矽肺与其并发症相关关系的临床分析

[目的]分析矽肺期别与其并发症的相关关系。[方法]收集2004～2006年经新疆乌鲁木齐铁路局职业病诊断组确诊的矽肺患者206例,平均年龄73岁,平均接尘史7.14年。其中Ⅰ期矽肺150例,Ⅱ期矽肺46例,Ⅲ期矽肺10例,分别用χ^2检验分析Ⅰ、Ⅱ、Ⅲ期矽肺与慢性阻塞性肺气肿,慢性肺源性心脏病、高血压病、糖尿病、冠心病、呼吸衰竭之间的相关关系。[结果]矽肺期别与慢性阻塞肺气肿及慢性肺源性心脏病之间相关关系分析,χ^2值分别为12.28、28.41,均为P﹤0.05,均有统计学差异;矽肺期别与高血压病、冠心病、糖尿病的相关关系分析χ^2值分别为0.2027、1.0004、1.4579,均为P﹥0.05,均无统计学差异。[结论]随着矽肺期别的升高,并发慢性阻塞性肺气肿、慢性肺源性心脏病的阳性率逐渐升高;而矽肺期别与高血压病、冠心病、糖尿病、呼吸衰竭的发病率无关。     

206例老年矽肺患者心电图分析

[目的]对老年矽肺患者的心电图进行分析,以了解老年矽肺患者心电图变化情况。[方法]新疆医科大学第五附属医院职防科2005～2006年206例老年矽肺住院患者的心电图进行了详细分析,并进行统计学方法处理。[结果]老年矽肺患者心电图以ST-T改变、不完全性右束支传导阻滞、窦速、左前分支传导阻滞、电轴左偏、肺型P波、室性早博为多见。心电图改变与矽肺期别无关,即心电图的变化并不随着矽肺期别的升高而呈某一类心电图变化占强大优势。[结论]心电图的变化可能与其并发症有关,积极预防与治疗老年矽肺患者并发症极其重要,对延长患者的生命及提高生命质量十分重要。     

石英的人类致癌性在DNA分子水平的证据

收集３６例石英粉尘作业工人肺癌（石英肺癌）的组织石蜡包埋物,提取其 Ｄ Ｎ Ａ,对 ｐ５３基因和 Ｋ ｒａｓ 基因进行了 Ｐ Ｃ Ｒ Ｓ Ｓ Ｃ Ｐ、 Ｐ Ｃ Ｒ Ｒ Ｆ Ｌ Ｐ及 Ｄ Ｎ Ａ 测序分析,发现具有完全有别于普通肺癌的特异基因突变谱。小细胞肺癌的 ｐ５３基因突变多发于第８外显子,腺癌的 ｐ５３基因突变率高。石英肺癌的 Ｋ ｒａｓ 基因突变未见一例发生于普通肺癌突变热点区第１２密码子上,相反发现多处非热点区突变,突变类型以 Ｇ→ Ｃ 突变为主。     

Observed and predicted silicosis risks in heavy clay workers

BACKGROUND: There is increasing pressure to tighten the regulation of workers' exposures to airborne silica, which can lead to severe and in some cases rapid development of disease. However, estimated risks from respirable silica vary greatly across industries. AIM: To clarify differences in risks between workers in the heavy clay and coal industries with documented exposures to respirable silica, in order to assist decisions on whether further investigation of possible differences might be justified. METHODS: We applied a published equation for radiological risks from exposure to respirable silica, from a study of Scottish coalworkers (with unusually high exposures) to exposure estimates from an epidemiological study of heavy clay workers, by the same research team and using similar methods. RESULTS: The equation based on coalworkers' risks predicted in the heavy clay workers 31 cases of abnormalities at grade 2/1+ on the International Labour Organization scale, greatly in excess of the eight cases observed. Statistical variation is an implausible explanation (P < 0.0001). CONCLUSIONS: While there were some methodological differences between the studies, the disparity in risks provides some support for the case for further investigation of possible differences.     

