大冶铁矿尘肺发病规律及其影响因素

目的]分析武钢大冶铁矿尘肺发病规律,探讨尘肺发病的主要影响因素。方法]选择该铁矿1960～1974年间登记在册且工作过1年以上的所有工人建立研究队列,随访至2003年底。收集队列成员的基本资料、职业史、疾病史及各工种历年的粉尘浓度监测资料,分析铁矿尘肺的发病规律。随机选取1714名存活的队列成员,测定TNF-α-308位点及hOGG1Ser326Cys多态性。计算各影响因素对尘肺发病的相对危险度（RR）。结果]队列共7666人,到2003年底共随访261410.72人年,失访275人。接尘工人3604人,共随访126863.13人年,诊断314例尘肺,尘肺发病率为0.25%,累计发病率8.71%。75.80%的尘肺病例1960年之前开始接尘,83.12%的病例累积接尘量大于50mg（/m^3·a）。铁矿尘肺的平均潜伏期19.65年,77.71%的病例潜伏期在10～30年之间。发病率随着累积接尘量的增加而升高,高、中接尘组相对于低接尘组的RR分别为8.25和2.27;吸烟组尘肺发病率是不吸烟组的1.7倍;肺结核组发生尘肺危险较非肺结核组明显增高（RR=32.34）;TNF-α-308位点及hOGG1Ser326Cys的突变型和野生纯合子组间发病情况差异无统计学意义（P〉0．05）.结论]累积接尘量高是影响铁矿尘肺发病的根本因素，吸烟和患肺结核可促进其发生。TNF-α-308位点及hOGGISer326Cys多态性在铁矿尘肺的发病中不起主要作用。

Characteristics and Influencing Factors of Pneumoconiosis in an Iron Mine

Objective] To describe the characteristics of the incidence of pneumoconiosis in Daye Iron Mine of Wuhan Iron Company,and to identify the main influencing factors which influence the incidence of pneumoconiosis among dust-exposed workers. Methods] A cohort of 7 666 workers registered in Daye Iron Mine of Wuhan Iron Company during 1960 through 1974 and had worked at least one year in this mine was established.The subjects were traced to the end of 2003.In 2005,TNF-α and hOGG1 polymorphism were analyzed using real-time polymerase chain reaction techniques in 1 714 randomly chosen survivors.The relative risks（RRs）were calculated for different influencing factors rated in pneumoconiosis group to non-pneumoconiosis group.Results] A total of 261 410.72 person years were traced,in which 314 cases of pneumoconiosis among 3 604 dust-exposed workers were diagnosed as pneumoconiosis by the end of 2003.The incidence of pneumoconiosis was 0.25% and accumulation morbidity was 8.71%.More than 75% pneumoconiosis victims started dust exposure before 1960 and the cumulative total exposure to dust of 83.12% pneumoconiosis victims was more than 50 mg/m^3·a.The average latency of pneumoconiosis was 19.65 years in the iron mine,and the latency of 77.71% cases was between 10 and 30 years.The incidence of pneumoconiosis rose along with the cumulative total exposure.The relative risks of pneumoconiosis for high and middle dust exposed workers were 8.25 and 2.27 compared with that in low dust exposure.The RRs of pneumoconiosis were 1.7 for smoking compared with non-smoking cases,and 32.34 for those complicated with tuberculosis compared with non-complicated cases.No significant difference was found among genotype groups of TNF-α-308 and hOGG1Ser326Cys. Conclusion] High dust-exposure was the most important influencing factor of pneumoconiosis in the iron mine,other factors as smoking and tuberculosis should also be considered.TNF-α-308 and hOGG1Ser326Cys gene polymorphism did not play an important role in susceptibility to pneu