【作者】 杨华；

【导师】 严孙杰；

【作者基本信息】 福建医科大学 ， 内科学， 2010， 硕士

【摘要】 职业紧张作为目前最重要的危害职业人群精神卫生和健康的主要问题之一,其对职业人群健康及社会经济的影响越来越受到重视。列车乘警的工作属于脑力和体力结合性,属于高紧张暴露水平的工作类型。生殖内分泌系统不仅是参与紧张反应的重要系统,更是易受紧张危害的系统,紧张已成为生殖内分泌疾病常见而重要的原因。有研究表明,职业紧张对生殖健康的激素分泌有着一定的影响。对男性乘警、乘务员职业紧张与生殖激素水平的分析,探讨职业紧张对男性乘警生殖激素水平的影响,从而为职业紧张影响男性生殖功能的机制提供理论依据。第一部分男性列车乘警职业紧张水平的调查与分析目的:调查研究并比较男性列车乘警和乘务员的职业紧张水平方法:以福州某铁路分局,工龄≥3年,初中文化以上在职男性乘警为研究对象,105人。采用整群抽样方法,抽取作环境和饮食生活习惯相同的同一铁路分局某条客运段,工龄≥3年,初中文化以上的男性乘务员为对照,158人。采用职业紧张量表(OSI-R)进行调查,该量表包括3个分量表14个子项140个条目。A型行为采用英国著名学者Cooper教授研制的《A型行为量表》,共14项,焦虑采用状态/特质焦虑调查表(STAI)。结果:为控制影响因素,将年龄、工龄和文化程度作为协变量,用协方差分析比较乘警和乘务员的职业紧张及各项得分的差异。乘警职业紧张总评分(279.68±38.35)高于乘务员(265.95±46.44)。职业任务的平均得分(169.18±21.62)紧张反应的平均得分(161.95±24.90)均高于乘务员(110.35±21.00、103.01±25.51)。各个子项目分析显示,职业任务问卷中,乘警在职业任务中的“任务过重”(30.70±6.00)、“任务不适”(27.92±4.01)、“责任”(27.84±5.34)和“工作环境”(37.51±6.11)得分均高于乘务员;紧张反应问卷中“心理紧张反应”(32.90±7.48)、“躯体紧张反应”(30.80±8.12)的得分均高于乘务员。乘警的A型行为评分(46.44±6.02)高于乘务员(44.42±6.07),差异有统计学意义。子项目分析显示,“生活态度”(21.83±3.04)和“抱负”(11.57±2.33)得分均高于乘务员。乘警的状态焦虑(49.87±9.10)和特质焦虑(48.68±6.95)平均得分均高于乘务员(44.74±8.10、45.48±6.99)。以上差异均有有统计学意义(P<0.01)。结论乘警的职业紧张程度高于乘务员,属于高紧张暴露水平的工作类型。乘警的A型行为和焦虑程度高于乘务员。第二部分行车人员职业紧张的影响因素分析目的:行车人员职业紧张的影响因素分析方法:将第一部分的乘警与乘务员两组人群加以合并,形成行车人员。平均年龄43.63±8.78岁,平均工龄21.35±9.67年。应用SPSS15.0建立数据库,进行单因素分析、分层分析、协方差分析、多因素Logistic回归模型分析。结果:(1)对年龄进行分层研究结果显示,随着年龄的增大,职业紧张、职业任务与紧张反应都有下降的趋势,高年龄组的职业紧张程度低于低年龄组。但是差异均无统计学意义(P﹥0.05)。(2)对工龄进行分层,工龄15～25年组的职业紧张、职业任务与紧张反应评分最高,高于～15岁和25～岁组。但是差异均无统计学意义。(3)对文化程度进行分层,随着文化程度的升高,职业紧张、职业任务与紧张反应都有增加的趋势,文化程度大专及以上组的职业紧张评分最高。但是差异均无统计学意义。(4)对婚姻状况进行分层,已婚组职业紧张、职业任务与紧张反应评分最低,但是差异均无统计学意义。(5)A型行为的职业紧张、职业任务与紧张反应评分均高于B型行为,差异均无统计学意义。(6)高状态焦虑的职业紧张、职业任务与紧张反应评分均高于低状态焦虑,但差异均无统计学意义。高特质焦虑的职业紧张、职业任务与紧张反应评分均高于低特质焦虑,差异均有计学意义。(7)多因素非条件Logistic回归分析(α入=0.10,α出=0.15)。结果显示:除常见的年龄进入回归方程外,职业(乘警)与职业紧张显著相关(OR =5.093,P<0.05)。特质焦虑也进入回归方程(OR =0.597、0.040,P<0.05)。结论(1)行车人员职业紧张随年龄的增大而降低,工龄15～25年组的职业紧张最高;随着文化程度的升高,职业紧张增大,文化程度大专及以上组的职业紧张最高,已婚组职业紧张最低。A型行为的职业紧张高于B型行为,高特质焦虑的职业紧张高于低特质焦虑。(2)乘警职业和特质焦虑与职业紧张显著相关。乘警是职业紧张的高暴露人群。第三部分职业紧张对男性列车乘警生殖激素水平的影响目的:职业紧张对男性列车乘警生殖激素水平的影响方法:通过放射免疫法检测生殖激素[睾酮(T)、黄体生成素(LH)、促卵泡刺激素(FSH)]水平。通过单因素,分层分析,多因素和相关分析等探讨职业紧张对男性列车乘警生殖激素水平的影响。结果:(1)生殖激素水平总体分析:乘警的T(495.03±284.59)低于乘务员(586.29±443.70),乘警的FSH(6.11±3.26)高于乘务员(4.02±2.32),差异有统计学意义(P<0.01),乘警与乘务员LH差异没有统计学意义(P>0.05)。(2)分层分析:①T:在乘警组中高特质焦虑评分组的T低于低组,差异有统计学意义(P<0.05)。文化程度仅在高中组中乘警的T低于乘务员,差异有统计学意义(P<0.05)。婚姻状况分析中,仅在已婚组中,乘警的T均低于乘务员,差异有统计学意义。T在中等程度职业紧张下下降最明显,差异有统计学意义(P<0.05)。②LH:乘警高状态焦虑组的LH均低于乘警低状态焦虑组,差异有统计学意义(P<0.05)。③FSH:A型行为、焦虑的分层中,乘警的FSH均高于乘务员,差异有统计学意义(P<0.05)。(3)影响生殖激素浓度的多因素分析以T、LH、FSH为应变量,以职业、年龄、工龄、婚姻状况、文化程度、吸烟情况、饮酒情况、体育活动、A型行为、状态焦虑、特质焦虑、职业紧张为自变量,进行多因素Logistic回归分析(α入=0.10,α出=0.15)。结果显示:职业(乘警)与T、FSH显著相关(OR =2.872、0.105,P<0.05)。由此可见,男性乘警职业紧张对生殖激素水平产生影响,T降低,FSH升高,乘警职业是T和FSH的重要影响因素。(4)生殖激素水平间相关性分析比较三种生殖激素水平间相关性,结果显示:T和LH浓度存在负相关,LH与FSH浓度存在正相关,而T与FSH无此相关性存在。结论(1)男性乘警职业紧张对生殖激素水平产生影响,T降低,FSH升高,LH不明显。(2)乘警职业是T和FSH的重要的影响因素。(3)T和LH浓度存在负相关,LH与FSH浓度存在正相关,而T与FSH无此相关性存在。更多还原

【Abstract】 Occupational stress was one of the most import problems of mental and health hazards in occupational group at present. Its influence on occupational health and socio-economic was more and more emphasized. The railway policemen’s work belongs to mental and physical combination, which was high stress exposure work type. Reproductive endocrine system was not only involved in stress response, but also was vulnerable hazarded by stress. The stress had become one of common and important causes in reproductive endocrine disorders. Studies had shown that occupational stress had a certain impact on reproductive hormones. The effect of occupational stress on reproductive hormone in railway policemen and male attendants provided a theoretical basis for the mechanism of its influence on male reproductive function.Part One: Investigation and Analysis of Occupational Stress in Railway PolicemenObjective: To study and compare the occupational stress between railway policemen and the male attendants.Methods: 105 railway policemen from Fuzhou branch of a railway were studied as the object. Cluster