Pneumoconiosis among workers in a Vietnamese refractory brick facility

BACKGROUND: Vietnam is a rapidly industrializing country with increasing needs for building materials, including refractory bricks. The manufacture of refractory bricks results in high levels of free silica, a recognized occupational hazard. METHODS: A cross-sectional survey was conducted among 158 employees using a respiratory symptom questionnaire and ILO classification of radiographs for pneumoconiosis. RESULTS: The prevalence of radiographic silicosis (ILO category 1/0 and greater) was 10% in all workers with evidence of a dose-response gradient. Pneumoconiosis prevalence increased from 0% in workers employed < 10 years at the plant to 18% for workers employed > 20 years (trend test P = 0.01 for each year increment after adjusting for gender and tobacco use). CONCLUSIONS: Workers in this plant demonstrate a consistent pattern of radiographic evidence of pneumoconiosis, which appears to be related to duration of work. Future studies should assess exposure control measures that are appropriate to countries undergoing rapid industrialization such as Vietnam.     

维生素E对大鼠矽肺支气管肺灌洗液中几种磷脂含量的影响

本文报告了维生素E对大鼠矽肺支气管肺泡灌洗液中几种磷脂含量的影响。实验分为正常对照,石英及维生素E治疗组,疗程270天。结果表明,维生素E组肺灌洗液中总磷脂、二棕榈酰卵磷脂(DPPC)、磷脂酰甘油三酯(PG)、磷脂酰乙醇胺(PE)含量早期高于同期对照组,但又都低于同期石英组。维生素E组全肺胶原蛋白含量高于对照组,但均低于同期石英组。提示维生素E在抗脂质过氧化、保护生物膜及抑制胶原合成上起着一定的作用。     

Respiratory Health and Silica Exposure of Stone Carvers in Thailand

Abstract

A cross-sectional study of dust exposures and health outcomes was conducted in a stone-carving company in Thailand. 147 respirable dust samples were collected and 97 subjects participated. Exposure indices were constructed and health outcomes, including respiratory symptoms, pulmonary functions, and chest radiographs, were assessed. Severities of employees' current exposures to quartz were 0.5–8.8 times the ACGIH-TLV,depending on job and site. Durations of exposures ranged from 4 months to 30 years. The prevalence of silicosis (profusion grade ≥ 1/0) was 2%. Pulmonary tuberculosis was also detected in 4%. Linear regression analyses revealed decreased lung function in workers with longer work durations (p < 0.05), regardless of age, sex, height, and smoking status. No clear association was seen between cumulative exposure metrics and indicators of silicosis. Elevated silica exposure levels indicate an ongoing risk of silicosis in this industry. Exposures were increased by the use of grinding tools with no ventilation and by proximity to other workers. However, because the number of workers with dust-exposure histories was limited, exposure measurements were confined to current conditions.     

建立矽肺犬动物模型的实验研究

目的模拟矽肺的致病过程,建立初步的矽肺犬动物模型。方法利用气管插管及呼吸机通气,将二氧化硅粉末吹入实验犬肺内,观察不同染尘剂量、不同染尘频次下,各持续时间段内(染尘前,染尘1、2、3个月)实验犬的动脉血气、胸部CT影像学、肺组织病理形态学改变。结果各组实验犬染尘前后的动脉血气水平无明显差异(P>0.05),但染尘后实验犬胸部CT均有不同程度的磨玻璃样改变,肺组织病理可见肺间质增厚,终末细支气管壁周围大量吞尘巨噬细胞聚集,有成纤维细胞增生及网状胶原纤维形成,偏光显微镜下可见肺间质内二氧化硅颗粒沉积,且染尘犬胸部CT及肺组织病理改变程度与染尘剂量、染尘频次、染尘时间呈正相关。结论经气管插管后呼吸机通气,每次按400 mg/kg称取二氧化硅粉尘吹入实验犬肺内,每周染尘1次,持续染尘3个月,可建立初步的矽肺犬动物模型。     

Accelerated silicosis and silico‐tuberculosis: A difficult diagnosis

It is well established that exposure to respirable crystalline silica is associated with higher mortality. Such exposures are associated with an increased risk of silico‐tuberculosis, silicosis, and other respiratory morbidities. We report two cases of accelerated silicosis, complicated with pulmonary tuberculosis and pulmonary infection.