某市轨道交通企业职业噪声暴露工人不同血压轨迹与听力阈值的关联性研究

Correlation between blood pressure trajectory and hearing threshold among workers exposed to occupational noise in a city's rail transit enterprise

  • 摘要:
    背景 高血压是我国患病率最高的慢性疾病之一,而高血压病史对听力损失具有潜在的加重倾向。探索血压长期趋势与听力阈值关联有助于职业噪声暴露人群听力保护工作。
    目的 通过调查某城市轨道交通企业职业噪声暴露工人的听力阈值与血压,综合分析长期血压变化和听力阈值的关联,为职业噪声暴露工人的健康管理提供数据参考。
    方法 选取某轨道交通企业所有接触噪声工人作为研究对象,对其进行纯音听力测试。使用组基轨迹模型识别工人的血压轨迹,通过χ2检验比较计数资料,通过t检验和方差分析比较服从正态分布的计数资料,采用广义线性混合模型检验这些轨迹组与高频听力阈值的关联。
    结果 2002名职业性噪声暴露工人年龄的中位数MP25P75)为32(28,35)岁,工龄MP25P75)为7(3,10)年。2019年时,高血压检出率为9.04%,平均收缩压为(122.97±11.60) mmHg,舒张压为(76.37±9.02) mmHg,听力损失检出率为10.1%,双耳高频平均听阈为(17.18±8.71)dB,双耳语频平均听阈为(13.79±3.46) dB。通过组基轨迹模型分别确定了3个收缩压轨迹组和3个舒张压轨迹组。与其他轨迹组相比,舒张压高稳定组听力损失检出率高于其他舒张压轨迹组(χ2=6.34,P=0.042),舒张压高稳定轨迹组的高频听力阈值分别高于低、中稳定组(P均<0.05)。在30~39岁人群中,舒张压中稳定组的高频听力阈值低于高稳定组β(95%CI)=−1.96(−3.61~−0.32)dB,P=0.020。
    结论 在某市轨道交通企业职业噪声暴露工人中,舒张压轨迹与高频听力呈正向关系。在中青年职业噪声暴露工人中,舒张压在听力损失的进展中,可能比收缩压扮演更为重要的角色。

     

    Abstract:
    Background Hypertension is one of the chronic diseases with the highest prevalence in China, and a history of hypertension may potentially exacerbate hearing loss. Investigating the association between long-term blood pressure trends and hearing thresholds could contribute to hearing protection efforts for occupationally noise-exposed populations.
    Objective By investigating hearing thresholds and blood pressure levels among occupationally noise-exposed workers in an urban rail transit enterprise, and conducting a comprehensive analysis of the association between long-term blood pressure changes and hearing thresholds, to provide data references for health management strategies targeting occupationally noise-exposed workers.
    Methods Workers exposed to occupational noise at a rail transit enterprise were enrolled as study subjects and underwent pure-tone audiometry. Group-based trajectory modeling was employed to identify blood pressure trajectories. Categorical data were compared using chi-square tests, while normally distributed continuous variables were analyzed via t-tests and analysis of variance (ANOVA). Generalized linear mixed models (GLMMs) were subsequently applied toexamine associations between these trajectory groups and high-frequency hearing thresholds.
    Results Among 2 002 occupationally noise-exposed workers, the median (P25, P75) age was 32 (28, 35) years, with a median (P25, P75) working tenure of 7 (3, 10) years. In 2019, the positive hypertension rate was 9.04%, with a mean systolic blood pressure (SBP) of (122.97±11.60) mmHg and a mean diastolic blood pressure (DBP) of (76.37±9.02) mmHg. The hearing loss prevalence was 10.1%, showing bilateral high-frequency average hearing thresholds of (17.18±8.71) dB and speech-frequency average thresholds of (13.79±3.46) dB. Three distinct trajectory groups were identified for both SBP and DBP. Compared with other trajectory groups, the high-stable DBP group exhibited significantly higher hearing loss prevalence (χ2=6.34, P=0.042) and elevated high-frequency hearing thresholds (all Ps<0.05). Specifically, within the 30-39 age subgroup, the moderate-stable DBP group demonstrated 1.96 dB lower high-frequency thresholds than the high-stable group β(95%CI): −1.96 (−3.61, −0.32), P=0.020.
    Conclusion Among occupationally noise-exposed workers in a municipal rail transit enterprise, DBP trajectories demonstrated a positive association with high-frequency hearing thresholds. Notably, in young and middle-aged occupationally noise-exposed populations, DBP may exert a more critical influence than SBP on the progression of hearing loss.

     

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