金属机械制造及加工业接触性皮肤损伤的调查与研究
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摘要
背景近年来,多个国家的研究均表明接触性皮肤损伤的患病率居高不下,不仅对劳动者的身心健康造成影响,也给社会经济发展造成严重损失,是职业卫生领域一项急需解决的问题。从事金属机械制造及加工业的作业工人被列为是接触性皮肤损伤的高风险人群之一。因此,对该人群接触性皮肤损伤的相关危害因素进行研究对预防控制该病的发生具有重要意义。
目的(1)掌握金属机械制造及加工业工人接触性皮肤损伤的发生率及其分布状态；(2)探讨金属机械制造及加工业工人接触性皮肤损伤的职业危害因素和非职业性影响因素；(3)探讨金属机械制造及加工业接触性皮肤损伤相关的个人防护及其有效性；(4)为进一步的干预研究提供依据。
方法本课题采用流行病学横断面调查和回顾性调查的方法,对11家金属机械制造及加工企业开展了企业调查和个人调查。企业调查采用自制的企业调查表,个人调查采用经过修订的北欧职业性皮肤问卷(Nordic Occupational Skin Questionnaire, NOSQ),对上述企业的生产工艺、职业危害因素及其分布、个体防护装备的配备情况、作业工人接触性皮肤损伤情况及其相关因素和防护现状等情况开展了调查与研究。调查周期为2008年9月至2009年9月。
研究结果本课题共发放调查问卷2420份,收回1964份,回收率81.6%,最终得到有效问卷1885份。(1)金属机械制造及加工业作业工人同时发生手部和腕或前臂湿疹的发生率为7.5%(141/1885)。问卷自诉湿疹患者经复诊后的接触性皮炎的确诊率为24.1%(20/81)。作业工人湿疹发生率最高的企业为水泵生产企业,手部湿疹发生率为37.8%(62/164),腕或前臂湿疹发生率为29.3%(48/164)。手机壳生产企业湿疹的发生率最低,手部湿疹的发生率为2.3%(6/258),腕或前臂湿疹的发生率为0.4%(1/258)。湿疹发生率高的前五位工序依次为：热处理工序、造型工序、金属熔炼工序、组装工艺及喷漆工序(手部)或清砂工序(腕或前臂)。年龄≥32岁的作业工人湿疹的发生率显著高于年龄<32岁作业工人湿疹的发生率。工龄为16-20年的作业工人手部湿疹的发生率最高,为20.7%(44/213)；工龄为26-30年的作业工人腕或前臂湿疹的发生率最高,为19.0%(16/84)。工龄为0-5年的作业工人湿疹的发生率最低,手部湿疹为7.9%(69/871),腕或前臂湿疹为5.3%(46/871)。男性作业工人湿疹的发生率高于女性作业工人。(2)导致接触性皮肤损伤发生的主要职业危害因素为铸造粉尘、金属加工液、环氧树脂、苯及其同系化合物、甲醛、金属及其盐类(锰及其化合物及铬、镍氧化物)和高温。导致接触性皮肤损伤加重的职业危害因素为铸造粉尘、苯及其同系化合物、强酸强碱、环氧树脂、重金属(锰及其化合物和铬、镍氧化物)以及合成清洁剂。单因素分析结果显示,敏感性皮肤和个人过敏史与湿疹的发生有统计学关联,二者可能增加发生湿疹的风险。多因素logistic回归分析表明,男性、年龄≥32岁、有皮肤过敏史、有哮喘史、皮肤干燥和出汗时皮肤瘙痒为手部湿疹发生的非职业性影响因素；年龄≥32岁、有皮肤过敏史、有哮喘史和出汗时皮肤瘙痒为腕或前臂湿疹发生的非职业性影响因素。(3)是否佩戴防护手套的两组作业工人湿疹发生率无统计学差异。企业虽然按照不同生产工序配备了相应的个体防护装备,但是依据个体防护装备选用规范(GB/T 11651-2008)中的规定,企业并没有为作业工人配备正确合理的个体防护装备。
结论(1)金属机械制造及加工业作业工人同时发生手部和腕或前臂湿疹的发生率为7.5%。问卷自诉湿疹患者经复诊后的接触性皮炎的确诊率为24.1%。水泵生产企业为湿疹发生率最高的企业。湿疹发生率高的前五位工序依次为：热处理工序、造型工序、金属熔炼工序、组装工艺及喷漆工序(手部)或清砂工序(腕或前臂)。(2)导致接触性皮肤损伤的主要职业危害因素有：铸造粉尘、高温、环氧树脂、甲醛和金属加工液。导致接触性皮肤损伤发生的非职业性影响因素有：年龄、工龄、性别、敏感性皮肤(皮肤干燥、出汗时皮肤瘙痒)和个人过敏史。(3)防护手套佩戴情况可能与湿疹的发生无关,其原因可能与防护手套的选择与配置不合理有关,应进一步采取切实有效的防护措施,以预防和减少接触性皮肤损伤的发生。
Background:In recent years, the prevalence rates of contact skin injury have been high in researches from many countries. And it is an urgent occupational health problem which not only affects workers'physical and mental health but also causes sever loss in social economical development. Workers in metal machinery manufacturing and processing industry are listed as one of the high risk population of contact skin injury. Therefore, researches on prevalence and related risk factors of contact skin injury in this population are greatly important for contact skin injury control and prevention.
