精细打磨工人甲襞微循环特点分析
|
摘要
目的分析手传振动作业对精细打磨工人手指甲襞微循环的影响。方法采用判断抽样方法,选择广东省某高尔夫球具厂从事手传振动作业的57名精细打磨工人为接振组,以30名无接触手传振动作业的工人为对照组。对2组工人进行甲襞微循环检查。结果接振组工人的管袢周围出血点检出率、异常管袢比例、管袢总宽均高于对照组[43. 9%vs 13. 3%,(56. 6±20. 9)%vs (41. 2±14. 5)%,(44. 7±4. 9) vs (42. 4±4. 9)μm,P <0. 05],管袢密度、管袢长度和输出支管径均低于对照组[(7. 7±1. 0) vs (8. 8±1. 0)个/mm,(185. 1±33. 9) vs (205. 6±23. 2)μm,(18. 3±1. 9) vs (19. 6±2. 6)μm,P <0. 05];但2组工人袢顶直径和输入支管径分别比较,差异均无统计学意义(P> 0. 05)。接振组工人左手异常管袢比例低于右手[(53. 1±20. 6)%vs (61. 5±24. 2)%,P <0. 01],管袢长度长于右手[(187. 2±33. 5) vs (179. 4±35. 4)μm,P <0. 05];但其左、右手的管袢密度、管袢总宽、袢顶直径、输入支管径和输出支管径分别比较,差异均无统计学意义(P> 0. 05)。结论手传振动接触可导致精细打磨工人的手指甲襞管袢密度减少,管袢长度变短,管袢总体变宽,异常管袢比例和管袢周围出血增加。甲襞微循环检查可作为早期发现手传振动所致血管损伤的辅助检查手段。
Objective To analyze the effects of hand-transmitted vibration operation on nailfold capillaroscopy( NFC) in fine sanding workers. Methods A total of 57 fine sanding workers of one golf ball production enterprise in Guangdong Province were selected as vibration exposure group and 30 workers without exposure to hand-transmitted vibration as control group by a judgement sampling method. NFC examination was carried out in workers of these two groups. Results The capillary haemorrhage detection rates,percentage of abnormal capillary loops and total capillary width in the vibration exposure group were higher than that in the control group [43. 9% vs 13. 3%,( 56. 6 ± 20. 9) % vs( 41. 2 ± 14. 5) %,( 44. 7 ± 4. 9) vs( 42. 4 ± 4. 9) μm,P < 0. 05]. The capillary density,capillary length and branch diameter in the vibration exposure group were lower than that in the control group [( 7. 7 ± 1. 0) vs( 8. 8 ± 1. 0) per mm,( 185. 1 ± 33. 9) vs( 205. 6 ± 23. 2) μm,( 18. 3 ± 1. 9) vs( 19. 6 ± 2. 6) μm,P < 0. 05]. No significant difference was found in the diameter of apical part and branch of capillaries between the two groups( P > 0. 05). In the vibration exposure group,the percentage of abnormal capillary loops in the left hand was lower than that in the right hand [( 53. 1 ± 20. 6) % vs( 61. 5 ±24. 2) %,P < 0. 01],the capillary length in the left hand of vibration exposure group was longer than that in the right hand [( 187. 2 ± 33. 5) vs( 179. 4 ± 35. 4) μm,P < 0. 05]. No significant difference was found in the capillary density,total capillary width,apical part diameter,output branch diameter and input branch diameter between two hands in the vibration exposure group( P > 0. 05). Conclusion The hand-transmitted vibration can lower the nailfold capillary density,shorten and widen capillary loops, increase percentage of abnormal capillary loops and induce capillary haemorrhage. NFC could be used to assist early detection of microvascular damage induced by hand-transmitted vibration.
Objective To analyze the effects of hand-transmitted vibration operation on nailfold capillaroscopy( NFC) in fine sanding workers. Methods A total of 57 fine sanding workers of one golf ball production enterprise in Guangdong Province were selected as vibration exposure group and 30 workers without exposure to hand-transmitted vibration as control group by a judgement sampling method. NFC examination was carried out in workers of these two groups. Results The capillary haemorrhage detection rates,percentage of abnormal capillary loops and total capillary width in the vibration exposure group were higher than that in the control group [43. 9% vs 13. 3%,( 56. 6 ± 20. 9) % vs( 41. 2 ± 14. 5) %,( 44. 7 ± 4. 9) vs( 42. 4 ± 4. 9) μm,P < 0. 05]. The capillary density,capillary length and branch diameter in the vibration exposure group were lower than that in the control group [( 7. 7 ± 1. 0) vs( 8. 8 ± 1. 0) per mm,( 185. 1 ± 33. 9) vs( 205. 6 ± 23. 2) μm,( 18. 3 ± 1. 9) vs( 19. 6 ± 2. 6) μm,P < 0. 05]. No significant difference was found in the diameter of apical part and branch of capillaries between the two groups( P > 0. 05). In the vibration exposure group,the percentage of abnormal capillary loops in the left hand was lower than that in the right hand [( 53. 1 ± 20. 6) % vs( 61. 5 ±24. 2) %,P < 0. 01],the capillary length in the left hand of vibration exposure group was longer than that in the right hand [( 187. 2 ± 33. 5) vs( 179. 4 ± 35. 4) μm,P < 0. 05]. No significant difference was found in the capillary density,total capillary width,apical part diameter,output branch diameter and input branch diameter between two hands in the vibration exposure group( P > 0. 05). Conclusion The hand-transmitted vibration can lower the nailfold capillary density,shorten and widen capillary loops, increase percentage of abnormal capillary loops and induce capillary haemorrhage. NFC could be used to assist early detection of microvascular damage induced by hand-transmitted vibration.
