云锡矿工肺癌发病的时相性规律和群体预测模型

利用云锡公司最大矿山老厂矿退休工人档案建立矿工肺癌流行病学研究的回顾前瞻队列(1960～1984),证明矿工肺癌发生率像一般居民肺癌一样随年龄而增加,符合相对危险模型.根据不同人群肺癌相对危险水平(SMR)和寿命表对肺癌死亡人数进行预测,结果预测值与实际发生人数间的误差不超过10～20%.该预测系统的优点是不需要提供既往剂星资料,例如WLM,其局限性是它祗能应用于具有相同暴露条件的人群.     

肺癌矿工肺组织中蓄积矿物的研究

应用 X线衍射及能谱方法分析患肺癌的云锡矿工27例和当地居民3例肺组织中蓄积的矿物。结果表明，矿工肺内蓄积的矿物量比居民大，成分复杂。云母与滑石最多见，次为石英与赤铁矿，来检出含砷矿物。原子荧光法检出了元索砷，不少矿工肺砷量与居民接近，未见肺砷量与井下采矿工龄的平行关系。     

Gallium-67 citrate imaging in underground coal miners

Twenty-two underground coal workers with 27 or more years of coal dust exposure were studied with gallium-67 citrate (Ga-67) imaging. Radiographic evidence of coal workers pneumoconiosis (CWP) was present in 12 subjects. The Ga-67 scan was abnormal in 11 of 12 with, and 9 of 10 without, CWP. The Ga-67 uptake index was significantly correlated with total dust exposure (p less than 0.01) and approached significant correlation with the radiographic profusion of the nodules (0.10 greater than p greater than 0.05). There was no correlation between Ga-67 uptake and spirometric function, which was normal in this group of patients; furthermore, increased lung uptake of gallium did not indicate a poor prognosis in subjects no longer exposed to coal dust. While coal dust exposure may be associated with positive Ga-67 lung scan in coal miners with many years of coal dust exposure, the scan provided no information not already available from a careful exposure history and a chest radiograph. Since Ga-67 scanning is a relatively expensive procedure we would recommend that its use in subjects with asymptomatic CWP be limited to an investigative role and not be made part of a routine evaluation.     

煤工尘肺胸膜病变的高分辨率CT形态学表现及其诊断价值

目的　通过煤工尘肺胸膜病变的CT和高分辨率CT(HRCT)检查研究煤工尘肺胸膜病变的可靠的诊断技术。方法　煤矿井下采掘混合工煤工尘肺患者 13 1例 (其中 ,0 14例、Ⅰ期 46例、Ⅱ期 58例、Ⅲ期 13例 )及对照组 2 0例 (均摄有同期高仟伏胸片 ) ,在胸部常规CT扫描后 ,另在 4个固定水平上及感兴趣区加作HRCT扫描 ,而后进行观察对比研究。结果　参照国家尘肺诊断标准中对胸膜病变 -胸膜斑的判定方法 ,共发现胸膜病变者 68例 (51.91% ) ,其中 ,尘肺Ⅰ期 12例 (17.65% )、Ⅱ期 43例 (63 .2 4% )、Ⅲ期 13例 (19.12 % )。据胸膜病变在HRCT的形态表现可分为 :结节型(73 .3 8% )、扁平型 (18.71% )、不规则型 (7.91% )、混合型 ;病变位于胸壁胸膜者占 65.0 2 %、纵隔面占2 2 .16%、心包占 12 .80 %。本组病例肺尖和肋膈角区均未见受累表现 ,胸膜病变厚度以 5～ 10mm者为多见 (88.17% )。结论　煤矿工人胸膜损害并非罕见。HRCT是显示胸膜病变的可靠检查方法 ,是常规CT的补充手段 ,具有重要的诊断和实用价值 ,但需进一步进行影像学与病理学的对照研究     

Cosmetic talc as a risk factor for pleural mesothelioma: a weight of evidence evaluation of the epidemiology

Objective: Due to some historical (and inaccurate) reports that asbestos might be present in some cosmetic talc products, questions are occasionally raised regarding the potential pleural mesothelioma risks associated with cosmetic talc products. Our objective was to determine the incidence of pleural mesothelioma of individuals exposed to cosmetic talc.

