焦炉逸散物作业工人慢性阻塞性肺疾病流行病学调查

[目的]探讨焦炉迭散物致慢性阻塞性肺疾病(COED)的剂量—反应关系和危险特征。[方法]对焦炉工和对照组进行间卷调查、肺功能测定和焦炉逸散物累积接触指数估算。[结果]焦炉工咳痰阳性率(16．2％)和CoPD患病率(14．5％)皆明显高于对照组(分别为8．0％和5．6％)(P＜0．05)。控制偏倚并与对照组成参比组比较，发现焦炉工接触焦炉达散物平均累积剂量(指数)为190．8时，其咳痰阳性率OR值为2．8(95％CI：1．0-7．9)；平均累积剂量(指数)为38．2时COPD患病率OR值分别为6．0(95％CI：2．3-15．5)。吸烟指数≥300患CoPD的危险性是吸烟指数＜100的3．6倍。[结论]暴露于焦炉逸散物和吸烟与CoPD的发生有关；又有明显的剂量—反应关系。     

职业性焦炉逸散物接触对工人肝功能的影响

目的研究职业性焦炉逸散物接触对作业工人肝功能的影响。方法选择河南省某焦化厂焦炉工551人作为暴露组,同时选择该地区无焦炉逸散物职业接触史的128名健康人作为对照组。按照接触焦炉逸散物的时间加权平均浓度将暴露组分为A、B、C 3组,分析不同浓度组工人和对照组的肝功能指标的变化。结果暴露组工人焦炉逸散物时间加权平均浓度的超标率为20.35%;暴露组的丙氨酸氨基转移酶(ALT)活力异常检出率高于对照组(P0.05);总胆红素(TBIL)和直接胆红素(DBIL)异常检出率与对照组相比,差异无统计学意义。结论长期接触焦炉逸散物可对作业工人的肝功能产生影响,导致ALT活力升高。     

焦炉逸散物暴露对焦炉工人肺功能影响的队列研究

目的 通过对比研究同一批焦炉工人焦炉逸散物暴露5年前后肺通气功能的损伤情况,进一步探讨焦炉逸散物与焦炉工人肺通气功能损伤的关系.方法 选取山西某焦化厂焦炉作业工人165人(暴露组)和辅助工人52人(对照组)为研究对象,使用统一调查表收集工人个人信息.定点定期采集工作场所中空气样本,高压液相色谱仪测定空气样本中苯并(a)芘浓度.分别于2009和2013年使用便携式肺功能仪测定研究对象肺通气功能,并进行对比分析.结果 2009至2013年同一区域B(a)P浓度的差异无计学意意义(P＞0.05).与2009年比较,2013年对照组工人各肺功能测定值及异常率差异无统计学意义(P＞0.05),而暴露组工人用力肺活量(FVC％)、第1秒用力呼气容积(FEV10％)、最大通气量(MVV％)、肺活量(VC％)、25％肺活量时呼气流速(FEF.％)均显著降低,FVC％、FEV10％和VC％异常率显著升高,差异有统计学意义(P＜0.05).新出现肺功能异常的工人主要分布在炉顶和炉侧,炉顶组FVC％、FEV1.0％、VC％新增异常人数(率)明显高于对照组和炉底组,炉侧组明显高于对照组,差异有统计学意义(P＜0.05).多因素logistic回归分析结果显示,继续暴露5年后,炉顶作业工人FVC％、FEV1.0％和VC％新出现肺功能异常的调整OR分别为7.939、5.966和4.956;接焦工龄为暴露组工人FVC％、FEV1.0％、MVV％、VC％异常的危险因素.接焦工龄与炉顶作业存在正向交互作用,差异有统计学意义(P＜0.05).结论 焦炉工人肺功能损伤与焦炉逸散物暴露有关,焦炉逸散物暴露水平和暴露时间是焦炉工人肺功能损伤的主要影响因素,二者存在正交互作崩.     

