蓄酸电池厂铅作业工人血铅异常回顾性队列研究

A retrospective cohort study on abnormal blood lead levels in lead-exposed workers in a storage battery factory

目的分析蓄电池厂铅作业工人血铅异常的影响因素。方法采用典型抽样方法,以某蓄电池厂的铅作业工人为研究对象,进行为期3年的回顾性队列研究。起点时间为2011年9月,起点事件为血铅水平〈400.0μg/L;观察截止时间为2014年9月,终点事件为血铅水平≥400.0μg/L（血铅异常）。采用COX回归分析分析血铅异常的影响因素。结果共有244名铅作业工人纳入研究。2011年9月时,基线铅作业工龄中位数（M）为6.3（0.7～35.9）年,基线血铅水平M为321.5（215.7～398.7）μg/L;3年间共有78人发生血铅异常,血铅异常发生率为32.0%。多因素COX回归分析结果显示,工作时不佩戴口罩、基线血铅水平〉300.0μg/L、工作场所铅超标和铅作业工龄〉5.0年者发生血铅异常的风险相对较高（P〈0.01）,相对危险度分别为工作时佩戴口罩、基线血铅水平≤300.0μg/L、工作场所铅不超标、铅作业工龄≤5.0年者的6.89、4.00、9.02和2.93倍。结论应加强对工作时不佩戴口罩、基线铅水平〉300.0μg/L、工作场所空气中铅超标和铅作业工龄〉5.0年的蓄电池厂铅作业工人的职业性慢性铅中毒防治工作。

Objective To analyze the influencing factors of high blood lead levels in lead-exposed workers of a storage battery factory. Methods By the typical sampling method,lead-exposed workers were chosen as study subjects for a three-year retrospective cohort study starting from September of 2011 and ending in September of 2014. The starting blood lead level was 400. 0 μg / L and ending blood lead level was ≥400. 0 μg / L（ abnormal level）. The influencing factors of abnormal blood lead level were analyzed by the COX regression analysis method. Results There were 244 lead-exposed workers included in this study. The median（ M） working years of baseline lead exposure was 6. 3（ 0. 7-35. 9） years,the M of baseline blood lead level was 321. 5（ 215. 7-398. 7） μg / L by September of 2011. During the 3 years,there were 78 workers found to have abnormal blood lead levels,with an abnormality rate of 32. 0%. The multivariable COX regression analysis indicated that the workers with following situations had relative higher incidences of abnormal blood lead level：working without masks,baseline blood lead level over 300. 0 μg / L,the air concentration of lead in workplace beyond the standard and the workers exposed to lead for over 5. 0 years,their relative risk ratios were 6. 89,4. 00,9. 02 and 2. 93 times of those workers with the opposite situations,respectively（ P〈0. 01）. Conclusion Measures should be taken to prevent and control the occupational chronic lead poisoning especially in those lead-exposed workers who don＇t wear masks during work,whose baseline blood lead level was over 300. 0 μg / L,whose air concentrations of lead in workplace were beyond the standard and whose lead exposure year was over 5. 0 years.