Materials and methods: We conducted a systematic review of the epidemiological literature for cosmetic talc miners and millers and found three occupational cohort studies that evaluated pleural mesothelioma incidence in workers in Italy, Norway, France, and Austria. We conducted a second literature review to evaluate the incidence and mortality of pleural mesothelioma among patients who received talc pleurodesis treatments before 1965 and found retrospective clinical studies including over 300 patients with follow-up ranging from 14 to 40?years.

Results: There were no mesotheliomas reported in any of the cosmetic talc miner and miller cohorts. A pooled analysis of data from the cohort mortality studies indicated that four mesothelioma deaths would have been expected from the 90,022 person-years of observation, and this was associated with 84% and 67% statistical power to observe a 3-fold or 2.5-fold increase in pleural mesothelioma mortality, respectively. None of the patients who received talc pleurodesis treatments developed mesothelioma.

Conclusion: We conclude that there is no epidemiological evidence to support the hypothesis that exposure to cosmetic talc is associated with the development of pleural mesothelioma.     

Dose–response relationships between occupational exposure to potash,diesel exhaust and nitrogen oxides and lung function: cross-sectional and longitudinal study in two salt mines

OBJECTIVE: Several studies have shown that underground salt miners may have an increased incidence of chest symptoms and sometimes decreased lung function. Miners of two salt mines were investigated to evaluate relationships between the lung function and the workplace exposure. The effect of nitrogen monoxide (NO) and nitrogen dioxide (NO(2)) was investigated in view of the recent debate on European occupational exposure limits. METHODS: A total of 410/463 miners (mine A/mine B) were examined cross-sectional and 75/64% of the first cohort were examined after a 5-year period. Exposure was measured by personal sampling. Personal lifetime exposure doses of salt dust, diesel exhaust, NO(2) and NO were calculated for all miners. Dose-response relationships were calculated by multiple regression analysis. Each exposure component acted as an indicator for the complex exposure. RESULTS: Exposure response relationships were shown in the cross-sectional and longitudinal investigations in both mines. In the 5-year period, the adjusted (age, smoking, etc.) effect of the exposure indicators resulted in a mean decrease of FEV(1) between -18 ml/year (mine A) and -10 ml/year (mine B). The personal concentrations related to this effect were 12.6/7.1 mg/m(3) inhalable dust, 2.4/0.8 mg/m(3) respirable dust, 0.09/0.09 mg/m(3) diesel exhaust, 0.4/0.5 ppm NO(2) and 1.7/1.4 ppm NO (mine A/B). Exposure was related to symptoms of chronic bronchitis only in mine B. CONCLUSION: The effects found in both mines indicate that the mixed exposure can cause lung function disorders in salt miners exposed over a long time. Because of the high correlation of the concentrations it was not possible to determine the effects of a single exposure component separately or to recommend a specific occupational exposure limit. However, possible maximum effects associated with the mixed exposure can be evaluated in the ranges of concentrations of the individual substances in the mines.     

邢台地区某煤矿工人口腔健康相关生活质量水平及影响因素分析

目的了解邢台地区某煤矿工人的口腔健康相关生活质量水平并探索相关影响因素。方法抽样调查邢台地区某煤矿1116名煤矿工人,采用口腔健康影响程度量表(OHIP-14中文版)进行生活质量调查,分析煤矿工人口腔健康相关生活质量的影响因素并根据性别、年龄等因素进行分组比较。结果回收有效问卷1054份,平均得分为14.93±3.12分,单因素分析中差异有统计学意义的是年龄、文化程度、余留牙数、龋齿数、失牙数、CPI值、楔状缺损。在多元逐步回归分析模型中,龋齿数、CPI值以及失牙数被纳入到最终模型中。男性总得分为14.91±3.11,女性总得分为15.25±3.28,两组差别无统计学差异(t=-0.787,P=0.431)。根据年龄分组显示≤34岁组得分为14.29±2.91,35~44岁组的得分为15.05±2.88,≥45岁组的得分为15.42±3.46,方差分析显示各组差异有统计学差异。结论煤矿工人口腔健康相关生活质量相对较低,生活质量与龋病、牙周病的患病情况有紧密的联系。     

