Pneumoconiosis in the Haematite Iron Ore Mines of West Cumbria. A Study of 45 Years of Control

Pneumoconiosis amongst haematite miners in West Cumbria hasbeen studied over a 45-year period. In 1934 the disease causedthe deaths of miners in early middle life from massive lungfibrosis, often complicated by tuberculosis and sometimes bycarcinoma. Many more suffered from advanced emphysema and hadto cease heavy face work 20 years before their time for retirement. The X-ray appearances and clinical symptoms are described. Studieshave been carried out on the lung physiology and comparisonsmade with similar groups of South Wales coal miners. All haematiteminers have been examined clinically and radiologically beforeadmission to the industry and regular two yearly examinationsby radiography have been made. Men with complicated pneumoconiosis(progressive massive fibrosis) have been withdrawn from dustyjobs and, where indicated, referred for treatment. Men withuncomplicated pneumoconiosis have been allowed to work in goodconditions and have been carefully supervised. The methods of mining control are described demonstrating thechanges from dense dustiness with many times the allowed limitof nitrous fumes to excellent conditions. Serial dust countsover many years have been personally undertaken, and subsequentlyregular estimations of mass of respirable dust per m³ of air.The results show that there has been almost complete eliminationof dust during the past 20 years. The disease has been eradicated and no miner who commenced workafter 1935 has shown X-ray evidence of proved pneumoconiosis.No case has been certified by the Pneumoconiosis Panel for 17years. Men are now fit to work at the face until retirementage, and young men are no longer aware that such a conditionever existed. Accepted        1 October 1981 ^*Based on the Fifth Meiklejohn Lecture read to the North StaffordshireMedical Institute, Arlidge Section of Occupational and PreventiveMedicine, at The Medical Institute, Stoke-on-Trent on the 15November 1979.     

骨桥蛋白对尘肺病并发心力衰竭的诊断价值研究

目的 通过对尘肺病并发心力衰竭患者中骨桥蛋白(osteopontin, OPN)水平测定, 分析OPN的临床意义。
方法 入选健康人群38人(对照组)、尘肺病患者25人(单纯尘肺病组)、尘肺病并发心力衰竭患者(尘肺病并发心力衰竭组)20人, 分别测定三组血液生化指标和OPN水平, 对结果进行统计学分析。
结果 尘肺病并发心力衰竭组血浆N末端B型利钠肽原(NT-proBNP)水平明显高于对照组及单纯尘肺病组, 单纯尘肺病组、尘肺病并发心力衰竭组的WBC、超敏C反应蛋白(hs-CRP)高于对照组, 差异均有统计学意义(P < 0.01)。对照组、单纯尘肺病组、尘肺病并发心力衰竭组中OPN水平分别为(71.3 ±15.3) ng/mL、(145.3 ±24.9) ng/mL、(199.4 ±25.2) ng/mL, 尘肺病并发心力衰竭组高于对照组及尘肺病组(P < 0.01)。
结论 OPN可能参与了尘肺病并发心力衰竭的病理、生理过程, 有望成为尘肺病并发心力衰竭早期血清学标志之一。
     

广东省老年尘肺流行病学调查分析

目的 探讨老年尘肺发病发展的流行病学特征。方法 对广东省7885例老年尘肺患者进行流行病学调查。分老年尘肺组（60岁以上）7885例和对照组（60岁以下）6637例。结果 老年尘肺组发病年龄、发病工龄、晋期年限、存活和死亡患者病程均明显长于对照组（P＜0．01）。老年尘肺组病死率、并发肺结核率均显著低于对照组（P＜0．01）。结论 首次接尘年龄大、发病工龄长、病变进展慢、并发肺结核率低是广东老年尘肺流行病学的主要特征。做好预防和治愈并发肺结核,是保证尘肺患者“长寿”的主要措施之一。     

Twins with Coal-workers'' Pneumoconiosis

As the tuberculous hypothesis of coal-workers' progressive massive fibrosis (P.M.F.) is not so strongly held nowadays the possible importance of genetic factors should be explored. Twins with pneumoconiosis should provide helpful information. Details are given of two pairs of twins; one pair is considered to be monozygotic and the other dizygotic. Blood grouping, secretor state, and Rose Waaler reactions were carried out as the results may help in any comparison with twins with coal-workers' pneumoconiosis discovered elsewhere.

