新疆沙漠油田作业人员职业紧张水平与高血压的相关研究

发布时间：2018-07-08 19:01

本文选题：石油工人 + 职业紧张　；参考：《新疆医科大学》2016年博士论文

【摘要】：目的:调查新疆沙漠油田作业人员职业紧张水平、心理健康状况、骨骼肌肉损伤以及生理健康等基本情况,采取前瞻性队列研究分析职业紧张因素对高血压的影响及其因果关系,探讨GR和β_2-AR基因多态性在职业紧张所致高血压中的作用。比较高血压和对照组以及不同紧张程度组间ADD1基因启动子区DNA甲基化的差异,探讨表观遗传学在职业紧张与高血压相关性中的作用。完善沙漠油田作业人员职业紧张和高血压的流行病学资料,为制定和提高沙漠油田作业人员的身心健康水平、防治高血压提供科学依据。方法:1)本研究采取分层整群抽样方法,使用职业紧张量表(OSI-R)、付出-回报失衡量表、症状自评量表、抑郁自评量表、焦虑自评量表、骨骼肌肉损伤量表等调查问卷,对4370名沙漠油田作业人员进行现况调查;2)随机抽取了3个油田公司共1280人作为实施本次队列研究的基线资料,进行2年的随访研究,分析职业紧张的变化对高血压的影响;3)应用聚合酶链式反应限制性片段长度多态法(polymerasechain reaction-restriction fragment length polymorphism,PCR-RFLP),检测确诊为高血压的179名病例组和179名对照组(匹配同性别、年龄±3岁、同民族)的GR和β_2-AR基因多态性;4)采用亚硫酸氢盐克隆测序法处理基因组DNA,随后设计BSP引物进行PCR,并对PCR产物进行测序判断ADD1基因CpG位点是否发生甲基化。结果:1)共发放调查问卷4500份,收回有效合格问卷4370份,问卷有效率为97.11%;2)本次调查的沙漠油田作业人员职业紧张得分高于全国常模;不同性别、不同民族、不同文化程度、不同工种、不同学历、不同工龄、不同职称间职业任务紧张得分比较差异有统计学意义(P0.05);3)不同文化程度组、不同工种、不同工龄组、不同职称组外在付出、工作回报比较,差异有统计学意义(P0.05);4)不同民族、年龄、工龄、职称和婚姻状况SCL-90得分、SDS得分、SAS得分比较差异有统计学意义(P0.05),职业任务紧张(ORQ)与个体紧张反应(PSQ)与SDS得分、SAS得分、SCL-90得分均呈正相关,个体应对资源(PRQ)与SDS得分、SAS得分、SCL-90得分均呈负相关。随着职业紧张程度的增加,缺勤发生率有所增加,付出-回报失衡者即高付出低回报者缺勤发生率较高;5)此次共调研4370人,近一年有肌肉骨骼损伤患病率为83.29%,其中腰背部损伤患病率为80.25%,颈肩部损伤患病率为70.96%。不同紧张程度组腰背部、颈肩部患病情况比较差异有统计学意义(p0.05)。腰背部及颈肩部有损伤组wai得分低于没有损伤组(p0.05)。对石油工人骨骼肌肉损伤状况的影响进行logistic回归分析,结果提示性别、民族、月收入、职业紧张程度、SCL-90得分、eri、wai是发生肌肉骨骼损伤的影响因素;6)此次调查高血压患病率最高,职业紧张与血糖呈正相关。随着职业紧张程度的增加血糖会升高;7)高血压发病情况:1080人进入队列,到随访终止时,共有85人失访,本研究共随访995名石油工人,有193名发生了高血压,高血压累积发病率为19.4%,年龄、行为生活方式(吸烟、饮酒、bmi值)、职业紧张状况(职业任务、个体紧张反应)和付出-回报失衡是沙漠油田作业人员高血压发病的主要危险因素;8)控制了其他因素后,队列开始和随访结束职业紧张水平低-高组发生高血压的风险是低-低组的2.687倍,职业紧张水平高-高组发生高血压的风险是低-低组的2.970倍。个体紧张反应水平低-高组发生高血压的风险是低-低组的2.141倍,个体紧张反应水平高-高组发生高血压的风险是低-低组的3.907倍;9)控制职业紧张这个危险因素,可使职业紧张低-高组、高-高组,个体紧张反应低-高组、高-高组中,高血压发病率分别减少14.35%、13.26%、11.52%、17.84%;10)GRBC1Ⅰ、β_2-AR46A/G、β_2-ARGln27glu在高血压病例组和对照组上的分布差异有统计学意义(p0.05);GRBC1Ⅰ位点cg+gg患高血压的风险增加,β_2-AR46A/G位点AG+GG患高血压的风险增加;11)采用gmdr软件分析,GRBC1Ⅰ和β_2-AR46A/G之间,职业紧张和GRBC1Ⅰ之间的交互作用有统计学意义;12)高血压组和对照组ADD1基因CpG3、CpG5和CpG10位点比较差异有统计学意义(p0.05),高血压患者中高度职业紧张组和低度职业紧张组ADD1基因CpG3、CpG5位点在两组比较差异有统计学意义(p0.05)。结论:1)沙漠油田作业人员职业紧张得分高于全国常模,男性、少数民族、钻井工、本科以上学历、10年工龄、初级职称的沙漠油田作业人员职业紧张程度较高。井下工人付出-回报不平衡最突出,随着工龄、职称、月收入的增加,付出-回报失衡感越重;2)少数民族的心理异常、焦虑和抑郁水平高于汉族。年龄在30~45岁组、工龄在10~20年的工人心理健康状态最差、焦虑和抑郁水平最高,高级职称、钻井工的心理异常、焦虑和抑郁水平较高。离异或是丧偶工人,焦虑抑郁水平高。随着职业紧张程度的增加,焦虑抑郁的检出率和缺勤发生率都有所增加,紧张反应是抑郁、焦虑和心理健康的危险因素;3)随着石油工人职业紧张程度的增加,腰背部、颈肩部损伤检出率增加;付出-回报失衡者腰背部、颈部及肩部损伤的检出率较高;4)此次调查高血压患病率最高,随着职业紧张程度的增加血糖会升高,职业紧张与血糖的含量呈正相关;5)高血压发病率随年龄和职业紧张水平的增加逐渐增加。年龄、行为生活方式(吸烟、饮酒、bmi值)、职业紧张和付出-回报失衡是石油工人高血压发病的主要危险因素。职业紧张水平升高组和个体紧张反应升高组发生高血压的风险更大,职业紧张水平越高,高血压发病的危险越大。通过控制职业紧张水平,可以降低人群高血压的发病率,具有一定的公共卫生意义;5)GR BclⅠ位点CG+GG基因型、β_2-AR 46A/G位点AG+GG基因型是高血压的易感基因型。GR BclⅠ和β_2-AR 46A/G之间的交互作用、职业紧张和GR BclⅠ之间的交互作用模型分别是基因-基因、基因-环境的最优交互作用组合。高血压组个别位点甲基化水平低于对照组,高血压患者的高度职业紧张组部分位点甲基化水平低于低度职业紧张组,说明ADD1基因启动子甲基化降低,可增加原发性高血压的风险,ADD1基因甲基化水平在职业紧张与高血压相关性中有一定的调控作用。
[Abstract]:Objective: To investigate the occupational stress level, mental health status, skeletal muscle injury and physiological health of the workers in Xinjiang desert oil field, take a prospective cohort study to analyze the effect of occupational stress factors on hypertension and its causality, and explore the role of GR and beta _2-AR based polymorphisms in hypertension induced by occupational stress. To compare the difference of DNA methylation in the promoter region of ADD1 gene between the hypertension and the control group and the different tension groups, to explore the role of epigenetics in the relationship between occupational stress and hypertension. To improve the epidemiological data of occupational stress and hypertension in desert oilfield workers, and to formulate and improve the body and mind of the workers in the desert oilfield. Health level, provide scientific basis for prevention and control of hypertension. Methods: 1) the study adopted a stratified cluster sampling method, using occupational stress scale (OSI-R), pay return imbalance scale, symptom checklist, self rating depression scale, self rating anxiety scale, skeletal muscle injury scale and so on, 4370 desert oil field workers were present. Survey; 2) a