Krause N, Lynch J W, Kaplan G A, Cohen R D, Salonen R, Salonen J T
Department of Epidemiology, School of Public Health, University of California, Berkeley 94720, USA.
Scand J Work Environ Health. 2000 Jun;26(3):227-36. doi: 10.5271/sjweh.536.
The association between the amount of standing at work and the progression of carotid intima media thickness (IMT) was studied among 584 active working men participating in the Kuopio Ischemic Heart Disease Risk Factor Study.
Ultrasound measurements of atherosclerotic changes in the carotid arteries were performed at the beginning of the study and after 4 years. Analyses of changes in IMT included adjustments for risk factors and stratification by base-line levels of atherosclerosis and prevalent ischemic heart disease (IHD).
Significant relationships were found between the amount of standing at work and atherosclerotic progression. After adjustment for the heaviness of the work, psychosocial job factors, income, and biological and behavioral risk factors, the mean change in maximum IMT for those standing not at all, a little, a lot, and very much was 0.24, 0.25, 0.28, and 0.33 mm, respectively. For men with IHD the respective changes were 0.08, 0.15, 0.37, and 0.75 mm -- a 9-fold difference between the no-exposure and high-exposure group. For the men with carotid stenosis, the respective difference was 3-fold.
These findings provide the first empirical support in a population study for the role of hemodynamic factors in the progression of atherosclerosis induced by long-term standing. Men with carotid stenosis or IHD appear especially vulnerable to the adverse effects associated with standing at work. Reducing the duration of standing at work should be considered both in the occupational rehabilitation of such patients and in the primary prevention of atherosclerosis.
在参与库奥皮奥缺血性心脏病危险因素研究的584名在职男性中，研究工作时站立时间与颈动脉内膜中层厚度（IMT）进展之间的关联。
在研究开始时和4年后，对颈动脉的动脉粥样硬化变化进行超声测量。IMT变化分析包括对危险因素的调整以及根据动脉粥样硬化基线水平和缺血性心脏病（IHD）患病率进行分层。
发现工作时站立时间与动脉粥样硬化进展之间存在显著关系。在对工作强度、心理社会工作因素、收入以及生物学和行为危险因素进行调整后，完全不站立、少量站立、大量站立和非常大量站立者的最大IMT平均变化分别为0.24、0.25、0.28和0.33毫米。对于患有IHD的男性，相应变化分别为0.08、0.15、0.37和0.75毫米——无暴露组和高暴露组之间相差9倍。对于患有颈动脉狭窄的男性，相应差异为3倍。
这些发现为血流动力学因素在长期站立引起的动脉粥样硬化进展中的作用提供了人群研究中的首个实证支持。患有颈动脉狭窄或IHD的男性似乎特别容易受到工作时站立相关不良影响的伤害。在这类患者的职业康复以及动脉粥样硬化的一级预防中，都应考虑减少工作时的站立时间。
