影响铸钢接尘工人肺功能损害的因素分析

对沈阳重型机器厂铸钢车间５０６名铸钢接尘工人进行了肺功能测定与影响因素分析。结果表明：不论吸烟与否，铸钢接尘工人ＦＶＣ、ＦＥＶ１、ＦＥＦ２５－７５％、Ｖ７５、Ｖ５０和ＦＥＶ１／ＦＶＣ％等肺功能指标的实测值占预计值百分比较对照组明显低（Ｐ均＜０．０１）．接尘工人肺功能损害随着累计接尘量的增加和接尘工龄的延长而加重。清砂工肺功能损害较其它工种为重．多因素分析表明：粉尘是影响工人肺功能损害的主要因素．     

滑石接尘矿工呼吸系统损害的调查

对接触滑石尘５年以上的２６７名男性矿工进行了呼吸系统症状阳性率，慢性支气管炎患病率与肺功能损害的调查与分析。结果表明：不论吸烟与否，接尘组咳嗽、咯痰、胸闷，气短等呼吸系统症状阳性率、慢性支气管炎患闰率均显著高于对照组。ＦＶＣ、ＦＥＶ１、ＭＭＦ、ＰＥＦ、Ｖ５０、Ｖ２５等指标实测值／预计值（％）较对照组明显较低，异常率明显升高。多因素分析结果表明：接尘工龄是影响肺功能损害的主要因素，即接尘工龄越长，肺     

滑石接尘退休工人肺功能损害的调查及其影响因素分析

对１２１名滑石接尘退休工人进行了肺功能损害的调查及其影响因素分析。结果表明：不论吸烟与否，退休接尘工人ＦＶＣ、ＦＥＶ１、ＭＭＦ、Ｖ５０、Ｖ２５等指标的实测值、实测值／预计值（％）较对照组明显降低，异常率则明显升高，且多具有显著或非常显著的统计学意义。多因素分析表明：慢性支气管炎和接尘工龄是影响退休接尘工人肺功能下降的主要因素。     

滑石粉尘对接尘工人肺通气功能影响的配对研究

本文按照配对设计方法，以年龄、身高、体重与吸烟习惯等作为配对条件，进行了滑石接尘工人肺功能损害的研究。结果表明，无论吸烟与否，接尘组ＦＶＣ，ＦＥＶ１，ＭＭＦ，ＰＥＦ，Ｖ＿（５０），Ｖ＿（２５）等指标的实测值，实测值占预计值％均较对照组显著降低，肺功能异常率明显升高，且多具有显著或非常显著的意义。     

铸钢与铸铁接尘工人肺功能测定的比较分析

本文对５０６名铸钢接尘工人，１５５０名铸铁接尘工人．７３８名对照工人进行了肺通气功能的测定与比较分析。结果表明：无论吸烟与否、铸钢、铸铁接尘工人ＦＶＣ、ＦＥＶ１．０等肺功能指标的实测值占预计值百分比的下降，肺功能异常率的升高，均较对照工人为明显，铸钢工人肺功能的损害尤为严重。三年追踪观察结果显示：铸钢工人ＦＶＣ、ＦＥＶ１．０的年均下降值大于铸铁工人。铸钢与铸铁接尘工人相同累计接尘量，相同接尘工龄与相同工种间的比较，亦均显示铸钢工人肺功能的损害较铸铁工人为重。     

高原石棉作业工人肺功能的调查

对青海省某高原石棉矿３５３名作业男工和河北省某石棉矿３４７名男工进行了肺功能检查。结果表明，高原石棉矿男工肺功能随着接尘工龄的增加而逐步下降，且入矿年代越早下降越明显，主要表现为：ＶＣ，ＦＥＶ１％及ＦＥＶ１等指标下降明显；从Ｘ线各期组男工肺功能异常率的比较可看出，高原石棉矿男工在Ｘ线０期组，其肺功能绝大部分指标异常率已超过４０％，其中ＦＥＶ１及ＭＭＥＦ异常率接近或超过９０％，显著高于对照石棉矿男工（Ｐ＜０．００１），可以认为，高原石棉矿作业男工肺功能损害为限制性损害和阻塞性损害并存，属混合性损害，但后者更主要，这对高原石棉作业工人石棉肺的早期诊断有参考价值。     

