消防员职业安全健康风险及运动潜在调节效应:基于复原力相关生物标志物视角

doi:10.16265/j.cnki.issn1003-3033.2023.06.2344

摘要/Abstract

摘要：

为从自然科学角度解释消防员在面临极端工作压力下造成心理塌陷或振作的成因,探究潜在的调节效应,首先,整理归纳消防职业压力对复原力相关生物标志物的影响;其次,借鉴不同特种人群在复原力相关生物标志物研究领域的成果,探寻构建与消防职业相适宜的复原力生物监测模型的路径;最后,从运动角度出发,阐释消防员是否在抵抗消防职业压力对复原力相关生物标志物产生的负面影响方面具有潜在调节效应。结果表明:消防职业压力会打破复原力生物适应的平衡状态,对消防员职业安全健康产生不利影响;与消防职业相适宜的复原力生物监测模型,需在借鉴不同特种人群指标选择的基础上,以适当生物标志物的平衡组合为基础构建;运动在促进神经内分泌稳态平衡、上调合成代谢、提高抗炎方面对复原力相关生物标志物的良性发展具有潜在调节效应。

关键词: 消防员, 职业安全健康风险, 运动, 调节效应, 复原力

Abstract:

In order to explain the causes of the psychological collapse and revitalisation of firefighters under extreme work stress from a natural science perspective, the potential moderating effects were explored. Firstly, the effects of firefighting occupational stress on resilience-related biomarkers were collated and summarised. Then, by drawing on the results of different special populations in the field of resilience-related biomarker research, possible pathways were explored in the construction of resilience biomonitoring models appropriate to the firefighting occupation. Finally, it was elucidated whether firefighters have a potential moderating effect in resisting the negative effects of firefighting occupational stress on resilience-related biomarkers from the perspective of exercise. The results show that: firefighting occupational stress can disrupt the equilibrium of resilience bio-adaptation and adversely affect firefighter occupational safety and health. A resilience biomonitoring model appropriate for firefighting occupations needs to be constructed based on a balanced combination of appropriate biomarkers with reference to the selection of indicators for different specialised populations; exercise has potential modulatory effects on the benign development of resilience-related biomarkers in terms of promoting neuroendocrine homeostatic balance, upregulating anabolism and enhancing anti-inflammation.

Key words: firefighter, occupational safety and health risks, exercise, moderating effects, resilience

杨三军, 王昆, 孟昀晨. 消防员职业安全健康风险及运动潜在调节效应:基于复原力相关生物标志物视角[J]. 中国安全科学学报, 2023, 33(6): 198-206.

YANG Sanjun, WANG Kun, MENG Yunchen. Occupational safety and health risks and potential moderating effects of exercise in firefighters:a resilience-related biomarker perspective[J]. China Safety Science Journal, 2023, 33(6): 198-206.

图/表 4

表1

续表1

表2

与复原力相关的主流生物标志物的补充

神经肽-Y	神经肽-Y是一种神经肽,表达于与恐惧、威胁检测和唤醒有关的皮层和皮层下区域的细胞体和神经纤维中,产生抗焦虑作用并促进对抗压力的保护性反应
促肾上腺皮质激素释放激素	促肾上腺皮质激素释放激素可以间接控制HPA轴的活动,其对边缘脑区的影响与恐惧、警觉等的增加有关,其主要通过与之相关的受体产生焦虑和抑郁样症状
谷氨酸	谷氨酸是中枢神经系统中的主要兴奋性神经递质,其浓度、功能对脑源性神经营养因子、星形胶质细胞的健康和功能、HPA轴调节和炎症过程有重大影响
γ-氨基丁酸	谷氨酸和γ-氨基丁酸之间的平衡作用目前被应用在压力诱发的情绪障碍发展和治疗,创伤事件后较高水平的γ-氨基丁酸可以预防慢性PTSD
脑源性神经营养因子	脑源性神经营养因子是一种在杏仁核、海马、基底前脑等不同脑区表达的神经营养因子,与情绪和焦虑症有关,通过对HPA轴的调节作用介导对慢性压力的恢复
内源性大麻素	大脑内源性大麻素系统将压力暴露与大脑神经突触可塑性的变化联系起来,促进HPA轴的激活和反馈调节,对生物体的长期生存能力、平衡和抗压能力至关重要
血清素	血清素通过独立脑区的血清素1-7受体影响压力反应和情绪行为的调节,血清素1A受体具有抗焦虑作用,在焦虑症的病因中发挥重要作用
别孕烷醇酮	急性应激会产生别孕烷醇酮水平的增加,激活γ-氨基丁酸A受体,并对应激引起的HPA轴的激活有负反馈的调节作用,具有潜在的抗惊厥和抗焦虑作用
甘丙肽	甘丙肽通常在去甲肾上腺素被高度激活时释放,去甲肾上腺素对压力的反应导致甘丙肽释放到杏仁核中央,作为对去甲肾上腺素致焦虑作用的抵抗

