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Article(id=1240977215865811720, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240977214964036360, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202501035, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1735833600000, receivedDateStr=2025-01-03, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773801624504, onlineDateStr=2026-03-18, pubDate=1748102400000, pubDateStr=2025-05-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773801624504, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773801624504, creator=13701087609, updateTime=1773801624504, updator=13701087609, issue=Issue{id=1240977214964036360, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='10', pageStart='1729', pageEnd='1920', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773801624289, creator=13701087609, updateTime=1773825591019, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241077738770068227, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240977214964036360, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241077738770068228, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240977214964036360, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1754, endPage=1760, ext={EN=ArticleExt(id=1240977216184578828, articleId=1240977215865811720, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Effects of smoking and shift work and their interaction on anxiety and depression in steelworkers, columnId=1228016570660745413, journalTitle=Modern Preventive Medicine, columnName=Environmental and Occupational Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the independent effects and interaction of smoking and shift work on anxiety, depression, and Comorbid Anxiety and Depressive symptoms (CAD) among steelworkers.

Methods

Steelworkers undergoing occupational health check-ups from March to September 2017 were studied. Anxiety, depressive symptoms and CAD were assessed using the SAS self-assessment questionnaire and the SDS self-assessment questionnaire. Basic information of workers, demographic characteristics, smoking, and shift data were collected using the Health Assessment Questionnaire. The shift-weighted index (WSI) and smoking index were analyzed for the dose-response relationship between them and the CAD; the WSI were grouped according to the Akaike information crite-rion. Logistic regression analyzed the relationship between smoking, shift work (WSI), and anxiety, depression, and CAD. And to explore the interactive effect of both on CAD.

Results

A total of 3 657 workers were included in this study. The detection rates for anxiety, depression, and CAD were 28.63%, 27.15%, and 22.52%, respectively. WSI > 159 and a smoking index ≥ 200 were independent risk factors for these conditions. Smoking and shift work showed multiplicative and synergistic effects on CAD, with SI, RERI, and AP of 11.86 (8.54-16.47), 28.94 (8.42-49.47), and 0.89 (0.84-0.93), respectively.

Conclusion

Both smoking and shift work increase the risk of anxiety, depression, and their comorbidity. Their combined presence significantly elevates CAD risk in steelworkers. Proper health management measures are recommended to improve mental health.

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目的

探讨吸烟和倒班工作对钢铁工人焦虑、抑郁及共病焦虑抑郁症状（CAD）的独立影响及交互作用。

方法

选取2017年3~9月参加职业健康体检的某钢铁企业工人为研究对象。焦虑、抑郁症状及CAD均采用SAS自评问卷和SDS自评问卷评估，工人的基本信息、人口学特征、吸烟情况、倒班情况等使用《健康评估调查表》采集。采用限制性立方样条（RCS）模型分析倒班加权指数（WSI）和吸烟指数与CAD的剂量—反应关系；根据赤池信息准则（AIC）对WSI进行分组。采用logistic回归分析吸烟和倒班工作（WSI）与焦虑、抑郁和CAD的关系，并探讨两者对CAD的交互影响。

结果

本研究共纳入3 657名工人，焦虑、抑郁和CAD的检出率分别为28.63%、27.15%和22.52%。WSI>159和吸烟指数≥200均为焦虑、抑郁及CAD的独立危险因素。吸烟与倒班对CAD存在相乘交互作用和协同作用，交互作用指数（SI）、交互作用相对超额危险度比（RERI）、交互作用归因比（AP）分别为11.86（8.54~16.47）、28.94（8.42~49.47）、0.89（0.84~0.93）。

结论

吸烟和倒班工作均增加焦虑、抑郁及其共病风险，两者同存时对钢铁工人CAD的协同作用更显著，应采取健康管理措施改善心理健康。

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武建辉和张秀军为共同通信作者。武建辉，E-mail：；
张秀军，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=Rt2XcxIl2HXqdIhRxyTxTw==, magXml=43GBwb63urI7Dm1Qcv3tcg==, pdfUrl=null, pdf=lSDh5W7y0vEbLsBZk6jZyg==, pdfFileSize=1014687, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=mAaQTlX9DpUGD5VQeAkwSA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=zpnP+ejvJyghvnU1A1qmOw==, mapNumber=null, authorCompany=null, fund=null, authors=

