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目的调查医院放射工作人员甲状腺异常情况,探讨长期低剂量电离辐射是否影响放射工作人员甲状腺形态或功能,为医院工作人员甲状腺异常聚集性事件处置提供科学依据。方法采用方便抽样方法,抽取广州市7家三甲医院从事放射作业工龄≥5年的144名放射工作人员为接触组,抽取工龄≥5年的200名无职业性电离辐射接触人员为对照组。对2组人员进行个人接触剂量调查和甲状腺B型超声波检查,采集肘静脉血检测血清三碘甲状腺原氨酸(T3)、甲状腺素(T4)、促甲状腺激素(TSH)水平,采集尿样检测尿碘水平。结果接触组人群年总有效剂量为0.12~2.44 m Sv/a,中位数为0.30 m Sv/a。接触组和对照组人群甲状腺结节患病率分别为32.64%(47/144)和31.00%(62/200),两者差异无统计学意义(P>0.05);接触组人群T3水平高于对照组[(1.63±0.34)vs(1.55±0.32)nmol/L,P<0.05],THS水平低于对照组[1.39(0.96,2.12)vs 1.98(1.29,2.67)m IU/L,P<0.01];2组人群T4水平差异无统计学意义[(107.69±23.30)vs(110.93±18.96)nmol/L,P>0.05]。接触组不同工种亚组和不同接触剂量亚组人群的甲状腺结节患病率,T3、T4、TSH水平及其异常率比较,差异均无统计学意义(P>0.05)。接触组和对照组中,不同尿碘水平人群的甲状腺结节患病率差异均无统计学意义(P>0.05)。多因素Logistic回归分析显示,放射接触、放射作业工龄以及工种均与罹患甲状腺结节无关联(P>0.05),但女性、年龄增加和吸烟均是罹患甲状腺结节的独立危险因素(P<0.05)。结论长期低剂量电离辐射接触可能对医院放射工作人员T3和TSH水平产生一定影响,但不增加甲状腺结节患病风险;女性、年龄增加及吸烟可增加甲状腺结节患病风险。医院内的电离辐射可能不是甲状腺异常变化聚集事件的原因。
Objective To investigate the abnormal thyroid status of radiation workers in the hospital and to explore whether the long-term low-dose ionizing radiation affects the thyroid morphology or function of radiation workers and provide a scientific basis for the treatment of abnormal thyroid gathering events in hospital staff. Methods Convenient sampling method was used to collect 144 radiation workers who were 5 or more years working in radiological operations in 7 top three hospitals in Guangzhou as the exposure group and 200 non-occupational ionizing radiation exposure workers (≥5 years) as the control group. The two groups of individuals were investigated for dose exposure and thyroid B ultrasonic examination. The elbow venous blood samples were collected for the detection of serum T3, T4 and TSH, and urine samples were collected Urinary iodine levels. Results The annual total effective dose of the contact group was 0.12 ~ 2.44 m Sv / a, with a median of 0.30 m Sv / a. The prevalence of thyroid nodules in contact group and control group were 32.64% (47/144) and 31.00% (62/200) respectively, with no significant difference between the two groups (P> 0.05). The T3 level in contact group was higher than that in control group (1.63 ± 0.34) vs (1.55 ± 0.32) nmol / L, P <0.05]. The THS level in the control group was significantly lower than that in the control group [1.39 (0.96, 2.12 vs 1.98, 1.29, 2.67 mIU / 0.01]. There was no significant difference in T4 level between the two groups (107.69 ± 23.30 vs 110.93 ± 18.96 nmol / L, P> 0.05). The prevalence of thyroid nodules, the levels of T3, T4, TSH and the abnormal rates of thyroid nodules among different working subgroups and contact subgroups in the exposure group were not significantly different (P> 0.05). There was no significant difference in the prevalence of thyroid nodules between the two groups (P> 0.05) in contact group and control group. Multivariate logistic regression analysis showed that there was no association between thyroid nodules and radiation exposure, radiation operation and labor (P> 0.05). However, women, age and smoking were all independent risk factors for thyroid nodules (P <0.05) ). Conclusion Exposure to long-term low-dose ionizing radiation may have some impact on T3 and TSH levels of hospital radiologists, but not increase the risk of thyroid nodules. Increasing age and smoking may increase the risk of thyroid nodules. Ionizing radiation in the hospital may not be the cause of abnormal thyroid events.