表2

图1

参考文献 49

[1]	张艺馨, 游波, 施式亮, 等. 安全心理学方法论研究[J]. 中国安全科学学报, 2021, 31(5):181-188. doi: 10.16265/j.cnki.issn1003-3033.2021.05.027
	ZHANG Yixin, YOU Bo, SHI Shiliang, et al. Research on safety psychology methodology[J]. China Safety Science Journal, 2021, 31(5): 181-188. doi: 10.16265/j.cnki.issn1003-3033.2021.05.027
[2]	张希臣, 杨雪莹, 刘畅, 等. 消防官兵抑郁现状及相关影响因素的分析[J]. 中华劳动卫生职业病杂志, 2021, 39(2): 130-133.
	ZHANG Xichen, YANG Xueying, LIU Chang, et al. Depression symtoms and related factors of fire fighters[J]. Chinese Journal of Industrial Hygiene and Occupational Diseases, 2021, 39(2): 130-133.
[3]	SUN Xiaoran, LI Xiaohui, HUANG Jiali, et al. Prevalence and predictors of PTSD, depression and posttraumatic growth among Chinese firefighters[J]. Archives of Psychiatric Nursing, 2020, 34(1): 14-18. doi: S0883-9417(19)30419-4 pmid: 32035583
[4]	WU Gang, FEDER A, COHEN H, et al. Understanding resilience[J]. Frontiers in Behavioral Neuroscience, 2013, 7: 1-10.
[5]	WALKER F R, PFINGST K, CARNEVALI L, et al. In the search for integrative biomarker of resilience to psychological stress[J]. Neuroscience and Biobehavioral Reviews, 2017, 74: 310-320. doi: S0149-7634(15)30360-2 pmid: 27179452
[6]	OPSTAD P K. Circadian rhythm of hormones is extinguished during prolonged physical stress, sleep and energy deficiency in young men[J]. European Journal of Endocrinology, 1994, 131(1): 56-66. pmid: 8038905
[7]	BECKNER M E, MAIN L, TAIT J L, et al. Circulating biomarkers associated with performance and resilience during military operational stress[J]. European Journal of Sport Science, 2022, 22(1): 72-86. doi: 10.1080/17461391.2021.1962983
[8]	LEDFORD A K, DIXON D, LUNING C R, et al. Psychological and physiological predictors of resilience in navy seal training[J]. Behavioral Medicine, 2020, 46(3/4): 290-301. doi: 10.1080/08964289.2020.1712648
[9]	HUANG C J, WEBB H E, GARTEN R S, et al. Psychological stress during exercise: lymphocyte subset redistribution in firefighters[J]. Physiology & Behavior, 2010, 101(3): 320-326. doi: 10.1016/j.physbeh.2010.05.018
[10]	WEBB H E, GARTEN R S, MCMINN D R, et al. Stress hormones and vascular function in firefighters during concurrent challenges[J]. Biological Psychology, 2011, 87(1): 152-160. doi: 10.1016/j.biopsycho.2011.02.024 pmid: 21382435
[11]	RAY M R, BASU C, ROYCHOUDHURY S, et al. Plasma catecholamine levels and neurobehavioral problems in Indian firefighters[J]. Journal of Occupational Health, 2006, 48(3): 210-215. doi: 10.1539/joh.48.210 pmid: 16788283
[12]	COEHOORN C J, NEARY J P, KRIGOLSON O E, et al. Firefighter salivary cortisol responses following rapid heat stress[J]. Journal of Thermal Biology, 2022, 108: 1-7.
[13]	PONCE T, MAINENTI M R M, CARDOSO E L, et al. Military field training exercise with prolonged physical activity and sleep restriction causes hormonal imbalance in firefighter cadets[J]. Journal of Endocrinological Investigation, 2022, 45: 1-11. doi: 10.1007/s40618-021-01601-9
[14]	WOLKOW A, AISBETT B, REYNOLDS J, et al. The impact of sleep restriction while performing simulated physical firefighting work on cortisol and heart rate responses[J]. International Archives of Occupational and Environmental Health, 2016, 89(3): 461-475. doi: 10.1007/s00420-015-1085-3 pmid: 26271391
[15]	SOPP M R, MICHAEL T, LASS-HENNEMANN J, et al. Longitudinal associations between hair cortisol, PTSD symptoms, and sleep disturbances in a sample of firefighters with duty-related trauma exposure[J]. Psychoneuroendocrinology, 2021, 134:1-9.
[16]	VAN DEN HEUVEL L L, ACKER D, DU PLESSIS S, et al. Hair cortisol as a biomarker of stress and resilience in South African mixed ancestry females[J]. Psychoneuroendocrinology, 2020, 113: 1-40.
[17]	LOFRANO P A, SOARES E M K V K, MATIAS A, et al. Borderline-low testosterone levels are associated with lower left ventricular wall thickness in firefighters: an exploratory analysis[J]. Andrology, 2020, 8(6): 1753-1761. doi: 10.1111/andr.v8.6
