0.876) > 5-HT (0.858) > CGRP (0.836).
    Conclusion The expression levels of LTB4, 5-HT, IL-1β, and CGRP are altered with occupational exposure in hand-transmitted vibration operations and may be associated with HAVD; VEGF is not found to be associated with HAVD. The accuracy of early screening for HAVD can be improved by combining the monitoring of various biochemical indicators.

     

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