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目的:研究生产和生活性青石棉暴露与恶性肿瘤死亡之间的关系。方法:利用1984年在云南省大姚县青石棉污染区建立的含1249例健康人群的回顾性队列,通过COX等比例风险模型计算青石棉接触时间以及生产风炉、原料处理、刷墙、砌灶和浆衣等过程中的青石棉暴露对恶性肿瘤死亡的风险比(hazard ratio,HR)及其95%可信区间(condence interval,CI)。结果:截至2011年4月30日,队列中共有121例恶性肿瘤死亡病例。调整年龄、性别、婚姻、文化程度、吸烟和饮酒等混杂因素后,与接触期限≤5年相比,青石棉接触6～10年的HR=2.898(95%CI:1.496～5.616)、11～15年的HR=4.159(95%CI:2.169～7.975)、>15年的HR=4.233(95%CI:1.182～9.886),且有显著的剂量-反应关系(Ptrend<0.05);与不生产风炉相比,零星生产风炉的HR=2.533(95%CI:1.549～4.142),成批生产风炉的HR=2.541(95%CI:1.642～3.935);与不处理原材料相比,机器粉碎原材料HR=1.811(95%CI:1.211～2.709),人工粉碎原材料HR=1.785(95%CI:1.072～2.793);刷墙4次以上HR=1.736(95%CI:1.000～3.012);砌灶HR=2.229(95%CI:0.97～5.122);浆衣HR=3.307(95%CI:1.522～7.184)。结论:生产和生活性青石棉接触均可增加恶性肿瘤的死亡风险。
Objective: To study the relationship between production and living crocidolite exposure and the death of malignant tumor. Methods: A retrospective cohort of 1249 healthy people established in crocidolite contaminated area in Dayao County, Yunnan Province in 1984 was used to calculate crocidolite exposure time and the production of stove, raw material processing, brushing and wall construction by COX proportional hazard model (Hazard ratio, HR) and its 95% confidence interval (CI) for crocidolite exposure to malignant tumor in the process of cooking, caulking and slimming. Results: As of April 30, 2011, there were 121 deaths from malignancies in the cohort. After adjusting for age, gender, marital status, education level, smoking and drinking, the HR of crocidolite exposed to 6 to 10 years was 2.898 (95% CI: 1.496-5.616) The 15-year HR was 4.159 (95% CI: 2.169-7.975) and> 15 years was 4.233 (95% CI: 1.182-9.886) with a significant dose- response relationship (Ptrend <0.05) HR = 2.533 (95% CI: 1.549 ~ 4.142) for blast stoves and HR = 2.541 (95% CI: 1.642 ~ 3.935) for blast furnaces in batch production compared with blast furnaces. Compared with the untreated raw materials, the machine HR = 1.811 (95% CI: 1.211 ~ 2.709), HR = 1.785 (95% CI: 1.072 ~ 2.793) for pulverized raw materials; HR = 1.736 HR = 2.229 (95% CI: 0.97 ~ 5.122); HR = 3.307 (95% CI: 1.522 ~ 7.184). Conclusion: Exposure to both productive and living crocidolite increases the risk of death from malignancies.