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对中国核工业职业人群原发性肝癌死亡调查及有关资料进行分析,探讨肝癌发生可能存在的危险因素,为制定防治措施提供参考依据。调查对象为11个单位组建至1990年底在册职工,分组、分行业、分性别观察分析,调查历年职工人数及死亡病例,按ICD-9原则统计,并结合有关体检实验室检查结果及某些临床流行病学资料进行总结。调查结果显示肝癌累计粗死亡率为19.20×10~(-5),标化死亡率为10.09×10~(-5);死亡多集中于35～54岁年龄组。SMR等于1.00(P>0.05),扩散元件系统SMR等于1.43(P<0.05),其余未见增加;RR值在铀矿系统为3.67(P<0.01),其余无增加意义。肝大检出率、GPT增高检出率均小于10％或居10％左右,HBsAg检出率均小于8％,居全国中等感染水平。肝癌病例的HBsAg检出率为61.6％,而合并慢性肝炎者为53.4％。结论为核工业职工总体肝癌死亡未见增加,仅见铀矿系统表现为有意义增加,目前无证据归因于放射性作业影响。核工业职工肝癌死亡主要危险因素可能为HBV感染,其次为慢性肝炎或环境因素。
The investigation of the deaths of primary liver cancer in occupational groups in China’s nuclear industry and related data were analyzed to discuss possible risk factors for the occurrence of hepatocellular carcinoma and provide reference for the formulation of prevention and treatment measures. The survey was conducted on 11 employees who were recruited by the end of 1990. They were divided into groups, sub-industries, and gender observations, and investigated the number of employees and deaths over the years. The statistics were based on ICD-9 principles, combined with the results of physical examination laboratory tests and certain clinical conditions. Epidemiological data are summarized. The survey results showed that the cumulative crude death rate of liver cancer was 19.20×10-5, and the standardized mortality rate was 10.09×10-5. Deaths were mostly concentrated in the 35-54 age group. The SMR was equal to 1.00 (P>0.05), the diffusion element system SMR was equal to 1.43 (P<0.05), and the rest was not increased; the RR value was 3.67 in the uranium ore system (P<0.01), and the rest had no significance. The detection rate of hepatomegaly and the increase of GPT detection rate were all less than 10% or about 10%. The detection rate of HBsAg was less than 8%, ranking the country’s moderate infection level. The detection rate of HBsAg in patients with liver cancer was 61.6%, compared with 53.4% in patients with chronic hepatitis. The conclusion is that there has been no increase in overall liver cancer deaths among workers in the nuclear industry. Only the uranium ore system has shown a meaningful increase. There is currently no evidence due to the impact of radiological operations. The main risk factors for the death of liver cancer workers in the nuclear industry may be HBV infection, followed by chronic hepatitis or environmental factors.