2009—2018年中国职业病发病规律及特征

目的 通过分析我国2009-2018年职业病发病规律和特征,为制定职业病防控措施提供理论依据。
方法 从中华人民共和国国家卫生健康委员会官网查找相关文件进行职业病发病数据的收集,对我国2009-2018年职业病发病情况进行回顾性分析,比较不同年度病种构成的差异。
结果 2009-2018年我国共确诊职业病270 254例,其中尘肺病及其他呼吸系统疾病235 553例（占87.16%）、职业性化学中毒15 589例（占5.77%）、职业性耳鼻喉口腔疾病9 047例（占3.35%）、职业性传染病3 883例（占1.44%）、物理因素所致职业病2 232例（占0.83%）、职业性皮肤病1 320例（占0.49%）、职业性眼病1 258例（占0.47%）、职业性肿瘤870例（占0.32%）、职业性放射性疾病143例（占0.05%）、其他职业病359例（占0.13%）。其间,尘肺病及其他呼吸系统疾病、职业性肿瘤发病无明显升高或下降趋势;耳鼻喉口腔疾病、物理因素所致职业病、职业性传染病发病人数呈增长的趋势;化学中毒、职业性皮肤病、职业性眼病、职业性放射性疾病发病人数呈下降的趋势。
结论 尘肺病及其他呼吸系统疾病是我国最主要的职业病,职业接触的化学物品危害较大。耳鼻喉口腔疾病等发病率呈增长趋势的职业病需要加强预防和控制。
     

Unusual pneumoconiosis in two patients with heavy print toner,and paper dust exposure

Workers in a print shop are exposed to photocopier toner dust and paper dust over a prolonged period of time. However, there are only rare case reports of toner and paper dust induced lung damage in humans. We reviewed our consultation files for a period of 30 years from 1987 to 2018 to look for cases with a diagnosis of giant cell interstitial pneumonia (GIP), printer toner exposure and paper dust exposure resulting in lung disease. There were two cases which met our inclusion criteria. Slides, clinical histories and imaging were reviewed. Both the patients had worked in print shops, and had no history of exposure to hard metals. Patient 1 presented with shortness of breath and cough over several months, while patient 2 was asymptomatic at presentation. Both the patients underwent surgical lung biopsies. Histopathologic examination from both the cases showed a spectrum of pathology, including features of GIP, desquamative interstitial pneumonia, chronic bronchiolitis with lymphoid hyperplasia, and particulate matter consistent with toner. Energy dispersive spectroscopy was performed on one case, and it revealed no cobalt or tungsten particles. The unusual combination of findings is very suggestive that toner particles with or without paper dust exposure were responsible for the pathologic changes in the lungs of these patients. This possibility should be explored further with additional patients who work in print shops where they are exposed to paper dust and paper toner and have signs or symptoms of diffuse lung disease.     

What is expected in lung function after lung transplantation due to end‐stage pulmonary silicosis?

In this study, we aimed to determine the impact of lung transplantation (LTx) on pulmonary function tests (PFTs) and survival among patients with end‐stage silicosis. We included patients with end‐stage silicosis on the wait list for LTx, between January 1989 and July 2015 (N = 26). Sixteen of these patients received LTx; 10 were eligible, but did not undergo LTx (non‐LTx) during the study period. Retrospective information on PFTs (spirometry [volumes and flows], 6‐minute walking test [6MWT], and DLCO) was retrieved from patients’ medical charts, including baseline information for all patients and follow‐up information for the LTx. At baseline, most patients presented with spirometric and 6MWT values that were suggestive of severe disease (FEV₁/FVC 76.5 ± 29.7; 6MWT 267.4 ± 104.5 m). Significant increases in these values were observed at follow‐up in the LTx (P = .036 and .151, respectively). The overall median survival of patients in the LTx and non‐LTx was 3.35 years (95% CI: 0.16‐14.38) and 0.78 years (95% confidence interval [CI]: 0.12‐3.65) (P = 0.002), respectively. For patients with end‐stage silicosis, LTx offers significant benefits regarding pulmonary function and survival when compared to non‐LTx, and is a reliable tool to help this critical population of patients, whose only treatment option is LTx.     

尘肺生物样本库蛋白组学的应用展望

职业性尘肺病是我国发病率和死亡率最高的职业病,尘肺病是以进行性肺间质纤维化为特征的肺部疾病,但临床缺乏特效药物及早期筛选的分子标志物,利用生物样本库及蛋白组学技术,筛选和研究尘肺病患者血液、支气管肺泡灌洗液等特异性蛋白的差异表达,将有利于特效药物的研发及早期分子标志物的建立。     

Elemental properties of coal slag and measured airborne exposures at two coal slag processing facilities

In 1974, the National Institute for Occupational Safety and Health recommended a ban on the use of silica sand abrasives containing >1% silica due to the risk of silicosis. This gave rise to substitutes including coal slag. An Occupational Safety and Health Administration investigation in 2010 uncovered a case cluster of suspected pneumoconiosis in four former workers at a coal slag processing facility in Illinois, possibly attributable to occupational exposure to coal slag dust. This article presents the results from a National Institute for Occupational Safety and Health industrial hygiene survey at the same coal slag processing facility and a second facility. The industrial hygiene survey consisted of the collection of: (a) bulk samples of unprocessed coal slag, finished granule product, and settled dust for metals and silica; (b) full-shift area air samples for dust, metals, and crystalline silica; and (c) full-shift personal air samples for dust, metals, and crystalline silica.

