本文選題：石油工人 + 職業(yè)緊張　； 參考：《新疆醫(yī)科大學》2016年博士論文

【摘要】：目的:調(diào)查新疆沙漠油田作業(yè)人員職業(yè)緊張水平、心理健康狀況、骨骼肌肉損傷以及生理健康等基本情況,采取前瞻性隊列研究分析職業(yè)緊張因素對高血壓的影響及其因果關系,探討GR和β_2-AR基因多態(tài)性在職業(yè)緊張所致高血壓中的作用。比較高血壓和對照組以及不同緊張程度組間ADD1基因啟動子區(qū)DNA甲基化的差異,探討表觀遺傳學在職業(yè)緊張與高血壓相關性中的作用。完善沙漠油田作業(yè)人員職業(yè)緊張和高血壓的流行病學資料,為制定和提高沙漠油田作業(yè)人員的身心健康水平、防治高血壓提供科學依據(jù)。方法:1)本研究采取分層整群抽樣方法,使用職業(yè)緊張量表(OSI-R)、付出-回報失衡量表、癥狀自評量表、抑郁自評量表、焦慮自評量表、骨骼肌肉損傷量表等調(diào)查問卷,對4370名沙漠油田作業(yè)人員進行現(xiàn)況調(diào)查;2)隨機抽取了3個油田公司共1280人作為實施本次隊列研究的基線資料,進行2年的隨訪研究,分析職業(yè)緊張的變化對高血壓的影響;3)應用聚合酶鏈式反應限制性片段長度多態(tài)法(polymerasechain reaction-restriction fragment length polymorphism,PCR-RFLP),檢測確診為高血壓的179名病例組和179名對照組(匹配同性別、年齡±3歲、同民族)的GR和β_2-AR基因多態(tài)性;4)采用亞硫酸氫鹽克隆測序法處理基因組DNA,隨后設計BSP引物進行PCR,并對PCR產(chǎn)物進行測序判斷ADD1基因CpG位點是否發(fā)生甲基化。結果:1)共發(fā)放調(diào)查問卷4500份,收回有效合格問卷4370份,問卷有效率為97.11%;2)本次調(diào)查的沙漠油田作業(yè)人員職業(yè)緊張得分高于全國常模;不同性別、不同民族、不同文化程度、不同工種、不同學歷、不同工齡、不同職稱間職業(yè)任務緊張得分比較差異有統(tǒng)計學意義(P0.05);3)不同文化程度組、不同工種、不同工齡組、不同職稱組外在付出、工作回報比較,差異有統(tǒng)計學意義(P0.05);4)不同民族、年齡、工齡、職稱和婚姻狀況SCL-90得分、SDS得分、SAS得分比較差異有統(tǒng)計學意義(P0.05),職業(yè)任務緊張(ORQ)與個體緊張反應(PSQ)與SDS得分、SAS得分、SCL-90得分均呈正相關,個體應對資源(PRQ)與SDS得分、SAS得分、SCL-90得分均呈負相關。隨著職業(yè)緊張程度的增加,缺勤發(fā)生率有所增加,付出-回報失衡者即高付出低回報者缺勤發(fā)生率較高;5)此次共調(diào)研4370人,近一年有肌肉骨骼損傷患病率為83.29%,其中腰背部損傷患病率為80.25%,頸肩部損傷患病率為70.96%。不同緊張程度組腰背部、頸肩部患病情況比較差異有統(tǒng)計學意義(p0.05)。腰背部及頸肩部有損傷組wai得分低于沒有損傷組(p0.05)。對石油工人骨骼肌肉損傷狀況的影響進行l(wèi)ogistic回歸分析,結果提示性別、民族、月收入、職業(yè)緊張程度、SCL-90得分、eri、wai是發(fā)生肌肉骨骼損傷的影響因素;6)此次調(diào)查高血壓患病率最高,職業(yè)緊張與血糖呈正相關。隨著職業(yè)緊張程度的增加血糖會升高;7)高血壓發(fā)病情況:1080人進入隊列,到隨訪終止時,共有85人失訪,本研究共隨訪995名石油工人,有193名發(fā)生了高血壓,高血壓累積發(fā)病率為19.4%,年齡、行為生活方式(吸煙、飲酒、bmi值)、職業(yè)緊張狀況(職業(yè)任務、個體緊張反應)和付出-回報失衡是沙漠油田作業(yè)人員高血壓發(fā)病的主要危險因素;8)控制了其他因素后,隊列開始和隨訪結束職業(yè)緊張水平低-高組發(fā)生高血壓的風險是低-低組的2.687倍,職業(yè)緊張水平高-高組發(fā)生高血壓的風險是低-低組的2.970倍。