上海某冶炼厂铅接触工人肿瘤死亡的回顾性队列研究

Cancer mortality of workers exposed to lead:A retrospective cohort study in a smeltery

目的 了解职业铅接触工人肿瘤死亡情况 ,探讨职业铅接触与肿瘤的关系。方法 1985年 1月 1日前在本厂工作 1年以上 ,且 1985年 1月 1日仍存活的男性工人共 6 971名组成全队列 ,其中 334 4名在铅接触车间工作的工人组成的亚队列为接触队列。随访从 1985年 1月 1日至1997年 12月 31日。以上海市人口的肿瘤死亡率作为标准对照 ,计算标化死亡比 (SMR) ;以本厂非接触人群作内对照计算相对危险度 (RR) ;估计累计接触剂量并进行剂量 -反应关系分析。结果 全队列 6 971人共观察 875 76人年 ,接触队列 334 4人共观察 415 0 5人年。全队列中 ,肺癌的SMR(95 %CI)为 12 8.0 (10 1.1～ 15 9.7)。 196 5年后入厂的工人肺癌的SMR为 46 3.7(P <0 .0 1)。有铅接触工作史且工龄超过 2 0年的工人鼻咽癌的SMR =40 8.0 (P <0 .0 1) ,肺癌的SMR =15 6 .6 (P <0 .0 1)。肿瘤总计、恶性肿瘤总计、食管癌、胃癌、肝和胆道癌、肺癌和膀胱癌的RR(95 %CI)分别为 3.2 5 (2 .43～3.89)、3.2 8(2 .5 4～ 4.32 )、3.5 7(1.0 8～ 10 .47)、2 .93(1.15～ 4.87)、4.5 8(2 .0 3～ 9.97)、8.5 8(4 .82～15 .11)、6 .6 6 (2 .83～ 13.0 1)。将累计接触剂量分为高、中、低 3个组 ,中、高组工人恶性肿瘤RR分别为1.6 2 (P <0 .0 5 )和 1.70 (P

Objective To determine the mortality of cancer and relative risk of long term lead exposure workers and to study the relation between occupational lead exposure and cancer. Methods A cohort study including 6 971 male workers employed for at least one year before Jan 1,1985 and still alive at this time,and a subcohort of 3?344 of them worked at lead exposed workshop was conducted.The study was followed up from Jan 1,1985 to Dec 31,1997.Standardized mortality ratios( SMR ) and relative risks( RR ) were calculated.Cumulative exposure dose was used for a dose response analysis. Results For 6?971lead exposure workers, SMR and its 95% CI for lung cancer were 128.0(101.1～159.7). SMR for lung cancer was 463.7( P <0.01) among lead exposure workers employed after Jan 1,1965. SMR for nasopharyngeal cancer was 408.0( P <0.01),lung cancer 156.6( P < 0.01), among workers with lead exposed history and length of more than 20 years. RR and 95% CI for neoplasms(in total),malignant neoplasms(in total),oesophageal cancer,stomach cancer,liver and biliary tract cancer,lung cancer,bladder cancer were 3.25(2.43～3.89),3.28(2.54～4.32),3.57(1.08～10.47),2.93(1.15～4.87),4.58(2.03～9.97),8.58(4.82～15.11),6.66(2.83～13.01) respectively. RR for malignant neoplasms at medium (0.1～0.5 mg·m -3 ·a -1 ) and high(0.5～ mg·m -3 ·a -1 ) cumulative exposure doses were 1.62 ( P <0.05) and 1.70( P <0.05) respectively and there was an increasing trend of RR as the doses raised.RR for lung cancer at medium and high exposure doses were 2.55 ( P <0.05) and 2.31( P <0.05) respectively. Conclusions The increased death risks may relate to lead exposure.However,further study under controlling the harmful factors of other occupational exposure and non occupational exposure is necessary.