某煤业集团煤工尘肺病人肺通气功能分析

目的了解某煤业集团煤工尘肺病人和接尘非煤工尘肺病人肺通气功能损伤情况,探讨煤工尘肺病人不同工种、工龄、分期之间肺通气功能损伤的差异。方法选取某煤业集团确诊的煤工尘肺病人555名。另外选取该煤业集团555名接尘的非煤工尘肺病人和207名非接尘工人作为对照。采用统一的体检表格,由专业医师进行统一体检,并逐一填写表格。肺功能测定仪器为北京产AS.507型肺量计,进行肺通气功能指标测定。运用卡方检验、单因素方差分析、相关分析进行统计学处理。结果尘肺病人组肺功能异常率高于接尘非尘肺病人组和不接尘健康工人组,差异有统计学意义(χ2=193.319,P<0.001);采用单因素方差分析,三组人群各指标的比较结果显示,尘肺病人组的FEV1.0相对值和FEV1.0%低于接尘非尘肺病人组和不接尘工人组,尘肺病人组和接尘非病人组的FVC相对值均低于不接尘工人组。555名尘肺病人包括不吸烟108人、戒烟427人和吸烟20人,其肺功能异常率分别是67.6%、74.5%和90.0%(χ2=4.381,P=0.036<0.05),不吸烟组和吸烟组的FVC相对值均低于戒烟组,戒烟组的FEV1.0%明显低于不吸烟组。FEV1.0相对值在各组之间差异无统计学意义。各工种之间FVC相对值、FEV1.0相对值,FEV1.0%比较,差异均无统计学意义;各工龄组之间差异亦无统计学意义。各期别尘肺病人FVC相对值、FEV1.0相对值比较,差异无统计学意义,但贰期、叁期尘肺病人FEV1.0%高于壹期尘肺病人。结论接尘非煤工尘肺病人与煤工尘肺病人肺通气功能均有损伤,煤工尘肺病人肺通气功能损伤重于接尘非煤工尘肺病人,说明肺通气功能可以作为监测煤工尘肺的早期敏感动态观察指标。吸烟是影响肺通气功能的一个重要因素,吸烟加剧煤工尘肺病人肺通气功能的损伤程度。     

矽肺致肺功能障碍的病例对照研究

采用病例对照设计,选择169名男性矽肺病人作观察,96名无矽肺的接尘矿工为对照.对所有研究对象进行问卷调查,并测定肺通气功能,参考各指标的实测和预测值之比对肺功能障碍进行分型.方差分析显示病例组各项肺功能参数值显著低于对照组,FEV1.0、FEV1.0/FVC、MEF75%的实测值占预测值百分比在Ⅰ期与Ⅱ+Ⅲ期矽肺组中差异有显著性.矽肺病人以限制性和混合性通气功能障碍为主.非条件Logistic回归显示各期矽肺、中重度吸烟、接尘工龄＞30年是矿工肺功能障碍的危险因素.提示随矽肺晋级,肺功能障碍发生率增加;导致矿工肺功能障碍的危险因素还有吸烟、长期接尘、患有矽肺相关并发症等.     

热休克蛋白HSP70-hom2437位点基因多态性与煤工尘肺的关系

[目的]探讨HSP70-hom 2437 T/C位点基因多态性与煤工尘肺(CWP)的关系.[方法]选择中国西南两省225例确诊的CWP患者为病例组(Ⅰ期:n=134;Ⅱ Ⅲ期:n=73 18),非CWP的294名接尘工人为对照组,均为男性,汉族.对研究对象进行问卷调查(接尘工种和接尘工龄,肺部疾病发生情况,吸烟情况等),采用PCR-RFLP方法进行多态性检测.[结果]HSP70-hom基因型频率分布在病例组和对照组间差异有统计学意义(x2=11.209,P=0.026),经多因素Logistic回归分析对年龄、接尘时间以及吸烟指数分级等因素校正后,与接尘对照组比较,Ⅱ Ⅲ期CWP患者HSP70-hom CC基因型频率明显增加,其调整OR=15.61,95%CI(1.25～194.6).[结论]HSP70-hom 2437基因多态可能与中国西南汉族人群中CWP易感性有关,并可能与CWP严重程度有关.     