α1-抗胰蛋白酶基因多态性与焦炉工慢性阻塞性肺疾病的关系

[目的]探讨α1-抗胰蛋白酶(α1-AT)基因多态性对焦炉逸散物致慢性阻塞性肺疾病(COPD)的影响。[方法]通过对458名焦炉逸散物接触和非接触工人肺功能测定，筛查到52名COPD患者，按1：1配对进行研究。应用PCR-RFLP技术检测α1-AT基因多态性。[结果]病例组见2例纯合子ZZ基因型，同时为SS基因型，对照组未见ZZ和SS基因型。MS或SS基因型频率在两组间无显著性差异，病例组MZ和ZZ基因型频率分别为11．5％和3．8％，明显高于对照组(3．8％和0．0％，P＜0．05)。携带MZ或ZZ基因型和焦炉选做物累积接触指数多38．2的个体，发生COPD的危险性，是携带MM基因型和焦炉选做物累积接触指数＜38．2的个体的24．05倍(95％CI：1．29-448.46)。[结论]α1-AT外显子V的MZ或ZZ基因型对焦炉选做物致CoPD有交互或修饰作用。     

53例宝石工矽肺肺功能分析

目的探讨宝石工矽肺肺功能受损情况.方法对53例宝石工矽肺患者和94名对照组分别做肺功能测定分析.结果宝石工矽肺患者肺功能各项指标(VC、FVC、FEV1、FEV1/FVC、PEF、FEE25-75FEF25、FEF50、FE75、MVV)均明显低于对照组(P＜0.01);Ⅰ期矽肺病人肺功能指标除最大呼气流速(PEF)外均明显高于Ⅱ、Ⅲ期病人(P＜0.05);Ⅱ期肺功能指标高于Ⅲ期的有:最大呼气中段流速(FEF25-75)、最大呼气25%肺活量的瞬间流速(FEF25)、最大呼气50%肺活量的瞬间流速(FEF50)、最大呼气75%肺活量的瞬间流速(FEF75)、通气功能和小气道功能异常率分别为58.49%和54.72%,对照组为0和6.38%(P＜0.01);混合性通气功能损害占70.97%.结论宝石工矽肺患者肺功能损伤明显,且随矽肺期别增加而加重,损伤类型以混合性为主.     

焦炉工人外周血淋巴细胞HSP 72表达特征

目的 研究焦炉工人外周血淋巴细胞热休克蛋白72(HSP72)表达特征及其影响因素.方法 选取某焦化厂焦炉工人267人和对照30人,蛋白印迹(Western blot)法检测外周血淋巴细胞HSP 72的表达,高效液相色谱法测定作业环境空气中苯并(a)芘[B(a)P]浓度.收集研究对象个人信息.结果 炉顶工、炉侧工外周血淋巴细胞HSP 72表达水平(G±SG)(1.20±0.47,1.30±0.37)显著高于对照组(0.85±0.34),炉侧工显著高于炉底工(1.01±0.35),差异有统计学意义(P＜0.05).不同作业环境[B(a)P]浓度与相应作业区工人外周血淋巴细胞HSP72表达水平呈二项式分布(R2=0.9999).Logistic分析显示,与对照组相比,焦炉逸散物暴露引起淋巴细胞HSP 72表达阳性的调整OR为1.31,其中炉顶工、炉侧工调整OR分别为1.49和2.69.多元线性回归分析显示,在低暴露水平下(炉底工、对照组),吸烟指数和饮酒是HSP 72表达水平升高的抑制因素(β分别为-0.0001和-0.05,P＜0.05).结论 焦炉逸散物可诱导外周血淋巴细胞HSP72表达升高,但高暴露剂量为焦炉逸散物对HSP 72表达有抑制作用.低暴露水平下吸烟和饮酒对HSP 72表达有抑制作用.     

焦炉工人血清p53蛋白表达及影响因素分析

目的检测职业接触焦炉逸散物的焦炉工人血清p53蛋白的表达情况,探讨p53蛋白作为焦炉工早期筛查肺癌指标的意义。方法运用免疫印迹技术（Western-blot）对118名接触组工人和50名对照组人群进行血清p53蛋白检测。比较接触组和对照组的血清p53蛋白水平,分析影响血清p53蛋白水平的因素。结果接触组不同工龄组之间p53蛋白的表达水平差异有统计学意义（P〈0.05）,且随着工龄的增加,p53蛋白的表达水平增加;导致血清p53蛋白水平升高的主要危险因素是炼焦工种及工龄。结论经常大量接触焦炉逸散物可使p53蛋白表达水平升高,可能增加了p53基因异常的危险性,从而使焦炉工得肺癌的危险性增加。     

