Nilsson Tohr, Wahlström Jens, Burström Lage
Occupational and Environmental Medicine, Department of Public Health & Clinical Medicine, Umeå University, Umeå, Sweden.
PLoS One. 2017 Jul 13;12(7):e0180795. doi: 10.1371/journal.pone.0180795. eCollection 2017.
Increased occurrence of Raynaud's phenomenon, neurosensory injury and carpal tunnel syndrome has been reported for more than 100 years in association with work with vibrating machines. The current risk prediction modelling (ISO-5349) for "Raynaud's phenomenon" is based on a few studies published 70 to 40 years ago. There are no corresponding risk prediction models for neurosensory injury or carpal tunnel syndrome, nor any systematic reviews comprising a statistical synthesis (meta-analysis) of the evidence.
Our aim was to provide a systematic review of the literature on the association between Raynaud's phenomenon, neurosensory injuries and carpal tunnel syndrome and hand-arm vibration (HAV) exposure. Moreover the aim was to estimate the magnitude of such an association using meta-analysis.
This systematic review covers the scientific literature up to January 2016. The databases used for the literature search were PubMed and Science Direct. We found a total of 4,335 abstracts, which were read and whose validity was assessed according to pre-established criteria. 294 articles were examined in their entirety to determine whether each article met the inclusion criteria. The possible risk of bias was assessed for each article. 52 articles finally met the pre-established criteria for inclusion in the systematic review.
The results show that workers who are exposed to HAV have an increased risk of vascular and neurological diseases compared to non-vibration exposed groups. The crude estimate of the risk increase is approximately 4-5 fold. The estimated effect size (odds ratio) is 6.9 for the studies of Raynaud's phenomenon when including only the studies judged to have a low risk of bias. The corresponding risk of neurosensory injury is 7.4 and the equivalent of carpal tunnel syndrome is 2.9.
At equal exposures, neurosensory injury occurs with a 3-time factor shorter latency than Raynaud's phenomenon. Which is why preventive measures should address this vibration health hazard with greater attention.
100多年来，一直有报告称，与操作振动机器的工作相关，雷诺现象、神经感觉损伤和腕管综合征的发生率有所增加。当前针对“雷诺现象”的风险预测模型（ISO - 5349）是基于70至40年前发表的一些研究。对于神经感觉损伤或腕管综合征，没有相应的风险预测模型，也没有包含证据统计综合（荟萃分析）的系统评价。
我们的目的是对关于雷诺现象、神经感觉损伤和腕管综合征与手臂振动（HAV）暴露之间关联的文献进行系统评价。此外，目的是使用荟萃分析估计这种关联的程度。
本系统评价涵盖截至2016年1月的科学文献。用于文献检索的数据库是PubMed和ScienceDirect。我们共找到4335篇摘要，对其进行了阅读，并根据预先设定的标准评估其有效性。对其中294篇文章进行了全面审查，以确定每篇文章是否符合纳入标准。对每篇文章评估了可能的偏倚风险。最终有52篇文章符合纳入系统评价的预先设定标准。
结果表明，与未暴露于振动的组相比，暴露于HAV的工人患血管和神经疾病的风险增加。风险增加的粗略估计约为4至5倍。仅纳入被判定偏倚风险较低的研究时，雷诺现象研究的估计效应量（优势比）为6.9。神经感觉损伤的相应风险为7.4，腕管综合征的等效风险为2.9。
在相同暴露水平下，神经感觉损伤发生的潜伏期比雷诺现象短3倍。这就是为什么预防措施应更关注这种振动健康危害的原因。
