Thyroid-stimulating hormone and thyroid hormone levels in association with occupational hazards in male coal miners
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摘要:背景
甲状腺激素对正常发育至关重要,也是生理系统正常运作所必需的。目前关于甲状腺的研究主要聚焦在生活行为因素对甲状腺功能异常的影响,聚焦甲状腺激素水平的影响因素的探究较少,尤其是职业危害因素,应予以进一步研究。
目的调查职业危害因素暴露与男性煤矿从业人员促甲状腺激素(TSH)和甲状腺激素水平的关联。
方法采用横断面设计的研究方法,选取2023年于西山煤电(集团)有限责任公司职业病防治所参与健康体检、符合纳入排除标准的
12564 名职业工人作为研究对象。采用自行设计的问卷收集所有研究对象的基本信息、职业史、生活行为习惯等信息,通过职业健康体检和工作场所职业危害因素检测资料,获取研究对象的身高、体重、甲状腺功能检查结果和职业危害因素暴露情况。本研究采用广义线性回归分析各职业危害因素与TSH和甲状腺激素水平的关联。结果12564 名男性煤矿从业人员三碘甲腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)和TSH水平的M (P 25,P 75)分别为1.16(1.03,1.29)ng·mL−1、7.70(6.70,8.90)μg·dL−1、3.63(3.40,3.84)pg·mL−1、1.19(1.08,1.30)ng·dL−1和1.93(1.36,2.78)μIU·mL−1。甲状腺激素异常总检出率为2.83%,其中亚临床甲状腺减退症的患病率最高(1.83%),其次为甲状腺功能亢进症(0.37%)、甲状腺功能减退症(0.32%)、亚临床甲状腺功能亢进症(0.31%)。调整混杂因素后,广义线性回归模型显示,长工时工作人群的T3、FT3水平更高,β (95%CI)分别为0.011(0.003~0.019)、0.038(0.019~0.057);夜班工作人群的TSH水平升高,而FT4水平降低,β (95%CI)分别为0.171(0.016~0.326)、−0.012(−0.019~−0.006);煤尘暴露人群的T3、T4水平降低,β (95%CI)分别为−0.022(−0.037~−0.008)、−0.320(−0.434~−0.207);噪声暴露人群的T4、FT4水平降低,β (95%CI)分别为−0.102(−0.166~−0.038)、−0.020(−0.027~−0.013)。结论煤矿从业人员TSH与甲状腺激素水平基本处于正常值参考范围内,异常率较低。长工时工作、夜班工作、煤尘、噪声等职业危害因素与男性煤矿从业人员TSH和甲状腺激素水平相关。煤矿企业应合理安排工作时间、科学优化夜班排班制度、加强煤尘和噪声防护措施,促进职业健康,保障煤矿从业人员的身体健康。
Abstract:BackgroundThyroid hormones are crucial for development and proper functioning of human physiological systems. Current research on the thyroid mainly focuses on the impacts of lifestyle factors on thyroid dysfunction, while less attention is paid to the factors affecting thyroid hormone levels, especially occupational hazards, which warrants further investigation.
ObjectiveTo investigate the associations between occupational hazard exposure and thyroid-stimulating hormone (TSH) and thyroid hormone levels in male coal mine workers.
MethodsA cross-sectional study design was adopted. A total of
12564 workers who participated in the occupational health check-ups at the Xishan Coal Electricity (Group) Corporation Occupational Disease Prevention and Control Institute in 2023 and met the inclusion and exclusion criteria were selected as research subjects. A self-designed electronic questionnaire was used to collect basic information, occupational history, and lifestyle habits of all study subjects. Height, weight, thyroid function test results, and occupational hazard exposure of the study subjects were obtained through occupational health examinations and routine workplace occupational hazard detection records. Generalized linear regression was used to analyze the associations between occupational hazard exposure and the levels of TSH and thyroid hormones.ResultsThe median (
P 25,P 75) levels of triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), free thyroxine (FT4), and TSH in the included12564 male coal mine workers were 1.16 (1.03, 1.29) ng·mL−1, 7.70 (6.70, 8.90) μg·dL−1, 3.63 (3.40, 3.84) pg·mL−1, 1.19 (1.08, 1.30) ng·dL−1, and 1.93 (1.36, 2.78) μIU·mL−1, respectively. The overall abnormality rate of thyroid hormones was 2.83%, with the highest rate for subclinical hypothyroidism (1.83%), followed by hyperthyroidism (0.37%), hypothyroidism (0.32%), and subclinical hyperthyroidism (0.31%). After adjustment for confounding factors, the generalized linear regression model showed that long working hours were associated with higher levels of T3 and FT3, withβ (95%CI) values of 0.011 (0.003, 0.019) and 0.038 (0.019, 0.057) respectively. Night shift work was linked to increased TSH levels and decreased FT4 levels, withβ (95%CI) values of 0.171 (0.016, 0.326) and −0.012 (−0.019, −0.006) respectively. Coal dust exposure was associated with decreased levels of T3 and T4, withβ (95%CI) values of −0.022 (−0.037, −0.008) and −0.320 (−0.434, −0.207) respectively. Noise exposure was related to decreased levels of T4 and FT4, withβ (95%CI) values of −0.102 (−0.166, −0.038) and −0.020 (−0.027, −0.013) respectively.ConclusionThe TSH and thyroid hormone levels of coal miners are mostly within the normal reference ranges, with a low abnormality rate. Long work hours, night shift work, coal dust, and noise are associated with the levels of TSH and thyroid hormone levels in the male miners. Coal companies should reasonably arrange working hours, optimize the night shift scheduling system, and enhance protection against coal dust and noise to promote occupational health and safeguard the physical health of miners.