Bulk samples consisted mainly of iron, manganese, titanium, and vanadium. Some samples had detectable levels of arsenic, beryllium, cadmium, and cobalt. Unprocessed coal slags from Illinois and Kentucky contained 0.43–0.48% (4,300–4,800 mg/kg) silica. Full-shift area air samples identified elevated total dust levels in the screen (2–38 mg/m³) and bag house (21 mg/m³) areas. Full-shift area air samples identified beryllium, chromium, cobalt, copper, iron, nickel, manganese, and vanadium. Overall, personal air samples for total and respirable dust (0.1–6.6 mg/m³ total; and 0.1–0.4 mg/m³ respirable) were lower than area air samples. All full-shift personal air samples for metals and silica were below published occupational exposure limits. All bulk samples of finished product granules contained less than 1% silica, supporting the claim coal slag may present less risk for silicosis than silica sand. We note that the results presented here are solely from two coal slag processing facilities, and more in-depth air monitoring is needed to better characterize occupational exposure to coal slag dust, metals, and silica at similar facilities.     

肺灌洗治疗尘肺合并COPD的疗效及对炎性因子的影响

目的 探讨小容量肺灌洗对煤工尘肺合并稳定期中重度慢性阻塞性肺疾病(COPD)的疗效及对炎性因子的影响.方法 选取2011年6月—2014年6月我院收治的煤工尘肺合并稳定期中重度COPD患者84例,将其随机分为观察组51例、对照组33例,对照组患者采取常规治疗,观察组患者在常规治疗的基础上使用小容量肺灌洗治疗.观察治疗1个月后2组患者的临床疗效,比较2组患者治疗前后肺功能、血清白介素6(IL-6)、转化生长团子β1 (TGF-β1)以及肿瘤坏死因子α(TNF-α)水平.结果 观察组患者治疗后总有效率为90.20%,对照组患者治疗后总有效率为72.73%,2组比较差异具有统计学意义(P<0.05);治疗前、治疗后2组患者肺功能比较,差异均无统计意义(P>0.05),治疗前后组内比较,2组患者肺功能均无显著变化(P>0.05);治疗前,2组患者血清IL-6、TGF-β1以及TNF-α水平均无显著差异(P>0.05),治疗后,2组患者各血清炎性因子水平均较治疗前显著降低(P<0.05),且观察组患者血清炎性因子水平显著低于对照组(P<0.05).结论 小容量肺灌洗治疗煤工尘肺合并稳定期中重度COPD具有显著的临床疗效,并且能够显著降低患者血清IL-6、TGF-β1、TNF-α水平,但是对于患者的肺功能无明显改善作用.     

Prevalence of occupational lung disease in a random sample of former mineworkers,Libode district,Eastern Cape Province,South Africa

Background Gold mineworkers in South Africa are exposed to high levels of silica dust as a result of which they are at risk of developing silicosis, which is a compensable disease. The incidence of tuberculosis is also high. Methods To determine the prevalence of occupational lung disease and the previous compensation history in former migrant mineworkers, a study was undertaken in a random sample of men living in Libode, a rural district of Eastern Cape Province, South Africa. Two hundred thirty-eight ex-mineworkers were examined according to a protocol that included chest radiography and spirometry. Chest radiographs were read into the International Labour Organisation (ILO) classification for pneumoconioses by two readers. Results The mean age was 52.8 years, and the mean length of service was 12.15 years. The prevalence of pneumoconiosis (≥ILO 1/0) was 22% and 36% (variation by reader). For both readers, a significant association between length of service and pneumoconiosis and between pneumoconiosis and reduction in FVC and FEV was found. Twenty-four percent of study subjects were eligible for compensation. Conclusion There is a high prevalence of previously undiagnosed, uncompensated pneumoconiosis in the study group. As a result of the failure to diagnose and compensate occupational lung disease, the social and economic burden of such disease is being borne by individuals, households, and the migrant labor-sending communities as a whole. Am. J. Ind. Med. 34:305–313, 1998. © 1998 Wiley-Liss, Inc.     

Lung granulomatosis in a dental technician

Background Dental technicians are potentially exposed to various occupational dusts and chemicals. Not surprisingly, occupational related lung diseases have been documented in this population. Methods We describe the case of a dental laboratory technician presenting progressive exertional dyspnea and cough. We used lung function tests, computed tomography, histological examination, mineralogical and immunological studies to characterize his condition. Results Lung function studies disclosed a restrictive pattern with a low diffusion capacity. A high-resolution CT scan revealed the presence of micronodules in both lungs corresponding to non-caseating foreign body granulomas at histological examination. Mineralogic studies showed the presence of silica, silicates, and aluminum. The lymphocytic transformation test was positive with the bronchoalveolar lavage for beryllium. Conclusions This dental technician developed pulmonary granulomatosis. Combined histological, mineralogical, and immunological studies led us to consider the diagnosis of pneumoconiosis most likely related to occupational exposure to beryllium and aluminum. Am. J. Ind. Med. 34:628–631, 1998. © 1998 Wiley-Liss, Inc.