铸钢和铸铁接尘工人肺功能损害的配对分析

本文按配对设计的原则，严格控制年龄、身高、吸烟量、接尘量等因素，分别对５２名铸钢和铸铁接尘工人进行了肺功能的比较分析，结果表明铸钢接尘工人的ＦＶＣ、ＦＥＶ_（１．０）、ＦＥＦ_（２５～７５）、Ｖ_（７５）、Ｖ_（５０）、Ｖ_（２５）等肺功能指标均低于铸铁接尘工人，ＦＶＣ、ＦＥＶ_（１．０）有显著意义的差别（Ｐ＜０．０５）；相同接尘工龄、相同累计接尘量的配对结果，尘龄小于２０年或累计接尘量小于５００毫克·年时，两组肺功能损害未见差别（Ｐ＞０．０５），当尘龄大于２０年或累计接尘量大于５００毫克·年时，铸钢接尘工人肺功能各项指标明显低于铸铁接尘工人（Ｐ＜０．０５或Ｐ＜０．０１）。     

烟草工人粉尘接触水平与肺功能损害的卫生学调查

对３０２名接触烟草粉尘工人与３２３名对照工人进行了肺功能检测．结果表明．接尘组工人肺功能各项指标（ＦＶＣ、ＦＥＶ１、ＭＭＦ、Ｖ（５０）、Ｖ（２５））的实测值占预计值百分比均较对照组为低；肺功能损害随累积接尘量增加而加重（Ｐ＜０．０１），肺功能异常率则随累积接尘量增加而增高（Ｐ＜０．０１）。     

皮毛加工工人粉尘接触水平与肺功能损害的关系

对２１２名接触皮毛粉尘工人与２０７名对照工人进行了肺功能检测。并对累积接尘量与肺功能损害的关系进行了分析。结果表明，接尘组肺功能各项指标（ＦＶＣ、ＦＥＶ１、Ｖ５０、Ｖ２５）的实测值占预计值％均较对照组为低。肺功能损害随累积接尘量的增加而加重（Ｐ＜０．０１），肺功能异常率则随累积接尘量增加而增高（Ｐ＜０．０１）。多因素分析表明，接尘是影响肺功能下降的主要因素，吸烟也与肺功能呈负相关关系。皮毛粉尘接触水平与肺功能损害呈明显的接触水平－反应关系。据此本文推荐了皮毛粉尘的接触限值。     

铸造接尘女工肺功能与呼吸系统症状的配对研究

为了深入探讨铸造粉尘对接尘女工呼吸系统的损害，本文按配对设计原则，就１６２对不吸烟的铸造接尘女工与对照女工进行了肺功能和呼吸系统症状的配对研究。结果表明：接尘组ＦＶＣ、ＦＥＶ１、ＦＥＦ２５％～７５％、Ｖ７５、Ｖ５０等肺功能指标的实测值均较对照组显著降低，除Ｖ７５外，Ｐ值均小于０．０１；肺功能各项指标异常、呼吸系统症状呈阳性以及患慢性支气管炎的例数，接尘组则均较对照组明显增加，且均具有统计学意义。因此，对铸造接尘女工的职业性危害问题应给予足够的重视。     

A cross sectional study of the independent effect of occupation on lung function in British coal miners.