Objectives:(1) To investigate prevalence and distribution of contact skin injury of workers in metal machinery manufacturing and processing industry;(2) To explore occupational hazard factors of contact skin injury of workers in metal machinery manufacturing and processing industry; (3) To explore related personal protective measure and its effectiveness on contact skin injury in metal machinery manufacturing and processing industry; (4) To provide basis for further intervention researches.
Methods:Cross-sectional study and retrospective study are conducted for enterprise survey and personal survey in 11 metal machinery manufacturing and processing enterprises from September 2008 to September 2009. Homemade enterprise questionnaires and revised Nordic Occupational Skin Questionnaire are administrated for enterprises and workers respectively. The study includes manufacturing technique, occupational hazard factors and their distribution, arrangement of personal protective equipment, the prevalence and its related factors, and protective status in workers.
Results:2420 questionnaires were delivered,1964 (81.6%) questionnaires were retrieved, and 1885 were valid. (1) The prevalence rate of eczema both on hand and wrist or forearm was 7.5% in workers of metal machinery manufacturing and processing industry. The confirm rate was 24.1% after diagnosis in workers who self-reported having contact skin injury. The prevalence rate of hand eczema was highest in workers of water pump manufacture enterprises, which was 37.8%, and its rate of eczema on wrist or forearm was 29.3%. The rate of hand eczema in workers of mobile phone shell manufacture enterprises was lowest, which was 2.3%, and its rate of eczema on wrist or forearm was 0.4%. The top five working procedures of highest prevalence rate of eczema in turn were heat treatment, modeling, metal melting, assembling and spray-painting(hand eczema) or sand stripping(eczema on wrist or forearm). The prevalence rate of eczema was statistically higher in workers aged 32 or more than those aged less than 32. The prevalence rate of hand eczema was highest in workers with 16-20 years'working age, which was 20.7%; the rate of eczema on wrist or forearm was highest in workers with 26-30 years' working age, which was 19.0%. It was lowest in those worked 0-5 years (hand eczema:7.9%, eczema on wrist or forearm:5.3%). And it was higher in male workers than in female workers. (2) The main occupational hazard factors causing contact skin injury were dust in mold casting, metal processing fluid, epoxide resin, benzene and its homologues, formaldehyde and high temperature. And the main occupational hazard factors leading contact skin injury to aggravate were dust in mold casting, benzene and its homologues, strong acid or strong base, epoxide resin, heavy metal (manganese and its chemical compounds, oxides of chromium and nickel) and synthetic detergent. Univariate analysis indicated that sensitive skin and allergic history of skin were statistically significant, and they might increase the risk of eczema. In multivariate logistic analysis, the factors associated with hand eczema were male, aged 32 or more, allergic history of skin, history of asthma, sensitive skin, and those factors except male were also associated with eczema on wrist or forearm. (3) In the aspect of personal protective equipment, wearing protective gloves or not was not statistically associated with eczema. Although enterprises have arranged personal protective equipment for corresponding working procedures, they haven't arrange correct and proper personal protective equipment according to regulation of personal protective equipment selection (GB/T 11651-2008).
Conclusion:(1) The prevalence rate of eczema on hand and wrist or forearm was high in workers of metal machinery manufacturing and processing industry. And it was highest in workers of water pump manufacture enterprises. The top five working procedures of highest prevalence rate of eczema in turn were heat treatment, modeling, metal melting, assembling and spray-painting(hand eczema) or sand stripping(eczema on wrist or forearm). (2) Occupational hazard factors associated with contact skin injury were dust in mold casting, metal processing fluid, epoxide resin and high temperature. Non-occupational factors associated with eczema were age, working age, sex, sensitive skin and allergic history of skin. (3) Wearing protective gloves or not was not be associated with eczema, the reason might be that protective gloves were not selected and arranged properly. Thus, further researches on contact skin injury in metal machinery manufacturing and processing industry are greatly necessary. Moreover, proper protective measurements should be implemented to control and prevent contact skin injury in this population.
