Objective: To investigate the impact of chromate exposure on pulmonary function indices in occupational populations and explore the potential role of alterations in inflammatory indicators in this process. Methods: In July 2024, A cross-sectional analysis was conducted using occupational health examination data of 30875 workers from chromate-related enterprises in Jiangsu Province in 2020 and 2021. Based on the occupational positions and whether there is chromium acid salt exposure in the occupational hazards of the research subjects over the years, they are divided into chromium acid salt exposure group and non-exposure group. For those exposed to chromium acid salts, based on job position descriptions and duration of chromium acid salt exposure, they are further categorized into intermittent exposure group and continuous exposure group; among them, the actual exposure time in the intermittent exposure group is less than half of the working shift time, and the exposure duration is less than the total working life. Pulmonary function test indicators include forced vital capacity (forced vital capacity, FVC) %, first-second forced expiratory volume (forced expiratory volume in one second, FEV(1.0)) %, and the ratio of first-second forced expiratory volume to forced vital capacity (FEV(1.0)/FVC) %. Peripheral blood samples from the upper limbs of the research subjects were collected on an empty stomach for routine blood tests, selecting neutrophil count, platelet count, and lymphocyte count results, calculating the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Quantitative data that meet normal distribution are expressed using Mean±SD, while variables that do not meet normal distribution are represented by M (Q(1), Q(3)). Categorical data are expressed using frequency or proportion (%). Linear variable comparisons between groups use t-tests. Generalized linear models were employed to assess the correlation between chromate exposure and pulmonary function indices, while mixed regression models were utilized to explore potential underlying effects. Results: Compared with the non-exposed group, the pulmonary function indices FVC (%), FEV(1.0)/FVC (%), and FEV(1.0) (%) in the chromate-exposed group showed a decreasing trend (P<0.01), indicating statistically significant differences. As the frequency of chromate exposure increased, the prevalence of pulmonary dysfunction rose. The prevalence rates of obstructive, restrictive, and mixed respiratory dysfunction among the chromate-exposed population (including intermittent exposure and continuous exposure groups) were 0.26%, 4.67%, and 0.12%, which were higher than those in the non-exposed group (0.09%, 0.84%, and 0.07%, respectively). All these differences were statistically significant (P<0.05). After stratification by gender, a negative correlation was observed between chromate exposure and the inflammatory indicator platelet-to-lymphocyte ratio (PLR) (P<0.05). Potential effect analysis revealed that PLR played a certain mediating role between chromate exposure and the decline in pulmonary function indices, with a mediating proportion of 2.2%. Conclusion: Chromate exposure in occupational populations may lead to a decline in pulmonary ventilatory function and alterations in peripheral blood inflammatory indicators. Inflammatory indicators may be involved in the pulmonary function decline caused by chromate exposure.
目的： 研究职业人群铬酸盐暴露对肺功能指标的影响，并探索炎性指标改变在其中的潜在作用。 方法： 于2024年7月，选取2020和2021年江苏省涉铬企业的30 875名工人职业健康检查数据进行横断面分析。依据研究对象历年从事的工作岗位及岗位职业病危害因素是否存在铬酸盐暴露，将其划分为铬酸盐暴露组和非暴露组。铬酸盐暴露者依据工作岗位描述和铬酸盐接触工龄，分为间隔暴露组和持续暴露组，间隔暴露组实际接触时间小于工作班时间的1/2，且暴露工龄小于总工龄。肺功能测定指标包括用力肺活量（forced vital capacity，FVC）、第1秒用力呼气容积（forced expiratory volume in one second，FEV(1.0)）及第1秒用力呼气容积占用力肺活量的比值（FEV(1.0)/FVC）。采集研究对象空腹上肢静脉外周血进行血常规测定，选取中性粒细胞数、血小板数和淋巴细胞数结果，计算中性粒细胞-淋巴细胞比（NLR）和血小板-淋巴细胞比（PLR）值。计量资料满足正态分布的用x±s表示，不满足正态分布的变量以M（Q(1)，Q(3)）表示，计数资料采用频数或构成比（%）表示。线性变量组间比较用t检验。采用广义线性模型比较铬酸盐暴露和肺功能指标的相关性，并使用混合回归模型探索潜在效应。 结果： 与非暴露组比较，铬暴露组FVC（%）、FEV(1.0)/FVC（%）、FEV(1.0)（%）均较低，差异均有统计学意义（P<0.01）。随着铬暴露频率增加，肺功能障碍比例升高，铬暴露人群（间隔暴露组和持续暴露组）阻塞型、限制型、混合型呼吸功能障碍的患病率分别为：0.26%、4.67%和0.12%，高于非暴露组（0.09%、0.84%和0.07%），差异均有统计学意义（P<0.05）。按照性别分层后，铬酸盐暴露与炎性指标PLR呈负相关关系（P<0.05）。潜在效应分析发现，PLR在铬酸盐暴露与肺功能指标下降之间存在一定的中介作用，中介比例为2.2%。 结论： 职业人群的铬酸盐暴露可能导致其肺通气功能下降，外周血炎性指标改变，炎性指标可能参与铬酸盐暴露引起的肺功能下降。.
Keywords: Chromates; Lung function; Occupational exposure; Occupational hazard.