The brothers resemble each other in having a similar type of pneumoconiosis. The monozygotic pair have a relatively benign type of pneumoconiosis with early P.M.F. which has remained unchanged for eight years; the dizygotic pair show a nodular type of pneumoconiosis which has shown definite progression with an increase in the extent of P.M.F. As a younger brother of the dizygotic pair also has pneumoconiosis details are included.

     

上海市青浦区职业性尘肺病发病情况和粉尘作业人员肺功能调查

目的 了解上海市青浦区职业性尘肺病发病趋势以及粉尘作业人员肺功能情况,为尘肺病防治提供依据。
方法 对2009-2018年青浦区所有职业性尘肺病新发病例和2018年在岗期间进行职业健康体检的粉尘作业人员的肺功能检查结果进行分析。
结果 2009-2018年青浦区新发职业性尘肺病52例,其中矽肺21例（占40.38%）,电焊工尘肺、铸工尘肺各9例（各占17.31%）,铝尘肺4例（占7.69%）,煤工尘肺、滑石尘肺各1例（各占1.92%）,其他尘肺7例（13.46%）。10年间,矽肺新发病例有增多趋势,而电焊工尘肺呈下降趋势,煤工尘肺已多年未发生新病例。尘肺病病例以壹期尘肺病为主。矽肺患者和电焊工尘肺患者工龄短于铸工尘肺工龄（P < 0.05）。2018年共检查粉尘作业人员1 673人,肺功能异常331例,异常率为19.78%。随着年龄和工龄的增长,肺功能异常率有升高趋势（P < 0.05）。
结论 近10年青浦区尘肺病发病数量先是逐渐减少,但2016年后尘肺病发病数量有升高趋势。接尘工人肺功能异常率较高。尘肺病防治仍然是青浦区职业病防治的工作重点。应注意年龄大人员的尘肺病预防工作。
     

Mortality in punctiform type of coalworkers'' pneumoconiosis

Waters, W. E., Cochrane, A. L., and Moore, F. (1974).British Journal of Industrial Medicine,31, 196-200. Mortality in punctiform type of coalworkers' pneumoconiosis. Recent studies conducted on miners at necropsy and on those attending a pneumoconiosis medical panel have suggested that the punctiform type of opacities are associated with a significant gas transfer defect and with emphysema. However, a 10-year follow-up of a random sample of miners and ex-miners in the Rhondda Fach found that the mortality experience of those with the punctiform type was, if anything, more favourable than that for other types of pneumoconiosis. This may be related to radiographic technique, but there may also be physiological reasons. There was no evidence that those with the punctiform type had different smoking habits from those with other types of pneumoconiosis.     

多模态影像学在职业性尘肺病诊断中的应用价值

目的 探讨多模态影像学在职业性尘肺病诊断中的应用价值。方法 选取2018年6月—2021年3月就诊的160例职业性尘肺病患者为研究对象,所有对象均进行高千伏X线摄影(HKV)、数字化X线摄影(DR)、数字X线摄影联合双能量减影(DES)、高分辨率CT(HRCT)检查,比较4种检查方法对尘肺病患者诊断分期结果的一致性以及肺部合并症检出率,评估4种检查方法在尘肺病诊断中的诊断效能。结果 HKV对尘肺病诊断具有中等一致性,HKV的Kappa=0.562(95%CI:0.471～0.652);DR、DES对尘肺病诊断结果均具有较高一致性,DR的Kappa=0.669(95%CI:0.584～0.753);DES的Kappa=0.750 (95%CI:0.677～0.823);而HRCT对尘肺病诊断具有高度一致性,HRCT的Kappa=0.882(95%CI:0.829～0.935)(P均<0.01)。该4种检查方法对肺气肿、肺大泡、胸膜增厚、胸腔积液检出率不同(P <0.05),而对于肺结核的检出率差异无统计学意义(P> 0.05)。HRCT对肺气肿、肺大泡、胸膜增厚、胸腔积...     

