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目的探讨血浆中4种血管调节因子与手传振动接触人群发生振动性白指(VWF)的相关性,初步探讨其用于筛查VWF的价值。方法采用典型抽样方法,抽取某金属加工厂从事金属打磨抛光作业1年以上的77名男性手传振动作业工人为研究对象。根据主诉VWF情况分为非VWF组(34人)和VWF组(43人)。采集研究对象肘正中静脉血,分离血浆,采用放射免疫法检测内皮素(ET)水平,采用酶联免疫吸附法检测转化生长因子-β(TGF-β)、可溶性细胞间黏附分子(s ICAM-1)和5-羟色胺(5-HT)水平。采用Logistic回归分析筛选VWF判断指标,并构建新的多变量模型指标^y,对有关指标进行受试者工作特征(ROC)曲线分析。结果与非VWF组比较,VWF组工人血浆中ET水平下降(P<0.01),TGF-β水平升高(P<0.01);但2组工人血浆中s ICAM-1和5-HT水平分别比较,差异均无统计学意义(P>0.05)。Logistic回归分析结果显示:在排除年龄、吸烟、饮酒和手部症状等混杂因素后,ET水平与VWF发生呈负相关(P<0.01),TGF-β水平与VWF发生呈正相关(P<0.01);s ICAM-1和5-HT水平均与VWF发生无关联(P>0.05)。采用ET和TGF-β判断VWF的ROC曲线下面积(A_Z)分别为0.787、0.691(P<0.01),灵敏度分别为70.60%和53.49%,特异度分别为79.10%和85.29%;通过Logistic回归模型,以ET和TGF-β构建的^y判断VWF的A_Z为0.821(P<0.01),灵敏度和特异度分别为72.09%和76.47%。ET和TGF-β、^y和ET的A_Z分别比较,差异均无统计学意义(P>0.05);^y的A_Z高于TGF-β(P<0.05)。结论手传振动接触人群血浆中ET和TGF-β水平均与VWF发生有关联,可进一步用于筛查VWF的研究;s ICAM-1和5-HT与VWF的关联性有待进一步研究。
Objective To investigate the correlation between four kinds of vascular regulators in plasma and VWF in patients exposed to hand-transmitted vibration, and to investigate the value of VWF in screening VWF. Methods A typical sampling method was used to select 77 masculine hand vibration workers who were engaged in metal polishing and polishing for more than one year in a metal processing factory. Divided into non-VWF group (34 persons) and VWF group (43 persons) according to the main VWF condition. Plasma samples were collected from the elbow of the elbow and plasma was collected. Endothelin (ET) was detected by radioimmunoassay. The levels of TGF-β, s ICAM- 1) and serotonin (5-HT) levels. Logistic regression analysis was used to screen VWF judgments, and a new multivariate model was constructed, and the receiver operating characteristic (ROC) curves were analyzed. Results Compared with non-VWF group, plasma ET level decreased and the level of TGF-β increased in VWF group (P <0.01). However, the levels of plasma s ICAM-1 and 5-HT in two groups of workers were compared , There was no significant difference (P> 0.05). Logistic regression analysis showed that there was a negative correlation between the level of ET and VWF (P <0.01), and the level of TGF-βwas positively correlated with the occurrence of VWF (P <0.01) after excluding confounding factors such as age, smoking, ; s ICAM-1 and 5-HT levels were not associated with VWF (P> 0.05). The area under the ROC curve of VWF was 0.787,0.691 (P <0.01), the sensitivity was 70.60% and 53.49%, the specificity was 79.10% and 85.29% respectively by using ET and TGF-β. The Logistic regression model The A_Z of VWF was 0.821 (P <0.01) with sensitivity of 72.09% and specificity of 76.47% for ET and TGF-β, respectively. There were no significant differences in the A_Z of ET, TGF-β, γ-y and ET between the two groups (P> 0.05). The A_Z of y was higher than that of TGF-β (P <0.05). Conclusions The levels of ET and TGF-β in plasma are closely related to the occurrence of VWF. The relevance of ICAM-1 and 5-HT to VWF remains to be further studied.