焦炉逸散物对作业工人的健康危害

[目的]探讨焦炉逸散物对焦炉作业工人脂质过氧化损伤效应指标血清MDA和酶性抗氧化指标血清SOD活性的影响,为进一步探讨焦炉逸散物对作业工人的危害机制以及为焦炉作业工人的健康监护提供基础资料。[方法]以焦炉作业工人106名为接触组,按工种分为3组,以不接触有害物质的某医院体检者72名作为对照组,对血清MDA含量及血清SOD活性进行测定,并测定作业环境空气中的苯溶物浓度。[结果]炉顶工、炉侧工和炉底工的血清MDA含量分别为:(10.68±5.25)mmol.L-1、(6.61±4.87)mmol.L-1和(6.79±4.45)mmol.L-1,三者均高于对照组(5.61±3.33)mmol.L-1,其中仅炉顶工与对照组比较,差异有统计学意义(P﹤0.05)。炉顶工、炉侧工和炉底工的血清SOD活性分别为:(60.48±15.35)U/ml、(59.67±16.35)U/ml和(76.44±13.46)U/ml,三者均低于对照组(77.78±13.12)U/ml,炉顶工和炉侧工分别与对照组和炉底工比较,差异均具有统计学意义(P﹤0.01)。[结论]接触焦炉逸散物的焦炉工体内脂质过氧化和抗氧化代谢水平会受到影响,测定血清中MDA含量和SOD活性对焦炉工的职业健康监护具有重要意义。     

焦炉工血清SOD活性IL-2、TNF-α表达水平

目的 探讨焦炉逸散物对焦炉工外周血血清中超氧化物歧化酶(SOD)活性、白细胞介素-2(IL-2)及肿瘤坏死因子-α(TNF-α)表达水平的影响.方法 随机选取焦炉作业工人60名(20名炉顶工、20名炉侧工和20名炉底工)作为暴露组,随机选取20名不接触有害物质的大学生作为对照组.用黄嘌呤氧化酶法对血清SOC活力进行测定;用双抗体夹心酶联免疫吸附法(ELISA)对IL-2和TNF-α的表达水平进行测定.结果 炉顶工SOD活力、IL-α水平、TNF-α水平分别为(10.50±5.34)U/mL、(59.188±47.7)pg/mL、(59.188±47.7)pg/mL;与对照组比较,焦炉工血清SOD活性明显增高(P＜0.05),IL-2和TNF-α表达水平明显降低(P＜0.05).结论 接触焦炉逸散物可以导致接触者SOD活性增高,IL-2和TNF-α表达水平降低.     

焦炉工淋巴细胞DNA断裂损伤和血清活性氧水平

目的探讨焦炉工外周血淋巴细胞DNA损伤及其血清活性氧水平,寻找职业性肺癌的早期筛检指标。方法用单细胞凝胶电泳法和Fenton法分别对39名焦炉工和21名对照者外周血淋巴细胞DNA损伤和血清活性氧水平进行检测。结果接触组外周血淋巴细胞DNA损伤阳性率及损伤程度明显高于对照组(P<0.01),且损伤阳性率及损伤程度随接触工龄增加呈上升趋势(P<0.05);接触组血清活性氧水平明显高于对照组,差异有统计学意义(P<0.05)。结论长期接触焦炉逸散物使职业人群DNA链断裂明显增加,且与工龄有剂量-反应关系,可能与机体活性氧水平升高有关。     

焦炉逸散物对作业工人呼吸系统影响的研究

目的　为探讨焦炉逸散物（ＣＯＥ） 对作业工人呼吸系统的影响。方法　对４６５ 名焦炉作业工人和３６５ 名对照工人进行了体格检查、胸部Ｘ 线摄片和肺功能测定。结果　与对照相比,作业工人呼吸道炎、咽喉炎发生率明显增高;Ｘ 线异常改变主要表现在肺纹理与肺门的变化,工龄超过２０ 年的有统计学意义;ＦＥＶ１ ．０ 、ＦＥＶ１ ％ 、ＭＭＦ、ＦＥＦ５０％ 、ＦＥＦ７５ ％ 等肺功能指标明显下降,工龄＜ １０ 年者ＦＥＦ７５％ 差异具有极显著性,工龄１０ ～２０ 年者ＦＥＦ５０ ％ 差异有显著性;工龄＞ ２０ 年者ＦＥＶ１ ％ 、ＭＭＦ、ＦＥＦ５０ ％ 、ＦＥＦ７５％ 的差异具显著性或极显著性意义。结论　提示接触ＣＯＥ 可引起肺通气功能减退和呼吸系统的损害,且随工龄延长有加重的趋势。     

