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基于生物学指标评估我院PIVAS医务人员职业性接触抗肿瘤药物的风险
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| 篇名： | 基于生物学指标评估我院PIVAS医务人员职业性接触抗肿瘤药物的风险 |
| TITLE： | Evaluation of the Risk of Medical Staff Occupationally Exposed to Antineoplastic Drugs in PIVAS of Our Hos- pital Based on Biological Indicators |
| 摘要： | 目的：为静脉用药调配中心（PIVAS）医务人员职业性接触抗肿瘤药物（ADs）的暴露风险评估提供方法学参考。方法：2019年8－12月，纳入我院15名PIVAS医务人员作为暴露组，另招募15名非PIVAS医务人员作为对照组。进行外周血淋巴细胞凋亡率、尿8-羟基脱氧鸟苷（8-OHdG）水平、尿液致突变（Ames）情况（考察相当于原尿样10、20、40mL的浓缩尿样致鼠伤寒沙门氏菌TA98、TA100的突变率）检测，同时收集两组人员当年的健康体检资料。采用Spearman等级分析纳入人员工作年限与外周血淋巴细胞早期凋亡率、晚期凋亡率、总凋亡率以及尿8-OHdG水平的相关性。比较两组人员的各类体检指标差异；针对存在差异且异常的体检指标，再按正常生理值范围进行人员分布统计。结果：暴露组和对照组人员工作年限中位数分别为3年和6年，两组人员基线资料具有可比性（P＞0.05）。暴露组人员的外周血淋巴细胞晚期凋亡率和尿8-OHdG水平均显著高于对照组（P＜0.05或P＜0.01），但两组人员外周血淋巴细胞早期凋亡率和总凋亡率差异无统计学意义（P＞0.05）。暴露组人员工作年限与外周血淋巴细胞早期凋亡率、晚期凋亡率、总凋亡率以及尿8-OHdG水平的Spearman等级相关性系数分别为0.22、0.03、0.19、0.44，均不具有统计学意义（P＞0.05）。与对照组比较，暴露组人员的低、中、高水平尿浓缩液致TA98、TA100菌的突变率分别提升13.33％、20.00％、26.66％和6.67％、13.34％、13.34％。健康体检资料中，两组人员的血糖、大型血小板比率、中性粒细胞比率、中值细胞比率、血小板数、平均血小板体积和球蛋白比较差异均有统计学意义（P＜0.05），但两组人员上述差异指标数值大部分都在正常范围内，异常值人员分布情况比较差异无统计学意义（P＞0.05）。结论：我院PIVAS医务人员存在一定的职业暴露风险，但风险程度尚处于机体代偿范围内。采用实验室检查结合健康体检资料的生物学指标评估PIVAS医务人员ADs职业暴露风险是一种可行的手段。 |
| ABSTRACT： | OBJECTIVE：To provide methodological reference for evaluating the r isk of occupational exposure to antineoplastic drugs（ADs）among the medical staff of pharmacy intravenous admixture services （PIVAS）in our hospital . METHODS ：From Aug. to Dec. 2019，15 PIVAS staff were enrolled in the exposure group and other 15 non-PIVAS staff were selected as the control group. The determination of peripheral blood lymphocyte apoptosis ，urine 8-hydroxydeoxyguanosine（8-OHdG）and mutagenicity （Ames）in urine （mutation rates of Salmenella typhimurium TA98 and TA 100 caused by concentrated urine samples of 10，20 and 40 mL were investigated ）were carried out. At the same time ，the physical examination data of 2 groups were collected. Spearman rank analysis was used to analyze the correlation of working years with early apoptosis rate ，late apoptosis rate and total （No.cstc2018jscx-msybX0138） apoptosis rate of peripheral blood lymphocytes as well as urine E-mail：hxgcq1987@126.com 8-OHdG level. The differences of various physical examination indexes between the two groups were compared. For the physical examination indexes with differences，the personnel distribution was counted according to the normal value range. RESULTS ：The median of service length were 3 years in the exposure group and 6 years in control group ，and baseline data of 2 groups were comparable （P＞0.05）. The late apoptosis rate of peripheral blood lymphocytes and urinary 8-OHdG level in the exposure group were significantly higher than control group （P＜ 0.05 or P＜0.01），but there was no statistical significance in early apoptosis rate and total apoptosis rate of peripheral blood lymphocytes between 2 groups（P＞0.05）. The Spearman rank correlation coefficients of service length with the early apoptosis rate，late apoptosis rate ，total apoptosis rate of peripheral blood lymphocytes as well as urine 8-OHdG level were 0.22，0.03，0.19 and 0.44，respectively，which were not statistically significant （P＞0.05）. Compared with control group ，the mutation rates of S. typhimurium TA98 and TA 100 induced by low ，medium and high doses of urine concentrate were increased by 13.33％，20.00％， 26.66％ and 6.67％，13.34％，13.34％ respectively. In health examination data ，blood glucose ，large platelet ratio ，neutrophil ratio，median cell ratio ，platelet count ，mean platelet volume and globulin were significantly different between 2 groups（P＜ 0.05）. However ，most of above difference indexes of 2 groups were within the normal range ，and there was no significant difference in the distribution of abnormal value （P＞0.05）. CONCLUSION ：PIVAS staff in our hospital have certain occupational exposure risk ，but the degree of risk is still within the range of body compensation. It is a feasible method to evaluate the occupational exposure risk of PIVAS staff to ADs by using biological indicators of experimental examination combined with physical examination data. |
| 期刊： | 2020年第31卷第18期 |
| 作者： | 胡小刚，张小华，陈开杰，刘玲，李娜 |
| AUTHORS： | HU Xiaogang ，ZHANG Xiaohua ，CHEN Kaijie，LIU Ling，LI Na |
| 关键字： | 抗肿瘤药物；静脉用药调配中心；生物学指标；职业危害；暴露风险 |
| KEYWORDS： | Antineoplastic drugs ；Pharmacy intravenous admixture services ；Biological indicators ；Occupational hazards ； |
| 阅读数： | 302 次 |
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