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目的分析GBZ 49—2014《职业性噪声聋的诊断》(以下简称“GBZ 49—2014”)的修订对职业性噪声聋(ONID)诊断结论的影响。方法采用判断抽样方法,以77例进行ONID诊断和鉴定的病例为研究对象,收集其纯音听阈测试结果,分别采用GBZ 49—2014和GBZ 49—2007《职业性噪声聋诊断标准》(以下简称“GBZ 49—2007”)进行诊断,比较诊断听阈值和诊断分级的变化情况。结果 77例研究对象采用GBZ 49—2014计算的较好耳听阈加权值、双耳高频平均听阈(BHFTA)分别高于采用GBZ 49—2007计算的较好耳语频平均听阈和BHFTA[(32.4±10.3)vs(29.8±10.6)dB,(50.5±13.3)vs(49.1±13.6)dB,P<0.01]。采用GBZ 49—2014和GBZ 49—2007对研究对象进行ONID诊断的结论一致性较好(Kappa值=0.92,P<0.01)。但2个版本诊断标准对研究对象ONID的诊断分级结果差异有统计意义(P<0.05),采用GBZ 49—2014进行诊断分级时,3例采用GBZ 49—2007诊断为非ONID者被诊断为轻度ONID,有5例采用GBZ 49—2007诊断为轻度ONID者被诊断为中度ONID。结论依据GBZ 49—2014计算的诊断听阈值高于依据GBZ 49—2007计算者;依据GBZ 49—2014诊断可导致ONID诊断病例数增加,并导致诊断分级加重。
Objective To analyze the influence of GBZ 49-2014 “Diagnosis of occupational noise deafness” (“GBZ 49-2014”) on the diagnosis of occupational noise deafness (ONID). Methods Totally 77 patients with ONID diagnosis and identification were selected as the research object by the method of judgment sampling. The test results of pure tone hearing threshold were collected and used respectively as GBZ 49-2014 and GBZ 49-2007 Diagnostic criteria of occupational noise deafness (hereinafter referred to as “GBZ 49-2007 ”) to diagnose, compare the diagnostic thresholds and diagnostic grading changes. Results The good ear hearing thresholds calculated by GBZ 49-2014 were used in 77 subjects. The mean high frequency hearing threshold (BHFTA) of both ears was higher than that of the best hearing threshold and BHFTA [(32.4 ± 10.3) vs (29.8 ± 10.6) dB, (50.5 ± 13.3) vs (49.1 ± 13.6) dB, P <0.01]. The results of ONID diagnosis using GBZ 49-2014 and GBZ 49-2007 were consistent (Kappa = 0.92, P <0.01). However, there was significant difference between the two diagnostic criteria for ONID diagnosis and classification (P <0.05). When using GBZ 49-2014 for diagnosis and classification, three cases diagnosed as non-ONID by GBZ 49-2007 were diagnosed as mild Degree ONID, 5 cases diagnosed with mild ONID using GBZ 49-2007 were diagnosed as moderate ONID. Conclusion The diagnostic threshold value calculated according to GBZ 49-2014 is higher than that calculated according to GBZ 49-2007. The diagnosis based on GBZ 49-2014 can increase the number of ONID diagnosis and lead to the increase of diagnosis grade.