[18]	KUTLIKOVA H H, DURDIAKOVA J B, WAGNER B, et al. The effects of testosterone on the physiological response to social and somatic stressors[J]. Psychoneuroendocrinology, 2020, 117: 1-9.
[19]	FANNIN N, DABBS J J M. Testosterone and the work of firefighters: fighting fires and delivering medical care[J]. Journal of Research in Personality, 2003, 37(2): 107-115. doi: 10.1016/S0092-6566(02)00533-0
[20]	MORGAN C A, SOUTHWICK S, HAZLETT G, et al. Relationships among plasma dehydroepiandrosterone sulfate and cortisol levels, symptoms of dissociation, and objective performance in humans exposed to acute stress[J]. Archives of General Psychiatry, 2004, 61(8): 819-825. doi: 10.1001/archpsyc.61.8.819 pmid: 15289280
[21]	SHIA R M, MCLNTIRE L K, HAGEN J A, et al. Biomarker and biometric indices of physical exhaustion in the firefighting community[J]. Procedia Manufacturing, 2015, 3: 5081-5087. doi: 10.1016/j.promfg.2015.07.522
[22]	LAU W K W, TAI A P L, CHAN J N M, et al. Integrative psycho-biophysiological markers in predicting psychological resilience[J]. Psychoneuroendocrinology, 2021, 129: 1-11.
[23]	BRUENIG D, MEHTA D, MORRIS C P, et al. Correlation between interferon gamma and interleukin 6 with PTSD and resilience[J]. Psychiatry Research, 2018, 260: 193-198. doi: 10.1016/j.psychres.2017.11.069
[24]	WATKINS E R, HAYES M, WATT P, et al. Extreme occupational heat exposure is associated with elevated haematological and inflammatory markers in Fire Service Instructors[J]. Experimental Physiology, 2021, 106(1): 233-243. doi: 10.1113/eph.v106.1
[25]	WOLKOW A, AISBETT B, REYNOLDS J, et al. Acute psychophysiological relationships between mood, inflammatory and cortisol changes in response to simulated physical firefighting work and sleep restriction[J]. Applied Psychophysiology and Biofeedback, 2016, 41(2): 165-180. doi: 10.1007/s10484-015-9329-2 pmid: 26698865
[26]	ADETONA A M, ADETONA O, GOGAL J R M, et al. Impact of work task-related acute occupational smoke exposures on select proinflammatory immune parameters in wildland firefighters[J]. Journal of Occupational and Environmental Medicine, 2017, 59(7): 679-690. doi: 10.1097/JOM.0000000000001053 pmid: 28692002
[27]	GIANNIOU N, KATSAOUNOU P, DIMA E, et al. Prolonged occupational exposure leads to allergic airway sensitization and chronic airway and systemic inflammation in professional firefighters[J]. Respiratory Medicine, 2016, 118: 7-14. doi: 10.1016/j.rmed.2016.07.006
[28]	GIANNIOU N, GIANNAKOPOULOU C, DIMA E, et al. Acute effects of smoke exposure on airway and systemic inflammation in forest firefighters[J]. Journal of Asthma and Allergy, 2018, 11: 81-88. doi: 10.2147/JAA.S136417 pmid: 29719412
[29]	GREVEN F E, KROP E J, SPITHOVEN J J, et al. Acute respiratory effects in firefighters[J]. American Journal of Industrial Medicine, 2012, 55(1): 54-62. doi: 10.1002/ajim.21012 pmid: 21959832
[30]	MAIN L C, WOLKOW A P, TAIT J L, et al. Firefighter's acute inflammatory response to wildfire suppression[J]. Journal of Occupational and Environmental Medicine, 2020, 62(2): 145-148. doi: 10.1097/JOM.0000000000001775 pmid: 31764604
[31]	SMITH D L, FRIEDMAN N M, BLOOM S I, et al. Firefighting induces acute inflammatory responses that are not relieved by aspirin in older firefighters[J]. Journal of Occupational and Environmental Medicine, 2019, 61(7): 617-622. doi: 10.1097/JOM.0000000000001626 pmid: 31090673
[32]	LIEBERMAN H R, BATHALON G P, FALCO C M, et al. Severe decrements in cognition function and mood induced by sleep loss, heat, dehydration, and undernutrition during simulated combat[J]. Biological Psychiatry, 2005, 57(4): 422-429. pmid: 15705359
[33]	ARNETZ B B, ARBLE E, BACKMAN L, et al. Assessment of a prevention program for work-related stress among urban police officers[J]. International Archives of Occupational and Environmental Health, 2013, 86(1): 79-88. doi: 10.1007/s00420-012-0748-6 pmid: 22366986