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Keywords:
- coal miner /
- thyroid-stimulating hormone /
- thyroid hormone /
- occupational hazard
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表 1 男性煤矿从业人员不同人口学特征组间TSH和甲状腺激素水平的比较[n=
12564 ,M(P25,P75)]Table 1 Comparison of TSH and thyroid hormone levels in male coal miners grouped by demographic characteristics [n=
12564 , M (P25, P75)]人口学特征 n(%) T3/(ng·mL−1) T4/(μg·dL−1) FT3/(pg·mL−1) FT4/(ng·dL−1) TSH/(μIU·mL−1) 民族 汉族 12482 (99.35)1.16(1.03,1.29) 7.70(6.70,8.90) 3.63(3.40,3.84) 1.19(1.08,1.30) 1.93(1.08,2.78) 其他民族 82(0.65) 1.13(0.94,1.24) 7.55(5.90,8.83) 3.66(3.42,3.89) 1.23(1.12,1.31) 1.97(1.32,2.75) Z −2.234 −1.462 −1.112 −1.59 −0.104 P 0.025 0.144 0.266 0.112 0.917 BMI 低体重 171(1.36) 1.10(0.98,1.24) 8.00(6.98,9.40) 3.51(3.25,3.78) 1.21(1.11,1.31) 1.79(1.33,2.59) 正常 3822 (30.42)1.14(1.02,1.27) 7.80(6.70,9.00) 3.61(3.38,3.81) 1.19(1.08,1.30) 1.87(1.31,2.68) 超重 5487 (43.67)1.15(1.03,1.28) 7.60(6.60,8.80) 3.63(3.40,3.84) 1.19(1.08,1.30) 1.94(1.36,2.80) 肥胖 3084 (24.55)1.18(1.05,1.32) 7.75(6.70,9.00) 3.66(3.42,3.87) 1.19(1.09,1.30) 2.03(1.43,2.88) H 80.606 34.377 51.534 3.424 47.138 P <0.001 <0.001 <0.001 0.331 <0.001 教育程度 小学及以下 139(1.11) 1.20(1.07,1.32) 7.80(6.60,9.10) 3.53(3.31,3.81) 1.14(1.05,1.22) 1.82(1.21,2.85) 初中 1533 (12.20)1.16(1.03,1.29) 7.60(6.40,8.70) 3.56(3.32,3.78) 1.14(1.05,1.25) 1.88(1.31,2.74) 高中/中专 4146 (33.00)1.18(1.05,1.31) 7.70(6.60,8.90) 3.64(3.42,3.85) 1.17(1.07,1.29) 1.94(1.36,2.81) 大专/本科及以上 6746 (53.69)1.14(1.02,1.27) 7.80(6.70,8.90) 3.64(3.40,3.85) 1.21(1.11,1.32) 1.94(1.37,2.77) H 58.339 20.375 71.745 292.439 4.673 P <0.001 <0.001 <0.001 <0.001 0.197 每月人均收入/元 ≤ 3000 5259 (41.86)1.16(1.03,1.30) 7.70(6.70,8.90) 3.62(3.39,3.84) 1.18(1.08,1.30) 1.93(1.36,2.77) 3001 ~6000 4592 (36.55)1.15(1.02,1.28) 7.70(6.70,8.90) 3.64(3.40,3.84) 1.19(1.09,1.31) 1.93(1.36,2.76) 6001 ~10000 1946(15.49) 1.17(1.04,1.30) 7.70(6.60,8.90) 3.63(3.41,3.84) 1.18(1.08,1.30) 1.96(1.35,2.83) ≥ 10000 767(6.10) 1.15(1.02,1.29) 7.70(6.70,9.00) 3.64(3.40,3.86) 1.19(1.09,1.31) 1.92(1.34,2.76) H 7.829 0.838 3.907 18.558 1.096 P 0.050 0.840 0.272 <0.001 0.778 婚姻状况 未婚 818(6.51) 1.15(1.02,1.27) 7.90(6.80,8.90) 3.65(3.44,3.86) 1.22(1.11,1.32) 2.09(1.45,2.94) 