Respiratory findings in spice factory workers

The respiratory consequences of working in the spice industry were studied in 92 female spice factory workers (mean age, 36 yr; mean exposure, 12 yr). A control group of 104 female workers employed in a nondusty industry was also studied. The prevalence of chronic respiratory symptoms was significantly higher in the exposed than in the control group. In particular, the prevalence of dyspnea (57.6%), chronic cough (22.8%), chronic phlegm and chronic bronchitis (19.6%), nasal catarrh (37.0%), and sinusitis (22.2%) was high when compared to controls (p less than .01). Among spice factory workers, a high prevalence of acute symptoms during the workshift was recorded. Acute reductions in lung function were statistically significant over the workshift for forced vital capacity (FVC), -2.0%; forced expiratory volume in one second (FEV1.0), -3.0%; and for maximum expiratory flow rates at 50% (FEF50), -8.3% and at 25% (FEF25), -15.2% measured on maximum expiratory flow-volume (MEFV) curves. No difference was found in across-shift ventilatory function in workers with or without chronic respiratory symptoms, except for FEF25 (with symptoms, 16.7%; without symptoms, 9.6%). Preshift administration of 40 mg of disodium cromoglycate (DSC) inhaled 15 min before the workshift significantly diminished acute reductions in FEF50 and FEF25 in exposed workers. Monday preshift FEF50 and FEF25 in exposed workers were significantly lower than in control workers (p less than .01), which suggests an early irreversible component to this illness.     

焦化作业工人代谢综合征与脂肪肝流行病学研究

目的 通过焦化作业工人代谢综合征、脂肪肝流行病学研究,为探讨代谢综合征、脂肪肝防治对策提供科学依据。方法选择某冶金焦化厂焦炉和化产作业工龄10年以上的男性工人535人为暴露组：选择不接触或较少接触焦炉逸散物的该厂工龄1年以上的男性工人174人为对照组。调查内容包括现场劳动卫生学调查、一般情况、职业史、个人史、血常规内科检查、血常规、血生化、乙肝五项、B超等。结果焦化生产场所不同程度存在焦炉逸散物（COE）危害,其中炉顶作业区苯并（a）芘（BaP）、苯溶物（BSM）危害比炉侧作业区和化产作业区严重,炉侧作业区BaP、BSM浓度比化产作业区略高。炉顶作业组高血压、代谢综合征、脂肪肝检出率分别为28．2％、10．4％、19．3％,炉侧作业组脂肪肝检出率为20．3％．均高于对照组（P〈0．05）;化产作业组高血压检出率为31．7％,与对照组（17．2％）相比,两者有极显著性差异（P〈0．01）。结论焦化作业工人中焦炉作业工人代谢综合征、脂肪肝高发可能与其职业暴露有关,COE有可能导致机体胰岛素抵抗（1R）而使代谢综合征和脂肪肝发生,应引起高度重视。     

Respiratory symptoms and lung function of coke oven workers: a lung function surveillance system from 1990-2000

This study investigated the association of exposure to coke oven emissions with respiratory symptoms and with lung function. Data for respiratory symptoms and lung function were repeatedly collected from 764 male coke oven workers between 1990 and 2000. The data were analyzed cross-sectionally and longitudinally. Working in "Operation" increased the risk for cough (odds ratio [OR] = 2.37), phlegm (OR = 2.55), and shortness of breath (OR = 1.52). Cross-sectionally, each year of working in Operation was associated with a reduction in FEV1 of approximately 10 mL (P = 0.006) and in FVC of around 21 mL (P = 0.0001). From longitudinal analysis, each year of working in Operation was associated with an extra annual decline in FEV1 of 1.5 mL (P = 0.0012) and in FVC of around 1.8 mL (P = 0.0017). Exposure to coke oven emissions increased the risk for respiratory symptoms and adversely affected lung function.     