total of 1280 people from 3 oilfield companies were randomly selected as baseline data for this cohort study for 2 years of follow-up study to analyze the impact of occupational stress changes on hypertension; 3) polymerase chain reaction restriction fragment length polymorphism (polymerasechain reaction-restriction fragment length polymorphism, PC). R-RFLP), 179 cases of hypertension were detected and 179 control groups (matching the same sex, age + 3 years old, the same nationality) GR and beta _2-AR gene polymorphism; 4) using hydrogen sulfite cloned sequencing method to deal with genomic DNA, then designed BSP primers for PCR, and sequencing the PCR product to determine whether the ADD1 gene CpG site was methylated. Results: 1) a total of 4500 questionnaires were issued, 4370 valid questionnaires were collected, the efficiency of the questionnaire was 97.11%; 2) the occupational stress score of the desert oilfield workers was higher than the national norm; the different sex, different ethnic groups, different cultural degrees, different types of work, different educational background, different work age, and different professional titles between different professional titles The differences were statistically significant (P0.05); 3) different cultural degree groups, different types of work, different work age groups, different professional title group external pay, work return comparison, the difference is statistically significant (P0.05); 4) different ethnic groups, age, work age, professional title and marital status SCL-90 score, SDS score, SAS scores are statistically significant difference (P0.05), occupation (P0.05), occupation Task tension (ORQ) and individual stressful response (PSQ) were positively correlated with SDS scores, SAS scores and SCL-90 scores. Individual coping resources (PRQ) were negatively correlated with SDS scores, SAS scores and SCL-90 scores. With the increase of occupational stress, the incidence of absenteeism increased, and the rate of absence of pay and return imbalances was higher in those with high pay and low returns, and 5 The prevalence rate of musculoskeletal injury was 83.29% in the last year of 4370 people. The incidence of lumbar and back injury was 80.25%, the incidence of neck and shoulder injury was 70.96%. in the waist and back of different tension groups, and the difference of neck and shoulder was statistically significant (P0.05). The score of Wai in the injured group of the back and the neck and shoulder was lower than that of no injury. Group (P0.05). Logistic regression analysis on the effects of skeletal muscle damage on oil workers, the results suggest that sex, nationality, monthly income, occupational stress, SCL-90 score, ERI, Wai are the factors affecting musculoskeletal injury; 6) the prevalence of hypertension is the highest in this survey, and the occupational stress is positively related to blood sugar. Increased blood sugar increased; 7) the incidence of hypertension: 1080 people entered the cohort, and at the end of the follow-up, 85 people were lost. A total of 995 oil workers were followed up, 193 had high blood pressure, the cumulative incidence of hypertension was 19.4%, age, behavioral lifestyle (smoking, drinking, BMI), occupational stress (occupational task, individual tension). Reaction) and pay return imbalance were the main risk factors for hypertension in desert oilfield workers; 8) after controlling other factors, the risk of high blood pressure in the low to high group at the beginning of the cohort and the end of the follow-up was 2.687 times as high as that of the low low group, and the risk of high blood pressure in the high and high group of occupational stress level was 2.970 of the low low group. The risk of high blood pressure in the low and high group was 2.141 times that of the low low group, and the risk of high blood pressure in the high group was 3.907 times that of the low low group; 9) the risk factor of controlling occupational stress could make the occupational stress low high group, high high group, the