引文
[1]中华人民共和国卫生部.卫生部通报2010年职业病防治工作情况和2011年重点工作[EB/OL].(2011-04-18)[2019-05-23].http://wsb.moh.gov.cn/mohwsjdj/s5854/201105/51676.shtml.
[2]中华人民共和国卫生部.关于2011年职业病防治工作情况的通报[Z/OL].(2012-09-16)[2019-05-23].http://www.nhfpc.gov.cn/jkj/s5899t/201309/14ddbd8fcd7b4385a1d0a6351b-5cebfc.shtml.
[3]中华人民共和国国家卫生和计划生育委员会.关于2012年职业病防治工作情况的通报[Z/OL].(2013-09-16)[2019-05-23].http://www.nhfpc.gov.cn/jkj/s5899t/201309/9af5b88cc6ea-40d592e8a5e0aa76914a.shtml.
[4]中华人民共和国国家卫生和计划生育委员会.关于2013年职业病防治工作情况的通报[Z/OL].(2014-06-30)[2019-05-23].http://www.nhfpc.gov.cn/jkj/s5899t/201406/ed8ed220d0b-74010bcb6dcd8e340f4fb.shtml.
[5]中华人民共和国国家卫生和计划生育委员会.关于2014年职业病防治工作情况的通报[Z/OL].(2015-12-03)[2019-05-23].http://www.nhfpc.gov.cn/jkj/s5899t/201512/c5a99f823-c5d4dd48324c6be69b7b2f9.shtml.
[6]中华人民共和国国家卫生和计划生育委员会,中华人民共和国国家安全生产监督管理总局.2015-2016年全国职业病防治报告情况[EB/OL].(2017-12-03)[2019-05-23].http://www.nhc.gov.cn/zyjks/zcwj2/201712/90667a5571e44ccca42e317b68f50-c40.shtml.
[7]陈嘉斌,陈青松,王建新,等.《职业性手臂振动病的诊断》标准修订说明[J].中国职业医学,2015,42(2):212-216.
[8]彭明益,郑创亮,许丹,等.某高尔夫球杆生产企业职业病危害调查分析[J].中国职业医学,2016,43(4):478-480.
[9]MAHMOOD F,FERGUSON K B,CLARKE J,et al.Hand-arm vibration in orthopaedic surgery:a neglected risk[J].Occup Med(Lond),2017,67(9):715-717.
[10]SHEN S C,HOUSE R A.Hand-arm vibration syndrome:what family physicians should know[J].Can Fam Physician,2017,63(3):206-210.
[11]SU A T,MAEDA S,FUKUMOTO J,et al.Dose-response relationship between hand-transmitted vibration and hand-arm vibration syndrome in a tropical environment[J].Occup Environ Med,2013,70(7):498-504.
[12]LAMBOVA S N,MULLER-LADNER U.Nailfold capillaroscopy within and beyond the scope of connective tissue diseases[J].Curr Rheumatol Rev,2018,14(1):12-21.
[13]KAYSER C,BREDEMEIER M,CALEIRO M T,et al.Position article and guidelines 2018 recommendations of the Brazilian Society of Rheumatology for the indication,interpretation and performance of nailfold capillaroscopy[J].Adv Rheumatol,2019,59(1):5.
[14]中华人民共和国卫生部.工作场所物理因素测量第9部分:手传振动:GBZ/T 189.9-2007[S].北京:人民卫生出版社,2008.
[15]中华人民共和国卫生部.工作场所有害因素职业接触限值第2部分:物理因素:GBZ 2.2-2007[S].北京:人民卫生出版社,2008.
[16]LEE C B,SUNG J H,PARK J H,et al.Nailfold capillary microscopy for evaluating hand-arm vibration syndrome[J].Ann Occup Environ Med,2014,26(1):27.