焦炉作业工人血清脂质过氧化物和抗氧化酶研究

目的为了探讨焦炉逸散物对作业工人血清脂质过氧化水平的影响。方法对焦炉作业工人４５９人和对照３５６人血清ＳＯＤ、ＧＳＨＰｘ、ＭＤＡ进行了测定分析。结果焦化作业组血清ＳＯＤ活性与对照相比轻度增高,差异无显著性（Ｐ＞０．０５）;ＧＳＨＰｘ活性较对照组明显增高,有非常显著性差异（Ｐ＜０．０１）;而ＭＤＡ与对照组比较无明显变化。结论提示在一定程度上接触焦炉逸散物,可能诱导了机体的氧化适应反应,使得焦炉作业工人抗氧化功能有所增强。     

Respiratory symptoms and lung function in furriers

Forty women who had been occupationally exposed in the fur coat manufacturing industry were studied. The mean age was 30 years; mean duration of exposure was 14 years. A group of 31 females who did not work in the furrier industry also was included in the study as the control group. A higher prevalence of all chronic respiratory symptoms was found among furriers when compared with controls; these differences were statistically significant for nasal catarrh (p less than 0.05) and sinusitis (p less than 0.01). Among the furriers, the highest prevalence of respiratory symptoms was recorded for chronic cough in 20 workers (50.0%), followed by sinusitis in 12 (30.0%), dyspnea in 10 (25.0%), and nasal catarrh in 8 workers (20.0%). Among the furriers, two (5.0%) had symptoms characteristic of occupational asthma. Most of the symptomatic furriers complained of acute symptoms during their work shifts. Statistically significant mean reductions in lung function over the work shift were recorded in furriers for forced vital capacity (FVC), -4.1%; one-second forced expiratory volume (FEV1), -5.2%; and flow rate at 50% vital capacity (FEF50%), -6.3%. Furriers demonstrated significantly lower mean Monday preshift measurements for FVC and flow rate at 25% (FEF25%) (p less than 0.05) when compared with those predicted. Preshift administration (by spinhaler) of 40 mg disodium cromoglycate in three workers reduced the intensity of acute respiratory symptoms and diminished the reductions in ventilatory capacity over the work shift. Data from six additional male workers demonstrated similar findings for symptoms and lung function. Our data suggest that furriers are at risk of developing both acute and chronic respiratory symptoms as well as ventilatory capacity impairment as a result of occupational exposure.     

焦炉工外周血TH1/TH2型细胞因子表达与IFN-γ、IL-10 DNA甲基化分析

目的了解焦炉逸散物(coke oven emissions,COEs)暴露的焦炉工多环芳烃(polycyclic aromatic hydrocarbons,PAHs)内暴露水平及焦炉工机体外周血白细胞介素-2(interleukin-2,IL-2)、γ-干扰素(interferon-γ,IFN-γ)、白细胞介素-4(IL-4)、白细胞介素-10(IL-10)的表达,及IFN-γ、IL-10表观遗传机制在COEs暴露损伤中的表现。方法随机选取某焦化厂炼焦车间接触COEs的85名工人作为暴露组,同是焦化厂非COEs暴露的47名作业工人作为对照组,采集暴露组及对照组工人晨尿进行碱水解-高效液相色谱荧光法检测1-羟基芘(1-OHPyr)水平,尿肌酐校正;采集空腹外周静脉血,用酶联免疫吸附试验测定血清中IL-2、IFN-γ、IL-4和IL-10的表达;采用飞行时间质谱分析IFN-γ和IL-10的甲基化水平。结果焦炉工人尿1-OHPyr含量高于对照组(F=12.446,P<0.05),且炉侧工和炉顶工高于对照组(P<0.05)。与对照组相比,焦炉工血清IL-2含量降低(F=14.774,P<0.05),焦炉工血清IFN-γ含量降低(F=46.379,P<0.05),焦炉工血清IL-4含量升高(F=17.426,P<0.05),焦炉工血清IL-10含量升高(F=33.515,P<0.05),焦炉工血清TH1/TH2比值降低(F=21.677,P<0.05)。在暴露组中,炉顶工IFN-γ水平高于炉底工,炉顶及炉底工IL-10水平低于炉侧工(P<0.05)。暴露组IL-10胞嘧啶(C)-磷酸(p)-鸟嘌呤(G)(CpG)-11、CpG-15和平均甲基化率低于对照组(P<0.05)。暴露组IFN-γCpG-5甲基化率高于对照组,差异有统计学意义。焦炉作业工人尿1-OHPyr含量与TH1/TH2比值、IFN-γ表达水平呈负相关,与IL-4、IL-10水平之间呈正相关。随着尿1-OHPyr浓度增加IL-10 CpG-11、CpG-15甲基化率有降低趋势。结论 COEs暴露的炉侧工与炉顶工为职业健康重点监护对象;焦炉工COEs暴露影响免疫调节细胞因子的表达;COEs暴露引起IL-10甲基化率改变。     