目的(1)掌握金属机械制造及加工业工人接触性皮肤损伤的发生率及其分布状态；(2)探讨金属机械制造及加工业工人接触性皮肤损伤的职业危害因素和非职业性影响因素；(3)探讨金属机械制造及加工业接触性皮肤损伤相关的个人防护及其有效性；(4)为进一步的干预研究提供依据。
方法本课题采用流行病学横断面调查和回顾性调查的方法,对11家金属机械制造及加工企业开展了企业调查和个人调查。企业调查采用自制的企业调查表,个人调查采用经过修订的北欧职业性皮肤问卷(Nordic Occupational Skin Questionnaire, NOSQ),对上述企业的生产工艺、职业危害因素及其分布、个体防护装备的配备情况、作业工人接触性皮肤损伤情况及其相关因素和防护现状等情况开展了调查与研究。调查周期为2008年9月至2009年9月。
研究结果本课题共发放调查问卷2420份,收回1964份,回收率81.6%,最终得到有效问卷1885份。(1)金属机械制造及加工业作业工人同时发生手部和腕或前臂湿疹的发生率为7.5%(141/1885)。问卷自诉湿疹患者经复诊后的接触性皮炎的确诊率为24.1%(20/81)。作业工人湿疹发生率最高的企业为水泵生产企业,手部湿疹发生率为37.8%(62/164),腕或前臂湿疹发生率为29.3%(48/164)。手机壳生产企业湿疹的发生率最低,手部湿疹的发生率为2.3%(6/258),腕或前臂湿疹的发生率为0.4%(1/258)。湿疹发生率高的前五位工序依次为：热处理工序、造型工序、金属熔炼工序、组装工艺及喷漆工序(手部)或清砂工序(腕或前臂)。年龄≥32岁的作业工人湿疹的发生率显著高于年龄<32岁作业工人湿疹的发生率。工龄为16-20年的作业工人手部湿疹的发生率最高,为20.7%(44/213)；工龄为26-30年的作业工人腕或前臂湿疹的发生率最高,为19.0%(16/84)。工龄为0-5年的作业工人湿疹的发生率最低,手部湿疹为7.9%(69/871),腕或前臂湿疹为5.3%(46/871)。男性作业工人湿疹的发生率高于女性作业工人。(2)导致接触性皮肤损伤发生的主要职业危害因素为铸造粉尘、金属加工液、环氧树脂、苯及其同系化合物、甲醛、金属及其盐类(锰及其化合物及铬、镍氧化物)和高温。导致接触性皮肤损伤加重的职业危害因素为铸造粉尘、苯及其同系化合物、强酸强碱、环氧树脂、重金属(锰及其化合物和铬、镍氧化物)以及合成清洁剂。单因素分析结果显示,敏感性皮肤和个人过敏史与湿疹的发生有统计学关联,二者可能增加发生湿疹的风险。多因素logistic回归分析表明,男性、年龄≥32岁、有皮肤过敏史、有哮喘史、皮肤干燥和出汗时皮肤瘙痒为手部湿疹发生的非职业性影响因素；年龄≥32岁、有皮肤过敏史、有哮喘史和出汗时皮肤瘙痒为腕或前臂湿疹发生的非职业性影响因素。(3)是否佩戴防护手套的两组作业工人湿疹发生率无统计学差异。企业虽然按照不同生产工序配备了相应的个体防护装备,但是依据个体防护装备选用规范(GB/T 11651-2008)中的规定,企业并没有为作业工人配备正确合理的个体防护装备。
结论(1)金属机械制造及加工业作业工人同时发生手部和腕或前臂湿疹的发生率为7.5%。问卷自诉湿疹患者经复诊后的接触性皮炎的确诊率为24.1%。水泵生产企业为湿疹发生率最高的企业。湿疹发生率高的前五位工序依次为：热处理工序、造型工序、金属熔炼工序、组装工艺及喷漆工序(手部)或清砂工序(腕或前臂)。(2)导致接触性皮肤损伤的主要职业危害因素有：铸造粉尘、高温、环氧树脂、甲醛和金属加工液。导致接触性皮肤损伤发生的非职业性影响因素有：年龄、工龄、性别、敏感性皮肤(皮肤干燥、出汗时皮肤瘙痒)和个人过敏史。(3)防护手套佩戴情况可能与湿疹的发生无关,其原因可能与防护手套的选择与配置不合理有关,应进一步采取切实有效的防护措施,以预防和减少接触性皮肤损伤的发生。
Background:In recent years, the prevalence rates of contact skin injury have been high in researches from many countries. And it is an urgent occupational health problem which not only affects workers'physical and mental health but also causes sever loss in social economical development. Workers in metal machinery manufacturing and processing industry are listed as one of the high risk population of contact skin injury. Therefore, researches on prevalence and related risk factors of contact skin injury in this population are greatly important for contact skin injury control and prevention.