sampling the male attendants from the same the railway were selected as the control, who had the same working environment and eating habits.They were both had≥3 years working age an the secondary and higher educational level. To studied by the investigate occupational stress scale, including 3 subscales,14 sub-entries and 140 entries. A Type behavior was by the well-known British Professor Cooper "A Type Behavior Scale", a total of 14. Anxiety used the state / trait anxiety questionnaire (STAI).Results: To control the factors, age, working age and educational level as a covariate, using covariance analysis and comparing the scores of occupational stress between the railway policemen and the attendants. The railway policemen’s scores of occupational stress (279.68±38.35), occupational role (169.18±21.62) and stress response (161.95±24.90) were higher than attendants’(265.95±46.44, 110.35±21.00, 103.01±25.51). Each sub-project analysis showed, the railway policemen had higher scores than attendants in“role overload”(30.70±6.00),“role indisposition”(27.92±4.01) ,"responsibility" (27.84±5.34) and“working environment”(37.51±6.11) of professional tasks, and "mental strain" (32.90±7.48) and "physical strain" (30.80±8.12) of stress reaction. The railway policemen (46.44±6.02) had higher score of A Type behavior than the attendants(44.42±6.07). The sub-project analysis showed, the railway policemen’s“attitude(”21.83±3.04)and“ambition”(11.57±2.33)were higher than attendants’. The policemen’s state and trait anxiety (49.87±9.10, 48.68±6.95) were higher than attendants’(44.74±8.10、45.48±6.99).The above differences were statistically significant (P<0.01).Conclusion: The railway policemen’s occupational stress was higher than attendants’, belonging to higher type of work in stress exposure. The railway policemen also had higher A Type behavior and anxiety than the attendants.Part Two: Analysis on the Factors of Occupational Stress in Traffic OfficersObjective: To study the factors of occupational stress in traffic officers.Methods: Merged the railway policemen and attendants from the first part as the traffic officers. The average age was 43.63±8.78 years, and average working age was 21.35±9.67 years. Applications SPSS15.0 established a database for single factor analysis, hierarchical analysis, analysis of covariance, multi-factor Logistic regression model analysis.Results: (1) Age-stratified results showed that occupational stress, occupational tasks and stress responses had downward trend with the increasing of age. The older had lower occupational stress than the young. But the difference wasn’t statistically significant (P> 0.05).(2) Stratified on working age, working age from 15 to 25 years group had the highest occupational stress, occupational role and stress response. However, the difference wasn’t statistically significant.(3) Stratified for educational level, occupational stress, occupational role and stress responses had an increasing trend with the educational level. The post-secondary and higher education level group had the highest scores. But the difference wasn’t statistically significant.(4) Stratified on marital status, married group had the lowest scores of occupational stress, occupational role and stress response. However, the difference wasn’t statistically significant.(5) A Type behavior had higher occupational stress, occupational role and response than B Type behavior. But there was no statistically significant difference(6) The higher state of anxiety had higher occupational stress, occupational role and response, but the differences were not statistically significant. In higher trait anxiety, occupational stress, occupational role and response were higher. And the differences were statistically significant.