[17]ETEHAD TAVAKOL M,FATEMI A,KARBALAIE A,et al.Nailfold capillaroscopy in rheumatic diseases:which parameters should be evaluated?[J].Biomed Res Int,2015:974530.doi:10.1155/2015/974530.
[18]CHEN Q S,CHEN G P,XIAO B,et al.Nailfold capillary morphological characteristics of hand-arm vibration syndrome:a crosssectional study[J].BMJ Open,2016,6(11):e012983.
[19]中华人民共和国国家卫生和计划生育委员会.职业健康监护技术规范:GBZ 188-2014[S].北京:中国标准出版社,2014.
[20]International Organization for Standardization.Mechanical vibration and shock--Cold provocation tests for the assessment of peripheral vascular function--Part 1:Measurement and evaluation of finger skin temperature:ISO 14835-1:2016[S/OL].(2016-02-15)[2019-05-23].https://www.iso.org/standard/69973.html.
[21]中华人民共和国国家卫生和计划生育委员会.职业性手臂振动病的诊断:GBZ 7-2014[S].北京:中国标准出版社,2014.
[22]肖斌,陈青松,郑倩玲,等.振动性白指工人冷水复温试验皮温变化特征[J].中国职业医学,2017,44(6):716-720,724.
[23]INGEGNOLI F,SMITH V,SULLI A,et al.Capillaroscopy in routine diagnostics:potentials and limitations[J].Curr Rheumatol Rev,2018,14(1):5-11.
[24]岳露瑶,徐源,于菁菁,等.系统性硬化症并发肺动脉高压与血尿酸水平的相关性[J].实用医学杂志,2016,32(17):2867-2871.
[25]OCAMPO-GARZA S S,VILLARREAL-ALARCN M A,VILLAR-REAL-TREVIO A V,et al.Capillaroscopy:a valuable diagnostic tool[J].Actas Dermosifiliogr,2019.doi:10.1016/j.ad.2018.10.018.
[26]MALDONADO G,PAREDES C,GUERRERO R,et al.Nailfold capillaroscopy in diabetes mellitus[J].Microvasc Res,2017,112:41-46.
[27]van den HOOGEN F,KHANNA D,FRANSEN J,et al.Classification criteria for systemic sclerosis:an american college of rheumatology/European league against rheumatism collaborative initiative[J].Arthritis Rheum,2013,65(11):2737-2747.
[28]GRASSI W,de ANGELIS R.Capillaroscopy:questions and answers[J].Clin Rheumatol,2007,26(12):2009-2016.
[29]肖斌,陈青松,林瀚生,等.手持工件打磨作业手传振动基本特征调查[J].中国职业医学,2016,43(3):312-315,319.
[30]阎蓉,陈青松,严茂胜,等.血管内皮损伤因子与职业性手臂振动病的关联性[J].中国职业医学,2018,45(2):138-143.
[31]李宏玲,陈青松,肖斌,等.手传振动工人累积暴露量及末梢血管损伤程度与血浆TGF-β水平的相关研究[J].中国工业医学杂志,2014,27(6):406-409.
[2]中华人民共和国卫生部.关于2011年职业病防治工作情况的通报[Z/OL].(2012-09-16)[2019-05-23].http://www.nhfpc.gov.cn/jkj/s5899t/201309/14ddbd8fcd7b4385a1d0a6351b-5cebfc.shtml.
[3]中华人民共和国国家卫生和计划生育委员会.关于2012年职业病防治工作情况的通报[Z/OL].(2013-09-16)[2019-05-23].http://www.nhfpc.gov.cn/jkj/s5899t/201309/9af5b88cc6ea-40d592e8a5e0aa76914a.shtml.
[4]中华人民共和国国家卫生和计划生育委员会.关于2013年职业病防治工作情况的通报[Z/OL].(2014-06-30)[2019-05-23].http://www.nhfpc.gov.cn/jkj/s5899t/201406/ed8ed220d0b-74010bcb6dcd8e340f4fb.shtml.
[5]中华人民共和国国家卫生和计划生育委员会.关于2014年职业病防治工作情况的通报[Z/OL].(2015-12-03)[2019-05-23].http://www.nhfpc.gov.cn/jkj/s5899t/201512/c5a99f823-c5d4dd48324c6be69b7b2f9.shtml.
[6]中华人民共和国国家卫生和计划生育委员会,中华人民共和国国家安全生产监督管理总局.2015-2016年全国职业病防治报告情况[EB/OL].(2017-12-03)[2019-05-23].http://www.nhc.gov.cn/zyjks/zcwj2/201712/90667a5571e44ccca42e317b68f50-c40.shtml.
[7]陈嘉斌,陈青松,王建新,等.《职业性手臂振动病的诊断》标准修订说明[J].中国职业医学,2015,42(2):212-216.
