郑州市尘肺流行病学调查研究

尘肺是我国工业生产中危害最严重的职业病。1988年以来,郑州市持续开展了尘肺流行病学调查。1992年全市粉尘作业厂矿接尘人数为103542人,尘肺累积病人2758例,其中现患2541例,死亡217例。尘肺累积患病比为2.59%,现患率为2.39%,病死率为7.87%。尘肺累积病例以巩义市、郑州矿务局、密县为较多;按系统以煤炭(包括县煤炭)、机械、轻工、有色金属为多;尘肺病主要为矽肺及煤工尘肺。统计分析各种尘肺的发病工龄、发病年龄、死亡年龄以及各期别晋级年限等数据。对郑州市尘肺的发展趋势作了预测。     

Biological markers as indicators of exposure and pneumoconiotic risk: Prospective study

This research is designed to evaluate a number of biological markers to estimate harmful exposure on coal miners from different mining regions in France and to relate the outcome to differences in prevalence of coal worker pneumoconiosis (CWP) between these regions. Eight epidemiological groups of active and ex-miners (smokers and non-smokers) have been selected in the French collieries (North, Lorraine and Provence) according to their occupational and pneumoconiotic status. The following biomarkers have been evaluated: cellularity of sputum, elementary analysis of particles in TEM/EDAX, plasma neutral metalloendo peptidase elastase type (NMEP), leucocyte elastase (HLE), fibronectin (FN) and elastin peptides. Pulmonary alveolitis, expressed by sputum cellularity, is different between active workers groups but not related to the general background of pneumoconiosis prevalence in the French collieries. In the plasma parameters, fibronectin, HLE and NMEP significantly increased in all groups of coal mine workers as compared to the control group, except for fibronectin parameter in Lorraine collierie. The degree of increase of these parameters allow us to discriminate the different groups and suggest that plasma FN, HLE and NMEP may be considered as biological markers of chronic inhalation of coal mine dust particles. The decrease of elastin peptides level in the Lorraine group alone suggests a specific alteration of elastin metabolism. These parameters were not related to the development of pneumoconiosis and its degree of severity.     

Some investigations into the nature and cause of massive fibrosis (MF) in the lungs of South African gold, coal, and asbestos mine workers

Samples from fibrotic lung lesions greater than 1 cm in diameter macroscopically (by definition, massive fibrosis; MF) were taken from the lungs of 9 randomly selected post-mortem cases of mine workers all showing a background of a pneumoconiosis. These samples were studied histologically, biochemically, and by X-ray diffraction and electron microscopy. As controls for the biochemical and X-ray diffraction investigations, nonfibrosed lung tissue was taken from the same specimens. The findings suggest that the higher quartz content may be the primary cause responsible for the MF formation in this series of cases, while other factors such as tuberculosis may play a part according to some relevant literature on MF. Although an area of MF appears macroscopically to be a solid lesion, on microscopy this is not the case and the lesion is composed of dense and sparse collagen bundles and cellular elements.     

Case-control study of silicosis, silica exposure, and lung cancer in white South African gold miners

A case-control study was undertaken to assess the association between lung cancer and silicosis or silica dust exposure in white South African gold miners. Cases and controls were identified from deaths reported to the Gold Miners Provident Fund for the period January, 1979-October, 1983. Two controls were matched to each case by year of birth (+/- 2 years) and by smoking (+/- 5 cigarettes or equivalents per day) assessed 10 years (+/- 2 years) prior to death. One hundred thirty-three matched triplets were identified. The results showed no overall association between lung cancer and radiological silicosis (OR = 1.08, p = 0.92). Autopsy data indicated no overall associations between lung cancer and silicosis of the lung parenchyma (OR = 1.49, p = 0.11), the pleura (OR = 0.72, p = 0.30), or the hilar glands (OR = 0.85, p = 0.72). A trend toward increased severity of silicosis of the parenchyma was evident; however, this was not statistically significant (p = 0.08). Odds ratios for lung cancer and silicosis were higher at lower levels of cumulative silica dust exposure (ORs = 2.43, 1.72, 1.35 and 0.62 for lung cancer and autopsy silicosis of the parenchyma for the lowest, second, third, and highest quartiles of dust exposure, respectively; all p greater than 0.05). Cases did not differ from controls for total silica dust exposure, length of exposure, weighted average intensity of exposure, or number of shifts at high dust (all p greater than 0.20). The data do not support the hypothesis of a carcinogenic role for silica dust and no statistically significant associations were found between lung cancer and silicosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

影响煤工尘肺病人减寿的因素分析

目的：探讨影响煤工尘肺患者减寿的因素，为进一步开展煤工尘肺的三级预防提供依据。方法：用非条件logistic回归分析对可能影响尘肺病人减寿的一些因素进行多因素逐步回归分析。结果：疗养和及时离尘是保护因子，有利于尘肺病人健康；吸烟、工种、初诊期别、Ⅰ期晋Ⅱ期的年限、合并肺结核是危险因子。结论：今后对尘肺病人三级预防的重点是防制肺结核和及时脱离粉尘接触。     

煤矿尘肺的尘斑气肿

对８６例煤工尸检肺组织呼吸性细支气和及所属肺泡道发生的尘斑气肿进行了观察。前述部位不同程度煤尘沉着构成尘斑或尘灶。尘灶系呼吸性细支气管壁及肺泡间隔内煤尘沉着不断增多，气腔壁增厚，闭塞或靠扰融合而成。少数尘灶亦可由局灶性肺泡内煤尘细胞聚集填充所致尘斑或尘灶处伴发的肺气肿，意味着组织破坏，肺功能受损。因此，尘斑气肿和尘灶气肿具有同样涵义。     