(7) Multi-factor non-conditional Logistic regression analysis (α入= 0.10,α出= 0.15). The results showed that: in addition to the common age entered the regression equation, the occupation (railway policemen) was related to occupational stress (OR = 5.093, P <0.05). Trait anxiety also entered the regression equation (OR = 0.597、0.040, P <0.05).Conclusion:(1)The traffic officers’occupational stress decreased with age. Working age form 15 to 25 years had the highest occupational stress. Occupational stress increased with the educational level, post-secondary and higher education level group had the highest occupational stress. Married group had the lowest occupational stress. A Type behavior had higher occupational stress than B Type behavior. Occupational stress was higher in high trait anxiety than in low trait anxiety.(2)Railway policemen and trait anxiety were significant related to occupational stress. Railway policemen were high exposure group of occupational stress.Part Three: Effect of Occupational Stress on Reproductive Hormone in Railway PolicemenObjective: To study the effect of occupational stress on reproductive hormone in railway policemen.Methods: Detected by radioimmunoassay of reproductive hormones [testosterone (T), luteinizing hormone (LH), follicle-stimulating hormone (FSH)]. Single factor, stratified analysis of the effect of occupational stress on reproductive hormone in railway policemen..Results:(1) Analysis on the reproductive hormone: the railway policemen’FSH (495.03±284.59) was significantly higher than attendants’(586.29±443.70), while the T (495.03±284.59) was lower than the attendants’(586.29±443.70), and the LH little changed.(2) Stratified analysis①T: The railway policemen’s T was lower in high trait anxiety. The difference was statistically significant (P <0.05). Educational level only in the high school group, railway policemen’s T was lower than attendants’. And there was statistically significant (P <0.05). Marital status analysis, only in the married group, the railway policemen’s T was lower than the attendants’. The difference was statistically significant. T in the middle occupational stress was declined significantly and the difference was statistically significant (P <0.05).②LH: In railway policemen high state anxiety group had lower LH, the difference was statistically significant (P <0.05).③FSH: Stratified analysis on A Type behavior and anxiety, the railway policemen’s FSH were higher than attendants’. The difference was statistically significant (P <0.05).(3) Multivariate analysis on the factors of reproductive hormoneT, LH, FSH as the dependent variables, occupation, age, working age, marital status, education level, smoking, alcohol consumption, physical activity, A Type behavior, state anxiety, trait anxiety, occupational stress as independent variables, Logistic regression analysis on multiple factors (α入= 0.10,α出= 0.15). The results showed that: Occupation (railway policemen) significantly correlated to T, FSH (OR = 2.872, 0.105, P <0.05). The railway policemen’s occupational stress had an impact on reproductive hormone levels, T decreased, FSH increased. Railway policemen’job was an important factor of T and FSH.(4) Analysis on the correlation between reproductive hormonesComparison correlation of three kinds of reproductive hormones, results showed that: T and LH had a negative correlation. LH and FSH were positively related, while the T and FSH had no such correlation.Conclusion:(1) The lowest occupational stress showed a protective effect on body; the body was more sensitive to the secondary occupational stress, with the greatest change in hormone levels; in the highest occupational stress the body produced tolerance, the hormone levels were stabilized.(2) Controlling for age, working age and body mass index, occupational stress caused the decreasing of T level in railway policemen, while increasing of FSH level. T secreted by Leydig cells maintained spermatogenesis, stimulated the growth of genital organs and maintained the normal sexual role. T levels in a certain extent reflected that the Leydig cells were damaged. FSH levels in a certain extent reflected that the Sertoli cells were damaged.更多还原