四川省自贡市极薄煤层煤矿煤工尘肺流行病学及影像学特点

目的探讨四川省自贡市极薄煤层煤矿煤工尘肺流行病学及影像学特点,为极薄煤层煤矿煤工尘肺防治提供基础性依据。方法对自贡市2004-2011年诊断资料完整的672例煤工尘肺采取回顾性调查研究;采用分层抽样,对15家煤矿企业的总粉尘浓度和游离二氧化硅含量进行现场检测;并用Spss20.0进行统计分析。结果 672例煤工尘肺来源于荣县和富顺县。发病工种主要为采煤工,占总数的69.05%。Ⅰ、Ⅱ、Ⅲ期煤工尘肺平均发病工龄分别为16.43年、16.98年和18.37年。606例煤工尘肺胸片影像表现以圆形小阴影为主,其中q影431例,占总数的71.12%。15家企业106个岗位的8 h时间加权平均浓度均超过国家职业卫生限值,88.89%的粉尘的游离二氧化硅含量大于10%。结论自贡市煤工尘肺的防治重点为荣县和富顺县的采煤工,其胸片影像以小阴影q影为主。     

煤工尘肺高千伏胸片和DR胸片对比研究分析

目的探讨煤工尘肺高千伏X线胸片和数字化X线摄影（digital Radiography,DR）胸片诊断结果的一致性,评估DR在尘肺病诊断中的应用价值。方法对来自某煤炭矿业集团的104例井下接尘工人行高千伏胸片及DR检查,患者均为男性,年龄35~70岁,平均接尘工龄9~40 a。3名诊断医师分别对104例接尘工人高千伏胸片及DR片进行肺内小阴影形态、密集度及分期诊断,对数据进行一致性检验,一致性评价采用一致率和平方加权Kappa（K）表示。结果①高千伏X线胸片和DR胸片在判断尘肺病肺内小阴影形态方面的一致性诊断率为61.54%,其中p、q、s、t一致率分别为15.63%,79.69%,1.56%,3.13%;不一致诊断率为38.46%,其中差异较大的是p/q,占比77.5%。②高千伏胸片和DR在判断尘肺病肺内结节总体密集度方面的一致性诊断率为81.75%,其中0、1、2、3级一致率分别为11.76%,61.18%,24.71%,2.35%,不一致诊断率为18.27%,其中DR过高诊断率约占52.63%,过低诊断率约为47.37%。③高千伏胸片与DR胸片诊断尘肺病的一致率为81.73%,Kpappa=0.714,P〈0.05。其中,观察对象、壹、贰、叁期分别占11.54%、36.54%、32.69%、0.96%。DR相对金标准高千伏X射线胸片诊断的煤工尘肺壹期过低诊断率为7/51（13.37%）,过高诊断率为6/51（11.76%）;DR相对高千伏X射线胸片诊断的煤工尘肺贰期过低诊断率为2/40（5%）,过高诊断率为0%;观察对象和叁期诊断一致率为100%。结论①煤工尘肺高千伏X线胸片和DR胸片在判断小阴影形态方面有较好一致性,但在p或q小阴影形态判断上容易出现差异;②煤工尘肺高千伏X射线胸片和DR胸片在判断尘肺病总体密度上有很好一致性,但两种检查方法在判断总体密集度为0或1时容易出现判断差异;③煤工尘肺高千伏X射线胸片和DR胸片在分期结果的诊断上有很好的一致性。④DR在煤工尘肺诊断中有较好的临床应用价值。     

2例煤工尘肺叁期误诊为结核的病例分析

煤工尘肺是在煤矿开采、运输工作中,工人们长期吸入较高浓度的煤尘、煤矽混合性粉尘和矽尘所导致的肺部疾病,是严重危害煤矿作业工人身体健康和寿命的职业病,大阴影是煤工尘肺晚期的病变表现,我们对2例长期被误诊为结核的煤工尘肺叁期病例进行了分析,现将结果报告如下.     

