矽肺矿工肺结核患病情况及结核菌素反应的调查分析

[目的]调查矽肺矿工中肺结核的流行情况,评估非结核矿工对结核菌素的反应性。[方法]病例对照设计,选择189例男性矽肺病人为病例,110例无矽肺的接尘矿工为对照。调查所有研究对象肺结核患病情况、职业史,并将接尘工龄划分为3组(<20年,20年-,30年-)。剔除肺结核患者59人,对其余矿工进行PPD皮肤试验。[结果]Ⅰ期矽肺组肺结核合并率为16.4%,Ⅱ期为29.0%,Ⅲ期为72.7%。对照组矿工中接尘工龄≥30年者肺结核患病率最高。Ⅱ期矽肺组结核菌素反应强阳性率为22.7%,高于对照组的8.3%。有明确的结核病接触史者,结核菌素反应阳性和强阳性率高于无结核病接触史者。[结论]随着矽肺期别升高,肺结核患病率增加。PPD皮肤试验可以作为矽肺患者合并肺结核的初筛手段之一。     

矽肺宿主、环境影响因素的病例对照研究

目的探讨矽肺病宿主因素（文化程度、行为因素）、环境因素（居住条件、家庭和睦、经济状况、负性事件）与矽肺易感性的关系。方法以某矿业公司两个矿区2002—2004年由职业病专业诊断机构按GBZ70—2002《尘肺病诊断标准》确诊的Ⅰ期矽肺男性患者为病例组，与病例组同性别、同工种、同班组、同工龄、年龄相差不超过3岁、2004年摄胸片非矽肺接尘工人为对照组。病例与对照按2：1配比。以问卷调查形式入户调查。结果矽肺组与对照组比较，其宿主影响因素：文化程度、行为因素中的嗜烟者及环境影响因素中的家庭经济状况、负性事件两组比较差异有显著性。其他各项无明显差异。结论接尘工人的文化程度即个人的文化素养、有无不良的嗜烟习性、工作期间有无家庭负性事件的发生及家庭经济状况可能对矽肺易感。     

Progressive massive fibrosis in the absence of lung modulation

Progressive massive fibrosis is a well-recognized complication of long-term industrial dust exposure. Typically, it occurs in a setting of background parenchymal nodulation. We wish to report a case occurring in the absence of lung nodules.     

抗栓酶－3号对实验性矽肺兔脂质过氧化的影响

将抗栓酶－３号（Ｓｖａｔｅ－３）注入实验性矽肺白兔耳静脉（０．２Ｕ／ｋｇ）观察６月。结果：实验组血浆和肺组织的丙二醛、血清羟脯氨酸及肺组织胶原蛋白的含量明显低于对照组；但肺组织的ＳＯＤ含量明显而于对照组。提示Ｓｖａｔｅ－３有一定的抗脂质过氧化和抗纤维化的作用。     

One agent, many diseases: exposure-response data and comparative risks of different outcomes following silica exposure

BACKGROUND: Evidence in recent years indicates that silica causes lung cancer, and probably renal disease, in addition to its well-known relationship to silicosis. There is also suggestive evidence that silica can cause arthritis and other auto-immune diseases. Silica has, therefore, joined a handful of other toxic exposures such as tobacco smoke, dioxin, and asbestos which cause multiple serious diseases. METHODS: The available exposure-response data for silica and silicosis, lung cancer, and renal disease are reviewed. We compare the corresponding excess risks (or absolute risks in the case of silicosis) of death or disease incidence by age 75 for these three diseases, subsequent to a lifetime (45 years) of exposure to silica at current US standard (0.1 mg/m(3) respirable crystalline silica). RESULTS: The absolute risk of silicosis, as defined by small opacities greater than or equal to ILO classification 1/1 on an X-ray, ranges from 47% to 77% in three cohort studies with adequate follow-up after employment. The absolute risk of death from silicosis is estimated at 1.9% (0.8%-2.9%), based on a pooled analysis of six cohort studies. The excess risk of lung cancer death, assuming US male background rates, is 1.7% (0.2%-3.6%), based on a pooled analysis of ten cohort studies. The excess risk of end-stage renal disease (assuming male background rates) is 5.1% (2.2%-7.3%), based on a single cohort. The excess risk of death from renal disease is estimated to be 1.8% (0.8%-9.7%), based on a pooled analysis of three cohorts. CONCLUSIONS: Keeping in mind that the usual OSHA acceptable excess risk of serious disease or death for workers is 0.1%, it is clear that the current standard is far from sufficiently protective of workers' health. Perhaps surprisingly, kidney disease emerges as perhaps a higher risk than either mortality from silicosis or lung cancer, although the data are based on fewer studies.     

