早期尘肺病的肺功能评定和劳动能力鉴定探讨

目的：为探讨早期尘肺病患者肺功能评定及其劳动能力鉴定中的应用。方法：本文做了Ⅰ期77例尘肺病人通过临床表现即呼吸困难的判定、高仟伏X线胸片检查、肺功能测定等检查进行了肺功能损伤分级及劳动能力鉴定。结果：矽肺组的肺功能较铸工尘肺明显下降。吸烟组肺功能测定结果低于不吸烟者，尤其是矽肺组，两组有显著性差异（P〈0．05）。77例尘肺病例中，44例尘肺病人为轻度损伤，其中矽肺33例，铸工尘肺11例，可定为伤残六级，33例尘肺肺功能测定正常，全部为铸工尘肺，伤残等级为七级。结论：我们测定的四项指标中有2项或2项以上指标有改变，并结合临床结果一致时，可诊断为该级别肺功能损伤较为合理。     

寻根：人类最初怎样装饰自己

——祖先那一声呐喊惊天动地,穿越现代美容的迷雾,那根放逐我们一代代的地母之根,正是我们苦苦追寻的生命之源。     

矽肺患者氧化应激指标及外周血单核细胞NF-κB水平的变化

目的 观察矽肺患者氧化应激指标及外周血单核细胞NF-κB水平的变化,探讨矽肺发生发展的机制.方法 选择某铸造厂接触矽尘作业工龄在1年以上的工人200例为接尘组,该厂2008年住院及门诊随访的矽肺患者130例为矽肺组,32例0+病例为观察对象组,同时选择某酒店服务人员100例为对照组.分别测定超氧化物歧化酶(SOD)、血清中谷胱甘肽过氧化物酶(GSH-Px)、一氧化氮合酶(NOS)活力,一氧化氮(NO)、丙二醛(MDA)含量及总抗氧化能力(T-AOC),外周血单核细胞核蛋白中NF-κB水平.结果 与对照组比较,接尘组和矽肺组NO含量明显升高,SOD活力明显降低,差异均有统计学意义(P＜0.01).与对照组及接尘组比较,矽肺组T-AOC水平、NOS活力、MDA含量均明显升高,差异均有统计学意义(P＜0.01).与对照组[(223.360±46.838)U/ml]比较,接尘组及矽肺组GSH-Px活力[(231.164±36.484)、(270.469±39.228)U/ml]明显升高,且矽肺组GSH-Px活力明显高于接尘组,差异均有统计学意义(P＜0.05,P＜0.01).与观察对象组[(256.906±21.418)U/ml]和Ⅰ期矽肺组[(259.594±34.790)U/ml]比较,Ⅲ期矽肺组GSH-Px活力[(290.750±39.129)U/ml]明显升高,差异均有统计学意义(P＜0.05).与对照组[(59.71±9.27)ng/L]比较,接尘组及矽肺组NF-κB水平[(72.06±9.12)、(85.25±11.64)ng/L]明显升高,且矽肺组NF-κB水平明显高于接尘组,差异均有统计学意义(P＜0.01).血清中GSH-Px活力与矽肺分期呈正相关(r=0.507,P＜0.01).外周血单核细胞核蛋白NF-κB水平与矽肺分期、年龄、GSH-Px活力、NO含量呈正相关,差异均有统计学意义(r值分别为0.376、0.243、0.233、0.221,P＜0.01).结论 机体氧化和抗氧化系统的失衡与矽肺的发生发展有关,并与NF-κB的活化一致.

