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目的研究铸造作业工人缺血性心脏病发病风险及其与铸造作业、矽尘累积接触量之间的剂量-反应关系,并对缺血性心脏病的发病风险进行预测。方法采用队列研究方法,选择某铸造厂1980年1月1日-1996年12月31日在册一年以上的铸造作业工人建立研究队列,观察终止日期为2009年12月31日。以浇注、配砂、清理、熔炼、天车、造型和制芯等工种工人作为铸造组,电工、钳工和检查工等辅助工作为对照组。使用SPSS软件Cox回归模型分析缺血性心脏病发病风险及其与铸造作业、矽尘累积接触量之间的剂量-反应关系,并使用logistic回归建立缺血性心脏病发病风险的预测模型。结果本研究共随访30年,1817人,45 553.05人年,缺血性心脏病156例,人-年发病率为342.46/10万,平均发病年龄51.46岁,发病工龄21.61年。男性、吸烟、饮酒、年龄和工龄分别都是缺血性心脏病发病的危险因素。缺血性心脏病发病风险与矽尘累积接触量呈正相关,调整吸烟的影响后,工人矽尘年累积接触量每增加1mg/m3,缺血性心脏病发病风险增加75.8%(RR=1.758,95%CI1.221～2.532)。铸造组工人缺血性心脏病发病风险显著增加,调整吸烟的影响后,与对照组工人相比,配砂工、清理工、熔炼工、造型工、制芯工分别增加1.048倍、1.395倍、70.4%、97.0%和1.270倍。根据预测模型,工人缺血性心脏病发病概率随日接触矽尘浓度的增加、接尘工龄的延长而增加。结论铸造作业工人面临较大的缺血性心脏病发病风险。不同工种工人缺血性心脏病发病风险不同,其中,配砂、清理、熔炼、造型、制芯工人较高。铸造作业、矽尘累积接触量是缺血性心脏病的独立危险因素。缺血性心脏病预测模型表明,发病概率与日接触矽尘浓度和接尘工龄呈明显的剂量-反应关系。
Objective To study the dose-response relationship between the risk of ischemic heart disease and the cumulative exposure of foundry workers and silicon dust in foundry workers and to predict the risk of ischemic heart disease. Methods A cohort research method was used to select a foundry who had a research cohort of foundry workers who had been on the books for more than one year from January 1, 1980 to December 31, 1996. The deadline for observation was Dec. 31, 2009. To cast, with sand, cleaning, melting, crane, modeling and core workers and other workers as a casting group of workers, electrician, fitter and inspectors and other auxiliary work as a control group. The Cox regression model was used to analyze the dose-response relationship between the risk of ischemic heart disease and cumulative contact with foundry and silica dust. The predictive model of ischemic heart disease was established using logistic regression. Results This study was followed up for 30 years, 1817 people, 45 553.05 years, 156 cases of ischemic heart disease, the annual incidence rate of 342.46 / 100,000, the average age of onset of 51.46 years old, the length of service 21.61 years. Men, smoking, alcohol consumption, age and length of service were all risk factors for ischemic heart disease. The risk of ischemic heart disease was positively correlated with the cumulative exposure to silica dust. After the impact of smoking was adjusted, the cumulative risk of exposure to silicon dust increased by 75.8% (RR = 1.758, 95% CI 1.221 ~ 2.532). Casting group workers significantly increased the risk of ischemic heart disease, adjusting the impact of smoking, compared with workers in the control group, with sand workers, cleaning workers, melting workers, modeling workers, core workers increased by 1.048 times, 1.395 times, 70.4%, 97.0% and 1.270 times. According to the prediction model, the incidence of worker-induced ischemic heart disease increases with the exposure to silica dust and the extension of the service life of dust. Conclusion Foundry workers face a greater risk of ischemic heart disease. Different types of workers with different risk of ischemic heart disease, of which, with sand, cleaning, smelting, modeling, core workers higher. Foundry work, the cumulative exposure to silica dust is an independent risk factor for ischemic heart disease. Ischemic heart disease prediction model showed that the probability of incidence of exposure to silica dust concentration and the length of dusting showed a significant dose-response relationship.