160例Ⅰ期煤工尘肺患者肺功能测定结果分析

目的探讨Ⅰ期煤工尘肺患者肺功能状态及肺通气功能损害的类型、年龄、接尘时间、工种、心肺合并症对肺功能的影响。方法采用日本美能MINATOAs-500型肺功能测定仪对160例Ⅰ期煤工尘肺及60名非粉尘作业工人进行肺通气功能测定,对所测定的结果比较分析。结果Ⅰ期煤工尘肺通气功能减退者99例,占61.9%。各项通气功能指标均明显低于对照组(P<0.001),尤以最大呼气中期流速(FEF)显著。结论160例Ⅰ期煤工尘肺通气功能障碍以混合型为主,并随着接尘工龄、年龄增加以及心肺合并症加重而肺通气功能随之下降,但与工种关系不密切。     

煤工尘肺的肺功能与X线对比观察

对92例煤工尘肺(单纯型56例、复合型36例)、30例接尘工人和30例不接尘的健康工人进行了肺量图肺功、MEFV 和残气测定。煤工尘肺组的肺量图肺功和MEFV 各项主要指标均值均低于正常对照组和接尘组,差异有显著性。残气和RV/TLC%增高,尤以复合煤工尘肺组明显。对不接尘和接尘工人中吸烟与不吸烟者的肺功能进行了比较,发现吸烟者各指标均值均低于非吸烟者,其中尤以FEV_1,FEF_((25)-(75))%、V_(?)/H 为明显,差异有显著性。粉尘和吸烟的联合作用是造成煤工尘肺肺功能损伤的主要因素。     

职业医学

960076矿棉对工人呼吸系统的影响/陈雪林…//中华劳动卫生职业病杂志一19gj,12(5)一268960077 180例I期煤工尘肺患者肺通气功能测定结果分析/黄崎…刀工业卫生与职业病一1994,20(5)一304~305 采用DFM一861型肺功能测定仪对180例I期煤工尘肺及50名非粉尘作业工人进行肺通气功能测定。结果表明,I期煤工尘肺肺通气功能减退者113例,占62.8%。大小气道异常率明显,尤以MMF显著,文中对肺通气功能损害的类型、接尘工龄、年龄、工种及心肺合并症对肺通气功能的影响进行了探讨,发现I期煤工尘肺以混合型为主,随着接尘工龄、年龄的增加及心肺合并症…     

180例Ⅰ期煤工尘肺患者肺通气功能测定结果分析

本文采用ＤＦＭ－８６Ⅱ型肺功能测定仪对１８０例Ⅰ期煤工尘肺及５０名非粉尘作业工人进行肺通气功能测定。结果表明，Ⅰ期煤工尘肺肺通气功能减退者１１３例，占６２．８％。大小气道异常率明显，尤以ＭＭＦ显著，文中对肺通气功能损害的类型，接尘工龄，年龄，工种及心肺合并症对肺通气功能的影响进行了探讨，发现Ⅰ期煤工尘肺以混合型为主，随着接尘工龄，年龄的增加及心肺合并症的加重而肺通气功能亦随这下降，但与工种关系不密     

煤工尘肺壹期患者血清SP-A和SP-D水平及意义

目的探讨煤工尘肺(CWP)壹期患者血清中表面活性蛋白(SP)A和SP-D水平变化及其意义。方法采用随机数表抽样法,以88名CWP壹期患者为CWP组,以50名与CWP组具备相同粉尘接触条件的健康井下接尘矿工为接尘组,以38名非粉尘接触井上人员为对照组。采用酶联免疫吸附法检测3组人群血清中SP-A和SP-D水平。结果 CWP组和接尘组人群血清中SP-A和SP-D水平均高于对照组(P0.05);CWP组人群血清中SP-D水平高于接尘组(P0.01)。CWP组吸烟亚组人群血清中SP-D水平低于CWP组非吸烟亚组(P0.05)。结论血清中SP-A和SP-D水平异常与CWP壹期发生发展有关;吸烟可影响CWP壹期患者血清中SP-D水平。     

