上海市某锂离子电池相关企业男性工人的肾功能现状分析

Kidney function among male workers of a lithium-ion battery-related enterprise in Shanghai

[背景]在“双碳”目标的指导下,锂离子电池的需求大幅增长。然而,在锂离子电池生产、使用、维修的过程中,工人不可避免地会接触到各种职业危害因素,其中一些化学物具有肾毒性。[目的]评估上海市某锂离子电池相关企业男性工人肾功能状况并探究肾功能状况的可能影响因素。[方法]收集在上海市某职业病防治机构开展的某锂离子电池相关企业工人职业健康检查资料,一批为上岗前体检,一批为在岗体检。使用血清肌酐、尿素氮、尿酸和肾脏B超结果评估工人的肾功能状况,根据《诊断学》第九版肾功能指标参考范围对肾功能状况进行分类,并以上岗前工人的肾功能状况作为对照进行分析比较。使用二元logistic回归模型和广义线性回归模型探究工人肾功能指标异常的影响因素。[结果]对照组工人共6 184人,平均年龄为(27.40±4.50)岁;在岗工人共3 526人,平均年龄为(29.40±4.99)岁,中位工龄为2.00(1.00,3.42)年。对照组工人血清肌酐偏高率、尿素氮偏高率、尿酸偏高率和肾脏B超异常率分别为0.66%、2.47%、30.32%和10.12%,在岗工人分别为0.96%、3.35%、38.25%和12.68%,在岗工人各项肾功能指标异常率均高于对照组工人(P <0.05)。在调整了工人年龄、工龄、吸烟状况、饮酒状况、高血压和高血糖后,二元logistic回归分析显示,经常吸烟工人的尿素氮偏高风险高于不吸烟者(OR=1.411,95%CI:1.011~1.969)。年龄越大的工人尿酸偏高风险越低(OR=0.966,95%CI:0.953~0.979),工龄越长(≤1年,OR=1.295,95%CI:1.093~1.534;> 1~3年,OR=1.747,95%CI:1.494~2.042;> 3年,OR=1.866,95%CI:1.511~2.304)、高血压患病(OR=1.400,95%CI:1.055~1.859)和高血糖患病(OR=1.565,95%CI:1.221~2.006)的工人尿酸偏高风险更高。年龄较大(OR=1.038,95%CI:1.022~1.054)、工龄较长(> 1~3年,OR=1.518,95%CI:1.201~1.920)、偶尔吸烟(OR=1.239,95%CI:1.039~1.478)、经常饮酒(OR=1.875,95%CI:1.139~3.087)和高血压患病(OR=1.465,95%CI:1.075~1.998)的工人肾脏B超异常风险更高。广义线性回归分析显示,工龄(> 1~3年,β=1.120,95%CI:0.360~1.880;> 3年,β=1.451,95%CI:0.543~2.358)、吸烟状况(偶尔吸,β=0.818,95%CI:0.156~1.479;经常吸,β=0.841,95%CI:0.066~1.616)和高血压(β=2.742,95%CI:1.390~4.094)是工人血清肌酐浓度的影响因素。年龄(β=0.014,95%CI:0.009~0.019)和工龄(> 1~3年,β=0.079,95%CI:0.012~0.146)是尿素氮的影响因素。年龄(β=–1.759,95%CI:–2.288~–1.231)、工龄(≤1年,β=10.676,95%CI:4.035~17.316;> 1~3年,β=26.117,95%CI:19.962~32.272;> 3年,β=34.558,95%CI:26.116~43.001)、高血压(β=23.162,95%CI:11.617~34.707)和高血糖(β=15.017,95%CI:4.853~25.180)是尿酸的影响因素。[结论]锂离子电池工厂工人的肾功能异常情况受年龄、工龄、吸烟、饮酒、高血压和高血糖的影响。随着在锂电池工厂工作年限的增加,工人的肾功能状况可能会变差。这需要引起企业重视,分析其改变的原因,并采取针对性干预措施。