多排螺旋CT诊断职业性尘肺病的价值评价

目的 研究探讨多排螺旋计算机断层扫描（computed tomography,CT）在职业性尘肺病患者诊断中的临床应用价值。
方法 对99例疑似职业性尘肺病患者实施胸部DR检查、多排螺旋CT（简称CT）检查,以临床确诊结果为参照,对其诊断结果进行比较分析。
结果 99例疑似职业性尘肺病患者中,有65例患者经临床确诊为职业性尘肺病,其中DR检查出63例,CT检查出62例。确诊为非尘肺病患者中,有1例被DR检查为尘肺病,2例被CT检查为尘肺病。以临床确诊结果为参照,DR、CT对尘肺病诊断的灵敏度、特异度、符合率差异均无统计学意义（P > 0.05）。CT对职业性尘肺病壹期的阳性检出率高于DR（P < 0.05）,而DR、CT对尘肺病贰期、叁期的阳性检出率差异均无统计学意义（P > 0.05）。在职业性尘肺病患者的肺大疱、肺气肿、肺部感染、胸膜肥厚粘连等并发症诊断中,DR、CT的阳性检出率差异均无统计学意义（P > 0.05）。经一致性分析,DR、CT诊断结果与临床确诊结果间的一致性分别为0.933、0.956,均达到良好。
结论 多排螺旋CT在职业性尘肺病诊断中具有良好的临床价值,可对职业性尘肺病及其并发症予以灵敏检出,还可对职业性尘肺病分期予以准确鉴别。
     

189例尘肺病合并肺结核情况分析

目的研究尘肺病患者合并肺结核的感染现状,降低尘肺病病人结核病的发生率。方法收集2020—2021年在湖南省职业病防治院住院治疗的尘肺病合并肺结核的189例病例进行调查。结果尘肺病合并肺结核的合并率为2.43%(189/7785)。尘肺病合并肺结核的病种包括煤工尘肺、矽肺、混合尘肺、水泥尘肺共4种,以煤工尘肺和矽肺为主,分别占56.6%和40.7%。合并肺结核的发病年龄为(58.31±9.08)岁,煤工尘肺合并肺结核病例的发病年龄高于矽肺合并肺结核病例(P<0.05)。尘肺病合并肺结核的病例中,壹期、贰期、叁期的合并率依次为1.00%、1.89%、3.56%,随着期别增加而上升(P<0.05)。煤工尘肺合并肺结核病例利福平耐药率为10.28%(11/107),矽肺则为11.68%(9/77),其余尘肺病患者利福平耐药率为0,三者差异无统计学意义(P>0.05)。结论尘肺病合并肺结核以煤工尘肺和矽肺最常见,对合并率影响最主要的因素是尘肺病期别。各种尘肺病合并肺结核病例对利福平的耐药率接近。     

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.     

尘肺病患者外周血维生素D与淋巴细胞亚群、炎症因子的相关性研究

目的 了解尘肺病患者的维生素D水平,并分析维生素D与炎症因子、淋巴细胞亚群各指标之间的相关性.方法 选取60名老年男性健康体检人员为对照组,182名尘肺病患者为研究组,比较两组的维生素D水平;同时分析研究组维生素D水平、尘肺病期别与炎症因子、淋巴细胞亚群的相关性.结果 182名尘肺病患者维生素D缺乏人员的占比高于对照组...     

EFFECT OF QUALITY OF CHEST RADIOGRAPHS ON THE CATEGORIZATION OF COALWORKERS'' PNEUMOCONIOSIS

An investigation into the effect of variations in radiographic technical quality on pneumoconiosis reading standards in the Pneumoconiosis Field Research of the National Coal Board is reported. From the group of men for whom retake films had been obtained because of unsatisfactory technique of the originals, a trial series of pairs and triplets of films showing differing technique was assembled.

A total of 778 films was read for pneumoconiosis and assessed for technical quality by four readers. The quality was assessed in terms of three separate factors, viz., density (at high, medium, and low levels), contrast (satisfactory and unsatisfactory), and definition (satisfactory and unsatisfactory). The intra and inter observer consistency of this assessment was estimated, and the effect of techical quality on the reading of pneumoconiosis category was determined. A tendency for lower pneumoconiosis readings to be recorded on films with unsatisfactory technique was demonstrated.

A random 10% sample of the best available films (those on which routine pneumoconiosis readings have been made) for all men examined since the beginning of the research was also read for technical quality. Of the total of 4,188 films, 80% were considered satisfactory. It appeared that films taken on second surveys were, in general, of rather better quality than those taken on first surveys.

The physical attributes of the men examined had some effect on the technical standards, the proportion of unsatisfactory films rising with increasing values of the weight/sitting height ratio and being greater in men with pneumoconiosis categories 1 and A and in the middle age group.

The tendency for lower pneumoconiosis readings to be recorded on films with unsatisfactory technique is in contrast to the results of work previously published. Different criteria for the selection of films and the assessment of technical quality, and possibly differing reading conventions, make comparison with other work difficult.