Abstract：

Objective To investigate the change of indicators of oxidative stress in serum and NF-κB in peripheral blood mononuclear cells of patients with silicosis, and explore the mechanism of the development of silicosis. Methods The subjects were divided into (1) 200 workers exposed to SiO2 for at least 1 years in a foundry served as the dust-exposure group; (2) 130 cases with silicosis (Ⅰ phase silicosis 64 cases, Ⅱ phase 46 cases Ⅲ phase 20 cases) served as the silicosis goup; (3) 32 cases with 0+ phase silicosis in the foundry served as the observed group,(4)100 subjects from a hotel served as the control group. The serum including superoxide dismutase (SOD), nitric oxide (NO), serum glutathione peroxidase (GSH-Px), total antioxidant capacity (T-AOC), nitric oxide synthase (NOS), lipid malondialdehyde (MDA) and NF-κB protein levels in peripheral blood mononuclear cells were determined, respectively. Results Compared with the control group,NO levels in dust-exposed group and silicosis group significantly increased, and SOD decreased significantly (P＜0.05 or P＜0.01). Compared with the control group and dust-exposed group, T-AOC, NOS, MDA levels in silicosis group significantly increased (P＜0.05 or P＜0.01). GSH-Px in dust-exposed group and silicosis group were (231.164±36.484) and (270.469±39.228)U/md, respectively which were significantly than that [(223.360±46.838) U/ml] in control group (P＜0.05 or P＜0.01), and there was significant difference of GSHPx between the silicosis group and the dust-exposed group significantly (P＜0.01). GSH-Px level [(290.750±39.129) U/ml] in Ⅲ phase silicosis group were significantly higher than those [(256.906±21.41) and (259.594±34.79) U/ml] in observation group and Ⅰ phase silicosis group (P＜0.05). NF-κB levels [(72.06±9.12) and (85.25±11.64) ng/L] in dust-exposed group and silicosis group were significantly higher than that [(59.71±9.27) ng/L] in control group (P＜0.01), and there was significant difference of between the silicosis group and the dust-exposed group (P＜0.01). There was a positive correlation between serum GSH-Px level and the silicosis stages (r=0.507,P＜0.0l). Also there was a positive correlation between NF-κB level and silicosis stages, age, GSH-Px or NO levels (r=0.376, 0.243, 0.233, 0.221, P＜0.01). Conclusion The imbalance of oxidative and anti-oxidation system and the activation of NF-κB are related with the occurrence and development of silicosis. The monitoring of oxidative stress indicators and NF-κB is beneficial to the prediction and prognosis assessment of silicosis.     

尘肺病患者血清中Cys-C水平及影响因素的研究

目的 研究尘肺病患者血清中胱抑素C(Cystatin C,Cys-C)的水平,并探究血清Cys-C与尘肺病患者肺功能及炎症指标的相关性。方法 随机选取2022年1-12月于本院就诊的261例尘肺病患者为尘肺组,选取同期门诊健康体检者77例为对照组,研究对象均完成肺功能、血清中Cys-C、超敏C反应蛋白、白细胞及肌酐等检测。结果 与对照组比较,尘肺组血清中Cys-C及超敏C反应蛋白水平明显升高(Z=-2.66、-5.27,P<0.01),第1秒用力呼气容积占预计值百分比(FEV_1.0%)、1秒率(FVE1.0/FVC)及一氧化碳弥散量占预计值百分比(DLCO%)明显降低(t=6.02、5.43、12.30,P<0.01),血清中Cys-C水平与血清中肌酐和超敏C反应蛋白呈正相关(r=0.45、0.33,P<0.01),与FEV_1.0%呈负相关(r=-0.59,P<0.01)。结论 血清中Cys-C水平与老年尘肺病患者的肺功能及炎症因子水平相关,为尘肺病的进一步研究提供理论依据。     

CJX－I型肺磁疗装置治疗尘肺的初步效果观察

ＣＪＸ－Ｉ型肺磁疗装置治疗尘肺的初步效果观察黑龙江省劳动卫生职业病研究所（哈尔滨１５００１０）宁滨莲刘锡诚金朝辉钟明姜凤发乔红宋雪娟李亚男哈磁集团郭立仪王明善李大明吕彩艳哈市汽轮机厂姜晨光五十年代，我国始用电磁效应治疗各种疾病［１］，但至今尚未见尘肺...     

某冶炼厂冶炼工人矽肺发病情况分析

目的:调查某冶炼厂冶炼工人矽肺发病情况况.方法:根据某冶炼厂的委托对该厂工人经体检后提出的可疑尘肺工人进行了职业性健康检查及诊断.体检项目包括职业史,现场劳动卫生学材料,内科检查,高仟伏胸片,肺功能检查,血尿常规,肝功,心电等.结果:截止至2009年10月31日,体检机构向诊断组提请的可疑尘肺工人共37名,诊断矽肺22人,其中通过我院诊断组诊断20人,国家诊断鉴定组诊断2人,总检出率59.46%(22/37).结论:该冶炼厂工人矽肺发病符合急进型矽肺的诊断,其特点为发病年龄小,接尘工龄短,预后差.冶炼厂工人矽肺发病率极高,现场粉尘浓度严重超标,含有高浓度的游离二氧化硅.必须采取切实有效的防治措施,降低冶炼厂工人的矽肺发病率,保护工人的合法权益.     