朱红敏（1998—），女，硕士在读，研究方向：流行病与卫生统计学

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Series B (Methodological), 1995, 57(1): 289-300., articleTitle=Controlling the false discovery rate: a practical and powerful approach to multiple testing, refAbstract=null)], funds=[Fund(id=1240996917941949172, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, awardId=2021ZD0200700, language=CN, fundingSource=科技创新2030-“脑科学与类脑研究”重大项目(2021ZD0200700), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240996911101038870, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, xref=1., ext=[AuthorCompanyExt(id=1240996911109427480, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, companyId=1240996911101038870, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, North China University of SCIence and Technology, Tangshan, Hebei 063210, China), AuthorCompanyExt(id=1240996911117816089, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, companyId=1240996911101038870, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.华北理工大学公共卫生学院，河北 唐山 063210)]), AuthorCompany(id=1240996911214285090, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, xref=2., ext=[AuthorCompanyExt(id=1240996911218479396, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, companyId=1240996911214285090, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.河北省煤矿健康卫生安全重点实验室)])], figs=[ArticleFig(id=1240996915857379936, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, language=EN, label=Fig.1, caption=Selection of the study subjects, figureFileSmall=fcI5uJ/Ebs917krGHF64LA==, figureFileBig=akwJ6PZBMYqq5R5+IeH1PQ==, tableContent=null), ArticleFig(id=1240996915979014765, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, language=CN, label=图1, caption=研究对象的选择, figureFileSmall=fcI5uJ/Ebs917krGHF64LA==, figureFileBig=akwJ6PZBMYqq5R5+IeH1PQ==, tableContent=null), ArticleFig(id=1240996916083872373, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, language=EN, label=Fig.2, caption=Restricted cubic spline models of smoking index and WSI with Anxiety, Depressive symptoms, and CAD, figureFileSmall=LBeu309v+h6JIqb5GAFO9A==, figureFileBig=McYeuafeAGwQLbv1VEjbpg==, tableContent=null), ArticleFig(id=1240996916234867325, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, language=CN, label=图2, caption=吸烟指数和WSI与焦虑、抑郁及CAD的限制性立方样条模型, figureFileSmall=LBeu309v+h6JIqb5GAFO9A==, figureFileBig=McYeuafeAGwQLbv1VEjbpg==, tableContent=null), ArticleFig(id=1240996916356502150, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, language=EN, label=Fig.3, caption=RCS model prediction of the effect of smoking index and WSI on CAD, figureFileSmall=k/WeK/9+EvEtfsgc8KHPKw==, figureFileBig=+3m6s7S07/lJ6GIw7CsHVQ==, tableContent=null), ArticleFig(id=1240996916478136976, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, language=CN, label=图3, caption=吸烟指数和WSI对CAD影响的RCS模型预测, figureFileSmall=k/WeK/9+EvEtfsgc8KHPKw==, figureFileBig=+3m6s7S07/lJ6GIw7CsHVQ==, tableContent=null), ArticleFig(id=1240996916582994582, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, language=EN, label=Table 1, caption=

Univariate analysis of the effect of population characteristics on anxiety and depression among workers in steel enterprises[n(％)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量焦虑抑郁CAD
否
(n=2 610)		是
(n=1 047)		P值否
(n=2 664)		否
(n=993)		P值否
(n=2 673)		是
(n=984)		P值
年龄（岁）<0.001<0.001<0.001
18~451 467(56.2)285(27.2)1 498(56.2)254(25.6)1 499(56.1)253(25.7)
46~601 143(43.8)762(72.8)1 166(43.8)739(74.4)1 174(43.9)731(74.3)
性别<0.001<0.001<0.001
女209(8.0)51(4.9)213(8.0)47(4.7)213(8.0)47(4.8)
男2 401(92.0)996(95.1)2 451(92.0)946(95.3)2 460(92.0)937(95.2)
教育程度<0.001<0.001<0.001
小学及以下30(1.1)19(1.8)30(1.1)19(1.9)30(1.1)19(1.9)
初中或高中1 905(73.0)903(86.2)1 945(73.0)863(86.9)1 954(73.1)854(86.8)
大专及以上675(25.9)125(11.9)689(25.9)111(11.2)689(25.8)111(11.3)
婚姻状况0.0300.0300.030
未婚109(4.2)25(2.4)111(4.2)23(2.3)111(4.2)23(2.3)
已婚或再婚2 438(93.4)993(94.8)2 488(93.4)943(95.0)2 497(93.4)934(94.9)
离异或丧偶63(2.4)29(2.8)65(2.4)27(2.7)65(2.4)27(2.7)
饮酒状况<0.001<0.001<0.001
从不饮酒1 613(61.8)548(52.3)1 645(61.7)516(52.0)1 649(61.7)512(52.0)
过去饮酒73(2.8)32(3.1)73(2.7)32(3.2)74(2.8)31(3.2)
现在饮酒924(35.4)467(44.6)946(35.5)445(44.8)950(35.5)441(44.8)
睡眠质量<0.001<0.001<0.001
无睡眠障碍1 367(52.4)519(49.6)1 378(51.7)508(51.2)1 385(51.8)501(50.9)
可疑失眠561(21.5)185(17.7)565(21.2)181(18.2)566(21.2)180(18.3)
失眠682(26.1)343(32.8)721(27.1)304(30.6)722(27.0)303(30.8)
高尿酸血症<0.001<0.001<0.001
否2 235(85.6)932(89.0)2 283(85.7)884(89.0)2 292(85.7)875(88.9)
是375(14.4)115(11.0)381(14.3)109(11.0)381(14.3)109(11.1)
高温<0.0010.8200.800
否1 140(43.7)414(39.5)987(37.0)372(37.5)990(37.0)369(37.5)
是1 570(56.3)633(60.5)1 677(63.0)621(62.5)1 683(63.0)615(62.5)
噪声<0.0010.2200.260
否823(32.5)223(31.3)747(28.0)299(30.1)751(28.1)295(30.0)
是1 787(68.5)824(78.7)1 917(72.0)694(69.9)1 922(71.9)689(70.0)
粉尘0.0500.6300.540
否1 352(51.8)580(55.4)1 401(52.6)531(53.5)1 404(52.5)528(53.7)
是1 258(48.2)467(44.6)1 263(47.4)462(46.5)1 269(47.5)456(46.3)
), ArticleFig(id=1240996916704629407, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, language=CN, label=表1, caption=

