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[目的]对三硝基甲苯(trinitrotoluene,TNT)致白内障的患病情况进行调查,探讨TNT白内障临床特点及发病与工种和工龄的关系,并对晶状体摄影留档。[方法]对某厂452例TNT作业工人,常规外眼检查后复方托品酰胺滴眼3次至双眼瞳孔散大7~8 mm,用裂隙灯显微镜观察晶状体,同时用裂隙灯显微镜对患者进行晶状体摄影。诊断及分级使用GBZ 45—2010《职业性三硝基甲苯白内障诊断标准》。[结果]452名作业人员中,符合TNT白内障观察对象标准者185例;确诊TNT白内障者132例,根据TNT不同分期,壹期97例、贰期27例、叁期8例,TNT白内障总患病率为29.20%,晶状体混浊检出率为70.13%(317/452)。随着工龄的增长,TNT白内障患病率逐渐升高,工龄分布以工作25年以上者为最高,且各工龄段的白内障检出率差异有统计学意义(χ2=80.60,P<0.01)。TNT白内障的岗位分布以混药工最高,其患病率的性别差异无统计学意义。[结论]TNT白内障患病率与工种关系密切,且随工龄的增加和接触TNT时间延长而升高。晶状体摄影能够作为确诊重要证据,可更好的帮助职业病诊断工作者准确地完成职业性三硝基甲苯白内障诊断。
[Objective] To investigate the prevalence of cataract caused by trinitrotoluene (TNT), discuss the clinical features and pathogenesis of TNT cataract, and discuss the relationship between the type and length of service. [Method] A total of 452 TNT workers in a factory were treated with compound tropicamide eye drops 3 times to 7 ~ 8 mm in both eyes after routine external eye examination. The patients were observed with slit lamp microscope Lens photography. Diagnostic and grading using GBZ 45-2010 “Diagnostic criteria of occupational trinitrotoluene cataract.” [Results] Of the 452 operatives, 185 were eligible for the observation of TNT cataract; 132 were diagnosed as TNT cataract. According to different TNT stages, 97 were in stage I, 27 in stage II, 8 in stage 3, The morbidity was 29.20%. The detection rate of lens opacity was 70.13% (317/452). With the increase of seniority, the prevalence of cataract in TNT increased gradually, the length of service was the highest in more than 25 years of work, and the difference of cataract detection rate was statistically significant (χ2 = 80.60, P <0.01). TNT cataract job distribution to mixed drug workers the highest, the prevalence of gender differences was not statistically significant. [Conclusion] The prevalence of cataract in TNT is closely related to the type of work, and increases with the increase of seniority and exposure to TNT. Lens photography can be used as important evidence of diagnosis, which can help occupational disease diagnosis workers accurately diagnose occupational TNT cataracts.