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目的了解兵器行业三硝基甲苯(TNT)作业人员恶性肿瘤的发病情况,为修订慢性TNT中毒诊断标准、制定TNT作业防护管理措施提供依据。方法对兵器行业8个工厂1970～1995年期间从事TNT作业1年以上的男工恶性肿瘤发病情况进行回顾性队列调查研究。结果接触组全恶性肿瘤发病率明显高于对照组,相对危险度(RR)为2.32。用全国大中城市1973～1975年和1990～1992年男性居民全恶性肿瘤死亡专率作标准计算标化死亡比(SMR)分别为71.8和179.6,99%CI为71.8～144.2,差异有显著性(P<0.01),表明TNT作业者全恶性肿瘤死亡率明显高于一般人群。肝癌发病率占全恶性肿瘤发病率的31.92%,死亡率为对照组的3.97倍。用全国大中城市1973～1975年和1990～1992年男性居民肝癌死亡率为标准计算,SMR分别为150.5和381.6,99%CI为59.3～184.0,差异有显著性(P<0.01),平均死亡年龄(51.7岁)比对照组(54.1岁)提前2.4岁,比全国大中城市居民(55.6岁)提前3.9岁。肝癌发病与工龄、工种以及接触TNT程度关系密切;饮酒有协同致癌作用。结论TNT作业男工全恶性肿瘤发病率和死亡率明显高于一般人群,肝癌居首位,其发病与工龄、工种、接触TNT程度关系密切。
Objective To understand the incidence of malignant tumor of trinitrotoluene (TNT) workers in the weaponry industry and provide the basis for revising the diagnostic criteria of chronic TNT poisoning and formulating TNT operation prevention and management measures. Methods A retrospective cohort study was conducted on the incidence of male worker malignancies who had been operating TNT for more than one year in eight factories in the weaponry industry from 1970 to 1995. Results The incidence of all malignant tumors in the contact group was significantly higher than that in the control group, with a relative risk (RR) of 2.32. The standardized mortality ratios (SMRs) were 71.8% and 179.6%, respectively, and the 91% -98% CIs were 71.8% ~ 144.2% with the rates of total cancer deaths of male residents from 1973 to 1975 and from 1990 to 1992. The differences were significant (P <0.01), indicating that TNT operators all-cause cancer mortality was significantly higher than the general population. The incidence of liver cancer accounted for 31.92% of the total incidence of malignant tumors, the mortality rate of 3.97 times the control group. According to the mortality rates of male residents in large and medium-sized cities in China from 1973 to 1975 and from 1990 to 1992, the SMRs were 150.5 and 381.6 respectively, with a 99% CI of 59.3-184.0 (P <0.01), with an average of death The age (51.7 years) was 2.4 years earlier than that of the control group (54.1 years), 3.9 years earlier than that of the residents in cities in China (55.6 years old). The incidence of liver cancer is closely related to the length of service, type of work and the degree of exposure to TNT; drinking has a synergistic carcinogenic effect. Conclusion The incidence and mortality rate of total malignant tumors in male TNT workers were significantly higher than those in the general population. The incidence of liver cancer was the highest. The incidence of TNT was closely related to the length of service, type of job and TNT exposure.