individual tension response low high group, high high group, high blood group. The incidence of pressure incidence was reduced by 14.35%, 13.26%, 11.52%, 17.84%, 10), GRBC1 I, beta _2-AR46A/G, and beta _2-ARGln27glu were statistically significant (P0.05) in the hypertension case group and the control group (P0.05); the risk of hypertension in GRBC1 I loci cg+gg increased, the risk of hypertension in the beta _2-AR46A/G point AG+GG increased; 11) the gmdr software analysis, GRBC1 was used, GRBC1. Between I and beta _2-AR46A/G, the interaction between occupational stress and GRBC1 I had statistical significance. 12) the ADD1 gene CpG3, CpG5 and CpG10 loci in the hypertension group and the control group were statistically significant (P0.05). The ADD1 gene CpG3 in the high occupational stress group and the low occupational stress group in the hypertensive patients and the CpG5 loci were different in the two groups. Statistical significance (P0.05). Conclusions: 1) the occupational stress score of the workers in the desert oil field is higher than the national norm. The occupational stress of the workers in the desert oilfield is higher than that of the male, the minority, the drilling workers, the undergraduate education, the 10 year working age and the primary title. Plus, the heavier the imbalance of pay and return; 2) the mental abnormality, anxiety and depression level of the minority nationalities is higher than that of the Han people. The age of the 30~45 year old group is the worst, the level of mental health of the workers in 10~20 years is the worst, the level of anxiety and depression is the highest, the higher professional title, the psychological abnormality of the drilling workers, the higher level of anxiety and depression. The level of depression was high. With the increase of occupational stress, the detection rate of anxiety and depression and the incidence of absenteeism increased, and the tension reaction was the risk factor of depression, anxiety and mental health. 3) with the increase of occupational stress in the oil workers, the detection rate of injury in the back and shoulder of the waist and the neck and shoulder increased, and the back, neck and shoulder of the pay and return imbalances were in the back. The detection rate of the injury was high; 4) the prevalence of hypertension was the highest in this survey. With the increase of occupational stress, the blood sugar increased, the occupational stress was positively correlated with the content of blood sugar; 5) the incidence of hypertension increased gradually with the increase of age and occupational stress level. Age, as the way of life (smoking, drinking, BMI), occupational stress and payment. The imbalance of output and return is the main risk factor of hypertension in oil workers. The risk of hypertension is greater in the higher occupational stress level group and the individual tension response group, the higher the occupational stress level, the greater the risk of hypertension. By controlling the occupational stress level, the incidence of hypertension can be reduced, and the risk of hypertension can be reduced. Public health significance; 5) GR Bcl I loci CG+GG genotype, the beta _2-AR 46A/G locus AG+GG genotype is the interaction between the susceptible genotype.GR Bcl I and the beta _2-AR 46A/G, the interaction model between occupational stress and GR Bcl I is the optimal interaction combination of gene gene, gene environment and the individual position of hypertension group. The level of methylation was lower than that of the control group. The methylation level in the high occupational stress group was lower than the low occupational stress group, indicating that the ADD1 gene promoter methylation decreased, which could increase the risk of primary hypertension, and the ADD1 gene methylation level had a certain regulatory role in the relationship between occupational stress and hypertension.
【学位授予单位】：新疆医科大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R131

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