某鞋厂苯接触工人血小板参数变化及其影响因素的前瞻性研究

Prospective study on the changes of platelet parameters and the influencing factors in benzene exposed population

目的探讨某鞋厂苯接触工人血小板参数变化及其影响因素的前瞻性研究。方法采用前瞻性研究设计,研究对象为某鞋厂新员工从事苯接触工作,到本中心参加职业健康体检者共84例。在研究对象刚参加工作,苯接触1年、2年、3年,分别检查血常规五分类,含血小板计数、血小板分布宽度、血小板平均容积、大血小板比率、以及血小板压积。应用重复测量资料分析方法探讨各血小板参数在每个检查时点的变化趋势,并通过协方差分析探讨血小板参数的影响因素。结果随着苯接触时间延长,血小板计数呈下降趋势,从基线(209.60±40.49)×109/L下降至第3年末的(183.96±63.90)×109/L,以第1年变化最显著(P<0.001);血小板压积(0.18±0.09%升至0.25±0.09%)、血小板平均容积(10.48±0.72 fl升至11.02±0.75 fl)、血小板分布宽度(12.63±1.47 CV%升至14.22±2.07 CV%)逐渐上升(P<0.001),但是第1年末至第2年末期间变化趋势无统计学意义(P>0.05);大血小板比率(29.16±5.47%升至35.65±5.69%)呈上升趋势,有统计学意义(P<0.001)。协方差分析提示,年龄越大、苯和甲苯接触剂量越高,血小板计数随之减少,血小板压积、血小板平均容积、血小板分布宽度,大血小板比率随之增大(P<0.05)。结论对于苯接触人群,血小板参数会随苯接触时间而发生变化,与年龄、苯接触剂量密切相关,应采取有效措施做好慢性苯中毒的三级预防。

Objective To prospectively study the changes in platelet parameters of the benzene-exposed population and the in- fluencing factors in a shoe factory. Methods This study used a prospective design. 84 new employees with benzene-exposed work in a shoe factory and having occupational health examination in Fanyu District Center tbr Disease Control and Prevention were served as the research subjects. Five items of routine blood test, including platelet count, platelet distribution width, mean platelet volume, platelet-large cell ratio and thrombocytocrit were detected in the employees at the beginning of the work, and with benzene exposure for 1 year, 2 and 3 years respectively. With the analysis method of repeated measurement data, the changing trend of the platelet parameters of each test time point was analyzed, and the factors influencing the platelet parameters were explored by cnvariant analysis. Results As the benzene exposure time extended, the platelet count declined from a baseline of （209.60±40.49）×10^9/L to （183.96±63.90）×10^9/L at the end of the third year, with the most significant change in the first year （ P〈0. 001 ）. Thrombocytocrit （from 0.18±0.09% to 0.25±0.09%）, mean platelet volume （from 10.48±0.72 fl to 11.02±0.75 fl） and platelel distribution width （from 12.63±1.47 CV% to 14.22±2.07 CV%） were gradually increased （P〈0.001）, but the changing trend had no statistical significance between the end of the first year and the end of the second year （ P〉0.05）. Platelet-large cell ratio （ from 29.16±5.47% to 35.65±5.69% ） showed an increasing trend, with statistical significance （ P〈0.001 ）. Covariance analysis showed that platelet count was decreased with the increasing age and the exposure to high doses of benzene and toluene, but throm- bocytoerit, mean platelet volume, platelet distribution width and platelet-large cell ratio were increased （P〈0.05）. Conclusions As for the benzene-exposed group, the platelet parameters will change with the time of benzene exposure and are closely corre- lated with age and the dose of benzene exposure. It is necessary to take effective measures so as to well implement the tertiary prevention of chronic benzene poisoning.