CAJ | 학술논문

目的对铬酸盐职业接触者现有健康监护方案监护指标进行循证研究,对该方案进行补充和完善.方法于2011年12月以六价铬与肝损伤、微核、尿铬为主要检索内容,检索“考克兰图书馆(Cochran library)”、“PubMed”、“OVID Medline”、“Web of knowledge”与“中国生物医学文献数据库”等数据库.并对检索到的文献按照制定的纳入与排除标准筛选后,共计22篇；依据牛津证据分级标准,对其进行分级评价.结合作业场所现场调查及健康体检工作及卫生经济学手段,并以总成本与总存活生命年数计算成本效果比,对方案的有效性及可行性进行评价.结果循证研究提示血清谷丙转氨酶(Alanine aminotransferase,ALT)不足以充分反映肝功损伤；尿铬与反映机体损伤的指标关联性较好；外周血淋巴细胞双核细胞微核率可反映铬酸盐接触的遗传损伤.铬酸盐制造业工人肺癌健康监护的卫生经济学评价结果:成本效果比(cost/effectiveness,C/E)为42 321.61元/年,而在普通人群中C/E ＞252 868.97元/年.结论建议将检测血清谷丙转氨酶改为检测肝功能全项,尿铬由选检项目提升为必检项目,并增加外周血淋巴细胞双核细胞微核率作为选检项目.
목적 대락산염직업접촉자현유건강감호방안감호지표진행순증연구,대해방안진행보충화완선.방법 우2011년12월이륙개락여간손상、미핵、뇨락위주요검색내용,검색“고극란도서관(Cochran library)”、“PubMed”、“OVID Medline”、“Web of knowledge”여“중국생물의학문헌수거고”등수거고.병대검색도적문헌안조제정적납입여배제표준사선후,공계22편；의거우진증거분급표준,대기진행분급평개.결합작업장소현장조사급건강체검공작급위생경제학수단,병이총성본여총존활생명년수계산성본효과비,대방안적유효성급가행성진행평개.결과 순증연구제시혈청곡병전안매(Alanine aminotransferase,ALT)불족이충분반영간공손상；뇨락여반영궤체손상적지표관련성교호；외주혈림파세포쌍핵세포미핵솔가반영락산염접촉적유전손상.락산염제조업공인폐암건강감호적위생경제학평개결과:성본효과비(cost/effectiveness,C/E)위42 321.61원/년,이재보통인군중C/E ＞252 868.97원/년.결론 건의장검측혈청곡병전안매개위검측간공능전항,뇨락유선검항목제승위필검항목,병증가외주혈림파세포쌍핵세포미핵솔작위선검항목.
Objective The health surveillance proposal for chromate exposed workers was provided and analyzed on the evidence-based study and then to be improved.Method Firstly,the related literatures were searched about liver damage,micronuclei,urinary chromium and hexavalent chromium exposure in Evidence Based Medicine Reviews such as Cochran library,OVID Medline,Web of knowledge in December 2011 ; and then,these literatures were reviewed in according to inclusion and exclusion criterias; 22 articles totally were retrieved,evaluated and classified in according to the grading standard by Oxford Centre for Evidence-based Medicine.Finally,field epidemiological investigation was further adopted to confirm the efficiency and feasibility of this proposal,combined with cost-effectiveness analysis:the ratio of total cost divided survival years was used to express the cost-effectiveness.Result Only the glutamic pyruvic transaminase test could not reflect liver damage caused by chromate exposure well; Unirary chromium correlated well with the index reflecting body damage caused by chromate exposure; Binucleated cells micronucleus index in peripheral blood lymphocyte could reflect the genetic damage caused by chromate exposure.As for health economic evaluation of chromate lung cancer,the value of cost/effectiveness was ￥42 321.61 per year that was far below the value of common people(￥ 252 868.97 per year).Conclusion It was suggested that serum glutamic pyruvic transaminase test should be replaced by liver function test,urinary chromium should be classified as a compulsory index and binucleated cells micronucleus index in peripheral blood lymphocyte should be supplied as a recommended index.