天津市职业性膀胱癌危险因素的病例对照研究

A case-control study on risk factor of occupational bladder cancer in Tianjin city

目的探讨天津市联苯胺职业接触人群膀胱癌的主要危险因素,以确定高危人群。方法对天津市联苯胺职业接触人群中106例膀胱癌和同时期、同车间的未发生膀胱癌的106人进行成组病例-对照研究,通过单因素和多因素非条件Logistic回归分析筛选职业人群中膀胱癌的主要危险因素,同时分析病例组与对照组尿中脱落细胞检查情况,为职业肿瘤的早期发现及高危人群的确定提供参考依据。结果单因素及多因素分析结果显示,联苯胺职业接触人群膀胱癌危险因素包括接触联苯胺浓度、专业工龄、吸烟（P〈0.05）;多因素分析结果表明,联苯胺职业接触人群膀胱癌的主要危险因素为高接触浓度（OR=4.752,95%CI=2.458-9.190）、专业工龄（OR=2.557,95%CI=1.394-4.692）、吸烟（OR=2.011,95%CI=1.020-3.966）。病例组巴氏分级Ⅱ级及以上和定量荧光影像分析（QFIA）阳性检出均高于对照组,P〈0.05。结论高浓度接触、专业工龄超过5年、吸烟是联苯胺职业接触人群发生膀胱癌的主要危险因素,应以此确定高危人群;尿脱落细胞检查巴氏分级Ⅱ级及以上和QFIA阳性者,也应加强监护。

Objective To identify the main risk factor associated with bladder cancer among benzidine occupationally exposed population in Tianjin city,there by screen out the high risk group. Methods A unmatched case-control study of 106 occupational bladder cancer patients caused by benzidine and 106 workers from the same workshop at that time was conducted to screen the main risk factor associcated with occupational bladder cancer by benzidine. Meanwhile,Urine exfoliative cell examination was also made to look for a basis for diagnosis of occupational tumor and identification of high risk group early. Results The results showed both univariate analysis and multivariate anaylsis all indicated that exposure concentration,working length and smoking were associated with bladder in benzidine exposed workers（P〈0. 05）; while the multivariate analysis showed that high concentration（OR = 4. 752,95% CI = 2. 458 - 9. 190）,long working length（ OR = 2. 557,95% CI = 1. 394 - 4. 692）and smoking（OR = 2. 011,95% CI = 1. 020 - 3. 966） were the risk. Additionally,the ratios of grade 2 of more of exfoliated cell according to Papanicolaou classification and positive quantitative fluorescence image analysis（QFIA） were higher in cancer group than that in control group（ P〈0. 05）. Conclustion The study showed that high concentration exposure,long working length（ 〉5 year） and smoking were three principal risk factors of occupational bladder cancer by benzidine,which may be helpful in screening high risk population; while grade 2 or more of exfoliated cell by Papanicolaou classification and positive QFIA may identify the high risk person who should be given more attention during health surveillance.