低剂量电离辐射照射与白内障危险关系研究
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摘要
目的：研究长期低剂量电离辐射照射与白内障危险关系。
方法：以放射工作人员和接受外照射剂量可比的广东阳江高本底辐射地区和对照地区居民为研究对象,通过问卷调查收集白内障危险因素信息,使用裂隙灯显微镜对白内障情况进行检查,并对调查数据进行统计分析。
结果：以广东阳江居民为研究对象,对性别、年龄、吸烟、饮酒因素调整后,与对照组(<50mSv)相比,累积受照剂量50～100mSv组、100～200mSv组、200mSv以上组患眼晶状体混浊的风险OR值分别为1.58(95%CI:0.98～2.56)、1.06(95%CI:0.72～1.56)和2.31(95%CI：1.21～4.42),其中200mSv以上组有统计学意义；患皮质性混浊的风险OR值分别为1.40(95%CI:0.74～2.63)、1.66(95%CI:0.96～2.90)和1.99(95%CI：1.03～3.85),其中200mSv以上组有统计学意义；患核性混浊的风险OR值分别为1.76(95%CI:1.10～2.84)、0.91(95%CI:0.62～1.34)和2.04(95%CI：1.11～3.73),其中50～100mSv组和200mSv以上组均有统计学意义；患后囊下混浊的风险OR值分别为3.93(95%CI:0.42～36.76),11.89(95%CI:1.49～95.03)和9.63(95%CI：1.06～87.17),其中100～200mSv组、200mSv以上组均有统计学意义。进一步分析结果显示,累积受照剂量与核性混浊无显著性关联(P>0.05),与皮质性混浊和后囊下混浊均有显著性关联且呈线性趋势关系(P<0.05),受照剂量每增加l00mSv,患皮质性混浊和后囊下混浊的风险分别增加30%和80%。
四川、河南、江苏、广东、山东等五省放射工作人员职业健康体检资料合并分析结果显示,对省份、性别、年龄、放射工龄因素进行调整后,与从事放射诊断和治疗的工作人员相比,从事核医学、介入放射学工作的人员患眼晶状体混浊的风险OR值分别为1.81(95%CI:1.01～3.26),1.49(95%CI:1.01～2.18),有显著性差异(P<0.05),从事工业应用、测井工作人员患眼晶状体混浊的风险OR值分别为1.07(95%CI:0.80～1.44),1.54(95%CI:0.42～5.63),无显著性差异(P>0.05)。与三级医院放射工作人员相比,三级以下医院放射工作人员患眼艮晶状体混浊的风险增高,OR值为2.21(95%CI：1.50～3.26)。
根据更为规范和完整的河南省放射工作人员眼晶状体混浊检查资料,对混浊的部位进行了分析。结果显示,对性别、年龄、工龄进行调整之后,与从事放射诊断和治疗人员相比,从事核医学、介入放射学、工业应用的人员患眼晶状体混浊的风险OR值分别为1.89(95%CI:0.97～3.71),0.82(95%CI:0.42～1.59),0.90(95%CI:0.45～1.82);患皮质性混浊的风险OR值分别为1.99(95%CI:0.72～5.48)、0.64(95%CI:0.21～1.93)、0.65(95%CI:0.18～2.36);患核性混浊的风险OR值分别为0.76(95%CI:0.17～3.31)、0.79(95%CI:0.26～2.38)、0.75(95%CI:0.24～2.40);患后囊下混浊的风险OR值分别为2.66(95%CI:1.08～6.56)、.88(95%CI:0.79～4.44)、1.51(95%CI:0.56～4.08).从事核医学工作人员患后囊下混浊的风险显著高于从事放射诊断和治疗的人员(P<0.05),从事介入放射学工作人员患后囊下混浊的风险同样增高,但是无显著性差异(P>0.05)。
结论：长期低剂量电离辐射受照可能会增加受照人员患皮质性混浊和后囊下混浊的风险。依据长期接受小剂量照射的阳江高本底地区居民估计,受照剂量每增加l00mSv,患皮质性混浊和后囊下混浊的风险分别增加30%和80%。长期从事核医学、介入放射学工作,可能会增加患眼晶状体混浊特别是被认为放射性典型相关的后囊下混浊的风险,提示应进一步加强医院从事核医学和介入放射学工作人员的职业健康防护。
Objective:To study the relationship between long-term low-dose ionizing radiation exposure and the risks.of cataracts.
