职业性高温接触对男性钢铁工人2型糖尿病影响
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摘要
目的探讨职业性高温接触对男性钢铁工人罹患2型糖尿病(T2DM)的影响。方法采用整群随机抽样法,以唐山市某钢铁企业职业性高温接触的684名男性钢铁工人为高温组,以无职业性高温接触的1 153名男性钢铁工人为对照组。测量2组工人工作场所高温水平,计算高温累积暴露量(CE),并对其进行职业健康检查;采用多因素Logistic回归分析和限制性立方样条分析高温CE与T2DM患病的关系。结果高温组工人T2DM患病率高于对照组(13. 0%vs 7. 9%,P <0. 01)。多因素Logistic回归分析结果显示:调整年龄、体质指数、吸烟、饮酒、体育锻炼以及父母患糖尿病等混杂因素后,高温组工人罹患T2DM的风险高于对照组(P <0. 05),比值比及其95%可信区间为1. 65(1. 17～2. 33)。限制性立方样条分析结果显示,高温CE与工人T2DM患病相关(P <0. 01),且呈线性关系(非线性检验,P> 0. 05)。结论职业性高温接触与男性钢铁工人罹患T2DM有关。男性钢铁工人高温CE越高,罹患T2DM的风险越高。
Objective To explore the effect of occupational high temperature exposure on type 2 diabetes( T2 DM) in male steel workers. Methods A cluster random sampling method was used to select 684 male steel workers,who exposed to occupational high temperature in a steel enterprise in Tangshan City,as the high temperature group,and 1 153 male steel workers without occupational high temperature exposure as the control group. The high temperature level of workers in these two groups was measured. The cumulative exposure( CE) of high temperature was calculated,and occupational health exam was performed. The multivariate logistic regression analysis and restricted cubic splines were used to analyze the relationship between high temperature CE and T2 DM. Results The prevalence of T2 DM in high-temperature group was higher than that in the control group( 13. 0% vs 7. 9%,P < 0. 05). The multivariate logistic regression analysis results showed that the risk of T2 DM in the high temperature group was higher than that in the control group after adjusting for age,body mass index,smoking,drinking,physical exercise and parents with diabetes( P < 0. 05). The 95% confidence interval was 1. 65( 1. 17-2. 33). Restricted cubic spline analysis showed that the high temperature CE was correlated with the prevalence of T2 DM in workers( P < 0. 01) and showed a linear correlation( nonlinearity test,P > 0. 05). Conclusion Occupational high temperature exposure is associated with the occurrence of T2 DM in male steel workers. The male steel workers with high temperature CE show high prevalence of T2 DM risk.
Objective To explore the effect of occupational high temperature exposure on type 2 diabetes( T2 DM) in male steel workers. Methods A cluster random sampling method was used to select 684 male steel workers,who exposed to occupational high temperature in a steel enterprise in Tangshan City,as the high temperature group,and 1 153 male steel workers without occupational high temperature exposure as the control group. The high temperature level of workers in these two groups was measured. The cumulative exposure( CE) of high temperature was calculated,and occupational health exam was performed. The multivariate logistic regression analysis and restricted cubic splines were used to analyze the relationship between high temperature CE and T2 DM. Results The prevalence of T2 DM in high-temperature group was higher than that in the control group( 13. 0% vs 7. 9%,P < 0. 05). The multivariate logistic regression analysis results showed that the risk of T2 DM in the high temperature group was higher than that in the control group after adjusting for age,body mass index,smoking,drinking,physical exercise and parents with diabetes( P < 0. 05). The 95% confidence interval was 1. 65( 1. 17-2. 33). Restricted cubic spline analysis showed that the high temperature CE was correlated with the prevalence of T2 DM in workers( P < 0. 01) and showed a linear correlation( nonlinearity test,P > 0. 05). Conclusion Occupational high temperature exposure is associated with the occurrence of T2 DM in male steel workers. The male steel workers with high temperature CE show high prevalence of T2 DM risk.
引文
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[24]TANAKA S,TANAKA S,LIMURO S,et al.Body mass index and mortality among Japanese patients with type 2 diabetes:pooled analysis of the Japan diabetes complications study and the Japanese elderly diabetes intervention trial[J].J Clin Endocrinol Metab,2014,99(12):E2692-E2696.
[25]GROENWOLD R H,KLUNGEL O H,ALTMAN D G,et al.Adjustment for continuous confounders:an example of how to prevent residual confounding[J].CMAJ,2013,185(5):401-406.
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[2]SHAW J E,SICREE R A,ZIMMET P Z.Global estimates of the prevalence of diabetes for 2010 and 2030[J].Diabetes Res Clin Pract,2010,87(1):4-14.