[34]	VAARA J P, ERANEN L, OJANEN T, et al. Can physiological and psychological factors predict dropout from intense 10-day winter military survival training?[J]. International Journal of Environmental Research and Public Health, 2020, 17(23): 1-15. doi: 10.3390/ijerph17010001
[35]	BECKNER M E, CONKRIGHT W R, EAGLE S R, et al. Impact of simulated military operational stress on executive function relative to trait resilience, aerobic fitness, and neuroendocrine biomarkers[J]. Physiology & Behavior, 2021, 236: 1-13.
[36]	董陇军, 王加闯. 智能安全人机工程学学科建设及内容体系研究[J]. 中国安全科学学报, 2022, 32(3):1-8. doi: 10.16265/j.cnki.issn1003-3033.2022.03.001
	DONG Longjun, WANG Jiachuang. Research on discipline construction and content system of intelligent safety ergonomics[J]. China Safety Science Journal, 2022, 32(3):1-8. doi: 10.16265/j.cnki.issn1003-3033.2022.03.001
[37]	MORGAN C A, WANG S, SOUTHWICK S M, et al. Plasma neuropeptide-Y concentrations in humans exposed to military survival training[J]. Biological Psychiatry, 2000, 47(10): 902-909. pmid: 10807963
[38]	SILVERMAN M N, DEUSTER P A. Biological mechanisms underlying the role of physical fitness in health and resilience[J]. Interface Focus, 2014, 4(5): 1-12.
[39]	WEBB H E, ROSALKY D S, TANGSILSAT S E, et al. Aerobic fitness affects cortisol responses to concurrent challenges[J]. Medicine and Science in Sports and Exercise, 2013, 45(2): 379-386. doi: 10.1249/MSS.0b013e318270b381
[40]	RIMMELE U, ZELLWEGER B C, MARTI B, et al. Trained men show lower cortisol, heart rate and psychological responses to psychosocial stress compared with untrained men[J]. Psychoneuroendocrinology, 2007, 32(6): 627-635. doi: 10.1016/j.psyneuen.2007.04.005 pmid: 17560731
[41]	SOTHMANN M S, BUCKWORTH J, CLAYTOR R P, et al. Exercise training and the cross-stressor adaptation hypothesis[J]. Exercise and Sport Sciences Reviews, 1996, 24: 267-287. pmid: 8744253
[42]	SCIOLI-SALTER E, FORMAN D E, OTIS J D, et al. Potential neurobiological benefits of exercise in chronic pain and posttraumatic stress disorder: pilot study[J]. Journal of Rehabilitation Research and Development, 2016, 53(1): 95-106. doi: 10.1682/JRRD.2014.10.0267
[43]	SZIVAK T K, LEE E C, SAENZ C, et al. Adrenal stress and physical performance during military survival training[J]. Aerospace Medicine and Human Performance, 2018, 89(2): 99-107. doi: 10.3357/AMHP.4831.2018 pmid: 29463354
[44]	PIHLAINEN K, KYROLAINEN H, SANTTILA M, et al. Effects of combined strength and endurance training on body composition, physical fitness, and serum hormones during a 6-month crisis management operation[J]. Journal of Strength and Conditioning Research, 2022, 36(9): 2361-2370. doi: 10.1519/JSC.0000000000003902
[45]	AMBROZY T, RYDZIK L, OBMINSKI Z, et al. The effect of high-intensity interval training periods on morning serum testosterone and cortisol levels and physical fitness in men aged 35-40 years[J]. Journal of Clinical Medicine, 2021, 10(10): 1-11. doi: 10.3390/jcm10010001
[46]	SATO K, IEMITSU M, MATSUTANI K, et al. Resistance training restores muscle sex steroid hormone steroidogenesis in older men[J]. Faseb Journal, 2014, 28(4): 1891-1897. doi: 10.1096/fj.13-245480 pmid: 24443372
[47]	RETHORST C D, TOUPS M S, GREER T L, et al. Pro-inflammatory cytokines as predictors of antidepressant effects of exercise in major depressive disorder[J]. Molecular Psychiatry, 2013, 18(10): 1119-1124. doi: 10.1038/mp.2012.125 pmid: 22925832
[48]	VAFAEE R, HATAMABADI H, SOORI H, et al. The impact of resveratrol supplementation on inflammation induced by acute exercise in rats: IL6 responses to exercise[J]. Iranian Journal of Pharmaceutical Research, 2019, 18(2): 772-784. doi: 10.22037/ijpr.2019.1100684 pmid: 31531060
[49]	MACEDO R C S, VIEIRA A, MARIN D P, et al. Effects of chronic resveratrol supplementation in military firefighters undergo a physical fitness test :a placebo-controlled, double blind study[J]. Chemico-Biological Interactions, 2015, 227: 89-95. doi: 10.1016/j.cbi.2014.12.033