肺灌洗结合肺内给药防治煤工尘肺患者肺部炎症初探

目的观察肺灌洗联合肺内应用抗生素和免疫调节剂防治煤工尘肺肺部炎症和感染的效果。方法选择某煤矿接尘工人、煤工尘肺患者,进行肺灌洗治疗,并在灌洗过程中肺内直接给予抗生素以及免疫调节剂。观察肺灌洗液沉渣和灰分,治疗前后肺灌洗液中白蛋白、免疫球蛋白含量、肺通气功能以及X线胸片尘肺影像变化。结果治疗后Ⅱ期煤工尘肺患者呼吸道自觉症状减轻,肺灌洗液白蛋白、IgG明显低于第1次灌洗,肺通气功能改善;煤工尘肺患者X线胸片纹理变清晰、部分患者尘肺小阴影密集度减轻。结论肺灌洗联合肺内抗生素、免疫调节剂应用对防治患者肺部炎症,延缓尘肺病变可能有积极作用。     

尘肺诊断标准中小阴影密集度的应用价值

目的探讨尘肺诊断标准中小阴影密集度的应用价值。方法采用职业流行病学的方法,参照1980ILO国际尘肺X线影像分类指南,分析比较了太钢耐火厂不同时期接尘工人X线胸片小阴影密集度小级的发生率、发生密度及其与工龄的关系。同时,选择了接触煤矽尘工人的X线胸片与之比较其胸片小阴影密集度小级的发展速度和特点。结果①不同时期接尘工人胸片小阴影密集度小级的发生率不同,统计学检验P＜0．05。②胸片小阴影密集度随工龄延长而呈现出由低到高的上升趋势。③接触不同性质粉尘的工人其小阴影密集度小级的晋级速度不同。结论小阴影密集度是观察尘肺发生发展、评价生产环境的质量和估测接触粉尘性质的指标。     

煤矿退养职工中煤工尘肺的X线胸片表现和肺功能关系

目的分析煤矿井下工人煤工尘肺患者X线胸片表现和肺功能的关系。方法选择234例煤工尘肺患者就其肺功能和X线胸片表现关系进行统计分析。结果Ⅰ、Ⅱ期煤工尘肺中通气功能以阻塞性和混合性障碍较多，分别占66．49％、84．62％；Ⅲ期1例为混合性障碍。肺功能损伤Ⅰ、Ⅱ期以轻度为主，分别占46．19％、50．00％，Ⅲ期为中度损伤。肺功能损伤程度及肺功能损伤与煤工尘肺X线胸片肺阴影的肺区分布的数量有关。结论随着煤工尘肺阴影分布范围的增加以及期别的增高，肺损伤程度加重，肺功能障碍分型也逐渐由限制性／阻塞性向混合性通气功能障碍转变。     

CT和高分辨CT对煤工尘肺小阴影和阴影融合及肺气肿诊断的价值

目的 探讨CT和高分辨CT(HRCT)早期检测煤工尘肺小阴影、阴影融合与肺气肿的敏感性和准确性.方法 77例煤工尘肺患者、36例无尘肺煤工和37例健康非煤工接受多层螺旋CT机无间隔胸部容积扫描及HRCT扫描,对所获得的CT图像进行煤工尘肺小阴影密集度分级、平均肺密度值和肺气肿指数测定,并与其X线胸片诊断结果对照.结果 对77例煤工尘肺患者CT和HRCT诊断的尘肺小阴影密集度分级与X线胸片尘肺分期一致性较好(Kappa=0.771,P＜0.01).CT和HRCT诊断尘肺的敏感性达到98.70％,在X线胸片确诊的77例煤工尘肺患者中,CT和HRCT评估76例为煤工尘肺,可疑1例.CT和HRCT从36例X线胸片无尘肺煤工中检出8例(22.22％)达到小阴影密集度1级;从73例Ⅰ～Ⅱ期煤工尘肺患者中,检出26例(35.62％)阴影密集度≥3级,其中3级密集度阴影20例,4级密集度阴影6例;对4例X线胸片Ⅲ期煤工尘肺患者,CT和HRCT与X线胸片诊断结果相同.从113例煤工中,X线胸片检出肺气肿7例(6.19％),CT检出36例(31.86％).CT尘肺小阴影密集度1～2级组的CT平均肺密度值最高,明显高于健康对照组、无尘肺组和小阴影密集度4级组,差异有统计学意义(F1=-45.73、F2=-23.00和F3=57.72,P＜0.01或P＜0.05).结论 从多层螺旋CT获得的CT和HRCT影像,与X线胸片比较,对煤工尘肺小阴影、阴影融合与肺气肿识别的敏感性和准确性均较高,可为煤工尘肺及其并发症的早期诊断提供更先进的手段.     