转化生长因子-β1基因509C/T多态性在宁夏煤工尘肺人群中的分布

[目的]探讨转化生长因子-β1（TGF-β1）基因509C/T多态性在宁夏汉族煤工尘肺（coal worker’s pneumoconiosis,CWP）人群中的分布情况。[方法]从宁夏某煤业集团所属煤矿已确诊的病例中随机抽取110名煤工尘肺病例（煤工尘肺组）、110名煤尘接触者（煤尘接触组）和110名当地不接尘的正常居民（非煤尘接触组）为研究对象,采集静脉血,使用聚合酶链反应-限制片段长度多态性（PCR-RFLP）分析TGF-β1基因509CT位点多态性。[结果]煤工尘肺组、煤尘接触组及非煤尘接触组平均年龄分别为（48.30±13.16）岁、（43.86±4.20）岁、（41.73±5.45）岁。煤工尘肺组和煤尘接触组工龄分别为（17.40±7.84）年和（16.95±6.10）年。工种构成：主掘进工在煤工尘肺组和煤尘接触组中分别占48.2%和49.1%。煤工尘肺组和煤尘接触组及非煤尘接触组中吸烟烟龄分别为（10.48±10.12）年、（11.34±10.48）年、（12.65±11.53）年;接尘工龄、工种构成、吸烟烟龄均无差别,均P〉0.05。TGF-β1基因509C/T位点多态性在煤工尘肺组、煤尘接触组及非煤尘接触组中所占比例分别为51.8%、30.9%、25.5%;等位基因频率T在煤工尘肺组、煤尘接触组及非煤尘接触组中所占比例分别为40.90%、23.20%、19.10%;煤工尘肺组与煤尘接触组比较,TGF-β1基因中CT基因型差异有统计学意义（P〈0.01）。煤工尘肺组不同期别人群的等位基因频率差异有统计学意义（P〈0.01）。[结论]TGF-β1-509C/T位点多态性在宁夏地区煤工尘肺者中的分布可能不同。     

某煤矿掘砌工人肺通气功能分析

[目的]了解煤矿掘砌工人肺通气功能损伤情况,探讨接尘工龄对肺功能的影响。[方法]。选取某煤矿纯掘砌工（纯掘砌作业工人）221名作为接尘组,选取该矿83名非接尘工人作为对照。行统一的体检和肺功能测定。测定结果均采用相对值,运用卡方检验、协方差分析进行统计学处理。[结果]接尘组非吸烟工人肺通气功能异常率与对照组差异不具有统计学意义（P〉0．05）,而接尘组吸烟工人肺通气功能异常率高于对照组（P〈0．05）。Mantel—Haenszel妒分析显示接尘组肺通气功能异常率高与对照组（P〈0．05）。以吸烟作为协变量,协方差分析结果显示,接尘组的用力肺活量、第一秒用力呼出量、呼气高峰流量、用力肺活量最大值、第一秒用力呼出量最大值明显低于对照组（尸〈0．05）。以吸烟为协变量,协方差分析结果显示,接尘组30年一工龄组呼气高峰流量和25％肺活量最大呼气流量明显低于10年～工龄组和20年～工龄组。以吸烟为分层因素,接尘组与对照组以及接尘组不同工龄间慢性阻塞性肺疾患患者分布差异均无统计学意义（P〉0．05）。[结论]掘砌作业工人肺通气功能明显低于对照组并随接尘工龄延长而降低。肺通气功能检测可以作为监测接尘作业工人肺部损失的指标。     

Genetic polymorphisms of MnSOD, GSTM1, GSTT1, and OGG1 in coal workers' pneumoconiosis

Little is known about the genetic susceptibility to coal workers' pneumoconiosis (CWP). We investigated the association between genetic polymorphisms of MnSOD, GSTM1, GSTT1, or OGG1 and susceptibility to CWP. The study population was composed of 259 Chinese retired coal miners who had similar dust exposure histories. Of these, there were 99 cases with International Labor Organization chest radiologic criteria for CWP and 160 controls (with no radiologic criteria for CWP). Individual dust exposure variables were estimated from work histories, and smoking information was obtained from interviews. Polymerase chain reaction-based techniques evaluated the genotypes of all study subjects. There were no differences in genotype frequency of MnSOD, GSTM1, GSTT1, and OGG1 between miners with CWP and miners without CWP, by logistic regression analysis. Cumulative dust exposures, but not genetic polymorphisms, were associated significantly with the presence of CWP. This study illustrates the complexity of factors that may contribute to the development of CWP.     

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.     