Objectives:(1) To investigate prevalence and distribution of contact skin injury of workers in metal machinery manufacturing and processing industry;(2) To explore occupational hazard factors of contact skin injury of workers in metal machinery manufacturing and processing industry; (3) To explore related personal protective measure and its effectiveness on contact skin injury in metal machinery manufacturing and processing industry; (4) To provide basis for further intervention researches.
Methods:Cross-sectional study and retrospective study are conducted for enterprise survey and personal survey in 11 metal machinery manufacturing and processing enterprises from September 2008 to September 2009. Homemade enterprise questionnaires and revised Nordic Occupational Skin Questionnaire are administrated for enterprises and workers respectively. The study includes manufacturing technique, occupational hazard factors and their distribution, arrangement of personal protective equipment, the prevalence and its related factors, and protective status in workers.
Results:2420 questionnaires were delivered,1964 (81.6%) questionnaires were retrieved, and 1885 were valid. (1) The prevalence rate of eczema both on hand and wrist or forearm was 7.5% in workers of metal machinery manufacturing and processing industry. The confirm rate was 24.1% after diagnosis in workers who self-reported having contact skin injury. The prevalence rate of hand eczema was highest in workers of water pump manufacture enterprises, which was 37.8%, and its rate of eczema on wrist or forearm was 29.3%. The rate of hand eczema in workers of mobile phone shell manufacture enterprises was lowest, which was 2.3%, and its rate of eczema on wrist or forearm was 0.4%. The top five working procedures of highest prevalence rate of eczema in turn were heat treatment, modeling, metal melting, assembling and spray-painting(hand eczema) or sand stripping(eczema on wrist or forearm). The prevalence rate of eczema was statistically higher in workers aged 32 or more than those aged less than 32. The prevalence rate of hand eczema was highest in workers with 16-20 years'working age, which was 20.7%; the rate of eczema on wrist or forearm was highest in workers with 26-30 years' working age, which was 19.0%. It was lowest in those worked 0-5 years (hand eczema:7.9%, eczema on wrist or forearm:5.3%). And it was higher in male workers than in female workers. (2) The main occupational hazard factors causing contact skin injury were dust in mold casting, metal processing fluid, epoxide resin, benzene and its homologues, formaldehyde and high temperature. And the main occupational hazard factors leading contact skin injury to aggravate were dust in mold casting, benzene and its homologues, strong acid or strong base, epoxide resin, heavy metal (manganese and its chemical compounds, oxides of chromium and nickel) and synthetic detergent. Univariate analysis indicated that sensitive skin and allergic history of skin were statistically significant, and they might increase the risk of eczema. In multivariate logistic analysis, the factors associated with hand eczema were male, aged 32 or more, allergic history of skin, history of asthma, sensitive skin, and those factors except male were also associated with eczema on wrist or forearm. (3) In the aspect of personal protective equipment, wearing protective gloves or not was not statistically associated with eczema. Although enterprises have arranged personal protective equipment for corresponding working procedures, they haven't arrange correct and proper personal protective equipment according to regulation of personal protective equipment selection (GB/T 11651-2008).
Conclusion:(1) The prevalence rate of eczema on hand and wrist or forearm was high in workers of metal machinery manufacturing and processing industry. And it was highest in workers of water pump manufacture enterprises. The top five working procedures of highest prevalence rate of eczema in turn were heat treatment, modeling, metal melting, assembling and spray-painting(hand eczema) or sand stripping(eczema on wrist or forearm). (2) Occupational hazard factors associated with contact skin injury were dust in mold casting, metal processing fluid, epoxide resin and high temperature. Non-occupational factors associated with eczema were age, working age, sex, sensitive skin and allergic history of skin. (3) Wearing protective gloves or not was not be associated with eczema, the reason might be that protective gloves were not selected and arranged properly. Thus, further researches on contact skin injury in metal machinery manufacturing and processing industry are greatly necessary. Moreover, proper protective measurements should be implemented to control and prevent contact skin injury in this population.