3例含铁颜料制造工尘肺报告

目的根据某颜料厂3例尘肺临床、实验室及器械检查结果,认识含铁颜料制造工尘肺的病因和临床特点。方法对3例患者的胸片、高分辨X射线电子计算机断层扫描(HRCT)片、大容量肺灌洗液、纤支镜活检、电镜X射线元素分析等结果进行分析。结果3例患者肺活检标本和大容量肺灌洗的电镜X射线元素分析均显示明显铁峰,高千伏胸片见双肺弥漫性小圆形阴影,而肺纹理没有明显增粗紊乱。病理切片铁染色阳性。结论铁尘致纤维化能力较轻,但长期接触高浓度的氧化铁粉尘也会造成尘肺的发生。     

煤矽肺患者肺通气功能与X线胸片小阴影表现的研究

目的 探索煤工尘肺（煤矽肺）患者X线胸片改变对肺通气功能测定结果的相关性。方法 选取146例煤工尘肺（煤矽肺）患者X线胸片和肺通气功能测定资料作统计分析。结果 煤工尘肺（煤矽肺）患者X线胸片表现的小阴影密集度，分布范围与肺通气功能障碍检出率呈正相关关系。而肺通气功能障碍类型与慢支改变有关。结论 X线胸片表现的小阴影密集度及分布范围等客观指标，在煤工尘肺（煤矽肺）患者肺通气功能测定结果的判定中，有其肯定的积极意义，尤其对Ⅰ期煤工尘肺（煤矽肺）患者显示突出。     

接尘作业工人504例X射线胸片分析

[目的]了解常州市天宁区粉尘作业工人的职业损伤情况,为保护尘肺高危人群身体健康,制定尘肺防治策略提供依据。[方法]对在辖区内疾病预防控制中心接受职业健康体检的504名粉尘作业劳动者的高千伏X射线胸片等资料进行统计分析。[结果]504例胸片中,双肺纹理增高61例(12.1%),双肺出现小阴影17例(3.4%);不同接尘种类X射线胸片阳性率比较,差异有统计学意义(χ2=42.149,P<0.01),电焊烟尘和矽尘阳性率相对较高;不同工龄组间(1~、5~、≥ 10年) X射线胸片阳性率比较,差异有统计学意义(χ2=16.804,P<0.01),工龄≥ 10年组阳性率较高。[结论]辖区内尘肺病防治形势严峻,电焊烟尘和矽尘对工人健康损害较大;随着接尘工龄增加,粉尘对工人危害也增大,尤其是对接尘工龄10 a及以上的工人。     

Pneumoconiosis and advanced occupational lung disease among surface coal miners--16 states, 2010-2011

Coal workers' pneumoconiosis (CWP) is a chronic occupational lung disease caused by long-term inhalation of dust, which triggers inflammation of the alveoli, eventually resulting in irreversible lung damage. CWP ranges in severity from simple to advanced; the most severe form is progressive massive fibrosis (PMF). Advanced CWP is debilitating and often fatal. To prevent CWP, the Coal Mine Health and Safety Act of 1969 established the current federal exposure limit for respirable dust in underground and surface coal mines. The Act also established a surveillance system for assessing prevalence of pneumoconiosis among underground coal miners, but this surveillance does not extend to surface coal miners. With enforcement of the exposure limit, the prevalence of CWP among underground coal miners declined from 11.2% during 1970-1974 to 2.0% during 1995-1999, before increasing unexpectedly in the last decade, particularly in Central Appalachia. Exposure to respirable dust is thought to be less in surface than underground coal miners. Although they comprise 48% of the coal mining workforce, surface coal miners have not been studied since 2002. To assess the prevalence, severity, and geographic distribution of pneumoconiosis among current surface coal miners, CDC obtained chest radiographs of 2,328 miners during 2010-2011 through the Coal Workers' Health Surveillance Program of the National Institute for Occupational Safety and Health (NIOSH). Forty-six (2.0%) of 2,257 miners with >1 year of surface mining experience had CWP, including 37 who had never worked underground. Twelve (0.5%) had PMF, including nine who had never worked underground. A high proportion of the radiographs suggested silicosis, a disease caused by inhalation of crystalline silica. Surface coal mine operators should monitor worker exposures closely to ensure that both respirable dust and silica are below recommended levels to prevent CWP. Clinicians should be aware of the risk for advanced pneumoconiosis among surface coal miners, in addition to underground coal miners, to facilitate prompt disease identification and intervention.     

Ventilatory Capacity and Lung Volumes of US Coal Miners

Between 1969 and 1971 the lung volumes and ventilatory capacity of 9, 076 US coal miners were determined. In miners with simple coal workers’ pneumoconiosis, no relationship existed between ventilatory capacity and radiographic category. However, complicated pneumoconiosis led to definite ventilatory impairment, in contrast, residual volume showed a slight increase with increasing radiographic category of simple pneumoconiosis.