Presence of stable coal radicals in autopsied coal miners' lungs and its possible correlation to coal workers' pneumoconiosis.

Stable coal radicals (SCRs) were detected by electron spin resonance (ESR) spectroscopy in the lung tissue of autopsied coal miners. The SCR concentrations were measured in the lung tissues from 98 coal miners with and without (a) coal workers' pneumoconiosis (CWP), (b) cancer, and (c) a history of cigarette smoking. Concentrations of SCRs were also determined in the lungs of nonminer controls. The SCR concentration was related to longer mining tenure, CWP disease severity, lung cancer, and cigarette smoking. The mean concentration of SCRs in the lung tissues of miners with 30 +/- 1.4 y of coal mining exposure was 5.3 +/- 1.3 x 10(17) spins/g versus controls who had a nondetectable level (less than 10(15) spins/g). An increase in disease severity was accompanied by a progressive increase in SCR concentration. A SCR concentration of 4.8 +/- 0.7 x 10(17) spins/g was found for simple CWP (with moderate coal macules) versus 7.8 +/- 4.6 spins/g lung tissue for complicated CWP (with progressive massive fibrosis). Significantly higher (i.e., 10 x 10(17] concentrations of SCR in the coal miners' lung tissues were associated with an exposure history in the anthracite regions of northeastern Pennsylvania. These results indicate a possible role for SCRs in the disease process. Furthermore, ESR appears to be an adequate methodology for the quantitation of coal dust retained in the lung and for distinguishing exposures to anthracite and/or bituminous coal.     

Presence of Stable Coal Radicals in Autopsied Coal Miners' Lungs and Its Possible Correlation to Coal Workers' Pneumoconiosis

Stable coal radicals (SCRs) were detected by electron spin resonance (ESR) spectroscopy in the lung tissue of autopsied coal miners. The SCR concentrations were measured in the lung tissues from 98 coal miners with and without (a) coal workers' pneumoconiosis (CWP), (b) cancer, and (c) a history of cigarette smoking. Concentrations of SCRs were also determined in the lungs of nonminer controls. The SCR concentration was related to longer mining tenure, CWP disease severity, lung cancer, and cigarette smoking. The mean concentration of SCRs in the lung tissues of miners with 30 ± 1.4 y of coal mining exposure was 5.3 ± 1.3 × 10¹⁷ spins/g versus controls who had a nondetectable level (< 10¹⁵ spins/g). An increase in disease severity was accompanied by a progressive increase in SCR concentration. A SCR concentration of 4.8 ± 0.7 × 10¹⁷ spins/g was found for simple CWP (with moderate coal macules) versus 7.8 ± 4.6 spins/g lung tissue for complicated CWP (with progressive massive fibrosis). Significantly higher (i.e., 10 × 10¹⁷) concentrations of SCR in the coal miners' lung tissues were associated with an exposure history in the anthracite regions of northeastern Pennsylvania. These results indicate a possible role for SCRs in the disease process. Furthermore, ESR appears to be an adequate methodology for the quantitation of coal dust retained in the lung and for distinguishing exposures to anthracite and/or bituminous coal.     

Respiratory impairments due to dust exposure: A comparative study among workers exposed to silica,asbestos, and coalmine dust

We conducted a comparative study of pulmonary dysfunction among workers who were exposed to silica, asbestos, or coalmine dust. The results showed that all three groups of dust-exposed workers, even those without radiographic signs of pneumoconiosis, had decreased spirometric parameters and diffusing capacity (DLco) in both nonsmokers and smokers. Pulmonary function was further decreased when pneumoconioses were present in the three groups. In accord with increasing radiographic categories, pulmonary function in the workers' pneumoconiosis (CWP), it changed relatively little. Workers with mild to moderate (radiographic category I–II) silicosis or asbestosis showed similarly decreased DLco, but those with silicosis showed lower FEV₁/FVC than those with asbestosis. The workers with CWP also showed a lower FEV₁/FVC than those with asbestosis. The major impairment patterns for silica workers, asbestos workers, and coal miners were mixed, restrictive and mixed, and obstructive, respectively. Smoking obviously increased the prevalence of obstruction for all the groups. We conclude from the present study that all the three dusts cause functional abnormalities that precede radiographic changes of pneumoconiosis. We should pay more attention to respiratory impairment in the initial stage of silicosis and CWP. Am. J. Ind. Med. 31:495–502, 1997. © 1997 Wiley-Liss, Inc.     