人群特征对钢铁企业工人焦虑抑郁影响的单因素分析[n(％)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量焦虑抑郁CAD
否
(n=2 610)		是
(n=1 047)		P值否
(n=2 664)		否
(n=993)		P值否
(n=2 673)		是
(n=984)		P值
年龄（岁）<0.001<0.001<0.001
18~451 467(56.2)285(27.2)1 498(56.2)254(25.6)1 499(56.1)253(25.7)
46~601 143(43.8)762(72.8)1 166(43.8)739(74.4)1 174(43.9)731(74.3)
性别<0.001<0.001<0.001
女209(8.0)51(4.9)213(8.0)47(4.7)213(8.0)47(4.8)
男2 401(92.0)996(95.1)2 451(92.0)946(95.3)2 460(92.0)937(95.2)
教育程度<0.001<0.001<0.001
小学及以下30(1.1)19(1.8)30(1.1)19(1.9)30(1.1)19(1.9)
初中或高中1 905(73.0)903(86.2)1 945(73.0)863(86.9)1 954(73.1)854(86.8)
大专及以上675(25.9)125(11.9)689(25.9)111(11.2)689(25.8)111(11.3)
婚姻状况0.0300.0300.030
未婚109(4.2)25(2.4)111(4.2)23(2.3)111(4.2)23(2.3)
已婚或再婚2 438(93.4)993(94.8)2 488(93.4)943(95.0)2 497(93.4)934(94.9)
离异或丧偶63(2.4)29(2.8)65(2.4)27(2.7)65(2.4)27(2.7)
饮酒状况<0.001<0.001<0.001
从不饮酒1 613(61.8)548(52.3)1 645(61.7)516(52.0)1 649(61.7)512(52.0)
过去饮酒73(2.8)32(3.1)73(2.7)32(3.2)74(2.8)31(3.2)
现在饮酒924(35.4)467(44.6)946(35.5)445(44.8)950(35.5)441(44.8)
睡眠质量<0.001<0.001<0.001
无睡眠障碍1 367(52.4)519(49.6)1 378(51.7)508(51.2)1 385(51.8)501(50.9)
可疑失眠561(21.5)185(17.7)565(21.2)181(18.2)566(21.2)180(18.3)
失眠682(26.1)343(32.8)721(27.1)304(30.6)722(27.0)303(30.8)
高尿酸血症<0.001<0.001<0.001
否2 235(85.6)932(89.0)2 283(85.7)884(89.0)2 292(85.7)875(88.9)
是375(14.4)115(11.0)381(14.3)109(11.0)381(14.3)109(11.1)
高温<0.0010.8200.800
否1 140(43.7)414(39.5)987(37.0)372(37.5)990(37.0)369(37.5)
是1 570(56.3)633(60.5)1 677(63.0)621(62.5)1 683(63.0)615(62.5)
噪声<0.0010.2200.260
否823(32.5)223(31.3)747(28.0)299(30.1)751(28.1)295(30.0)
是1 787(68.5)824(78.7)1 917(72.0)694(69.9)1 922(71.9)689(70.0)
粉尘0.0500.6300.540
否1 352(51.8)580(55.4)1 401(52.6)531(53.5)1 404(52.5)528(53.7)
是1 258(48.2)467(44.6)1 263(47.4)462(46.5)1 269(47.5)456(46.3)
), ArticleFig(id=1240996916838847149, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, language=EN, label=Table 2, caption=

Univariate analysis of the effects of smoking and shift work on anxiety, depression and CAD among workers in steel enterprises [n (%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量焦虑抑郁CAD
否
(n=2 610)		是
(n=1 047)		P值否
(n=2 664)		是
(n=993)		P值否
(n=2 673)		是
(n=984)		P值
倒班情况<0.001<0.001<0.001
从不倒807(30.9)41(3.9)810(30.4)38(3.8)816(30.5)32(3.2)
过去倒402(15.4)194(18.5)412(15.5)184(18.5)413(15.5)183(18.6)
现在倒1 401(53.7)812(77.6)1 442(54.1)771(77.7)1 444(54.0)769(78.2)
吸烟状况<0.001<0.001<0.001
从不吸1 070(41.0)348(33.2)1 106(41.5)312(31.4)1 106(41.4)312(31.7)
已戒烟166(6.4)39(3.7)166(6.2)39(3.9)166(6.2)39(4.0)
现在吸1 374(52.6)660(63.1)1 392(52.3)642(64.7)1 401(52.4)633(64.3)
), ArticleFig(id=1240996916964676279, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, language=CN, label=表2, caption=

吸烟和倒班情况对钢铁企业工人焦虑、抑郁和CAD影响的单因素分析[n (%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量焦虑抑郁CAD
否
(n=2 610)		是
(n=1 047)		P值否
(n=2 664)		是
(n=993)		P值否
(n=2 673)		是
(n=984)		P值
倒班情况<0.001<0.001<0.001
从不倒807(30.9)41(3.9)810(30.4)38(3.8)816(30.5)32(3.2)
过去倒402(15.4)194(18.5)412(15.5)184(18.5)413(15.5)183(18.6)
现在倒1 401(53.7)812(77.6)1 442(54.1)771(77.7)1 444(54.0)769(78.2)
吸烟状况<0.001<0.001<0.001
从不吸1 070(41.0)348(33.2)1 106(41.5)312(31.4)1 106(41.4)312(31.7)
已戒烟166(6.4)39(3.7)166(6.2)39(3.9)166(6.2)39(4.0)
现在吸1 374(52.6)660(63.1)1 392(52.3)642(64.7)1 401(52.4)633(64.3)
), ArticleFig(id=1240996917094699714, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, language=EN, label=Table 3, caption=