BACKGROUND: Chronic bronchitis and emphysema are now recognised complications of occupational exposure to coal dust, and since 1992 compensation has been available for miners with impaired lung function provided that they also have x ray film evidence of pneumoconiosis. However, many miners with heavy exposure to coal dust and impairment of lung function therefore do not qualify for compensation because they do not have simple pneumoconiosis. In the present study attempts were made to determine whether coal mining is an independent risk factor for impairment of lung function in a group of Nottinghamshire miners with no evidence of simple pneumoconiosis, by comparing these men with a group of local controls who were not occupationally exposed. METHOD: Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were obtained on 1286 miners with no evidence of pneumoconiosis on x ray film. Lung function data were also obtained from a random sample of 567 men aged between 40 and 70 living in a district of Nottingham and who had never worked in the mining industry or in any other dusty occupation. Multiple linear regression in SPSS was used to estimate the mean independent effect of mining on FEV1 and FVC after adjustment for age, height, and smoking, in all miners and controls, and in a subgroup of men of 45 and under. In men of 45 and under, the independent effects of mining and smoking on the probability of a deficit of one litre or more from modelled predicted FEV1 values were computed with logistic regression in EGRET. RESULTS: There was a significant mean effect of mining on FEV1 after adjustment for age, height, and smoking of -155 ml (95% confidence interval (95% CI) -74 to -236 ml, P < 0.001), but the size of effect was inversely related to age such that in men of 45 and under the estimated mean effect of mining was -251 ml (95% CI -140 to -361 ml, P < 0.001). In this subgroup of younger men, 4.7% of miners and 0.7% of controls had a deficit of one litre or more from predicted FEV1 values, and in logistic regression, there was a marginally significant independent effect of both smoking (P = 0.05) and mining (P = 0.07) for a deficit of this magnitude. CONCLUSIONS: Occupational exposure to coal dust is associated with a small mean deficit in lung function even in the absence of simple pneumoconiosis, and independently from the effects of smoking. The requirement that miners should have evidence of pneumoconiosis to qualify for compensation for impaired lung function is therefore unjustified.     

Emphysema and airway obstruction in non-smoking South African gold miners with long exposure to silica dust.

OBJECTIVE--Occupational exposure to silica dust is associated with significant impairment of lung function. The present study investigates which pathological changes in the lung are associated with impairment of lung function in silica dust exposed workers who were life-long non-smokers. METHODS--242 South African white gold miners who were lifelong non-smokers and who had a necropsy at death were studied. The pathological features identified at necropsy were the degree and type of emphysema, the presence of airway disease, and the degree of silicosis in the lung parenchyma and pleura. These features were related to lung function tests done a few years before death, to type of impairment (obstructive or restrictive), and to cumulative silica dust exposure. RESULTS--The degree of emphysema found at necropsy was not associated with a statistically significant impairment of lung function or with dust exposure. The degree of silicosis in the lung parenchyma and the large airways disease (based on mucus gland hyperplasia) were associated with a statistically significant impairment of lung function. The large airway disease was, however, not positively associated with dust exposure or silicosis. In miners with a moderate or a higher degree of limitation of airflow the main findings were silicosis, heart disease, and obesity. The presence of small airways disease could not be established from the necropsy material. CONCLUSION--The results indicate that the level of exposure to silica dust to which these miners were exposed, without a confounding effect of tobacco smoking, is not associated with a degree of emphysema that would cause a statistically significant impairment of lung function. Silicosis of the lung parenchyma was associated with loss of lung function. Other factors that may play a part in impairment of lung function in these miners are obesity and heart disease.     

煤矿新工人早期肺通气功能的变化

目的　研究煤矿粉尘对新工人肺通气功能的早期影响。方法　选择徐州矿务集团新招收的男性工人2 87人为矿工组,选择该集团技工学校在校男生132人为对照组。调查内容包括个人基本资料、家族疾病史、职业史、吸烟史、作业场所粉尘浓度、肺通气功能随访测定。前瞻性队列调查为期3年,每半个月测定作业场所的总粉尘和呼吸性粉尘浓度;定期测定两组人群的用力肺活量(FVC)和第一秒用力呼气量(FEV1)。结果　矿工作业场所的总粉尘平均浓度为2 3.8mg/m3 ,呼吸性粉尘平均浓度为8.9mg/m3 ,均超过国家卫生标准。接尘第1年,矿工组FVC(5 .19L)高于对照组(4.92L) ,差异有统计学意义(P <0 .0 1) ,第2年和第3年的差异均无统计学意义(P >0 .0 5 )。接尘前矿工组FEV1[(4.4 8±0 .4 9)L]高于对照组[(4.2 8±0 .4 8)L];接尘1年时FEV1下降至4 .2 5L ;第2年和第3年FEV1(4.34L)低于对照组(4.5 6L) ,差异有统计学意义(P <0 .0 1)。矿工组FEV1呈下降趋势。矿工吸烟者3年中的FVC、FEV1损失量(15 4、184ml)高于不吸烟者(83、91ml)。FVC、FEV1与年龄、身高和体重存在一定相关。结论　粉尘对煤矿新工人的早期肺通气功能有明显影响,FEV1下降比FVC更为明显;吸烟可加重粉尘对肺通气功能的损害。     