Methods:Taking radiation workers and residents living in Guangdong Yangjiang high background radiation area and control area whose External irradiation dose is comparable as the research object, information of risk factors about cataracts was collected through questionnaire investigation, cataracts were examined using slit-lamp microscope, and put the survey datum into statistical analysis.
Results:Taking residents living in Guangdong Yangjiang area as the research objects,with the gender, age, smoking, drinking adjusted,50～100mSv,100-200mSv group,200mSv group show risks of cataracts with the OR values1.58(95%CI:0.98～2.56),1.06(95%CI:0.72～1.56) and2.31(95%CI:1.21～4.42) respectively compared with the control group (<50mSv),the200mSv group has statistical significance; the risks for cortical opacities are1.40(95%CI:0.74～2.63),1.66(95%CI:0.96～2.90) and1.99(95%CI:1.03～3.85) respectively, the200mSv group has statistical significance; the risk for nuclear opacities are1.76(95%CI:1.10～2.84),0.91(95%CI:0.62～1.34) and2.04(95%CI:1.11-3.73) respectively,50-100mSv group and200mSv group show statistical significance; the risks for posterior subcapsular opacities are3.93(95%CI:0.42～36.76),11.89(95%CI:1.49～95.03) and9.63(95%Cl:1.06～87.17) respectively,100-200mSv group,200-mSv group show statistical significance. Further analysis showed that the cumulative dose has no significant correlation with the nuclear opacities (P>0.05), and significant correlation with the cortical opacities and posterior subcapsular opacities with a linear trend (P<0.05), the risk for cortical and posterior subcapsular opacities increased30%and80%respectively with the exposure dose increased per100mSv.
Combined analysis results of radiation workers through occupation health examination in Sichuan, Henan, Jiangsu, Guangdong, Shandong Province showed that compared with the radioactive diagnosis and treatment of staff with the gender, age, length of service factors adjusted,workers engaged in nuclear medicine, and interventional radiology had higher risks of eye lens opacities, and there was a statistical difference, OR values were1.81(95%CI:1.01～3.26),1.49(95%CI:1.01～2.18) respectively, industrial application workers and logging workers show no significant difference,the OR values were1.07(95%CI:0.80-1.44) and1.54(95%CI:0.42-5.63) respectively.Compared with the radiation workers in class3hospitals, radiation workers in lower class hospitals suffer increased risks of eye lens opacities, the OR value was2.21(95%CI:1.50～3.26).
The location of eye lens opacities is analyzed according to the examination datum about the radiation workers in Henan Province which are more standardized and complete.The results showed that compared with the radioactive diagnosis and treatment workers with the gender, age, length of service adjusted,the OR values for eye lens opacities were1.89(95%CI:0.97～3.71),0.82(95%CI:0.42～1.59),0.90(95%CI:0.45～1.82) for the workers engaged in nuclear medicine,interventional radiology, industrial application respectively; the OR values for cortical opacities were1.99(95%CI:0.72～5.48),0.64(95%CI:0.21～1.93),0.65(95%CI:0.18-2.36); the OR values for nuclear opacities were0.76(95%CI:0.17～3.31),0.79(95%CI:0.26-2.38),0.75(95%CI:0.24～2.40); the OR values for posterior subcapsular opacities were2.66(95%CI:1.08～6.56),1.88(95%CI:0.79～4.44),1.51(95%CI:0.56-4.08).Workers engaged in nuclear medicine have higher risks for posterior subcapsular opacities than the workers engaged in radioactive diagnosis and treatment (P<0.05), workers engaged in interventional radiology have higher risks also,but the difference is not significant(P<0.05).
Conclusion:Long-term low-dose ionizing radiation exposure will probably increase the risks of cortical opacities and posterior subcapsular opacities for residents. According to the estimation results of the residents living in Yangjiang high background area who suffered long-term low-dose radiation, the risk for cortical and posterior subcapsular opacities increased30%and80%respectively with the exposure dose increased per100mSv. Long-term working in nuclear medicine and interventional radiology will probably increase the risks of eye lens opacities especially the posterior subcapsular opacities which is considered having close relationship with the radiation. This point out that occupation health protection should be further strengthened for the workers engaged in nuclear medicine and interventional radiology in hospitals.