     

寿命表法及Cox回归分析608例尘肺病患者发病特征与生存情况

  目的  分析菏泽市尘肺病发病特征，探讨接尘工龄与尘肺病发病之间的关系、尘肺病患者死亡趋势和影响生存年限的相关因素。
  方法  对菏泽市1971—2019年诊断的608例尘肺病患者进行调查，采用寿命表法分析接尘工龄与尘肺病的关系、尘肺病病死率及预期存活年限，用Cox比例风险回归模型进行生存分析。
  结果  608例尘肺病患者中壹期575例、贰期24例、叁期9例；年龄主要分布在50 ~ 70岁；工龄主要在10年以内；接尘工种主要为纯掘进工、掘岩工和主掘进工。尘肺病患者发病的接尘工龄为1 ~ 34年；随访时间（x）与累积存活概率（?）的线性回归方程为:? = 1.070 7- 0.037 6 x（r = - 0.937 1，P＜0.001），尘肺病患者初诊20年后的估计累积存活率为31.87%；理论推算随访时间0 ~ 1年全死因尘肺病患者预期存活年限为11.37年；Cox回归分析结果显示:分别相比壹期、纯掘进工患者，叁期、其他工种患者死亡的风险升至8.590、3.150倍（P < 0.05）；相比上一年，本年度接尘的患者死亡的风险降至0.970倍（P < 0.05）。
  结论  提高生活水平和落实各种保障可延长尘肺病患者寿命。在对重点行业、重点岗位和人群加强健康监管的同时，更要重视既往接尘人员的医学随访。
     

煤工尘肺并发肺癌患者C-erbB-2基因表达的研究

目的　检测C erbB 2癌基因在煤工尘肺并发肺癌患者的表达与单纯肺癌患者的差异及与临床病理的关系。方法　采用免疫组织化学方法分别检测 32例煤工尘肺并发肺癌者及 30例单纯肺癌者的C erbB 2表达。结果　煤工尘肺肺癌组患者C erbB 2阳性表达率为 5 3.13% ,单纯肺癌组患者C erbB 2阳性表达率为 2 6 .6 7% ,差异有显著性 (P <0 .0 5 ) ;两组中有淋巴结转移者C erbB 2阳性表达率 (尘肺组 70 .5 9%、单纯肺癌组 5 0 .0 0 % )与无淋巴结转移者 (尘肺组 33.33%、单纯肺癌组 11.11% )的差异有显著性 (P <0 .0 5 ) ;C erbB 2阳性表达者预后差 ,与病理组织学类型无关。结论　C erbB 2是煤工尘肺并发肺癌的重要的调控基因之一 ,可作为判断有无淋巴结转移及预后的参考指标。     

Carbon pneumoconiosis in a synthetic graphite worker

Lister, W. B., and Wimborne, D. (1972).Brit. J. industr. Med.,29, 108-110. Carbon pneumoconiosis in a synthetic graphite worker. A case of carbon pneumoconiosis previously described in this journal in 1961 is followed up and the post-mortem findings show that the pneumoconiosis developed after prolonged exposure to synthetic graphite without any significant silica content.     

52年间589例尘肺病例生存分析

目的 探讨达州市某煤矿尘肺病患者生存状况及其影响因素。
方法 对1965-2017年诊断报告的589例尘肺病例,采用Kaplan-Meier法与寿命表法进行生存分析,采用Cox回归模型分析影响患者生存时间的因素。
结果 该煤矿1965-2017年共报告尘肺病例589例,死亡185例,病死率31.41%;中位生存时间31.47年。随着诊断年代的推移,病死率呈降低趋势（P < 0.01）,中位生存时间呈上升趋势（P < 0.01）。随着生存时间的增加,尘肺病例的累积生存率逐步降低。相比煤工尘肺组,矽肺组患者生存时间减少的风险增加（OR=1.424,P < 0.05）;相比壹期尘肺组,叁期、贰期尘肺组患者生存时间减少的风险增加（OR=6.210、1.475,P < 0.05）;相比不合并肺结核组,合并肺结核组患者生存时间减少的风险增加（OR=1.570,P < 0.05）;相比不吸烟组,吸烟组患者生存时间减少的风险增加（OR=1.601,P < 0.05）;相比接尘工龄 < 10年组,接尘工龄10~20年、> 20年组患者生存时间减少的风险增加（OR=5.013、7.585,P < 0.05）;相比发病年龄 < 30岁组,发病年龄30~39岁、40~49岁、50~59岁、≥ 60岁组患者生存时间减少的风险增加（OR=3.906~86.572,P < 0.05）。
结论 尘肺病患者的死亡风险同接尘工龄、尘肺期别、吸烟、肺结核、尘肺病种类及发病年龄均有关。应有效控制危险因素,提高尘肺病患者生活质量,延长其寿命。
     

