摘要目的:研究长期接触职业X射线对人群各种疾病的死亡风险及其规律。方法:采用回顾性和前瞻性队列相结合的研究方法，选取1950—1980年间在江苏省医院放射科工作的医用X射线诊断工作者为放射组；同医院同时期未从事过放射工作的其他科室医务人员为对照组，形成调查队列。计算该队列1950—2011年间累计观察人年数，采用Cox回归模型，计算调整性别、到达年龄、出生年代和开始工作年代等因素后医用X射线诊断工作者的各种疾病的死亡风险。结果:该队列共完成随访6 953人，其中照射组3 649人，对照组3 304人，总观察人年数为347 362人年。截至2021年12月31日，该队列共死亡2 099人。Cox回归结果显示，与对照组相比，放射组中死亡危险显著增高的疾病有：全癌( RR＝1.20，95% CI：1.04～1.39， Z＝2.56， P<0.05；其中肺癌 RR＝1.52，95% CI：1.17～1.98， Z＝3.10， P<0.01；胰腺癌 RR＝1.96，95% CI：1.11～3.46， Z＝2.31， P<0.05)；循环系统疾病( RR＝1.29，95% CI：1.06～1.57， Z＝2.58， P<0.01)；内分泌、营养和代谢疾病( RR＝1.90，95% CI：1.06～3.42， Z＝2.14， P<0.05)。分层分析结果显示，男性工作者中，放射组全癌和肺癌的死亡风险增高( Z＝3.50、2.92， P<0.01)；开始工作年龄为26～30岁年龄组中，放射组循环系统疾病死亡风险增高( Z＝2.06， P<0.05)；到达年龄为61～岁年龄组中，放射组因全癌、肺癌和循环系统疾病死亡的风险增高( Z＝2.90～4.31， P<0.01)。 结论:江苏省医用X射线诊断工作者肺癌、胰腺癌、循环系统疾病的死亡危险升高，未来可进一步深入开展相关领域的研究。

abstractsObjective:To study the risk and pattern of deaths caused by various diseases in the population and in the case of long-term occupational X-ray exposure.Methods:Using a combination of retrospective and prospective cohort research methods, an exposure group of medical X-ray diagnostic workers who worked in the radiology department of Jiangsu Provincial Hospital between 1950 and 1980 and a control group of medical workers from other departments who did not work with radiolog during the same period in the same hospital were selected to form a study cohort. The cumulative number of person years of observation in the cohort during 1950-2011 was calculated, and the Cox regression model was used to calculate the risk of deaths of medical X-ray diagnostic workers for various diseases through adjusting sex, attained age, birth age, and starting working age.Results:A total of 6 953 follow-up visits was completed to the cohort, including 3 649 in the radiation group and 3 304 in the control group, with a total of 347 362 person years of observation. There were 2 099 deaths in the cohort as of December 31, 2021. Cox regression results showed that diseases with a significantly higher risk of death in the radiation group compared with the control group were: all-cancer ( RR=1.20, 95% CI: 1.04-1.39, Z=2.56, P<0.05, including lung cancer RR=1.52, 95% CI: 1.17-1.98, Z=3.10, P<0.01, and pancreatic cancer RR=1.96, 95% CI: 1.11-3.46, Z=2.31, P<0.05); diseases of the circulatory system ( RR=1.29, 95% CI: 1.06-1.57, Z=2.58, P<0.01); endocrine, nutritional and metabolic diseases ( RR=1.90, 95% CI: 1.06-3.42, Z=2.14, P<0.05). Stratified analyses showed that, of male workers, the radiation group had an increased risk of death caused by all-cancer and lung cancer ( Z=3.50, 2.92, P<0.01); of the age group at starting ages 26 to 30, the radiation group had an increased risk of death distributed to circulatory diseases ( Z=2.06, P<0.05); and in the age group at attained ages elder than 61 years, the radiation group had an increased risk of death distributed to all cancers, lung cancer, and circulatory diseases ( Z=2.90-4.31, P<0.01). Conclusions:As has been shown, threre is an increasing risk of death distributed to lung cancer, pancreatic cancer, and circulatory diseases in medical X-ray diagnostic workers in Jiangsu province. Further in-depth research in related areas may be conducted in the future.