引文
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[30]. MEDING B. Differences between the sexes with regard to work-related skin disease [J]. Contact Dermatitis,2000,43(2):65-71.
[31]. Athavale P, Shum KW, Chen Y,et al. Occupational dermatitis related to chromium and cobalt:experience of dermatologists (EPIDERM) and occupational physicians (OPRA) in the U.K. over an 11-year period (1993-2004) [J].Br J Dermatol,2007,157(3):518-522.
[32].杨平镇,李夫国.某焦化厂职业危害及作业工人皮肤黑色素沉着症的调查[J].预防医学论坛,2005,11(1)：20-21.
[33].张志云,陈涛,白永利等.包钢稀土和煤焦油作业人员皮肤病调查[J].中华劳动卫生职业病杂志,2000,18(5)：285-286.
[34].曾小莉.玻璃纤维作业工人职业性接触性皮炎调查[J].实用预防医学,2001,8(6)：454
[35]. Kaukiainen A, Riala R, Martikainen R,et al. Chemical exposure and symptoms of hand dermatitis in construction painters [J]. Contact Dermatitis,2005,53(1):14-21.
[36]. Montnemery P, Nihlen U, Lofdahl CG, et al. Prevalence of Hand Eczema in an Adult Swedish Population and the Relationship to Risk Occupation and Smoking [J]. Acta Derm Venereol,2005,85(5):429-432.
[37]. Attwa E, el-Laithy N. Contact dermatitis in car repair workers [J]. J Eur Acad Dermatol Venereol,2009,23(2):138-145.
[38]. Flyvholm MA, Bach B, Rose M, et al. Self-reported hand eczema in a hospital population [J]. Contact Dermatitis,2007,57(2):110-115.
[39]. Stutz N, Becker D, Jappe U, et al. Nurses' perceptions of the benefits and adverse effects of hand disinfection:alcohol-based hand rubs vs. hygienic handwashing:a multicentre questionnaire study with additional patch testing by the German Contact Dermatitis Research Group [J]. Br J Dermatol,2009,160(3):565-572.
[40]. Nettis E, Colanardi MC, Soccio AL,et al. Occupational irritant and allergic contact dermatitis among healthcare workers [J]. Contact Dermatitis,2002,46:101-107.
[41]. Lerbaek A, Kyvik KO, Ravn H, et al. Incidence of hand eczema in a population-based twin cohort:genetic and environmental risk factors [J]. Br J Dermatol,2007,157(3):552-557.
[42]. Lerbaek A, Kyvik KO, Mortensen J, et al. Heritability of Hand Eczema Is Not Explained by Comorbidity with Atopic Dermatitis [J]. J Invest Dermatol, 2007,127(7):1632-1640.
[43]. Suuronen K, Jolanki R, Luukkonen R, et al. Self-reported skin symptoms in metal workers [J]. Contact Dermatitis,2007,57(4):259-264.
[44]. Skudlik C, Dulon M, Wendeler D, et al. Hand eczema in geriatric nurses in Germany-prevalence and risk factors [J]. Contact Dermatitis,2009,60(3):136-143.
[45]. Berndt U, Hinnen U, Iliev D, et al. Hand eczema in metalworker trainees-an analysis of risk factors [J]. Contact Dermatitis,2000,43(6):327-332.
[46]. de Joode BW, Vermeulen R, Heederik D, et al. Evaluation of 2 self-administered questionnaires to ascertain dermatitis among metal workers and its relation with exposure to metalworking fluids [J]. Contact Dermatitis,2007,56(6):311-317.
[47]. Rademaker M. Occupational epoxy resin allergic contact dermatitis [J]. Australas Dermatol,2000,41:222-224.
[48].吴达福,吴应花.甲醛致职业性接触性皮炎调查[J].劳动医学,2001,18(4)：226.
[49].朱玉华,田月秋,曹钟兴等.苯胺接触性皮炎伴发哮喘1例[J].环境与职业医学,2003,20(1)：9.
[50]. Li LF, Liu G, Wang J. Prevalence and 1-year outcome of facial allergic contact dermatitis in patients patch tested in a university hospital [J]. Contact Dermatitis,2007,57(3):187-190.
