职业性噪声聋2014与2007版诊断标准对比研究

Comparative study on the diagnostic criteria of occupational noise-induced deafness between version 2014 and version 2007

目的分析GBZ 49—2014《职业性噪声聋的诊断》(以下简称"GBZ 49—2014")和GBZ 49—2007《职业性噪声聋诊断标准》(以下简称"GBZ 49—2007")对职业性噪声聋(ONID)诊断结果的影响。方法采用判断抽样方法,以采用GBZ 49—2007诊断为观察对象的84例噪声作业工人为研究对象,分别采用GBZ 49—2014和GBZ 49—2007进行诊断,分析GBZ 49—2014采用的不同诊断听力图、不同年龄与性别修正方法以及纳入权重为0.1的高频4.0 k Hz听阈作为诊断听阈对ONID诊断的影响。结果 84例研究对象采用GBZ 49—2014计算的双耳高频平均听阈(BHFTA)低于采用GBZ 49—2007计算的BHFTA[(52.1±10.3)vs(52.8±10.1)d B,P<0.05],而采用GBZ 49—2014计算的较好耳听阈加权值(MTWV)高于采用GBZ 49—2007计算的较好耳语频平均听阈[(23.2±4.1)vs(19.3±4.8)d B,P<0.01]。84例研究对象采用GBZ 49—2007进行诊断时,BHFTA均≥40 d B,较好耳语频平均听阈均<26 d B,均不能诊断为ONID;采用GBZ 49—2014进行诊断时,33.3%人员BHFTA≥40 d B且较好耳MTWV≥26 d B,可诊断为轻度ONID。在采用不同诊断听力图和不同年龄与性别修正方法的条件下,纳入4.0 k Hz听阈作为诊断听阈时对ONID的检出率较不纳入增加21.4%~34.5%(P<0.01)。结论 GBZ 49—2014中纳入权重为0.1的高频4.0 k Hz听阈作为诊断听阈,降低了ONID的诊断条件。

Objective To analyze the impact of GBZ 49-2014 Diagnosis of Occupational Noise-induced Deafness and GBZ49-2007 Diagnostic Criteria of Occupational Noise-induced Deafness on the diagnosis of occupational noise-induced deafness（ ONID）. Methods A total of 84 individuals,who were workers exposed to noise and diagnosed as observation subjects by GBZ 49-2007 were selected as the subjects of study by judgment sampling. They were diagnosed based on the criteria of GBZ 49-2014 and GBZ 49-2007. The impact of different diagnostic audiometry,different age and gender correction methods and the inclusion of a weighting of 0. 1 high-frequency 4. 0 kHz hearing threshold of GBZ 49-2014 on the diagnosis of ONID was analyzed. Results The binaural high frequency threshold average（ BHFTA） calculated by GBZ 49-2014 were lower than that of GBZ 49-2007 [（ 52. 1 ± 10. 3） vs（ 52. 8 ± 10. 1） dB,P〈0. 05 ],but monaural threshold of weighted value（ MTWV） of the good ear calculated by GBZ 49-2014 were higher than speech frequency threshold average（ SPTA） of the good ear of GBZ 49-2007 [（ 23. 2 ± 4. 1） vs（ 19. 3 ± 4. 8） dB,P〈0. 01]. All of the 84 patients hadBHFTA ≥40 dB and SPTA 〈26 dB when diagnosed by GBZ 49-2007,and could not be diagnosed as ONID. A total of33. 3% patients hadBHFTA ≥40 dB and MTWV ≥26 dB when diagnosed by GBZ 49-2014 which could be diagnosed as mild ONID. The detection rate of ONID was 21. 4% to 34. 5%（ P〈0. 01） when the threshold of 4. 0 kHz was used as the weighting diagnostic threshold of hearing in the case of using different diagnostic audiograms and different age and sex correction methods. Conclusion A high-frequency hearing threshold of 4. 0 kHz with a weighting of 0. 1 was included in GBZ 49-2014 as a diagnostic threshold,which reduced the diagnostic threshold of ONID.