個體緊張反應水平低-高組發(fā)生高血壓的風險是低-低組的2.141倍,個體緊張反應水平高-高組發(fā)生高血壓的風險是低-低組的3.907倍;9)控制職業(yè)緊張這個危險因素,可使職業(yè)緊張低-高組、高-高組,個體緊張反應低-高組、高-高組中,高血壓發(fā)病率分別減少14.35%、13.26%、11.52%、17.84%;10)GRBC1Ⅰ、β_2-AR46A/G、β_2-ARGln27glu在高血壓病例組和對照組上的分布差異有統(tǒng)計學意義(p0.05);GRBC1Ⅰ位點cg+gg患高血壓的風險增加,β_2-AR46A/G位點AG+GG患高血壓的風險增加;11)采用gmdr軟件分析,GRBC1Ⅰ和β_2-AR46A/G之間,職業(yè)緊張和GRBC1Ⅰ之間的交互作用有統(tǒng)計學意義;12)高血壓組和對照組ADD1基因CpG3、CpG5和CpG10位點比較差異有統(tǒng)計學意義(p0.05),高血壓患者中高度職業(yè)緊張組和低度職業(yè)緊張組ADD1基因CpG3、CpG5位點在兩組比較差異有統(tǒng)計學意義(p0.05)。結論:1)沙漠油田作業(yè)人員職業(yè)緊張得分高于全國常模,男性、少數(shù)民族、鉆井工、本科以上學歷、10年工齡、初級職稱的沙漠油田作業(yè)人員職業(yè)緊張程度較高。井下工人付出-回報不平衡最突出,隨著工齡、職稱、月收入的增加,付出-回報失衡感越重;2)少數(shù)民族的心理異常、焦慮和抑郁水平高于漢族。年齡在30~45歲組、工齡在10~20年的工人心理健康狀態(tài)最差、焦慮和抑郁水平最高,高級職稱、鉆井工的心理異常、焦慮和抑郁水平較高。離異或是喪偶工人,焦慮抑郁水平高。隨著職業(yè)緊張程度的增加,焦慮抑郁的檢出率和缺勤發(fā)生率都有所增加,緊張反應是抑郁、焦慮和心理健康的危險因素;3)隨著石油工人職業(yè)緊張程度的增加,腰背部、頸肩部損傷檢出率增加;付出-回報失衡者腰背部、頸部及肩部損傷的檢出率較高;4)此次調(diào)查高血壓患病率最高,隨著職業(yè)緊張程度的增加血糖會升高,職業(yè)緊張與血糖的含量呈正相關;5)高血壓發(fā)病率隨年齡和職業(yè)緊張水平的增加逐漸增加。年齡、行為生活方式(吸煙、飲酒、bmi值)、職業(yè)緊張和付出-回報失衡是石油工人高血壓發(fā)病的主要危險因素。職業(yè)緊張水平升高組和個體緊張反應升高組發(fā)生高血壓的風險更大,職業(yè)緊張水平越高,高血壓發(fā)病的危險越大。通過控制職業(yè)緊張水平,可以降低人群高血壓的發(fā)病率,具有一定的公共衛(wèi)生意義;5)GR BclⅠ位點CG+GG基因型、β_2-AR 46A/G位點AG+GG基因型是高血壓的易感基因型。GR BclⅠ和β_2-AR 46A/G之間的交互作用、職業(yè)緊張和GR BclⅠ之間的交互作用模型分別是基因-基因、基因-環(huán)境的最優(yōu)交互作用組合。高血壓組個別位點甲基化水平低于對照組,高血壓患者的高度職業(yè)緊張組部分位點甲基化水平低于低度職業(yè)緊張組,說明ADD1基因啟動子甲基化降低,可增加原發(fā)性高血壓的風險,ADD1基因甲基化水平在職業(yè)緊張與高血壓相關性中有一定的調(diào)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.
【學位授予單位】：新疆醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R131

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