视觉对比敏感度和OCT在焊工体检中的应用

The application of visual contrast sensitivity and OCT in physical examination of welder

目的探讨在焊接工人体检中应用视觉对比敏感度（cs）和光学相干断层扫描（OCT）检查的意义。方法横断面调查研究，以2014年5月在河北省沧州市中心医院体检的某工厂焊接工人86人为研究对象（焊工组），同期体检的焊接作业区以外的工人62人为对照（对照组），对上述人群除进行一般的系统体检外，着重进行眼部的检查，包括：自觉症状、视力、检眼镜检查、OCT及CS等检查。采用卡方分析比较两组眼部检查结果；采用Kappa检验分析焊工组人员的自觉症状与视力、检眼镜、OCT、CS检查的一致性；采用等级相关检验分析cs和OCT检查结果的相关性。结果焊工组在自觉症状、视力、检眼镜、CS、OCT检查的异常率分别为：25．6％，5．8％，2．3％，30．2％，22．1％；其中自觉症状、CS（6c／d）和OCT检查结果的异常率明显高于对照组（χ2=7．412，P=0．007）、（χ2=8．982，P=0．003）、（χ2=10．533，P=0．001）；焊工组人员OCT、CS（6c／d）检查的结果分别与自觉症状呈高度一致（P0=0．919，K=0．776）、（P0=0．905，K=0．767）；焊工组CS（6c／d）和OCT检查结果呈正相关（C=0．7539（2=97．577，P=0．000）。结论部分焊接工人存在明显的视网膜光损伤，cs和OCT检查能够从功能和解剖形态上精确反映这些损伤的存在，适用于焊接工人的电弧光性黄斑损伤筛查。视网膜黄斑区形态的改变可能是功能异常的基础。

Objective To investigate the application of visual contrast sensitivity （CS） and optical coherence tomography （OCT） in physical examination of welder. Methods This is a cross-sectional study. Eighty-six welding workers who had medical checks in May 2014 in our hospital were the research objects （welder group ） , and 62 other type workers were the control group. Besides the general medical system examinations, eye examinations had been performed on the crowd including subjective symptoms, visual acuity, ophthalmoscopy, OCT and CS. The eye examination results in two groups were compared by chi- square analysis. The consistency in the results of readme symptoms with the results of visual acuity, ophthalmoscopy, OCT and CS were analysed by Kappa test, and the correlation between the results of OCT and CS were analysed by rank correlation test. Results In welder group, the abnormal rates of the examinations in readme symptoms, vision, ophthalmoscope, CS （6c/d） and OCT were 25.6% , 5.8%, 2.3%, 30.2% and 22.1%. Compared with the results in control group, the differences in the results of symptoms, CS（6c/d） and OCT were statistically significant （χ2 = 7. 412, P = 0. 007 ）, （χ2 = 8. 982, P = 0.003）, （χ2 = 10. 533, P =0. 001）. In welder group, the results of OCT and CS （6c/d） were highly consistent with the results of subjective symptoms （Po = 0. 919, K = 0. 776）, （ Po = 0. 905, K = 0. 767 ）. Positive correlation was found out between the results of OCT and the results of CS （6c/d） （C = 0. 753, χ2 =97. 577, P = 0. 000）. Conclusion Obvious retinal light damage exists in part welders. CS and OCT examination can accurately find out this damage respectively from the function and anatomy which are applied to eye examinations in welders. The damage of anatomy may be the cause for the change of the function.