[Background]Under the guidance of achieving carbon peaking and carbon neutrality goals,the demand for lithium-ion batteries has increased significantly.However,during the production,use,and maintenance of lithium-ion bat-teries,workers are inevitably exposed to various occupational hazards,and some chemicals are nephrotoxic.[Objective]To evaluate the kidney function and potential determinants among male workers in a lithium-ion battery-related enterprise in Shanghai.[Methods]The data of occupational health examination carried out by an occupational disease prevention and control institution for workers in a lithium-ion battery-related enterprise in Shanghai were collected.The workers participating pre-employment occupational health examination were treated as a control group,and the other group was recruited from those participating periodic health examina-tion.Serum creatinine,urea nitrogen,uric acid,and renal ultrasound were used to assess the kidney function of workers.Kidney function was classified according to the reference range of kidney function indicators in Diagnostics(9th Edition,national planning textbook for high education in medicine).Binary logistic regression and generalized linear regression were used to identify potential determinants of abnormal values in kidney function indicators in workers.[Results]There were 6184 workers in the control group(pre-employment)with a mean age of(27.40±4.50)years.There were 3526 workers on the job with a mean age of(29.40±4.99)years and the median time of service was 2.00(1.00,3.42)years.The prevalence rates of high serum creatinine,high urea nitrogen,and high uric acid,and abnormal kidney ultrasound among the control group were 0.66%,2.47%,30.32%,and 10.12%,respectively;the indicators in the on-the-job workers were 0.96%,3.35%,38.25%,and 12.68%,re-spectively,significantly higher than those in the control group(P<0.05).After adjusting for worker age,length of service,smoking status,drinking status,hypertension,and hyperglycemia,the binary logistic regression models showed that regular smokers had a higher risk of high urea nitrogen than nonsmokers(OR=1.411,95%CI:1.011,1.969).The risk of high uric acid was lower in older workers(OR=0.966,95%CI:0.953,0.979),and higher in workers with more years of service(≤1 year,OR=1.295,95%CI:1.093,1.534;>1-3 years,OR=1.747,95%CI:1.494,2.042;>3 years,OR=1.866,95%CI:1.511,2.304),hypertension(OR=1.400,95%CI:1.055,1.859),and hyperglycemia(OR=1.565,95%CI:1.221,2.006).Workers who were older(OR=1.038,95%CI:1.022,1.054)and had longer working years(>1-3 years,OR=1.518,95%CI:1.201,1.920),occasional smoking habits(OR=1.239,95%CI:1.039,1.478),regular drinking habits(OR=1.875,95%CI:1.139,3.087),and hypertension(OR=1.465,95%CI:1.075,1.998)were at a higher risk of renal ultrasound abnormalities.The generalized linear models showed that length of service(>1-3 years,β=1.120,95%CI:0.360,1.880;>3 years,β=1.451,95%CI:0.543,2.358),smoking status(occa-sional,β=0.818,95%CI:0.156,1.479;regular,β=0.841,95%CI:0.066,1.616),and hypertension(β=2.742,95%CI:1.390,4.094)were the influencing factors of serum creatinine concentration in the workers.Age(β=0.014,95%CI:0.009,0.019)and length of service(>1-3 years,β=0.079,95%CI:0.012,0.146)were the influencing factors of urea nitrogen.Age(β=−1.759,95%CI:−2.288,−1.231),length of service(≤1 year,β=10.676,95%CI:4.035,17.316;>1-3 years,β=26.117,95%CI:19.962,32.272;>3 years,β=34.558,95%CI:26.116,43.001),hyper-tension(β=23.162,95%CI:11.617,34.707),and hyperglycemia(β=15.017,95%CI:4.853,25.180)were the influencing factors of uric acid.[Conclusion]The prevalence of abnormal kidney function of workers in selected lithium-ion battery-related enterprise is varied by age,length of service,smoking status,drinking status,hypertension,and hyperglycemia.There may be a trend that the longer the time working in a lithium-ion battery-related enterprise,the worse the workers'kidney function.Therefore,the enterprise should pay attention to the possible reasons for their changes and take targeted interventions.