煤矿接尘工人生存质量与职业紧张职业倦怠关系研究

目的探讨煤矿接尘工人生存质量与职业紧张、职业倦怠的相互关系。方法调查山西省7个煤矿2 058名煤矿接尘工人,采用中文版SF-36量表评价其生存质量,职业倦怠量表评价倦怠感,职业紧张量表评价职业任务、个体紧张度以及应对情况,运用SPSS 13.0和AMOS 17.0软件进行统计分析。Pearson相关描述各变量间相关程度,路径分析构建职业紧张和职业倦怠对生存质量的影响。P<0.05为差异有统计学意义。结果职业任务、个体紧张、倦怠和个体应对均与生存质量有直接作用(P<0.001),随着煤矿工人职业任务的加重,个体紧张增强,倦怠感加重,使得生存质量降低(b=-0.38;b=-1.31;b=-0.68);同时个体应对增强又能够使得生存质量得以提高(b=0.97)。个体紧张、倦怠和个体应对又是职业任务与生存质量的中间调节作用。职业任务的加重,使得个体紧张度增加(b=0.25)、倦怠感增强(b=0.09),从而降低生存质量;个体紧张的增加同时也使得倦怠感增强(b=0.32);而个体应对能力强则可以降低个体紧张度(b=-0.15)与倦怠感(b=-0.28),从而提高生存质量。结论煤矿接尘工人职业任务、个体紧张、个体应对以及职业倦怠均与其生存质量有密切关系。关注煤矿接尘工人,积极改进作业环境,降低工作强度,增加人文关怀,提升应对能力,有助于生存质量的提高。     

山西省1 337名煤矿工人血脂异常患病情况及相关因素分析

目的 了解山西省煤矿工人血脂异常患病情况并分析其相关因素。方法 收集2016年4月在山西省太原市某煤矿1 337名工人体格检查与血液生化指标检测资料;按照2007年《中国成人血脂异常防治指南》诊断标准作为血脂异常的判定标准;采用χ²检验和非条件logistic回归模型对该煤矿工人血脂异常相关因素进行分析。结果 1 337例煤矿工人血脂异常总患病率为59.1%（790/1 337）,其中男性患病率为60.4%（708/1 173）,女性患病率为50.0%（82/164）,男性患病率高于女性（χ²=6.386,P<0.05）;20~34、35~49和≥50岁工人患病率分别为68.8%、58.7%和49.5%,20~34岁年龄组患病率最高。χ²检验结果显示,煤矿工人性别、年龄和BMI是血脂异常的相关因素（χ²=7.117,P<0.01;χ²=37.135,P<0.01;χ²=7.009,P<0.05）;非条件logistic回归分析结果显示,该煤矿工人性别、年龄、BMI水平、收缩压≥140 mmHg（1 mmHg=0.133 kPa）与血脂异常存在关联（P<0.05）;与女性矿工相比,男性矿工患血脂异常的风险是女性矿工的1.501倍（OR=1.501,95%CI：1.895~2.516）;从年龄分组看,35~49岁组、20~34岁组血脂异常患病风险分别为≥50岁组的1.672倍（OR=1.672,95%CI：1.501~2.392）和2.369倍（OR=2.369,95%CI：1.275~3.469）;较正常BMI组,高BMI组血脂异常患病风险为其1.443倍（OR=1.443,95%CI：1.139~1.828）;收缩压异常组血脂异常患病风险为正常组的1.829倍（OR=1.829,95%CI：1.152~2.906）;而舒张压、血糖、血尿酸、心电图检测结果与血脂异常的差异均无统计学意义。结论 该煤矿工人血脂异常患者主要为20~34岁男性,有高血压（收缩压异常）病史、高BMI（≥24.0 kg/m²）的该煤矿工人患血脂异常可能性较大,需要引起重视。