Differences in cellular and inflammatory cytokine profiles in the bronchoalveolar lavage fluid in bagassosis and silicosis

BACKGROUND: Little is known about the crucial mediators involved in the inflammation and fibrogenesis in bagassosis. The aim of this study was to characterize the cellular and cytokine patterns in the airways of bagassosis and to compare these with silicosis subjects and controls. METHODS: Bronchoalveolar lavage (BAL) was performed in 11 patients with bagassosis, 16 cases with silicosis, and 8 controls. Differential cell counts, total protein concentration, TNF-alpha, IL-1beta, IL-5, IL-6, and IL-8 were analyzed in the bronchoalveolar lavage fluid (BALF). RESULTS: Bagassosis was characterized with hypercellularity with neutrophilia in BALF; while the predominant cell in the BALF in silicosis was macrophage. Compared with control subjects, increased TNF-alpha, IL-1beta, IL-8, and IL-6 levels were found in the BALFs in both bagassosis and silicosis. Furthermore, IL-6 levels in the BALF of silicosis subjects were significantly higher than that seen in bagassosis. In contrast, bagassosis had higher level of IL-8 in BALF than that in silicosis. Relationship among these parameters were found between IL-8 levels and neutrophils, lymphocytes and IL-1 beta in bagassosis, macrophages and IL-1beta in silicosis. No significant differences of total protein concentrations and IL-5 in BALF were found between controls or bagassosis, and silicosis. CONCLUSIONS: The findings of this study suggest that neutrophils, TNF-alpha, IL-1beta, IL-8, and IL-6 are involved in the pathogenesis in bagassosis. The mechanisms underline the different cellular and cytokine profiles in bagassosis and silicosis warrant further investigation.     

Exposure to silica and silicosis among tin miners in China: exposure-response analyses and risk assessment

OBJECTIVES—To investigate the risk of silicosis among tin miners and to investigate the relation between silicosis and cumulative exposure to dust (Chinese total dust and respirable crystalline silica dust).
METHODS—A cohort study of 3010 miners exposed to silica dust and employed for at least 1 year during 1960-5 in any of four Chinese tin mines was conducted. Historical total dust data from China were used to create a job exposure matrix for facility, job title, and calendar year. The total dust exposure data from China were converted to estimates of exposure to respirable crystalline silica for comparison with findings from other epidemiological studies of silicosis. Each worker''s work history was abstracted from the complete employment records in mine files. Diagnoses of silicosis were based on 1986 Chinese pneumoconiosis Roentgen diagnostic criteria, which classified silicosis as stages I-III—similar to an International Labour Organisation (ILO) classification of 1/1 or greater.
RESULTS—There were 1015 (33.7%) miners identified with silicosis, who had a mean age of 48.3 years, with a mean of 21.3 years after first exposure (equivalent to 11.0 net years in a dusty job). Among those who had silicosis, 684 miners (67.4%) developed silicosis after exposure ended (a mean of 3.7 years after). The risk of silicosis was strongly related to cumulative exposure to silica dust and was well fitted by the Weibull distribution, with the risk of silicosis less than 0.1% when the Chinese measure of cumulative exposure to total dust (CTD) was under 10 mg/m³-years (or 0.36 mg/m³-years of respirable crystalline silica), increasing to 68.7% when CTD exposure was 150 mg/m³-years (or 5.4 mg/m³-years of respirable crystalline silica). Latency period was not correlated to the risk of silicosis or cumulative dose of exposure. This study predicts about a 36% cumulative risk of silicosis for a 45 year lifetime exposure to these tin mine dusts at the CTD exposure standard of 2 mg/m³, and a 55% risk at 45 years exposure to the current United States Occupational Safety and Health Administration and Mine Safety and Health Administration standards of 0.1 mg/m³ 100% respirable crystalline silica dust.
CONCLUSIONS—A clear exposure-response relation was detected for silicosis in Chinese tin miners. The study results were similar to most, but not all, findings from other large scale exposure-response studies.