A prospective cohort study among new Chinese coal miners: the early pattern of lung function change

Aims: To investigate the early pattern of longitudinal change in forced expiratory volume in 1 second (FEV1) among new Chinese coal miners, and the relation between coal mine dust exposure and the decline of lung function. Methods: The early pattern of lung function changes in 317 newly hired Chinese underground coal miners was compared to 132 referents. This three year prospective cohort study involved a pre-employment and 15 follow up health surveys, including a questionnaire and spirometry tests. Twice a month, total and respirable dust area sampling was done. The authors used a two stage analysis and a linear mixed effects model approach to analyse the longitudinal spirometry data, and to investigate the changes in FEV1 over time, controlling for age, height, pack years of smoking, mean respirable dust concentration, the room temperature during testing, and the groupxtime interaction terms. Results: FEV1 change over time in new miners is non-linear. New miners experience initial rapid FEV1 declines, primarily during the first year of mining, little change during the second year, and partial recovery during the third year. Both linear and quadratic time trends in FEV1 change are highly significant. Smoking miners lost more FEV1 than non-smokers. Referents, all age less than 20 years, showed continued lung growth, whereas the miners who were under age 20 exhibited a decline in FEV1. Conclusion: Dust and smoking affect lung function in young, newly hired Chinese coal miners. FEV1 change over the first three years of employment is non-linear. The findings have implications for both methods and interpretation of medical screening in coal mining and other dusty work: during the first several years of employment more frequent testing may be desirable, and caution is required in interpreting early FEV1 declines.     

Dust exposure, respiratory symptoms, and longitudinal decline of lung function in young coal miners.

OBJECTIVES: To study the role of dust exposure on incidence of respiratory symptoms and decline of lung function in young coal miners. METHODS: The loss of lung function (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory flow (MEF), carbon monoxide transfer factor (TLCO)) with time and the incidence of respiratory symptoms in 909 Sardinian coal miners (followed up between 1983 and 1993 with seven separate surveys) has been compared with the past and current individual exposures to respirable mixed coal dust. Multiple linear and logistic regression models were used simultaneously controlling for age, smoking, past occupational exposures, and other relevant covariates. RESULTS: According to the relatively low dust exposures experienced during the follow up few abnormal chest x ray films were detected. In the cross sectional analysis of initial data, significant associations between individual cumulative exposure to dust, decrements in FEV1 and MEFs, and increasing prevalence of respiratory symptoms were detected after allowing for the covariates included in the model. The yearly decline of FVC, FEV1, and single breath carbon monoxide transfer factor (TLCO/VA) was still significantly related to the individual exposure to dust experienced during the follow up, even after allowing for age, smoking, initial cumulative exposure to dust, and initial level of each functional variable. In logistic models, dust exposure was a significant predictor of the onset of respiratory symptoms besides age and smoking. CONCLUSIONS: The results show that even moderate exposures to mixed coal dust, as in our study, significantly affect lung function and incidence of symptoms of underground miners. Although the frequency of chest x ray examination might be fixed at every three or four years, yearly measurements of lung function (spirometry, MEFs, and TLCO) are recommended for evaluation of the respiratory risk from the coal mine environment to assess the need for further preventive interventions.     

