稳态噪声暴露与高血压剂量－反应关系的人群研究

INVESTIGATION OF DOSE-RESPONSE RELATIONSHIP BETWEEN STEADY STATE NOISE EXPOSURE AND HYPERTENSION IN WORKING POPULATION OF BEIJING.

本文分三个阶段对稳态噪声暴露人群的高血压调查资料进行多因素分析。发现声压级与高血压患病率之间存在剂量一反应关系。用Ｌｏｇｉｓｔｉｃ回归模型校正多个危险因素的影响后，声压仍是一个高血压病的独立的危险因素，其ＯＲ（ＯｄｄｓＲａｔｉｏ）值为１．０３１，Ｐ＜０．０５。在校正年龄与工龄高度相关（ｒ＝０．９６６）在此模型中产生多元共线性的缺点后，ＯＲ值为１．０３３，年龄ＯＲ值由１．１０１增大至１．１５７，其对高血压病的危险性约为累积噪声暴露量的３倍。在两个模型中父母高血压史和吃菜咸淡对高血压病的危险性约分别为噪声暴露的２倍左右。发现公式ＣＮＥ＝声压级＋ｋ×［Ｉｎ（工龄）Ｉｎ（２）］中，多危险因素同时进入模型，以ｋ＝２．９时模型的最大似然值最大，该数值非常接近于３，支持噪声暴露与健康危害关系的等能量学说。

A dose-response relationship for noise induced hypertension was found in working population of Beijing by stratum analysis. A logistic regression model was added and found the adjusted odds ratio(OR) of noise exposure level(SPL) was 1. 031(P= 0.047). Cumulative noise exposure(CNE), which incorporates both SPL and duration of noise exposure and reduces the high correlation of both variables. was applied with adjusted OR of CNE being 1.033(P=0.034).The adjusted OR of age was 1. 101(P=0. 126) in SPL model and 1. 157(P<0. 001) in CNE model. This finding supports the hypothesis that CNE may be a more appropriate measure of risk for hypertension due to exposure to steady state noise and it results in a model consistent with the known effect of age on hypertensive risk. The OR for parental hypertensive history and self-reported salt intake was very nearly equal between the two models.Using likelihood measures, the contribution of age showed three times the influence of noise exposure where parental hypertensive history and salt intake were 2.0 and 1. 6 times more important than noise exposure. The exchange rate(k) in CNE function was changed as CNE = SPL+K×[ln (working years)/ln(2)]. The-2log(likelihood) in CNE model arrived to maximum when k equals 2. 9. The value of 2. 9 is very near 3 as equal energy theory on noise exposure.