Proposed criteria for mixed-dust pneumoconiosis: definition, descriptions, and guidelines for pathologic diagnosis and clinical correlation

We defined mixed-dust pneumoconiosis (MDP) pathologically as a pneumoconiosis showing dust macules or mixed-dust fibrotic nodules (MDF), with or without silicotic nodules (SN), in an individual with a history of exposure to mixed dust. We defined the latter arbitrarily as a mixture of crystalline silica and nonfibrous silicates. According to our definition of MDP, therefore, MDF should outnumber SN in the lung to make a pathologic diagnosis of MDP. In the absence of confirmation of exposure, mineralogic analyses can be used to support the pathologic diagnosis. The clinical diagnosis of MDP requires the exclusion of other well-defined pneumoconioses, including asbestosis, coal workers’ pneumoconiosis, silicosis, hematite miners’ pneumoconiosis, welders’ pneumoconiosis, berylliosis, hard metal disease, silicate pneumoconiosis, diatomaceous earth pneumoconiosis, carborundum pneumoconiosis, and corundum pneumoconiosis. Typical occupations associated with the diagnosis of MDP include metal miners, quarry workers, foundry workers, pottery and ceramics workers, and stonemasons. Irregular opacities are the major radiographic findings in MDP (ILO 1980), in contrast to silicosis, in which small rounded opacities predominate. Clinical symptoms of MDP are nonspecific. MDP must be distinguished from a variety of nonoccupational interstitial pulmonary disorders.     

Expression of leucocyte–endothelial adhesion molecules is limited to intercellular adhesion molecule-1 (ICAM-1) in the lung of pneumoconiotic patients: role of tumour necrosis factor-alpha (TNF-α)

Coal workers' pneumoconiosis (CWP) is characterized by a chronic inflammatory lung reaction associated with macrophage accumulation in alveolar spaces. In this study, we investigated in CWP the implication of adhesion molecules such as E-selectin, ICAM-1 and vascular cell adhesion molecule-1 (VCAM-1) and the role of TNF-α which is one of the cytokines inducing their expression. Adhesion molecule expression was analysed by immunohistochemistry on lung biopsies from patients with CWP and from healthy subjects. In parallel, soluble adhesion molecules were detected in bronchoalveolar lavage fluids (BALF) from patients by specific ELISA. The involvement of TNF in the induction of these adhesion molecules was measured (i) by immunohistochemistry on sections from lung fragments, and (ii) by evaluating in vitro the expression of adhesion molecules on endothelial cells and on alveolar epithelial cells in the presence of alveolar macrophage supernatants. In control subjects, a weak staining of ICAM-1 was detected only in alveolar walls, while E-selectin and VCAM-1 were undetectable. In pneumoconiotic patients, ICAM-1 was expressed at a high level by endothelium, by alveolar and bronchial epithelial cells and by alveolar macrophages. E-selectin and VCAM-1 expression remained undetectable. Measurement of soluble adhesion molecule showed that only the concentration of sICAM-1 was significantly increased in BALF from patients with CWP compared with controls. The involvement of TNF in this ICAM-1 expression was shown by the in vitro effect of alveolar macrophage supernatants on adhesion molecule expresssion by endothelial cells and epithelial cells (this effect was neutralized by anti-TNF antibodies) and by the increased production of TNF in the lung of pneumoconiotic patients. These data provide evidence for the involvement of ICAM-1, induced at least in part by alveolar macrophage-derived TNF, in the development of the inflammatory reaction in CWP.     

Respiratory abnormalities among male foundry workers in central Taiwan

The objectives of this study were to determine the relationship between exposure levels and respiratory abnormalities, to measure FVC and FEV1(1) changes per year based on work duties and to investigate the prevalence of and factors related to pneumoconiosis. A total of 583 male workers from 50 iron foundries in central Taiwan were investigated. First, workers' respiratory symptoms were categorized using a modified American Thoracic Society (ATS) questionnaire and then were verified by physician's examination. Next, pulmonary function tests were performed including: forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and forced expiratory flow rate. A chest radiograph was used to diagnose pneumoconiosis according to ILO criteria. Furnace workers were found to have the highest prevalence of chronic phlegm, thoracic disorders and chronic bronchitis. In general, smokers had a higher prevalence of respiratory symptoms as compared with non-smokers. Pulmonary function abnormalities and pneumoconiosis were closely linked to smoking and work duration. After adjusting for age, height and smoking there was a significant decrease based on work duration in FVC and FEV1 for furnace and moulding workers compared with after-processing and administrative workers. The overall prevalence of pneumoconiosis was 8.8%, highest among furnace (16.3%) and after-processing workers (11.4%) and lowest among administrative workers (2.5%). Using multiple logistic regression, the risk of developing pneumoconiosis (as compared with the administrative workers) for furnace workers was highest (8.98 times greater risk), followed by after-processing workers (6.77 times greater risk) and moulding workers (5.41 times greater risk). Prolonged exposure to free silica, and smoking habits, can result in respiratory abnormalities among foundry workers.     

实施越冬疗养的煤工尘肺患者生命质量评价

采用自行设计并经过质量检验的调查表,对某矿务局职业病防治院的全部Ⅰ期尘肺虎科疗养前后进行了调查,并采用整群对照的方法,选取未实施越冬疗养的Ⅰ期尘肺患者作对照。结果表明,疗养组越冬疗养前后生命质量的有显著差异,疗养后患者生命质量明显提高;而对照组在越冬前后生命质量无显著改变,说明越冬疗养对煤工尘肺患者生命质量有着积极的作用。