尘肺患者肺功能200例分析

为了研究不同期别尘肺病人肺功能损害与伤残等级情况,为我国尘肺病人致残程度鉴定标准修订提供依据。我们按照统一标准收集200例尘肺患者资料,常规体检,拍摄高仟伏X射线胸片,进行肺功能测定,并根据我国《职工工伤与职业病致残程度鉴定标准》进行伤残分级。结果表明,Ⅰ期和Ⅱ期尘肺病人FVC、FEV1、DLC0和FEV／FVC(％)4项指标的平均值均在正常范围,但有28．6％～43．2％的病人有一项或多项肺功能异常;Ⅲ期病人各项指标均值均异常,且与Ⅰ、Ⅱ期病人比较,P＜0．05。戒烟组与吸烟组、不吸烟组比较,各项指标均明显降低(P＜0．05)。尘肺并发慢性支气管炎者的4项指标测定均值均低于尘肺者,但差异无显著性。受检者中肺功能轻度损伤70人,根据尘肺期别不同,致残程度判断为6级的49人,4级的18人,3级的3人;肺功能中度损伤30人,判断为4级的16人,3级的14人;肺功能重度损伤15人,均被评为2级。提示,以尘肺病分期作为致残程度评定的主要依据存在明显的缺陷,建议以肺功能损伤为基本依据,结合尘肺病诊断分期对尘肺病人进行致残程度评定。     

石墨烯致肺损伤机制的实验研究进展

石墨烯(GP)是一种新型的二维碳纳米材料,由于具有优异的电子、光学和机械等特性,已经被广泛应用于包括能量存储,复合材料工业和生物医学等多个领域。然而,随着GP的大量生产,接触GP粉尘的职业人群也日益扩大,其对职业健康造成的风险需要格外关注。本文从GP暴露对组织的病理学改变入手,综述近年来GP致肺损伤机制的研究进展,为进一步研究和预防GP导致的肺组织损伤提供参考依据。     

有创机械通气治疗8例尘肺合并呼吸衰竭的临床观察

选择我院2005年3月至2010年5月收治的尘肺病合并呼吸衰竭病例8例,进行气管插管(和/或气管切开)行有创机械通气,给予压力控制通气(PCV)和同步间歇指令通气+压力支持通气(SIMV+PSV)模式交替进行。通过有创机械通气时的血气分析指标、有创机械通气时间、脱机成功率、死亡人数(住院病死率),总结观察有创机械通气的临床疗效。8例中6例未成功脱机死亡,2例成功脱机。有创机械通气治疗尘肺病合并呼吸衰竭不能降低病死率,临床疗效有待进一步观察。     

Effects of oxidative stress and NF-κB levels in peripheral blood mononuclear cells on development of silicosis

Objective To investigate the change of indicators of oxidative stress in serum and NF-κB in peripheral blood mononuclear cells of patients with silicosis, and explore the mechanism of the development of silicosis. Methods The subjects were divided into (1) 200 workers exposed to SiO2 for at least 1 years in a foundry served as the dust-exposure group; (2) 130 cases with silicosis (Ⅰ phase silicosis 64 cases, Ⅱ phase 46 cases Ⅲ phase 20 cases) served as the silicosis goup; (3) 32 cases with 0+ phase silicosis in the foundry served as the observed group,(4)100 subjects from a hotel served as the control group. The serum including superoxide dismutase (SOD), nitric oxide (NO), serum glutathione peroxidase (GSH-Px), total antioxidant capacity (T-AOC), nitric oxide synthase (NOS), lipid malondialdehyde (MDA) and NF-κB protein levels in peripheral blood mononuclear cells were determined, respectively. Results Compared with the control group,NO levels in dust-exposed group and silicosis group significantly increased, and SOD decreased significantly (P＜0.05 or P＜0.01). Compared with the control group and dust-exposed group, T-AOC, NOS, MDA levels in silicosis group significantly increased (P＜0.05 or P＜0.01). GSH-Px in dust-exposed group and silicosis group were (231.164±36.484) and (270.469±39.228)U/md, respectively which were significantly than that [(223.360±46.838) U/ml] in control group (P＜0.05 or P＜0.01), and there was significant difference of GSHPx between the silicosis group and the dust-exposed group significantly (P＜0.01). GSH-Px level [(290.750±39.129) U/ml] in Ⅲ phase silicosis group were significantly higher than those [(256.906±21.41) and (259.594±34.79) U/ml] in observation group and Ⅰ phase silicosis group (P＜0.05). NF-κB levels [(72.06±9.12) and (85.25±11.64) ng/L] in dust-exposed group and silicosis group were significantly higher than that [(59.71±9.27) ng/L] in control group (P＜0.01), and there was significant difference of between the silicosis group and the dust-exposed group (P＜0.01). There was a positive correlation between serum GSH-Px level and the silicosis stages (r=0.507,P＜0.0l). Also there was a positive correlation between NF-κB level and silicosis stages, age, GSH-Px or NO levels (r=0.376, 0.243, 0.233, 0.221, P＜0.01). Conclusion The imbalance of oxidative and anti-oxidation system and the activation of NF-κB are related with the occurrence and development of silicosis. The monitoring of oxidative stress indicators and NF-κB is beneficial to the prediction and prognosis assessment of silicosis.