职业性铅接触对作业工人骨密度影响的现状调查

Investigation on the effect of occupational lead exposure on bone mineral density of workers

目的了解江苏省某铅酸蓄电池企业职业卫生状况,观察职业性铅接触人员血铅及骨密度检查结果,探讨职业性铅接触对骨密度的影响,为防治职业性铅中毒和骨质疏松提供依据。方法于2019年1月,对江苏省某铅酸蓄电池企业进行劳动卫生学调查,收集402名职业性铅接触人员的基本信息和职业健康检查结果,测定其骨密度。采用Spearman秩相关检验分析铅接触人员血铅与骨密度的关联,logistic回归分析法进行骨密度的影响因素分析。结果 402名职业性铅接触人员血铅水平M(P25,P75)为220.5(118.0,307.0)μg/L,血铅值≥400 μg/L者46人(11.4%),≥600 μg/L者5人(1.2%);骨密度检查异常124人(30.8%)。工作场所铅尘、铅烟浓度分别为<0.004~0.027、<0.021~0.045 mg/m^(3),超标点岗位主要集中在铅烟岗位的铸焊组(44.4%,4/9)。不同骨密度水平铅接触人员血铅总体分布差异有统计学意义,血铅与骨密度呈正相关(P<0.01)。单因素分析结果显示,不同性别、岗位和血铅水平接触人员骨密度异常分布差异均有统计学意义(P<0.01);多因素logistic回归分析结果显示,男性作业工人骨密度异常的风险是女性的5.069倍(95%CI:2.906~8.840,P<0.01)。结论职业性铅接触人员血铅水平较高且骨密度异常率高,暴露于铅工作环境是导致作业人员骨密度异常的一个影响因素,企业管理者应注重一线工人的职业防护、职业健康监护以及工作环境的监管。

Objective To understand the occupational health status of a lead-acid battery enterprise in Jiangsu Province,to observe the results of blood lead and bone mineral density(BMD)of the workers exposed to occupational lead,and to explore the effect of occupational lead exposure on BMD,so as to provide basis for the prevention and treatment of occupational lead poisoning and osteoporosis.Methods An occupational health survey was conducted in a lead-acid battery enterprise in Jiangsu Province in January 2019.Basic information and occupational health examination results of 402 persons exposed to occupational lead were collected,and BMD was measured.Spearman rank correlation test was used to analyze the relationship between blood lead and BMD,and logistic regression analysis was used to analyze the influencing factors of BMD.Results The blood lead level M(P25,P75)of 402 occupational lead exposure workers was 220.5(118.0,307.0)μg/L,46 workers(11.4%)had blood lead value≥400μg/L,and 5 workers(1.2%)≥600μg/L.124 workers(30.8%)had abnormal BMD.The concentrations of lead dust and lead smoke in the workplace were<0.004-0.027 and<0.021-0.045 mg/m^(3),respectively.The positions exceeding the standard point were mainly concentrated in the casting and welding group(44.4%,4/9)of lead smoke positions.There was a statistically significant difference in the overall distribution of blood lead levels among lead exposure workers with different BMD levels,and there was a positive correlation between blood lead and BMD(P<0.01).The results of univariate analysis showed that there were statistically significant differences in the distribution of abnormal BMD among workers exposed to different genders,positions and blood lead levels(P<0.01).The results of multivariate logistic regression analysis showed that the risk of abnormal BMD in male workers was 5.069 times of that in female worker(95%CI:2.906-8.840,P<0.01).Conclusion Occupational lead exposure personnel have a high blood lead level and a high abnormal BMD rate.Exposure to lead working environment is an influencing factor for the abnormal BMD of workers,so enterprise managers should pay attention to health protection,occupational health monitoring and supervision of working environment of front-line workers.