Univariate analysis of the effects of WSI and smoking index on Anxiety, Depression, and CAD in steelworkers [n (%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量焦虑抑郁CAD
否
(n=2 610)		是
(n=1 047)		P值否
(n=2 664)		是
(n=993)		P值否
(n=2 673)		是
(n=984)		P值
WSI分段<0.001<0.001<0.001
<54.6657(25.2)74(7.1)655(24.6)76(7.7)657(24.6)74(7.5)
54.6~159675(25.9)48(4.6)683(25.6)40(4.0)687(25.7)36(3.7)
160~388490(18.8)236(22.5)505(19.0)221(22.3)506(18.9)220(22.4)
389~590413(15.8)307(29.3)427(16.0)293(29.5)428(16.0)292(29.7)
>590375(14.4)382(36.5)394(14.8)363(36.6)395(14.8)362(36.8)
吸烟指数分段
（包年）		<0.001<0.001<0.001
<2001 887(72.3)287(27.4)1 887(70.8)287(28.9)1 887(70.6)287(29.2)
200~400313(12.0)316(30.2)321(12.1)308(31.0)321(12.0)308(31.3)
>400410(15.7)444(42.4)456(17.1)398(40.1)465(17.4)389(39.5)
), ArticleFig(id=1240996917199557319, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, language=CN, label=表3, caption=

WSI和吸烟指数对钢铁企业工人焦虑、抑郁和CAD影响的单因素分析[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量焦虑抑郁CAD
否
(n=2 610)		是
(n=1 047)		P值否
(n=2 664)		是
(n=993)		P值否
(n=2 673)		是
(n=984)		P值
WSI分段<0.001<0.001<0.001
<54.6657(25.2)74(7.1)655(24.6)76(7.7)657(24.6)74(7.5)
54.6~159675(25.9)48(4.6)683(25.6)40(4.0)687(25.7)36(3.7)
160~388490(18.8)236(22.5)505(19.0)221(22.3)506(18.9)220(22.4)
389~590413(15.8)307(29.3)427(16.0)293(29.5)428(16.0)292(29.7)
>590375(14.4)382(36.5)394(14.8)363(36.6)395(14.8)362(36.8)
吸烟指数分段
（包年）		<0.001<0.001<0.001
<2001 887(72.3)287(27.4)1 887(70.8)287(28.9)1 887(70.6)287(29.2)
200~400313(12.0)316(30.2)321(12.1)308(31.0)321(12.0)308(31.3)
>400410(15.7)444(42.4)456(17.1)398(40.1)465(17.4)389(39.5)
), ArticleFig(id=1240996917371523793, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, language=EN, label=Table 4, caption=

Logistic regression analysis of the relationship between smoking and shift exposure and Anxiety symptoms, Depressive symptoms and CAD in steel workers

, figureFileSmall=null, figureFileBig=null, tableContent=
变量焦虑抑郁CAD
OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值
WSI分段
<54.61.00-1.00-1.00-
54.6~1590.32(0.21~0.50)<0.0010.26(0.16~0.41)<0.0010.27(0.18~0.42)<0.001
160~3881.94(1.91~4.86)<0.0011.87(1.23~2.84)<0.0011.96(1.34~2.88)<0.001
389~5902.11(1.27~2.97)<0.0012.29(1.02~5.16)<0.0012.14(1.03~4.45)<0.001
>5902.37(1.30~4.34)<0.0012.49(1.38~4.47)0.0402.34(1.41~4.06)<0.001
吸烟指数分段（包年）
<2001.00-1.00-1.00-
200~4001.75(0.99~3.08)0.0501.09(1.62~1.92)<0.0011.85(1.12~3.07)0.020
>4003.96(2.85~5.50)<0.0013.61(2.60~5.01)<0.0013.99(2.98~5.35)<0.001
), ArticleFig(id=1240996917463798489, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, language=CN, label=表4, caption=

吸烟和倒班暴露情况与钢铁工人焦虑症状、抑郁症状和CAD关系的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量焦虑抑郁CAD
OR(95%CI)P值OR(95%CI)P值OR(95%CI)P值
WSI分段
<54.61.00-1.00-1.00-
54.6~1590.32(0.21~0.50)<0.0010.26(0.16~0.41)<0.0010.27(0.18~0.42)<0.001
160~3881.94(1.91~4.86)<0.0011.87(1.23~2.84)<0.0011.96(1.34~2.88)<0.001
389~5902.11(1.27~2.97)<0.0012.29(1.02~5.16)<0.0012.14(1.03~4.45)<0.001
>5902.37(1.30~4.34)<0.0012.49(1.38~4.47)0.0402.34(1.41~4.06)<0.001
吸烟指数分段（包年）
<2001.00-1.00-1.00-
200~4001.75(0.99~3.08)0.0501.09(1.62~1.92)<0.0011.85(1.12~3.07)0.020
>4003.96(2.85~5.50)<0.0013.61(2.60~5.01)<0.0013.99(2.98~5.35)<0.001
), ArticleFig(id=1240996917547684574, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, language=EN, label=Table 5, caption=

The impact of the interaction between smoking index and shift work weighted index on CAD

, figureFileSmall=null, figureFileBig=null, tableContent=
变量1变量2RERI（95%CI）AP（95%CI）SI（95%CI）P相乘FDR显著性判断
吸烟指数（包年）WSI28.94((8.42~49.47)0.89(0.84~0.93)11.86(8.54~16.47)<0.001<0.001显著
), ArticleFig(id=1240996917644153575, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977215865811720, language=CN, label=表5, caption=