煤矿工人呼吸系统的健康状况调查

目的对煤矿工人呼吸系统的健康状况进行调查。方法选择中国西南两煤矿225例确诊的矽肺患者为病例组,294名接尘工人组成对照组,均为男性,进行详细地问卷调查并对肺功能进行检查分型。结果病例组和对照组比较,呼吸困难及肺功能障碍的严重程度均有所增加,且随着工种接触数值估测(JEM)及矽肺晋级增加而加重(P<0.05)。结论矽肺晋级、吸烟及其程度以及高剂量粉尘暴露等为影响矽肺患者呼吸系统健康的重要因素,需加强防尘控烟,从而提高矿工的健康质量。     

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.     

煤尘职业接触者和早期煤工尘肺BAL液中表面活性物质研究

目的 探讨煤尘职业接触者和早期煤工尘肺患者BAL液中表面活性物质含量改变特点及其意义。方法 采煤工人23人,按X线诊断煤工尘肺期别分为0期（煤尘接触者）组7人、0^ 组8人和I期组8人,并取健康农民7人为对照组。经纤维支气管肺泡灌洗（BAL）收集BAL液,测定表面活性蛋白A(SP－A）和磷脂（PL）及其组分含量。结果 0期组BAL液中SP－A含量、SP－A／PL和PG／PI明显高于对照组（P＜0．01）,且随煤工尘肺期别增加而有降低趋势。结论 BAL液中SP－A含量、SP－A／PL和PG／PI升高可能是煤尘接触的早期效应指标。     

Respiratory outcomes among South African coal miners at autopsy

BACKGROUND: Studies of dose-response relationships between respiratory outcomes at autopsy and coal dust exposure are limited. The Pathology Automation System (PATHAUT) database of South African miners, is one of the largest autopsy databases of occupational lung disease. This study described the prevalence of respiratory outcomes among South African coal miners at autopsy, and determined whether dose response relationships existed between emphysema and exposure. METHODS: Autopsies conducted from 1975 to 1997 on coal miners with exclusive coal mining exposure and having exposure duration information (n = 3,167) were analyzed from PATHAUT. Logistic regression was used to determine relationships between exposure and outcomes, controlling for race, smoking and age on a subset for whom smoking history was available (n = 725). RESULTS: The mean duration of exposure was 11.0 years. Most were black miners (75.3%) with significant differences in the mean ages of black and white miners (37.9 and 55.3 years, respectively). Only 22.9% of cases had information on smoking. The prevalence of silicosis, tuberculosis (TB), coal workers' pneumoconiosis (CWP), and moderate and marked emphysema were 10.7%, 5.2%, 7.3%, and 6.4%, respectively. All diseases, except TB, were associated with exposure duration. Black miners had 8.3 and 1.2 fold greater risks for TB and CWP, respectively, than white miners. White miners had an increased risk of 1.4 and 5.4 for silicosis and moderate to marked emphysema, respectively. In models unadjusted for age, and including smoking, moderate to marked emphysema was strongly associated with exposure duration (OR = 3.4; 95% CI = 1.9-5.9 for highest tercile of exposure duration). Exposure-related risk estimates were reduced when age was introduced into the model. However, age and duration of exposure were highly correlated, (r = 0.68) suggesting a dilution of the exposure effect by age. CONCLUSIONS: There were significant dose related associations of disease, including emphysema, with coal dust exposure.     

煤矿工人肺功能损害的调查研究

本文用协方差、Ｍａｎｔｅ－Ｈａｅｎｓｚｅｌ和Ｌｏｇｉｓｔｉｃ方法对煤矿工人肺功能进行统计分析，结果表明：反映煤矿工人肺功能损害的敏感而稳定的指标有ＦＥＶ１、ＦＥＶ１％，ＭＴＴ和ＲＶ％，煤矿工人肺功能损害以阻塞型为主，功能残气增加为其明显特点，混合型次之，限制型最少，肺功能损害概率随单纯性煤工尘肺期别的增加而增大，影响煤矿工人肺功能损害的主要因素是年龄、接尘工龄、吸烟指数和接尘工龄与吸烟年的交互作用