Respiratory symptoms and lung function in hemp workers.

Respiratory symptoms and abnormalities of lung function were studied in 84 female and 27 male hemp workers employed in two textile mills (A and B) processing soft hemp (C sativa). In mill A 46 women and 27 men were investigated and 38 female workers were studied in mill B. Forty nine women and 30 men from a non-dusty industry served as controls. A significantly higher prevalence of almost all chronic respiratory symptoms was found in female hemp workers when compared to control workers. Among the men these differences were significant for nasal catarrh and sinusitis. A high prevalence of byssinosis was found among female hemp workers in both mills (group A, 47.8%; group B, 57.9%) as well as in the male workers (66.7%). Statistically significant across shift reductions in lung function were found for all ventilatory capacity measurements in female and male hemp workers varying from 7.1% for forced expiratory volume in one second (FEV1) to 15.1% for flow rates at 50% vital capacity (FEF50). Measured Monday baseline values before the work shift were significantly lower than expected for hemp workers, being particularly reduced for FEF25 and FEF50. The data suggest that occupational exposure to hemp dust is a significant risk factor for the development of acute and chronic lung disease in workers employed in this textile industry.     

Respiratory symptoms and lung function in hemp workers

Respiratory symptoms and abnormalities of lung function were studied in 84 female and 27 male hemp workers employed in two textile mills (A and B) processing soft hemp (C sativa). In mill A 46 women and 27 men were investigated and 38 female workers were studied in mill B. Forty nine women and 30 men from a non-dusty industry served as controls. A significantly higher prevalence of almost all chronic respiratory symptoms was found in female hemp workers when compared to control workers. Among the men these differences were significant for nasal catarrh and sinusitis. A high prevalence of byssinosis was found among female hemp workers in both mills (group A, 47.8%; group B, 57.9%) as well as in the male workers (66.7%). Statistically significant across shift reductions in lung function were found for all ventilatory capacity measurements in female and male hemp workers varying from 7.1% for forced expiratory volume in one second (FEV1) to 15.1% for flow rates at 50% vital capacity (FEF50). Measured Monday baseline values before the work shift were significantly lower than expected for hemp workers, being particularly reduced for FEF25 and FEF50. The data suggest that occupational exposure to hemp dust is a significant risk factor for the development of acute and chronic lung disease in workers employed in this textile industry.     

Respiratory function in animal food processing workers

A group of 71 men employed in animal food processing was studied to assess the prevalence of acute and chronic respiratory symptoms and the presence of lung function abnormalities. In addition, a control group of 55 unexposed men was studied for the prevalence of chronic respiratory symptoms. A significantly higher prevalence for most of the chronic respiratory symptoms was found among the exposed workers compared to the control workers. Those workers who smoked had a significantly higher prevalence of chronic cough, chronic phlegm, chronic bronchitis, and chest tightness than the smokers in the control group. For nonsmokers, the differences between exposed and control workers were significant for chronic phlegm and chest tightness. The frequency of acute symptoms associated with the work shift was high among the animal food workers. There were significantly lower measured values for FVC, FEV1, and FEF50 in the exposed group (smokers and nonsmokers) compared to predicted lung function values. In smokers, all measured parameters of ventilatory capacity were significantly less than predicted; for nonsmokers, the FVC and FEV1 were less than normal. Our data indicate that exposure to dust in the animal food industry may be associated with the development of acute and chronic respiratory symptoms and the impairment of lung function. Smoking, in this setting, appears to aggravate these changes.