已婚 11309 (90.01)1.16(1.03,1.29) 7.70(6.60,8.90) 3.63(3.39,3.84) 1.18(1.08,1.30) 1.93(1.35,2.76) 其他 437(3.48) 1.16(1.03,1.30) 7.80(6.80,8.90) 3.58(3.36,3.83) 1.20(1.09,1.33) 1.90(1.38,2.89) H 1.199 3.899 10.508 33.825 10.313 P 0.549 0.142 0.005 <0.001 0.006 吸烟 否 2416 (19.23)1.12(0.99,1.24) 7.60(6.50,8.70) 3.56(3.32,3.81) 1.18(1.08,1.30) 2.10(1.48,3.03) 已戒烟 3019 (24.03)1.18(1.06,1.31) 7.70(6.70,8.80) 3.65(3.42,3.85) 1.17(1.07,1.28) 2.04(1.41,2.94) 是 7129 (56.74)1.16(1.03,1.30) 7.80(6.70,9.00) 3.64(3.41,3.85) 1.20(1.09,1.31) 1.84(1.31,2.64) H 155.910 32.610 75.878 50.026 137.503 P <0.001 <0.001 <0.001 <0.001 <0.001 饮酒 否 4636 (36.90)1.18(1.05,1.31) 8.00(6.80,9.20) 3.63(3.39,3.84) 1.17(1.08,1.28) 1.91(1.33,2.75) 已戒酒 580(4.62) 1.17(1.04,1.31) 7.90(6.80,9.10) 3.60(3.37,3.81) 1.18(1.06,1.28) 1.91(1.38,2.84) 是 7348 (58.48)1.14(1.02,1.27) 7.60(6.50,8.70) 3.63(3.40,3.84) 1.20(1.09,1.31) 2.02(1.41,2.91) H 115.492 135.150 4.412 59.926 2.969 P <0.001 <0.001 0.110 <0.001 0.227 喝茶 否 8145 (64.83)1.16(1.03,1.29) 7.80(6.70,8.90) 3.64(3.40,3.85) 1.18(1.08,1.30) 1.94(1.37,2.81) 是 4419 (35.17)1.15(1.03,1.28) 7.70(6.60,8.90) 3.61(3.39,3.83) 1.20(1.09,1.31) 1.90(1.35,2.73) Z −2.606 −1.119 −3.413 −3.947 −2.281 P 0.009 0.263 0.001 <0.001 0.023 体育锻炼 否 10006 (64.83)1.16(1.04,1.30) 7.80(6.70,8.90) 3.64(3.41,3.85) 1.19(1.08,1.30) 1.94(1.35,2.78) 是 2558 (35.17)1.13(1.00,1.26) 7.60(6.60,8.80) 3.59(3.36,3.82) 1.19(1.08,1.31) 1.93(1.36,2.78) Z −7.918 −3.581 −6.027 −1.058 −0.442 P <0.001 <0.001 <0.001 0.290 0.658 表 2 男性煤矿从业人员不同职业危害因素组间TSH和甲状腺激素水平的比较 [n=
12564 ,M(P25,P75)]Table 2 Comparison of TSH and thyroid hormone levels in male coal miners grouped by occupational hazards [n=
12564 , M (P25, P75)]职业危害因素 n (%) T3/(ng·mL−1) T4/(μg·dL−1) FT3/(pg·mL−1) FT4/(ng·dL−1) TSH//(μIU·mL−1) 长工时工作 否 4445 (35.38)1.15(1.03,1.29) 7.70(6.70,8.90) 3.60(3.37,3.82) 1.19(1.09,1.31) 1.97(1.39,2.83) 是 8119 (64.62)1.16(1.03,1.29) 7.70(6.60,8.90) 3.64(3.41,3.85) 1.19(1.08,1.30) 1.91(1.34,2.75) Z −2.087 −0.461 −5.364 −1.569 −2.820 P 0.037 0.645 <0.001 0.117 0.005 夜班工作 否 5766 (45.89)1.15(1.03,1.28) 7.80(6.70,9.00) 3.62(3.39,3.83) 1.20(1.10,1.31) 1.90(1.35,2.70) 是 6798 (54.11)1.16(1.03,1.29) 7.70(6.60,8.90) 3.64(3.40,3.85) 1.18(1.07,1.29) 1.96(1.37,2.85) Z −1.372 −2.758 −3.064 −8.037 −3.292 P 0.170 0.006 0.002 <0.001 0.001 煤尘暴露 否 11560 (92.01)1.16(1.03,1.29) 7.80(6.70,8.90) 3.62(3.39,3.84) 1.19(1.09,1.30) 1.94(1.36,2.78) 是 1004 (7.99)1.15(1.02,1.27) 7.40(6.30,8.60) 3.69(3.45,3.88) 1.16(1.05,1.28) 1.89(1.35,2.75) Z 5.143 46.396 29.352 26.895 0.189 P 0.023 <0.001 <0.001 <0.001 0.664 噪声暴露 否 6299 (50.14)1.15(1.02,1.28) 7.80(6.80,9.00) 3.59(3.32,3.82) 1.21(1.11,1.32) 1.91(1.37,2.72) 是 6265 (49.86)1.16(1.03,1.29) 7.70(6.60,8.90) 3.64(3.41,3.85) 1.18(1.08,1.29) 1.94(1.35,2.79) Z 2.398 21.499 20.553 97.219 0.052 P 0.122 <0.001 <0.001 <0.001 0.820 表 3 职业危害因素与TSH和甲状腺激素水平的关联 [β(95%CI)]
Table 3 Relationships of occupational hazards with TSH and thyroid hormone levels [β (95%CI)]
组别 模型1 模型2 模型3 长工时工作 T3 0.009(0.001~0.017)* 0.010(0.002~0.018)* 0.011(0.003~0.019)* T4 0.017(−0.046~0.080) 0.026(−0.036~0.089) 0.043(−0.020~0.105) FT3 0.035(0.018~0.053)* 0.036(0.019~0.054)* 0.038(0.019~0.057)* FT4 −0.004(−0.011~0.003) −0.005(−0.011~0.002) −0.003(−0.010~0.004) TSH −0.017(−0.172~0.139) −0.006(−0.161~0.150) −0.022(−0.178~0.135) 夜班工作 T3 0.003(−0.005~0.010) −0.001(−0.009~0.006) −0.002(−0.010~0.006) T4 −0.083(−0.143~−0.023)* −0.092(−0.152~−0.032)* −0.058(−0.120~0.004) FT3 0.017(0.001~0.034)* 0.016(−0.001~0.032) 0.006(−0.013~0.025) FT4 −0.021(−0.028~−0.015)* −0.017(−0.023~−0.010)* −0.012(−0.019~−0.006)* TSH 0.190(0.040~0.339)* 0.176(0.025~0.327)* 0.171(0.016~0.326)* 煤尘 T3 −0.018(−0.032~−0.004)* −0.020(−0.034~−0.006)* −0.022(−0.037~−0.008)* T4 −0.399(−0.509~−0.288)* −0.397(−0.507~−0.287)* −0.320(−0.434~−0.207)* FT3 0.048(0.014~0.081)* 0.045(0.011~0.078)* 0.035(− 0.001 ~0.069)FT4 −0.026(−0.038~−0.014)* −0.024(−0.036~−0.012)* −0.010(−0.022~0.003) TSH 0.001(−0.274~0.275) −0.005(−0.281~0.270) −0.072(−0.356~0.213) 噪声 T3 0.007(−0.001~0.015) 0.003(−0.005~0.010) 0.006(−0.002~0.014) T4 −0.139(−0.199~−0.079)* −0.161(−0.221~−0.100)* −0.102(−0.166~−0.038)* FT3 0.032(0.014~0.051)* 0.024(0.005~0.043)* 0.017(−0.002~0.037) FT4 −0.025(−0.032~−0.019)* −0.024(−0.031~−0.018)* −0.020(−0.027~−0.013)* TSH 0.084(−0.065~0.233) 0.079(−0.074~0.231) 0.056(−0.104~0.217) [注]*:P<0.05;模型1:不调整协变量;模型2:调整年龄、民族、BMI、教育程度、每月人均收入、婚姻状况、吸烟、饮酒、喝茶、体育锻炼;模型3:调整模型2+职业危害因素。 -
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