吸烟指数与WSI的交互作用对共病焦虑抑郁症状（CAD）的影响

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变量1变量2RERI（95%CI）AP（95%CI）SI（95%CI）P相乘FDR显著性判断
吸烟指数（包年）WSI28.94((8.42~49.47)0.89(0.84~0.93)11.86(8.54~16.47)<0.001<0.001显著
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倒班工作与吸烟及其交互作用对钢铁工人焦虑抑郁的影响
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朱红敏 1 , 张尚明珠 1 , 王丹 1 , 武建辉 2 , 张秀军 1
现代预防医学 | 环境与职业卫生 2025,52(10): 1754-1760
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现代预防医学 | 环境与职业卫生 2025, 52(10): 1754-1760
倒班工作与吸烟及其交互作用对钢铁工人焦虑抑郁的影响
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朱红敏1, 张尚明珠1, 王丹1, 武建辉2 , 张秀军1
作者信息
  • 1.华北理工大学公共卫生学院，河北 唐山 063210
  • 2.河北省煤矿健康卫生安全重点实验室

    • 朱红敏（1998—），女，硕士在读，研究方向：流行病与卫生统计学

通讯作者:

武建辉和张秀军为共同通信作者。武建辉，E-mail：；
张秀军，E-mail：
Effects of smoking and shift work and their interaction on anxiety and depression in steelworkers
Hong-min ZHU1, Shang-ming-zhu ZHANG1, Dan WANG1, Jian-hui WU2 , Xiu-jun ZHANG1
Affiliations
  • School of Public Health, North China University of SCIence and Technology, Tangshan, Hebei 063210, China
出版时间: 2025-05-25 doi: 10.20043/j.cnki.MPM.202501035
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摘要
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目的

探讨吸烟和倒班工作对钢铁工人焦虑、抑郁及共病焦虑抑郁症状（CAD）的独立影响及交互作用。

方法

选取2017年3~9月参加职业健康体检的某钢铁企业工人为研究对象。焦虑、抑郁症状及CAD均采用SAS自评问卷和SDS自评问卷评估，工人的基本信息、人口学特征、吸烟情况、倒班情况等使用《健康评估调查表》采集。采用限制性立方样条（RCS）模型分析倒班加权指数（WSI）和吸烟指数与CAD的剂量—反应关系；根据赤池信息准则（AIC）对WSI进行分组。采用logistic回归分析吸烟和倒班工作（WSI）与焦虑、抑郁和CAD的关系，并探讨两者对CAD的交互影响。

结果

本研究共纳入3 657名工人，焦虑、抑郁和CAD的检出率分别为28.63%、27.15%和22.52%。WSI>159和吸烟指数≥200均为焦虑、抑郁及CAD的独立危险因素。吸烟与倒班对CAD存在相乘交互作用和协同作用，交互作用指数（SI）、交互作用相对超额危险度比（RERI）、交互作用归因比（AP）分别为11.86（8.54~16.47）、28.94（8.42~49.47）、0.89（0.84~0.93）。

结论

吸烟和倒班工作均增加焦虑、抑郁及其共病风险，两者同存时对钢铁工人CAD的协同作用更显著，应采取健康管理措施改善心理健康。

倒班指数  /  吸烟指数  /  焦虑  /  抑郁  /  共病焦虑抑郁  /  交互作用
Objective

To investigate the independent effects and interaction of smoking and shift work on anxiety, depression, and Comorbid Anxiety and Depressive symptoms (CAD) among steelworkers.

Methods

Steelworkers undergoing occupational health check-ups from March to September 2017 were studied. Anxiety, depressive symptoms and CAD were assessed using the SAS self-assessment questionnaire and the SDS self-assessment questionnaire. Basic information of workers, demographic characteristics, smoking, and shift data were collected using the Health Assessment Questionnaire. The shift-weighted index (WSI) and smoking index were analyzed for the dose-response relationship between them and the CAD; the WSI were grouped according to the Akaike information crite-rion. Logistic regression analyzed the relationship between smoking, shift work (WSI), and anxiety, depression, and CAD. And to explore the interactive effect of both on CAD.

Results

A total of 3 657 workers were included in this study. The detection rates for anxiety, depression, and CAD were 28.63%, 27.15%, and 22.52%, respectively. WSI > 159 and a smoking index ≥ 200 were independent risk factors for these conditions. Smoking and shift work showed multiplicative and synergistic effects on CAD, with SI, RERI, and AP of 11.86 (8.54-16.47), 28.94 (8.42-49.47), and 0.89 (0.84-0.93), respectively.

Conclusion

Both smoking and shift work increase the risk of anxiety, depression, and their comorbidity. Their combined presence significantly elevates CAD risk in steelworkers. Proper health management measures are recommended to improve mental health.