[51]. Diepgen TL, Weisshaar E. Contact dermatitis:epidemiology and frequent sensitizers to cosmetics [J]. J Eur Acad Dermatol Venereol,2007,Suppl 2:9-13.
[52]. Reich HC, Warshaw EM. Allergic Contact Dermatitis from Formaldehyde Textile Resins [J]. Dermatitis,2010,21(2):65-76.
[53].杨卫兵,李欣,张栋等.金属所致系统性接触性皮炎81例临床分析[J].第三军医大学学报,2008,30(17)：1590.
[54].刘广仁,李邻峰.电镀工人职业性接触性皮炎1例报告[J].中国工业医学杂志,2004,17(6)：355.
[55]. Sarma N, Ghosh S.Clinico-allergological pattern of allergic contact among 70 Indian children [J]. Indian J Dermatol Venereol Leprol,2010,76(l):38-44.
[56]. Nielsen NH, Kristiansen J, Borg L, et al. Repeated exposures to cobalt or chromate on the hands of patients with hand eczema and contact allergy to that metal [J]. Contact Dermatitis,2000,43(4):212-215.
[57]. Clarys P, Manou I, BarelA.O. Influence of temperature on irritation in the hand/forearm immersion test [J]. Contact Dermatitis,2006,36(5):240-243.
[58].姜文忠,杨学敏,李淑华.乳胶手套致接触性皮炎一例[J].中华全科医师杂志,2005,4(11)：695.
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[6]WEISSHAAR E, RADULESCU M, SODER S, et al. Secondary individual prevention of occupational skin diseases in health care workers, cleaners and kitchen employees:aims, experiences and descriptive results [J]. Int Arch Occup Environ Health,2007,80(6):477-484.
[7]WEISSHAAR E, RADULESCU M, BOCK M, et al. Educational and dermatological aspects of secondary individual prevention in healthcare workers [J]. Contact Dermatitis,2006,54(5):254-260.
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[9]. Weisshaar E, Radulescu M, Soder S, et al. Secondary individual prevention of occupational skin diseases in health care workers, cleaners and kitchen employees: aims, experiences and descriptive results [J]. Int Arch Occup Environ Health, 2007,80(6):477-484.
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[12]. Lerbaek A, Kyvik KO, Ravn H, et al. Incidence of hand eczema in a population-based twin cohort:genetic and environmental risk factors [J]. British Journal of Dermatology,2007,157(3):552-557.
[13]. Weisshaar E, Radulescu M, Bock M, et al. Educational and dermatological aspects of secondary individual prevention in healthcare workers [J].Contact Dermatitis,2006,54(5):254-260.
[14]. Diepgen TL. Occupational skin-disease data in Europe [J]. Int Arch Occup Environ Health,2003,76(5):331-338.
[15]. Skudlik C, Dulon M, Wendeler D,et al. Hand eczema in geriatric nurses in Germany—prevalence and risk factors[J]. Contact Dermatitis. 2009,60(3):136-143.
[16].王建平,肖方威.某铸钢厂工人职业性接触性皮炎患病调查[J].中国工业医学杂志,2006,19(4)：236.
[17].梁学邈,程子权,孙洪娟等.钢铁作业工人皮肤患病情况的研究[J].工业卫生与职业病,2005,31(6)：379-383.
[18]. DICKEL H, BRUCKNER T, BERNHARD-KLIMT C, et al. Surveillance scheme for occupational skin disease in the Saarland [J]. Contact Dermatitis,2002,46(4): 197-206.
[19]. DIEPGEN T L, SCHMIDT A. Are incidence and prevalence of occupational skin diseases underestimated? [J]. Arbeitsmed Sozialmed Umweltmed,2002,37: 477-480.
[20].李林峰,刘广仁.职业性接触性皮炎的重要性及我国研究报告现状分析[J].中国工业医学杂志,2004,17(6)：384-386.
[21]. LUSHNIAK B D. Occupational contact dermatitis [J]. Dermatologic Therapy, 2004,17(3):272-277.
[22]. Suuronen K, Aalto-Korte K, Piipari R, et al. Occupational dermatitis and allergic respiratory diseases in Finnish metal working machinists [J]. Occupational Medicine,2007,57(4):277-283.
[23]. Diepgen TL. Occupational skin-disease data in Europe [J]. Int Arch Occup Environ Health,2003,76(5):331-338.