方法：以放射工作人员和接受外照射剂量可比的广东阳江高本底辐射地区和对照地区居民为研究对象,通过问卷调查收集白内障危险因素信息,使用裂隙灯显微镜对白内障情况进行检查,并对调查数据进行统计分析。
结果：以广东阳江居民为研究对象,对性别、年龄、吸烟、饮酒因素调整后,与对照组(<50mSv)相比,累积受照剂量50～100mSv组、100～200mSv组、200mSv以上组患眼晶状体混浊的风险OR值分别为1.58(95%CI:0.98～2.56)、1.06(95%CI:0.72～1.56)和2.31(95%CI：1.21～4.42),其中200mSv以上组有统计学意义；患皮质性混浊的风险OR值分别为1.40(95%CI:0.74～2.63)、1.66(95%CI:0.96～2.90)和1.99(95%CI：1.03～3.85),其中200mSv以上组有统计学意义；患核性混浊的风险OR值分别为1.76(95%CI:1.10～2.84)、0.91(95%CI:0.62～1.34)和2.04(95%CI：1.11～3.73),其中50～100mSv组和200mSv以上组均有统计学意义；患后囊下混浊的风险OR值分别为3.93(95%CI:0.42～36.76),11.89(95%CI:1.49～95.03)和9.63(95%CI：1.06～87.17),其中100～200mSv组、200mSv以上组均有统计学意义。进一步分析结果显示,累积受照剂量与核性混浊无显著性关联(P>0.05),与皮质性混浊和后囊下混浊均有显著性关联且呈线性趋势关系(P<0.05),受照剂量每增加l00mSv,患皮质性混浊和后囊下混浊的风险分别增加30%和80%。
四川、河南、江苏、广东、山东等五省放射工作人员职业健康体检资料合并分析结果显示,对省份、性别、年龄、放射工龄因素进行调整后,与从事放射诊断和治疗的工作人员相比,从事核医学、介入放射学工作的人员患眼晶状体混浊的风险OR值分别为1.81(95%CI:1.01～3.26),1.49(95%CI:1.01～2.18),有显著性差异(P<0.05),从事工业应用、测井工作人员患眼晶状体混浊的风险OR值分别为1.07(95%CI:0.80～1.44),1.54(95%CI:0.42～5.63),无显著性差异(P>0.05)。与三级医院放射工作人员相比,三级以下医院放射工作人员患眼艮晶状体混浊的风险增高,OR值为2.21(95%CI：1.50～3.26)。
根据更为规范和完整的河南省放射工作人员眼晶状体混浊检查资料,对混浊的部位进行了分析。结果显示,对性别、年龄、工龄进行调整之后,与从事放射诊断和治疗人员相比,从事核医学、介入放射学、工业应用的人员患眼晶状体混浊的风险OR值分别为1.89(95%CI:0.97～3.71),0.82(95%CI:0.42～1.59),0.90(95%CI:0.45～1.82);患皮质性混浊的风险OR值分别为1.99(95%CI:0.72～5.48)、0.64(95%CI:0.21～1.93)、0.65(95%CI:0.18～2.36);患核性混浊的风险OR值分别为0.76(95%CI:0.17～3.31)、0.79(95%CI:0.26～2.38)、0.75(95%CI:0.24～2.40);患后囊下混浊的风险OR值分别为2.66(95%CI:1.08～6.56)、.88(95%CI:0.79～4.44)、1.51(95%CI:0.56～4.08).从事核医学工作人员患后囊下混浊的风险显著高于从事放射诊断和治疗的人员(P<0.05),从事介入放射学工作人员患后囊下混浊的风险同样增高,但是无显著性差异(P>0.05)。
结论：长期低剂量电离辐射受照可能会增加受照人员患皮质性混浊和后囊下混浊的风险。依据长期接受小剂量照射的阳江高本底地区居民估计,受照剂量每增加l00mSv,患皮质性混浊和后囊下混浊的风险分别增加30%和80%。长期从事核医学、介入放射学工作,可能会增加患眼晶状体混浊特别是被认为放射性典型相关的后囊下混浊的风险,提示应进一步加强医院从事核医学和介入放射学工作人员的职业健康防护。
Objective:To study the relationship between long-term low-dose ionizing radiation exposure and the risks.of cataracts.