WSI  /  Smoke index  /  Anxiety  /  Depressive symptoms  /  Comorbid Anxiety and Depressive symptoms  /  Interactive effect
朱红敏, 张尚明珠, 王丹, 武建辉, 张秀军. 倒班工作与吸烟及其交互作用对钢铁工人焦虑抑郁的影响. 现代预防医学, 2025 , 52 (10) : 1754 -1760 . DOI: 10.20043/j.cnki.MPM.202501035
Hong-min ZHU, Shang-ming-zhu ZHANG, Dan WANG, Jian-hui WU, Xiu-jun ZHANG. Effects of smoking and shift work and their interaction on anxiety and depression in steelworkers[J]. Modern Preventive Medicine, 2025 , 52 (10) : 1754 -1760 . DOI: 10.20043/j.cnki.MPM.202501035
正文
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焦虑和抑郁是全球性心理健康问题。抑郁以持续的情绪低落、兴趣减退和认知功能受损为主要特征，是造成慢性疾病负担的第二大因素[1]。焦虑通常包括持续性恐惧、回避可感知的威胁及可能的惊恐发作[2]。在全球疾病负担中排名前25位[3]，每年导致全球劳动生产率损失超过1万亿美元[4]。它们不仅单独存在，还常常共病出现。共病焦虑和抑郁症状(Comorbid Anxiety and Depressive symptoms,CAD)者的病情往往更为复杂，且呈年轻化发展[2,5]。已经对公共卫生构成了重大挑战。
研究显示，吸烟增加抑郁风险，且存在剂量依赖性，戒烟可显著改善抑郁、焦虑等症状，提升心理幸福感[6]，效果与抗抑郁药相当[7]。然而，Yao等[8]则认为，抑郁症的遗传易感性可能促使个体采取吸烟行为作为一种自我调节情绪的方式，而不是吸烟直接导致抑郁症状。此外，轮班工人因生物钟紊乱[9]，患抑郁症和焦虑症风险高出25%至40%[10]，中度及以上心理问题发生率可达21.2%[11]。它们对心理健康存在多因素影响。据报道，吸烟和BMI等生活方式因素可解释倒班工作与抑郁、焦虑相关性的31.3%和21.2%[10]。这表明倒班工作对心理健康的影响可能是多维度的，可能还受到其他未被考虑的因素影响，如吸烟等。但目前对倒班与吸烟的联合作用对CAD的影响研究较少。因此，本研究旨在探讨吸烟和倒班工作对焦虑、抑郁和CAD的独立影响，及其交互作用是否会导致工人出现更高水平的CAD，为保护钢铁工人的心理健康提供理论依据。
1　对象与方法
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1.1　研究对象
为2017年3~9月参加职业体检的某钢铁企业工人，纳入标准：自愿参与研究；排除标准：非一线在岗工人，工龄<1年；患严重神经系统疾病、双相障碍、其他精神疾病及物质滥用者；信息不完整者。该企业共8646名工人参加体检，经筛选，3 657名纳入研究，见图1。所有参与者均知情同意，本研究经华北理工大学医学伦理审查委员会批准（批准号：16040）。
1.2　问卷调查
本研究使用自制《健康评估调查表》，培训调查员一对一采集钢铁工人的基本信息、人口学特征、疾病史、倒班情况及生活方式（饮食、运动、吸烟、饮酒）等数据。
1.3　体格检查
身高体重测量使用德康DK-08-C超声波身高体重仪，被测者摘掉身上不相干物品，重复2次取均值。
1.4　血生化检测
要求钢铁工人禁食≥8 h，倒班者在休息日抽血，用Mindray BS-800生化仪4小时内检测血糖、HDL-C、LDL-C等指标。
1.5　相关变量定义
1.5.1　焦虑和抑郁的评估
采用抑郁自评量表（SDS）和焦虑自评量表（SAS）进行[12]。SDS和SAS均包含20个项目，采用4级评分，计算粗分后乘以1.25并取整得到标准分，标准分≥50分分别表示抑郁和焦虑。若工人SDS和SAS得分均≥50分，则诊断为共病焦虑和抑郁症状（CAD），并分为共病组和非共病组。
1.5.2　吸烟情况及吸烟指数评估
吸烟情况分为从不吸烟、已戒烟和现在吸烟三种。已戒烟指调查时已至少半年不吸烟。吸烟指数通过以下公式计算：
其中每包20支。根据指数，工人分为不吸烟或轻度吸烟(<200)、中度吸烟(200~400)，及重度吸烟(>400)。
1.5.3　倒班加权指数（Weighted Shift Index, WSI）的评估
本研究中轮夜班主要是四班三运转制和三班两运转制，被分为现在倒班、过去倒班和从不倒班。持续某一特定时间工作或倒班<1年被定义为从不倒班。WSI计算公式如下：
其中，T表示上夜班的时间，n是上夜班的天数。
1.5.4　协变量评估
积极/消极事件：消极事件如失业、退休、物品损失/生意失败等；积极事件如家庭成员婚礼、新工作或家庭成员出生等；
体脂百分比（Body Fat Percentage，BF%）：
其中男性性别为1，女性为0。男性BF%≥25%、女性BF%≥36%为超重；男性BF%≥30%、女性BF%≥42%为肥胖；体质指数(Body Mass Index，BMI) = 体重(kg) / 身高2(m2)；
体力活动：根据国际身体活动量表分为轻、中和重度[13]；
饮酒情况：分为从不饮酒、已戒酒和现在饮酒；
社会支持：采用肖水源社会支持评定量表（Social Support Rating Scale，SSRS）定义[14]，总分 < 23分为低支持，23～44分为中度支持，> 44分为高支持；
睡眠质量[15]：采用阿森斯失眠量表（Athens Insomnia Scale，AIS）进行测评。AIS < 4为无睡眠障碍，4 ≤ AIS ≤ 6为可疑失眠，AIS > 6为失眠；
职业紧张：采用修订的中文版工作内容问卷（Job Content Questionnaire，JCQ）[16]进行测评；