脱尘矿工肺通气功能损害及其影响因素的调查分析

本文对３２６名脱尘矿工和６９名不接触尘毒的健康工人分别进行了肺通气功能测定，并对影响脱尘矿工肺通气功能损害的因素进行了分析，结果表明：无论是肺通气功能的实测值、实测值占预计值的百分比，还是肺通气的异常率，或是最大呼气流速容量曲线的比较分析，均显示脱尘矿工的肺气功能损害较对照工人为严重。多因素分析结果表明：接尘起始年代、慢性支气管炎对脱尘工人肺通气功能损害的影响尤为明显。即接尘起始年代越早或有慢性支     

Ventilatory function after exposure to various respirable hazards in a population of former coal miners

The ventilatory function of 406 male former coal miners who had presented at the Cook County Hospital occupational medicine clinic between January 1976 and April 1987 was studied to determine whether subsequent exposure to respiratory hazards after leaving the coal mines adversely affected lung function. The miners were divided into five exposure groups based on their exposure to respirable hazards. These were coal dust only, coal dust plus asbestos dust, coal dust plus silica dust, coal dust plus another respirable hazard and coal dust plus two other respirable dust exposures. Duration of employment in coal mines, race, smoking history, and mean age were not significantly different between the various exposure groups. No significant difference was found in the per cent of predicted forced expiratory volume in one second (FEV1), per cent of predicted forced vital capacity (FVC), and FEV1/FVC when the coal dust only group was compared with each of the other four exposure groups using ANOVA. Among former coal miners who present for a respiratory disability determination, therefore, exposure to respirable hazards subsequent to employment in coal mines is not associated with a statistically significant deterioration in ventilatory function.     

Ventilatory function after exposure to various respirable hazards in a population of former coal miners.

The ventilatory function of 406 male former coal miners who had presented at the Cook County Hospital occupational medicine clinic between January 1976 and April 1987 was studied to determine whether subsequent exposure to respiratory hazards after leaving the coal mines adversely affected lung function. The miners were divided into five exposure groups based on their exposure to respirable hazards. These were coal dust only, coal dust plus asbestos dust, coal dust plus silica dust, coal dust plus another respirable hazard and coal dust plus two other respirable dust exposures. Duration of employment in coal mines, race, smoking history, and mean age were not significantly different between the various exposure groups. No significant difference was found in the per cent of predicted forced expiratory volume in one second (FEV1), per cent of predicted forced vital capacity (FVC), and FEV1/FVC when the coal dust only group was compared with each of the other four exposure groups using ANOVA. Among former coal miners who present for a respiratory disability determination, therefore, exposure to respirable hazards subsequent to employment in coal mines is not associated with a statistically significant deterioration in ventilatory function.     

Respiratory Status of Surface Coal Miners in the United States

The United States Public Health Service examined 1,438 surface coal miners to determine the prevalence of coal worker’s pneumoconiosis (CWP), chronic bronchitis, and ventilatory impairment among them. Four percent (fifty-nine individuals) showed some roentgenographic evidence of pneumoconiosis, but only seven miners had films interpreted as CWP of category2 or greater (according to the UlCC/Cincinnati classification system). Moreover, most of the affected miners had worked in underground coal mines for prolonged periods. Significant decrements in pulmonary function to increasing exposure to surface mine dust were demonstrated only in the forced vital capacity of smokers. Increased prevalence of chronic bronchitis with increasing exposure was found in all smoking categories. However, significant airway obstruction was an uncommon finding (6.6%) in nonsmoking miners. Employment in surface mining was not likely to cause either the development of CWP or clinically significant respiratory impairment.     

Respiratory protection: associated factors and effectiveness of respirator use among underground coal miners

BACKGROUND: We investigated factors associated with the use of respiratory protection and explored the effectiveness of respirators among coal miners. METHODS: Between 1987 and 1992, respiratory symptoms, smoking, lung function, and dust exposures were assessed longitudinally among 185 underground bituminous coal miners. Self-reported use of respiratory protection was expressed as mean percent time wearing a respirator. RESULTS: Miners' respirator use increased with mean dust concentration, but decreased with tobacco consumption. Increasing age was associated with greater respirator use. Miners who had respiratory symptoms at the initial survey subsequently reported greater use of respirators. A significant protective association was found between the miners' respirator use and FEV(1) levels at both the initial and follow-up surveys. CONCLUSIONS: These results provide additional evidence that respirator use is protective of lung health. When respiratory protection programs are developed, factors that may affect respirator use behavior, such as age, smoking, and respiratory symptoms, should be considered. Future studies of respiratory health will need to consider workers' use of respiratory protection.