Methods:Taking radiation workers and residents living in Guangdong Yangjiang high background radiation area and control area whose External irradiation dose is comparable as the research object, information of risk factors about cataracts was collected through questionnaire investigation, cataracts were examined using slit-lamp microscope, and put the survey datum into statistical analysis.
Results:Taking residents living in Guangdong Yangjiang area as the research objects,with the gender, age, smoking, drinking adjusted,50～100mSv,100-200mSv group,200mSv group show risks of cataracts with the OR values1.58(95%CI:0.98～2.56),1.06(95%CI:0.72～1.56) and2.31(95%CI:1.21～4.42) respectively compared with the control group (<50mSv),the200mSv group has statistical significance; the risks for cortical opacities are1.40(95%CI:0.74～2.63),1.66(95%CI:0.96～2.90) and1.99(95%CI:1.03～3.85) respectively, the200mSv group has statistical significance; the risk for nuclear opacities are1.76(95%CI:1.10～2.84),0.91(95%CI:0.62～1.34) and2.04(95%CI:1.11-3.73) respectively,50-100mSv group and200mSv group show statistical significance; the risks for posterior subcapsular opacities are3.93(95%CI:0.42～36.76),11.89(95%CI:1.49～95.03) and9.63(95%Cl:1.06～87.17) respectively,100-200mSv group,200-mSv group show statistical significance. Further analysis showed that the cumulative dose has no significant correlation with the nuclear opacities (P>0.05), and significant correlation with the cortical opacities and posterior subcapsular opacities with a linear trend (P<0.05), the risk for cortical and posterior subcapsular opacities increased30%and80%respectively with the exposure dose increased per100mSv.
Combined analysis results of radiation workers through occupation health examination in Sichuan, Henan, Jiangsu, Guangdong, Shandong Province showed that compared with the radioactive diagnosis and treatment of staff with the gender, age, length of service factors adjusted,workers engaged in nuclear medicine, and interventional radiology had higher risks of eye lens opacities, and there was a statistical difference, OR values were1.81(95%CI:1.01～3.26),1.49(95%CI:1.01～2.18) respectively, industrial application workers and logging workers show no significant difference,the OR values were1.07(95%CI:0.80-1.44) and1.54(95%CI:0.42-5.63) respectively.Compared with the radiation workers in class3hospitals, radiation workers in lower class hospitals suffer increased risks of eye lens opacities, the OR value was2.21(95%CI:1.50～3.26).
The location of eye lens opacities is analyzed according to the examination datum about the radiation workers in Henan Province which are more standardized and complete.The results showed that compared with the radioactive diagnosis and treatment workers with the gender, age, length of service adjusted,the OR values for eye lens opacities were1.89(95%CI:0.97～3.71),0.82(95%CI:0.42～1.59),0.90(95%CI:0.45～1.82) for the workers engaged in nuclear medicine,interventional radiology, industrial application respectively; the OR values for cortical opacities were1.99(95%CI:0.72～5.48),0.64(95%CI:0.21～1.93),0.65(95%CI:0.18-2.36); the OR values for nuclear opacities were0.76(95%CI:0.17～3.31),0.79(95%CI:0.26-2.38),0.75(95%CI:0.24～2.40); the OR values for posterior subcapsular opacities were2.66(95%CI:1.08～6.56),1.88(95%CI:0.79～4.44),1.51(95%CI:0.56-4.08).Workers engaged in nuclear medicine have higher risks for posterior subcapsular opacities than the workers engaged in radioactive diagnosis and treatment (P<0.05), workers engaged in interventional radiology have higher risks also,but the difference is not significant(P<0.05).
Conclusion:Long-term low-dose ionizing radiation exposure will probably increase the risks of cortical opacities and posterior subcapsular opacities for residents. According to the estimation results of the residents living in Yangjiang high background area who suffered long-term low-dose radiation, the risk for cortical and posterior subcapsular opacities increased30%and80%respectively with the exposure dose increased per100mSv. Long-term working in nuclear medicine and interventional radiology will probably increase the risks of eye lens opacities especially the posterior subcapsular opacities which is considered having close relationship with the radiation. This point out that occupation health protection should be further strengthened for the workers engaged in nuclear medicine and interventional radiology in hospitals.
引文
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