Objective: To explore the change of hearing threshold of workers exposed to noise, establish an individual-based hearing loss early warning model, accurately and differentiated the health of workers exposed to noise. Methods: In September 2019, all physical examination data of 561 workers exposed to noise from an enterprise were collected since their employment. Three indicators of average hearing threshold of the better ear, namely, at high frequency, 4000 Hz and speech frequency, were constructed. The generalized estimating equation (GEE) was used to adjust gender and age and establish the warning model of each indicator. Finally, sensitive indicators and warning models were screened according to AUC and Yoden index. Results: Among the 561 workers exposed to noise, 26 (4.6%) workers had hearing loss. The sensitivity indicators were the average hearing threshold at speech frequency ≥20 dB, high frequency ≥30 dB and 4000 Hz ≥25 dB. The AUC of each index was 0.602, 0.794 and 0.804, and the Youden indexes were 0.204, 0.588 and 0.608, respectively. In GEE of hearing loss warning models, high-frequency hearing threshold ≥20 dB and 4000 Hz hearing threshold ≥25 dB were the optimal models, with AUC of 0.862. Conclusion: Combined with the changes of individual hearing threshold over the years, can accurately assess the risk of individual hearing loss of workers exposed to noise.
目的： 探讨接触噪声工人听阈变化规律，建立基于个体的听力损失预警模型，以期精准化和差异化管理接触噪声工人的健康。 方法： 于2019年9月，收集某企业561名接触噪声工人自入职以来所有体检资料，收集较好耳高频平均听阈值、较好耳4 000 Hz平均听阈值和较好耳语频平均听阈值指标，利用广义估计方程（GEE）调整性别和年龄，建立各指标的预警模型，根据ROC曲线面积（AUC）和约登指数筛选敏感指标和预警模型。 结果： 561名接触噪声工人中，有26人出现听力损失（4.6%）；敏感指标为较好耳语频平均听阈值≥20 dB、较好耳高频平均听阈值≥30 dB和较好耳4 000 Hz听阈值≥25 dB，各指标AUC分别为0.602、0.794和0.804，约登指数分别为0.204、0.588和0.608；GEE听力损失预警模型中较好耳高频平均听阈值≥20 dB和较好耳4 000 Hz平均听阈值≥25 dB为最优模型，AUC均为0.862。 结论： 个体水平的听力损失预警模型可较为准确评估接触噪声工人个体听力损失的发生风险。.
Keywords: Early warning model; GEE; Hearing loss; Noise, Occupational.