中文摘要：

目的探讨血浆中4种血管调节因子与手传振动接触人群发生振动性白指（VWF）的相关性,初步探讨其用于筛查VWF的价值。方法采用典型抽样方法,抽取某金属加工厂从事金属打磨抛光作业1年以上的77名男性手传振动作业工人为研究对象。根据主诉VWF情况分为非VWF组（34人）和VWF组（43人）。采集研究对象肘正中静脉血,分离血浆,采用放射免疫法检测内皮素（ET）水平,采用酶联免疫吸附法检测转化生长因子-β（TGF-β）、可溶性细胞间黏附分子（s ICAM-1）和5-羟色胺（5-HT）水平。采用Logistic回归分析筛选VWF判断指标,并构建新的多变量模型指标^y,对有关指标进行受试者工作特征（ROC）曲线分析。结果与非VWF组比较,VWF组工人血浆中ET水平下降（P〈0.01）,TGF-β水平升高（P〈0.01）;但2组工人血浆中s ICAM-1和5-HT水平分别比较,差异均无统计学意义（P〉0.05）。Logistic回归分析结果显示：在排除年龄、吸烟、饮酒和手部症状等混杂因素后,ET水平与VWF发生呈负相关（P〈0.01）,TGF-β水平与VWF发生呈正相关（P〈0.01）;s ICAM-1和5-HT水平均与VWF发生无关联（P〉0.05）。采用ET和TGF-β判断VWF的ROC曲线下面积（A_Z）分别为0.787、0.691（P〈0.01）,灵敏度分别为70.60%和53.49%,特异度分别为79.10%和85.29%;通过Logistic回归模型,以ET和TGF-β构建的^y判断VWF的A_Z为0.821（P〈0.01）,灵敏度和特异度分别为72.09%和76.47%。ET和TGF-β、^y和ET的A_Z分别比较,差异均无统计学意义（P〉0.05）;^y的A_Z高于TGF-β（P〈0.05）。结论手传振动接触人群血浆中ET和TGF-β水平均与VWF发生有关联,可进一步用于筛查VWF的研究;s ICAM-1和5-HT与VWF的关联性有待进一步研究。

英文摘要：

Objective To analyze the correlation between four vessel regulate factors and vibration-induced white finger（ VWF） evaluating in workers exposed to hand-arm vibration,and discuss the value of regulate factors for VWF screening.Methods Using typical sampling method,77 male workers exposed to hand-arm vibration with more than 1 year of polish work from a metalwork factory were selected as the study subjects. Based on the workers＇ self-report,they were divided into VWF group（ 43 workers） and non-VWF group（ 34 workers）. The venous blood from center elbow was collected and plasma was separated. The plasma level of endothelin（ ET） was detected by radioimmunoassay. The plasma levels of transforming growth factor beta（ TGF-β）,soluble intercellular adhesion molecule-1（ s ICAM-1） and 5-hydroxytryptamine（ 5-HT） were detected by enzyme-linked immunosorbent assay. The regulate factors for evaluating VWF were screened and the new multivariable model index ^y was built by logistic regression. The related factors were analyzed according to the receiver operating characteristic（ ROC） curve. Results Compared with the non-VWF group,the plasma level of ET in VWF group was decreased（ P〈0. 01）,and the plasma level of TGF-β was increased（ P〈0. 01）. Both the levels of s ICAM-1 and 5-HT between the two groups showed no significant difference（ P〉0. 05）. The logistic regression analysis results showed that after adjusting the confounding factors of age,smoking,alcohol and symptoms in hands,there was a negative correlation found between the ET plasma level and VWF（ P〈0. 01） and a positive correlation between the TGF-βplasma level and VWF（ P〈0. 01）. The VWF incidence was not correlated with plasma levels of s ICAM-1 and 5-HT（ P〈0. 05）. According to ROC curve analysis,the area under the curve（ AZ） value of the plasma levels of ET and TGF-β were0. 787 and 0. 691,respectively（ P〈0. 01）; the sensitivity were 70. 60% and 53. 49%,and the specificity were 79. 10%and