高温、噪声、粉尘暴露情况均通过问卷以“是”和“否”定义。
1.6　统计分析
分类变量用率或百分比表示，组间比较采用χ2检验。采用限制性立方样条（RCS）模型分析WSI和吸烟指数与焦虑、抑郁及CAD的剂量-反应关系；根据赤池信息准则(Akaike information crite-rion，AIC)对WSI进行分组。并采用RCS模型分析两个变量对CAD的交互作用。使用多因素logistic回归模型分析WSI和吸烟指数与焦虑、抑郁和CAD的关系及两者的相乘交互作用。并计算交互作用指数（SI）、相对超额危险度比（RERI）和交互作用归因比（AP）来评价相加交互作用。为控制多重共线性问题，后续分析引入Benjamini-Hochberg程序来校正P值，以控制错误发现率（FDR）。上述所有的统计分析都使用R软件(版本4.2.2)进行。检验水准α=0.05。
2　结果
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2.1　钢铁工人的基本特征
本研究共包括了3 657名参与者，平均年龄为45(36,49)岁。焦虑、抑郁和共病焦虑抑郁症状的检出率分别为28.63%、27.15%和22.52%。见表1。
2.2　不同特征对钢铁企业工人焦虑抑郁影响的单因素分析
经比较，在人口学特征上，年龄46~60岁者在焦虑、抑郁及共病组中比例分别为72.8%、74.6%和74.3%，高于未检出组，差异有统计学意义(P<0.001)。男性工人在焦虑、抑郁和CAD组中的比例高于女性，差异有统计学意义(P<0.001)。学历为初中或高中者在检出组与未检出组中占比最高，大专及以上人群检出组占比低于对照组，差异显著(P<0.001)。婚姻状况中，已婚或再婚、离异或丧偶者检出比例高于未检出组，差异有统计学意义(P=0.03)。在身体健康状况方面，检出焦虑、抑郁和CAD组中失眠者和高尿酸血症者的比例高于未检组，差异有统计学意义(均P<0.05)。行为生活方式上，焦虑、抑郁和CAD组现在饮酒者比例高于对照组，差异有统计学意义(均P<0.001)。职业因素方面，焦虑组中暴露于高温和噪声的工人比例高于不暴露者，差异显著(均P<0.001)。但在抑郁组和共病组中，这一比例低于对照组，且两组分布无统计学差异(均P>0.05)。尚未发现肥胖、积极或消极事件、社会支持、超负荷、糖尿病、职业紧张以及暴露于粉尘等方面的统计学差异(均P>0.05)，见表1。
2.3　吸烟和倒班情况对钢铁企业工人焦虑抑郁影响的单因素分析
经比较，发现焦虑组、抑郁组和CAD组现在倒班的工人比例分别为77.6%、77.7%和78.2%，均高于未检出组，差异均有统计学意义(均P<0.001)。焦虑组、抑郁组和CAD组现在吸烟的比例均高于未检出组，差异均具有统计学意义(均P<0.001)。见表2。
2.4　WSI和吸烟指数对钢铁企业工人焦虑抑郁影响的单因素分析
用限制性立方样条（RCS）拟合WSI和吸烟指数与CAD关系，基于AIC分组（图2）。最终选择4个节点(P5、P35、P65、P95)拟合的模型，将其分为5段（<54.6=1，54.6 ~ 159=2，160~388=3，389~590=4，>590=5）。两者与焦虑、抑郁及CAD呈非线性剂量反应，关联性和非线性均显著(P<0.001)。按百分数（36%、65%和95%）将WSI分低、中、高三个水平，分析吸烟指数和WSI对CAD影响。图3显示，吸烟指数对CAD的影响受WSI水平调节，交互作用在高WSI水平显著。此外，焦虑组中吸烟指数在200~400和>400所占比例为30.2%和42.4%，抑郁组的比例分别为31.0%和31.3%，CAD组的比例分别为31.3%和39.5%，均高于未检出组，有统计学差异(P<0.001)；在WSI方面，焦虑组、抑郁组和CAD组在159 ~ 时所占比例也均高于未检出组，差异有统计学意义(P<0.001)，见表3。
2.5　倒班和吸烟暴露对钢铁企业工人焦虑、抑郁和共病焦虑抑郁症状的多因素分析
表4显示，调整混杂因素后，焦虑症状分析中，吸烟指数200~400和>400的工人检出风险更高，OR(95%CI)分别为1.75(0.99~3.08)和3.96(2.85~5.50)。WSI为54.6~159时，焦虑风险降低，OR(95%CI)为0.32(0.21~0.50)；而WSI在160~388、389~590和>590时，风险增加，OR(95%CI)分别为1.94(1.91~4.86)、2.11(1.27~2.97)和2.37(1.30~4.34)。抑郁症状分析中，吸烟指数200~400和>400的工人检出风险更高，OR(95%CI)分别为1.09(1.62~1.92)和3.61(2.60~5.01)。WSI为54.6~159时，为保护因素，OR(95%CI)为0.26(0.16 ~ 0.41)；WSI在160~、389~和>590时为危险因素，OR(95%CI)分别为1.87(1.23~2.84)、2.29(1.02~5.16)和2.49(1.38~4.47)。在CAD方面，吸烟指数200~400和>400为危险因素，OR(95%CI)分别为1.85(1.12~3.07)和3.99(2.98~5.35)。WSI为54.6~159时为保护因素，OR(95%CI)为0.27(0.18~0.42)；WSI在160~388、389~590和>590时为危险因素，OR(95%CI)分别为1.96(1.34~2.88)、2.14(1.03~4.45)和2.34(1.41~4.06)。
2.6　吸烟和倒班之间的交互作用与共病焦虑抑郁症状的关联
吸烟与倒班对CAD风险存在相乘交互作用（P交互< 0.001）。将吸烟指数和WSI分别以200和159为截断点分为两组进行交互作用分析，结果提示吸烟与倒班存在协同作用，SI、RERI、AP分别为11.86（95%CI：8.54~16.47）、28.94（95%CI：8.42~49.47）和0.89（95%CI：(0.84~0.93）。经过Benjamini-Hochberg方法校正后，吸烟指数与WSI的交互作用对CAD有显著影响（P<0.001）。见表5。