[8]彭明益,郑创亮,许丹,等.某高尔夫球杆生产企业职业病危害调查分析[J].中国职业医学,2016,43(4):478-480.
[9]MAHMOOD F,FERGUSON K B,CLARKE J,et al.Hand-arm vibration in orthopaedic surgery:a neglected risk[J].Occup Med(Lond),2017,67(9):715-717.
[10]SHEN S C,HOUSE R A.Hand-arm vibration syndrome:what family physicians should know[J].Can Fam Physician,2017,63(3):206-210.
[11]SU A T,MAEDA S,FUKUMOTO J,et al.Dose-response relationship between hand-transmitted vibration and hand-arm vibration syndrome in a tropical environment[J].Occup Environ Med,2013,70(7):498-504.
[12]LAMBOVA S N,MULLER-LADNER U.Nailfold capillaroscopy within and beyond the scope of connective tissue diseases[J].Curr Rheumatol Rev,2018,14(1):12-21.
[13]KAYSER C,BREDEMEIER M,CALEIRO M T,et al.Position article and guidelines 2018 recommendations of the Brazilian Society of Rheumatology for the indication,interpretation and performance of nailfold capillaroscopy[J].Adv Rheumatol,2019,59(1):5.
[14]中华人民共和国卫生部.工作场所物理因素测量第9部分:手传振动:GBZ/T 189.9-2007[S].北京:人民卫生出版社,2008.
[15]中华人民共和国卫生部.工作场所有害因素职业接触限值第2部分:物理因素:GBZ 2.2-2007[S].北京:人民卫生出版社,2008.
[16]LEE C B,SUNG J H,PARK J H,et al.Nailfold capillary microscopy for evaluating hand-arm vibration syndrome[J].Ann Occup Environ Med,2014,26(1):27.
[17]ETEHAD TAVAKOL M,FATEMI A,KARBALAIE A,et al.Nailfold capillaroscopy in rheumatic diseases:which parameters should be evaluated?[J].Biomed Res Int,2015:974530.doi:10.1155/2015/974530.
[18]CHEN Q S,CHEN G P,XIAO B,et al.Nailfold capillary morphological characteristics of hand-arm vibration syndrome:a crosssectional study[J].BMJ Open,2016,6(11):e012983.
[19]中华人民共和国国家卫生和计划生育委员会.职业健康监护技术规范:GBZ 188-2014[S].北京:中国标准出版社,2014.
[20]International Organization for Standardization.Mechanical vibration and shock--Cold provocation tests for the assessment of peripheral vascular function--Part 1:Measurement and evaluation of finger skin temperature:ISO 14835-1:2016[S/OL].(2016-02-15)[2019-05-23].https://www.iso.org/standard/69973.html.
[21]中华人民共和国国家卫生和计划生育委员会.职业性手臂振动病的诊断:GBZ 7-2014[S].北京:中国标准出版社,2014.
[22]肖斌,陈青松,郑倩玲,等.振动性白指工人冷水复温试验皮温变化特征[J].中国职业医学,2017,44(6):716-720,724.
[23]INGEGNOLI F,SMITH V,SULLI A,et al.Capillaroscopy in routine diagnostics:potentials and limitations[J].Curr Rheumatol Rev,2018,14(1):5-11.
[24]岳露瑶,徐源,于菁菁,等.系统性硬化症并发肺动脉高压与血尿酸水平的相关性[J].实用医学杂志,2016,32(17):2867-2871.
[25]OCAMPO-GARZA S S,VILLARREAL-ALARCN M A,VILLAR-REAL-TREVIO A V,et al.Capillaroscopy:a valuable diagnostic tool[J].Actas Dermosifiliogr,2019.doi:10.1016/j.ad.2018.10.018.
[26]MALDONADO G,PAREDES C,GUERRERO R,et al.Nailfold capillaroscopy in diabetes mellitus[J].Microvasc Res,2017,112:41-46.
[27]van den HOOGEN F,KHANNA D,FRANSEN J,et al.Classification criteria for systemic sclerosis:an american college of rheumatology/European league against rheumatism collaborative initiative[J].Arthritis Rheum,2013,65(11):2737-2747.
[28]GRASSI W,de ANGELIS R.Capillaroscopy:questions and answers[J].Clin Rheumatol,2007,26(12):2009-2016.
[29]肖斌,陈青松,林瀚生,等.手持工件打磨作业手传振动基本特征调查[J].中国职业医学,2016,43(3):312-315,319.
[30]阎蓉,陈青松,严茂胜,等.血管内皮损伤因子与职业性手臂振动病的关联性[J].中国职业医学,2018,45(2):138-143.
[31]李宏玲,陈青松,肖斌,等.手传振动工人累积暴露量及末梢血管损伤程度与血浆TGF-β水平的相关研究[J].中国工业医学杂志,2014,27(6):406-409.