[24]. Henriks-Eckerman ML, Suuronen K, Jolanki R.Analysis of allergens in metalworking fluids [J]. Contact Dermatitis,2008,59(5):261-267.
[25]. Geier J, Lessmann H, Dickel H et al. Patch test results with the metalworking fluid series of the German Contact Dermatitis Research Group (DKG) [J]. Contact Dermatitis,2004,51(3):118-130.
[26].赵志炼,叶进,劳力民等.三家中小型轴承厂工人职业性接触性皮炎调查分析及其试点干预[J].中国皮肤性病学杂志,2008,22(10)：613-614.
[27].彭文彬,刘晓虎,王琴芳等.常州市武进区乡镇企业电镀业铬职业危害的调查[J].职业与健康,2004,20(12)：29-30.
[28]. Berndt U, Hinnen U, Iliev D, et al. Hand eczema in metalworker trainees--an analysis of risk factors [J]. Contact Dermatitis,2000,43(6):327-332.
[29]. Funke U, Fartasch M, Diepgen TL.Incidence of work-related hand eczema during apprenticeship:first results of a prospective cohort study in the car industry [J]. Contact Dermatitis,2001,44(3):166-172.
[30]. MEDING B. Differences between the sexes with regard to work-related skin disease [J]. Contact Dermatitis,2000,43(2):65-71.
[31]. Athavale P, Shum KW, Chen Y,et al. Occupational dermatitis related to chromium and cobalt:experience of dermatologists (EPIDERM) and occupational physicians (OPRA) in the U.K. over an 11-year period (1993-2004) [J].Br J Dermatol,2007,157(3):518-522.
[32].杨平镇,李夫国.某焦化厂职业危害及作业工人皮肤黑色素沉着症的调查[J].预防医学论坛,2005,11(1)：20-21.
[33].张志云,陈涛,白永利等.包钢稀土和煤焦油作业人员皮肤病调查[J].中华劳动卫生职业病杂志,2000,18(5)：285-286.
[34].曾小莉.玻璃纤维作业工人职业性接触性皮炎调查[J].实用预防医学,2001,8(6)：454
[35]. Kaukiainen A, Riala R, Martikainen R,et al. Chemical exposure and symptoms of hand dermatitis in construction painters [J]. Contact Dermatitis,2005,53(1):14-21.
[36]. Montnemery P, Nihlen U, Lofdahl CG, et al. Prevalence of Hand Eczema in an Adult Swedish Population and the Relationship to Risk Occupation and Smoking [J]. Acta Derm Venereol,2005,85(5):429-432.
[37]. Attwa E, el-Laithy N. Contact dermatitis in car repair workers [J]. J Eur Acad Dermatol Venereol,2009,23(2):138-145.
[38]. Flyvholm MA, Bach B, Rose M, et al. Self-reported hand eczema in a hospital population [J]. Contact Dermatitis,2007,57(2):110-115.
[39]. Stutz N, Becker D, Jappe U, et al. Nurses' perceptions of the benefits and adverse effects of hand disinfection:alcohol-based hand rubs vs. hygienic handwashing:a multicentre questionnaire study with additional patch testing by the German Contact Dermatitis Research Group [J]. Br J Dermatol,2009,160(3):565-572.
[40]. Nettis E, Colanardi MC, Soccio AL,et al. Occupational irritant and allergic contact dermatitis among healthcare workers [J]. Contact Dermatitis,2002,46:101-107.
[41]. Lerbaek A, Kyvik KO, Ravn H, et al. Incidence of hand eczema in a population-based twin cohort:genetic and environmental risk factors [J]. Br J Dermatol,2007,157(3):552-557.
[42]. Lerbaek A, Kyvik KO, Mortensen J, et al. Heritability of Hand Eczema Is Not Explained by Comorbidity with Atopic Dermatitis [J]. J Invest Dermatol, 2007,127(7):1632-1640.
[43]. Suuronen K, Jolanki R, Luukkonen R, et al. Self-reported skin symptoms in metal workers [J]. Contact Dermatitis,2007,57(4):259-264.
[44]. Skudlik C, Dulon M, Wendeler D, et al. Hand eczema in geriatric nurses in Germany-prevalence and risk factors [J]. Contact Dermatitis,2009,60(3):136-143.
[45]. Berndt U, Hinnen U, Iliev D, et al. Hand eczema in metalworker trainees-an analysis of risk factors [J]. Contact Dermatitis,2000,43(6):327-332.