3　讨论
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全球焦虑和抑郁构成重大疾病负担[3,17]。钢铁工人焦虑和抑郁问题日益凸显，成为公共卫生新挑战。目前，虽缺乏直接证据，但根据孟加拉国的研究[18]，建筑工人的焦虑、抑郁的检出率分别为17.9%、30.3%。钢铁工人因身体伤害和心理压力，抑郁和焦虑风险可能更高。本研究中，钢铁工人焦虑、抑郁和CAD检出率分别为28.63%、27.15%和22.52%，与国内外研究差异显著。例如，中国煤矿工人焦虑、抑郁阳性检出率高达51.1%和60.5%[19]，北京某区制造业工人分别为23.40%和9.09%[20]。这些差异可能源于研究领域、工具和对象不同，但均凸显职业人群的高发风险。
研究显示倒班和吸烟与抑郁和/或焦虑正相关[6,9]，共同神经递质通路是机制之一[7]。本研究中，过去/现在倒班和现在吸烟均为焦虑、抑郁和CAD检出的危险因素，与主观和客观研究一致[6-7]。吸烟指数和WSI与焦虑、抑郁和CAD均存在非线性剂量-反应关系，这表明倒班和吸烟对健康的影响可能随着频率和强度的增加而加剧。此外，吸烟指数>400者检出焦虑、抑郁和CAD的风险分别为对照组的3.96倍、3.61倍和3.99倍，同时当WSI>159时，研究发现其与焦虑、抑郁和CAD的风险增加呈现类似情况。有趣的是，调整混杂因素后发现，WSI在54.6~159时，焦虑、抑郁和CAD检出风险低于WSI<54.6者，这可能与工作适应和阈值效应[21]有关。我们也观察到，高温/噪声暴露者焦虑检出率在单因素分析中略高，在抑郁和CAD症状则较低，可能存在阈值，超过这个阈值时高温/噪声就会对心理健康产生负面影响。也表明流行病学研究应考虑更多潜在因素，而非单一指标。
倒班和吸烟可能通过相互作用对心理健康产生更复杂影响[22-23]。如橡胶工人研究显示，吸烟和职业暴露PFTs（肺功能测试）有协同效应[24]，呼吸系统疾病使焦虑和抑郁的风险分别增加了2.25倍和1.84倍，这意味着倒班与吸烟对焦虑和抑郁症状可能存在未被充分探索的交互效应[25]，从机制学上来说，倒班会增加心理压力，导致社会心理应激升高，而吸烟常被用作缓解压力的手段，但反而可能增强尼古丁依赖，加重心理负担。尽管目前缺乏直接证据表明两者存在协同作用，但从现有研究来看，倒班工作和吸烟均对心理健康有负面影响，且倒班工人中吸烟行为较为普遍，暗示两者可能存在协同作用。本研究中，两者的交互作用显著加剧了CAD的风险，不仅存在相乘交互作用，还存在相加交互作用。具体而言，与吸烟指数<200的工人比，指数为200~400和>400在WSI>159时对CAD的影响更为显著。此外，吸烟指数对心理健康结局的影响可能受到高WSI水平的调节，提示在高倒班压力下，吸烟可能对结局产生更大的负面影响。这一发现与现有研究结果一致[22-23]。未来的研究需要进一步探讨这种交互作用的潜在机制，并考虑在不同人群中的适用性。
局限性：首先，横断面设计无法确定因果关系，需前瞻性研究证实；其次，研究对象局限于唐山地区，且钢铁企业环境特殊，男女比例失衡，外推结果需谨慎；最后，由于本研究因涉及多变量和交互作用，多重检验可能增加假阳性概率。尽管采用了交互作用分析、RCS模型和FDR校正，有效降低假阳性，提高了结果的可靠[26]。但我们也意识到任何方法都无法完全消除多重检验风险，在解释结果时需结合研究综合判断。我们的研究结果对于公共卫生政策制定者来说具有重要意义。强调需综合措施减少吸烟和改善倒班工作制度，促进工人心理健康。未来的研究应探索针对高风险群体的特定干预，深入研究相关神经生物学机制，开发针对性预防和干预措施。
4　结论
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总之，吸烟和倒班工作均与钢铁工人焦虑症状、抑郁症状及共病焦虑抑郁症状风险增加有关，且吸烟和倒班存在协同作用，两者同存时对钢铁工人共病焦虑抑郁症状的影响更显著。针对这一群体，需要特别关注其心理健康状况，并采取相应的干预措施。
基金
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  • 科技创新2030-“脑科学与类脑研究”重大项目(2021ZD0200700)
文献
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2025年第52卷第10期
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doi: 10.20043/j.cnki.MPM.202501035
  • 接收时间：2025-01-03
  • 首发时间：2026-03-18
  • 出版时间：2025-05-25
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  • 收稿日期：2025-01-03
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科技创新2030-“脑科学与类脑研究”重大项目(2021ZD0200700)
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    1.华北理工大学公共卫生学院，河北 唐山 063210
    2.河北省煤矿健康卫生安全重点实验室

通讯作者:

武建辉和张秀军为共同通信作者。武建辉，E-mail：；
张秀军，E-mail：
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https://castjournals.cast.org.cn/joweb/xdyfyx/CN/10.20043/j.cnki.MPM.202501035
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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