     

Polymorphisms of the IL-1 gene complex in coal miners with silicosis

BACKGROUND: Silicosis is characterized by fibrosing nodular lesions that eventually develop into progressive pulmonary fibrosis. Pro-inflammatory cytokines, such as interleukin-1 (IL-1), play a key role in the development of silicosis by regulating mediators which are responsible for lung injury, inflammation, and potentially fibrosis. To study whether functional single nucleotide polymorphisms (SNPs) located in the regulatory elements of genes coding for the IL-1alpha, IL-1beta, and IL-1 receptor antagonist (RA) cytokines are associated with silicosis, we examined 318 Caucasian cases confirmed histopathologically with pulmonary silicosis and 163 controls without any apparent inflammation or other pulmonary disease. METHODS: Genotyping was carried out by polymerase chain reaction-restriction fragment length polymorphism technique. RESULTS: The proportion of the IL-1RA (+ 2018) allele 2 genotype was increased in miners with silicosis (0.27) compared to controls (0.16). The odds of being a case were 2.15 (CI = 1.4-3.3) times higher for subjects with at least one copy of allele 2. No statistically significant differences in the allelic frequencies or genotype distributions for IL-1alpha (+ 4845) or IL-1beta (+ 3953) were found between the control and disease groups. CONCLUSIONS: This is the first report showing an association between the IL-1RA (+ 2018) polymorphism and silicosis, and suggests that this polymorphism may confer increased risk for the development of the disease.     

抗人尘细胞单克隆抗体用于低SiO2粉尘所致尘肺的诊断研究

目的研究抗人尘细胞单克隆抗体(McAb)用于低SiO2粉尘所致尘肺病人的特异性及灵敏度检测.扩大抗人尘细胞McAb在尘肺诊断中的应用范围.方法用人体巨噬细胞体外加SiO2培养、提纯抗原免疫BALB/C小鼠获取致敏的小鼠脾细胞与骨髓瘤细胞融合、克隆化,筛选出两株分泌抗人尘细胞McAb的杂交瘤细胞,用其分泌的McAb分别测定了138例各期尘肺病人的血清,其中矽肺58例,电焊工尘肺33例,煤工尘肺39例,石棉肺8例以及84例0+观察者、54例非接尘作业的正常人,32例肺科病人.结果矽肺、低SiO2尘肺与抗人细胞MoAb反应的均值无显著性差异(P＞0.05),各类尘肺与正常人之间有明显的界限值分别为(1.77±0.41)g/L,(0.98±0.34)g/L.Ⅰ、Ⅱ、Ⅲ期各类尘肺间无明显的剂量反应关系.结论机体接尘后所产生的异性蛋白具有同源性,相对抗人细胞McAb是同一种抗原.抗人细胞McAb不仅可用于矽肺的检测诊断,同样也可用于低SiO2粉尘所致尘肺的检测诊断.     

矾矿工人矽肺的转归分析

本文阐述了矽－矾共存矿山矽肺患者的转归情况，用寿命表法生存率统计对101例单纯Ⅰ期矽肺患者进行病情稳定和尚存情况分析。累积晋期概率单位与衣断后年数呈正相关，病情稳定在50％的期望年限为依断后第12.33年；累积生存率概率单位与诊断年数呈负相关，自下而上率在50％的期望年限为诊断后第15年。认为矽－矾共存的矿山矽肺得预后较差，应做好三级预防。