Significant geographic variations in ventilatory capacity and lung volumes occurred that appeared to be related, partly to the type of coal dust to which the miners were exposed, partly to the ethnic origin of the miners, and partly to other miscellaneous nonoccupational factors.

While the occupation of coal mining may, in certain instances, lead to very minor reductions of ventilatory capacity, such reductions are minimal in the absence of complicated pneumoconiosis and would not be associated with respiratory disability.     

煤矿工人慢性支气管炎的病理分析

目的了解煤矿工人慢性支气管炎的病变特点。方法对１８０例煤矿工人的尸检材料进行病理分析。结果在１８０例煤矿工人中，患慢性支气管炎的１５５例，检出率为８６．１％，与是否患煤工尘肺无关。其好发部位主要在小支气管和细支气管。煤矿工人慢性支气管炎最显著的特点是在各级支气管管壁有粉尘沉积和尘细胞浸润，支气管壁周围可有尘性纤维化，特别是在呼吸性细支气管处尘性病变最重。结论煤矿工人慢性支气管炎主要表现为尘性和尘性与炎性混合性（占８０．０％），单纯的炎性支气管炎数量较少     

2018年吉林市重点职业病监测结果分析

目的 通过分析2018年吉林市重点职业病监测结果,为吉林市职业病防治工作提供必要参考.方法 通过吉林市7家职业健康检查机构的职业病报告系统个案导出数据、职业健康检查系统导出数据,收集2018年接触煤尘(煤矽尘)、矽尘、苯、铅、噪声、石棉等6种职业病危害因素,对作业人员的职业健康检查数据进行汇总分析,评估职业健康风险.结...     

Identification and classification of high risk groups for Coal Workers' Pneumoconiosis using an artificial neural network based on occupational histories: a retrospective cohort study

Background  

Coal workers' pneumoconiosis (CWP) is a preventable, but not fully curable occupational lung disease. More and more coal miners are likely to be at risk of developing CWP owing to an increase in coal production and utilization, especially in developing countries. Coal miners with different occupational categories and durations of dust exposure may be at different levels of risk for CWP. It is necessary to identify and classify different levels of risk for CWP in coal miners with different work histories. In this way, we can recommend different intervals for medical examinations according to different levels of risk for CWP. Our findings may provide a basis for further emending the measures of CWP prevention and control.     

Pneumoconiosis prevalence among working coal miners examined in federal chest radiograph surveillance programs--United States, 1996-2002

Coal workers' pneumoconiosis (CWP) is a chronic lung disease caused by inhalation of coal mine dust. To characterize the prevalence of CWP, the National Institute for Occupational Safety and Health (NIOSH) analyzed recent radiographic information from the U.S. National Coal Workers' X-ray Surveillance Program (CWXSP). Established under the Federal Coal Mine Health and Safety Act of 1969, CWXSP is administered by NIOSH under federal regulations. NIOSH is responsible for approving coal miner examination plans, submitted approximately every 5 years by companies that operate underground coal mines. This report summarizes the results of the analysis, which indicate that the overall prevalence of CWP among participating miners continues to decline; however, new cases are occurring among miners who have worked exclusively under current dust exposure limits. An evaluation of the mining conditions that have resulted in these cases is underway.     

Advanced cases of coal workers' pneumoconiosis--two counties, Virginia, 2006

This report describes 11 newly identified cases of advanced coal workers' pneumoconiosis (CWP), including progressive massive fibrosis (PMF), in working coal miners from Lee and Wise counties in southwestern Virginia. PMF is a disabling and potentially fatal form of CWP, an occupational lung disease caused by the inhalation of coal mine dust. The continuing occurrence of advanced forms of CWP emphasizes the importance of comprehensive measures to control coal mine dust effectively and reduce the potential for inhalation exposures in coal mining.     

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.     

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.     

Silicon carbide in lung tissue of a worker in the abrasive industry

Lung tissue of a worker in an abrasive manufacturing plant, whose duration of dust exposure was about 10 years, was analyzed by means of bulk analysis and in situ analytical electron microanalysis. The content of the total dust in the lung was 120 mg/g of the dried lung tissue. This value is close to the average concentration of the total dust in the lungs of coal miners with massive fibrosis. The lung dust composition in this case was approximately 43% silicon carbide, 24% aluminium oxide, 2.3% cristobalite, 2.0% quartz, and trace of talc and feldspar. Silicon carbide may be one of the major etiologic agents in this case of pneumoconiosis.