[46]. de Joode BW, Vermeulen R, Heederik D, et al. Evaluation of 2 self-administered questionnaires to ascertain dermatitis among metal workers and its relation with exposure to metalworking fluids [J]. Contact Dermatitis,2007,56(6):311-317.
[47]. Rademaker M. Occupational epoxy resin allergic contact dermatitis [J]. Australas Dermatol,2000,41:222-224.
[48].吴达福,吴应花.甲醛致职业性接触性皮炎调查[J].劳动医学,2001,18(4)：226.
[49].朱玉华,田月秋,曹钟兴等.苯胺接触性皮炎伴发哮喘1例[J].环境与职业医学,2003,20(1)：9.
[50]. Li LF, Liu G, Wang J. Prevalence and 1-year outcome of facial allergic contact dermatitis in patients patch tested in a university hospital [J]. Contact Dermatitis,2007,57(3):187-190.
[51]. Diepgen TL, Weisshaar E. Contact dermatitis:epidemiology and frequent sensitizers to cosmetics [J]. J Eur Acad Dermatol Venereol,2007,Suppl 2:9-13.
[52]. Reich HC, Warshaw EM. Allergic Contact Dermatitis from Formaldehyde Textile Resins [J]. Dermatitis,2010,21(2):65-76.
[53].杨卫兵,李欣,张栋等.金属所致系统性接触性皮炎81例临床分析[J].第三军医大学学报,2008,30(17)：1590.
[54].刘广仁,李邻峰.电镀工人职业性接触性皮炎1例报告[J].中国工业医学杂志,2004,17(6)：355.
[55]. Sarma N, Ghosh S.Clinico-allergological pattern of allergic contact among 70 Indian children [J]. Indian J Dermatol Venereol Leprol,2010,76(l):38-44.
[56]. Nielsen NH, Kristiansen J, Borg L, et al. Repeated exposures to cobalt or chromate on the hands of patients with hand eczema and contact allergy to that metal [J]. Contact Dermatitis,2000,43(4):212-215.
[57]. Clarys P, Manou I, BarelA.O. Influence of temperature on irritation in the hand/forearm immersion test [J]. Contact Dermatitis,2006,36(5):240-243.
[58].姜文忠,杨学敏,李淑华.乳胶手套致接触性皮炎一例[J].中华全科医师杂志,2005,4(11)：695.
[1]FOWLER J. Chronic hand eczema:a prevalent and challenging skin condition [J].Cutis,2008,82(s4):4-8.
[2]HELD E, MYGIND K, WOLFF C, et al. Prevention of work related skin problems: an intervention study in wet work employees [J]. Occup Environ Med,2002, 59(8):556-561.
[3]LIVESLEY E J, RUSHTON L, English J S, et al. The prevalence of occupational dermatitis in the UK printing industry [J]. Occup Environ Med,2002,59(7): 487-492.
[4]SELL L, FLYVHOLM MA, LINDHARD G. Implementation of an occupational skin disease prevention programme in Danish cheese dairies [J]. Contact Dermatitis, 2005,53(3):155-161.
[5]BROWN T. Strategies for prevention:occupational contact dermatitis [J]. Occupational Medicine,2004,54(7):450-457.
[6]WEISSHAAR E, RADULESCU M, SODER S, et al. Secondary individual prevention of occupational skin diseases in health care workers, cleaners and kitchen employees:aims, experiences and descriptive results [J]. Int Arch Occup Environ Health,2007,80(6):477-484.
[7]WEISSHAAR E, RADULESCU M, BOCK M, et al. Educational and dermatological aspects of secondary individual prevention in healthcare workers [J]. Contact Dermatitis,2006,54(5):254-260.
[8]LIM Y L, GOON A. Occupational skin diseases in Singapore 2003-2004:an epidemiologic update [J]. Contact Dermatitis,2007,56(3):157-159.
[9]王建平,肖方威.某铸钢厂工人职业性接触性皮炎患病调查[J].中国工业医学杂志,2006,19(4)：236.
[10]梁学邈,程子权,孙洪娟,等.钢铁作业工人皮肤患病情况的研究[J].工业 卫生与职业病,2005,31(6)：379-383.
[11]彭文彬,刘晓虎,王琴芳,等.常州市武进区乡镇企业电镀业铬职业危害的调查[J].职业与健康,2004,20(12)：29-30.
[12]DICKEL H, BRUCKNER T, BERNHARD-KLIMT C, et al. Surveillance scheme for occupational skin disease in the Saarland [J]. Contact Dermatitis,2002,46(4): 197-206.
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