The “Middling” Tendency

The UICC/ILO Classification of pneumoconiosis divides each of the three major categories of simple pneumoconiosis into three subcategories. Although it is often assumed that the relative widths of the central and marginal subcategories, eg, 1/0, 1/1, and 1/2, that compose a major category are equal, the original describes of the elaboration did not subscribe to this view.

It is well known that the percentage of subjects with the major categories of simple pneumoconiosis decreases with increasing category. Similarly it might be inferred that the percentage of subjects with each subcategory would decline as one proceeds up the scale from 0/0 to 3/4. In practice this phenomenon is not seen and more subjects are placed in the middle subcategories.     

The Effect of Film Quality on Reading Radiographs of Simple Pneumoconiosis in a trial of X-ray sets

Four chest radiographs (14 in. × 14 in. postero-anterior) for each of 86 coal-miners were taken (in a trial to compare -ray sets) and assessed by a number of experienced readers for both quality and pneumoconiosis. All films were developed by one technician under standard conditions so that variations in the quality of the films produced for one subject arose because of differences in the sets and in the way they were used by the radiographers taking the films. The data thus obtained allowed a study of film quality to be made (a) in relation to the subject and (b) as it affected the reading of simple pneumoconiosis.

The subjects were selected to include a high proportion whose earlier radiographs showed pneumoconiosis; they were thus substantially older than a normal colliery population.

The assessments of quality were found to be reasonably consistent both between observers and on different occasions for the same observer.

A clear tendency was found for the quality of a film to depend on the subject. Men with no radiological evidence of pneumoconiosis tended to produce films which were assessed as of better quality than those of men with pneumoconiosis, however slight. Among the latter, chest thickness had an important effect on film quality; men with thicker chests produced poorer films. The subject's age did not appear to have any effect on the quality of his film.

Film quality was found to introduce only slight biases into the reading of pneumoconiosis. Individual readers varied considerably so that, although on average the readers tended to overcorrect for technical faults, i.e. to read more abnormality in black films than in good ones, and less in grey, some readers undercorrected slightly.

What little evidence was available did not suggest that poor quality of films introduced any excess variability into film reading.

     

Lung gas exchange in simple pneumoconiosis of coal workers

Cotes, J. E., and Field, G. B. (1972).Brit. J. industr. Med.,29, 268-273. Lung gas exchange in simple pneumoconiosis of coal workers. Indices of lung function and gas exchange, including some based on measurement of the arterial blood gases and physiological response to exercise, were obtained in 19 coal workers with simple pneumoconiosis of the pinhead or micronodular type, of whom 11 also had bronchitis. p-Type pneumoconiosis differed from the m-type in being associated with a smaller transfer factor, larger physiological deadspace relative to tidal volume (Vd/Vt), and increased ventilation during submaximal exercise. Vd/Vt was also raised in patients with bronchitis. The venous admixture effect (including physiological shunt) was within normal limits. Breathing oxygen increased Vd/Vt in patients with bronchitis but not with p-type pneumoconiosis. The findings are evidence for p-type pneumoconiosis being associated with abnormal function of the lung parenchyma; the changes are consistent with cystic lung.     

肺灌洗排尘病因治疗的资料分析和实验研究

目的针对支气管肺泡灌洗术（ＢＡＬ）治疗尘肺存在议点,探讨 ＢＡＬ治疗尘肺的可能性。方法对 ＢＡＬ治疗尘肺理论依据、肺间质排尘以及影响排尘的主要因素,进行了资料分析和实验研究。结果尘肺发生发展的剂量反应和剂量效应关系,为ＢＡＬ治疗尘肺奠定了理论基础;肺间质封闭技术建立及其应用,证实了肺间质内沉积尘和ＰＡＭ可随ＢＡＬＦ排出体外;尘肺病变程度和染尘后持续时间是影响排尘量的主要因素;模拟ＢＡＬ减尘实验的效果,加深了对尘肺 ＢＡＬ治疗的正确认识。结论ＢＡＬ拟用于早期和急性尘肺的治疗。