[3]WHITING D R,GUARIGUATA L,WEIL C,et al.IDF diabetes atlas:global estimates of the prevalence of diabetes for 2011 and 2030[J].Diabetes Res Clin Pract,2011,94(3):311-321.
[4]洪春霞,王益丽,田江宣.1 000名健康体检人员2型糖尿病的患病率及危险因素分析[J].中国现代医生,2018,56(23):68-70,73.
[5]CHEN Y,ZHANG X P,YUAN J,et al.Association of body mass index and age with incident diabetes in Chinese adults:a populationbased cohort study[J].BMJ Open,2018,8(9):e021768.
[6]王坚.糖尿病慢性并发症的防治展望[J].中华临床医师杂志(电子版),2013,7(8):3225-3228.
[7]MANASI G,ASIF I,SUMA N,et al.Parental transmission of type 2diabetes mellitus among patients attending a tertiary care hospital[J].Clin Epidemiol Glob Health,2015,3(2):99-102.
[8]车崇亮,范红敏,肖孟迎,等.倒班年限与男性钢铁工人2型糖尿病患病率的剂量-反应关系[J].环境与职业医学,2017,34(6):503-510.
[9]王华,邱蕾,王剑飞.高温作业对劳动者血糖值的影响[J].科技致富向导,2014(18):88,186.
[10]周阳阳,刘为甜,李军,等.唐山市某钢铁厂高温作业工人水分代谢特征分析[J].中国职业医学,2017,44(4):414-419.
[11]肖孟迎.某钢铁集团工人职业有害因素组与高血压关系的研究[D].唐山:华北理工大学,2017.
[12]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2007年版)[J].中华医学杂志,2008,88(18):1227-1245.
[13]朱志媚,林爱华,庄宏杰,等.高温作业对某钢铁企业工人心血管系统及血糖尿酸的影响[J].实用医学杂志,2013,29(10):1594-1597.
[14]钟皓成,陈静,周银姬,等.高温作业工人颈动脉粥样硬化病变调查[J].预防医学,2018,30(2):184-185.
[15]张平安,吴健民,李艳.C-反应蛋白与2型糖尿病[J].国外医学(临床生物化学与检验学分册),2004,25(3):231-233.
[16]ARBEEV K G,UKRAINTSEVA S V,AKUSHEVICH I,et al.Age trajectories of physiological indices in relation to healthy life course[J].Mech Ageing Dev,2011,132(3):93-102.
[17]SIMON P H,SYLVESTRE M P,TREMBLAY J,et al.Key considerations and methods in the study of gene-environment interactions[J].Am J Hypertens,2016,29(8):891-899.
[18]SANCHEZ-POZOS K,MENJIVAR M.Genetic component of type 2diabetes in a Mexican population[J].Arch Med Res,2016,47(7):496-505.
[19]RUTTERS F,BESSON H,WALKER M,et al.The association between sleep duration,insulin sensitivity,andβ-cell function:the EGIR-RISCstudy[J].J Clin Endocrinol Metab,2016,101(9):3272-3280.
[20]GANIC E,SINGH T,LUAN C,et al.Maf A-controlled nicotinic receptor expression is essential for insulin secretion and is impaired in patients with type 2 diabetes[J].Cell Rep,2016,14(8):1991-2002.
[21]朱志媚.高温作业对某钢铁企业工人健康状况影响的研究[D].广州:中山大学,2010.
[22]班永宏,陈敏.高温对作业人群空腹血糖浓度的影响[J].职业与健康,2010,26(4):封2-封3.
[23]IMAMURA F,MUKAMAL K J,MEIGS J B,et al.Risk factors for type 2 diabetes mellitus preceded byβ-cell dysfunction,insulin resistance,or both in older adults:the Cardiovascular Health Study[J].Am J Epidemiol,2013,177(12):1418-1429.
[24]TANAKA S,TANAKA S,LIMURO S,et al.Body mass index and mortality among Japanese patients with type 2 diabetes:pooled analysis of the Japan diabetes complications study and the Japanese elderly diabetes intervention trial[J].J Clin Endocrinol Metab,2014,99(12):E2692-E2696.
[25]GROENWOLD R H,KLUNGEL O H,ALTMAN D G,et al.Adjustment for continuous confounders:an example of how to prevent residual confounding[J].CMAJ,2013,185(5):401-406.
[26]罗剑锋,金欢,李宝月,等.限制性立方样条在非线性回归中的应用研究[J].中国卫生统计,2010,27(3):229-232.