文献来源与研究主题	被试	显著变化的炎症标志物	主要研究结论
GIANNIOU等^[27]:检查全职消防员与受训者相比,支气管痰液以及血液炎症标志物水平是否升高	63名全职专业消防员、29名兼职受训者(工作<1年)、18名健康被试	血液:全职消防员与受训者和健康被试相比IL-8↑、TNF-α↑ 痰液:全职消防员与受训者和健康被试相比IL-8↑、ECP↑、VEGF↑和TNF- α↑	长期暴露在污染环境中对职业消防员的支气管和全身炎症有“剂量反应”效应,炎症程度与消防员在职时间存在线性关系
GIANNIOU等^[28]:与淡季相比(暴露后3个月),连续几天密集接触火灾烟雾对气道和系统炎症的影响	60名森林消防员	血液:与淡季相比,暴露后IL-8↑、VEGF↑、TNF- α↑、NEUT↑ 痰液:与淡季相比,NEUT↑、EOS↑、IL-8↑、TNF-α↑	在森林灭火期间的急性暴露明显增强了气道和系统炎症的强度,连续参加消防行动>10 h的消防员比<10 h的消防员有更强烈的全身性炎症
GREVEN等^[29]:暴露于火灾烟雾后24 h内、1周后、3个月后炎症的炎症反应	51名消防员	血液:IL-8↑(24 h内、1周后、3月后)、TNFα↑(24 h内) 痰液:NEUT↑(24 h内)	急性暴露于火灾烟雾会诱发健康消防员气道中的急性中性粒细胞增多,导致持久的系统性炎症反应增强
MAIN等^[30]:12 h野火抑制前后消防员的炎症反应	38名消防员	血液:IL-6↑、IL-8↑、IL-10↓	体力消耗、热应激或轮班时吸入的烟雾会诱发急性炎症反应