Hodgson M J, Bracker A, Yang C, Storey E, Jarvis B J, Milton D, Lummus Z, Bernstein D, Cole S
Occupational Health Program, Veterans Health Administration, Washington, DC, USA.
Am J Ind Med. 2001 Jun;39(6):616-28. doi: 10.1002/ajim.1061.
An outbreak of lung disease among workers in a metal-working plant included 16 biopsy-confirmed cases of hypersensitivity pneumonitis and additional patients with asthma, bronchiolitis and emphysema, usual interstitial pneumonitis, and sarcoidosis. Study design Clinical examination of patients; cross-sectional questionnaire survey of the outbreak plant and two control plant areas, one with and one without MWF exposures, in a separate facility; industrial hygiene survey with laboratory characterization of microbial flora; and immunological investigation.
Patients with suspected hypersensitivity pneumonitis underwent a clinical examination including detailed lung function, imaging, and tissue studies. A plant walk-through identified metal-working processes, microbial aerosols, and work practices. Microbial characteristics of the three microbial aerosol-producing processes were characterized. Antibodies to those agents were determined in patient sera. A questionnaire survey was conducted in the case plant and in two areas of a control plant, one with and one without metal-working fluids exposure.
Thirty-nine (79.6%) patients described symptoms consistent with work-related lung disease, eight received other diagnoses, and two did not complete their examinations. Sixteen patients had hypersensitivity pneumonitis confirmed on biopsy. Mean decrements in lung forced expiratory volume in 1 s and force vital capacity from before to after work were similar in the 16 biopsy-confirmed cases of hypersensitivity pneumonitis ( - 6.3%; - 7.2%) and the 19 symptomatic patients without biopsies ( - 11.2%, - 10.1%). Symptoms were more common in the case plant than in a non-MWF control plant area. Three sources of water-based aerosols were identified that grew similar microbial flora. Although machining increased airborne bacterial levels, the increase was not related to the concentration of viable bacteria in the sumps. Antibody testing did not identify a specific single organisms. Endotoxin levels were similar in case and MWF control plant.
Lung disease in environments with water-based aerosols may be more common than usually recognized. Patients with HP often present with only subtle abnormalities and may be missed if multiple clinical abnormalities are required to document disease.
一家金属加工工厂的工人中爆发了肺部疾病，其中包括16例经活检确诊的过敏性肺炎病例，以及其他患有哮喘、细支气管炎和肺气肿、寻常型间质性肺炎和结节病的患者。研究设计：对患者进行临床检查；对爆发疫情的工厂以及另一个独立设施中的两个对照厂区进行横断面问卷调查，其中一个对照厂区有金属加工液暴露，另一个没有；进行工业卫生调查并对微生物菌群进行实验室鉴定；以及进行免疫学调查。
疑似过敏性肺炎患者接受了包括详细肺功能、影像学和组织学研究在内的临床检查。对工厂进行巡查，确定金属加工工艺、微生物气溶胶和工作流程。对三种产生微生物气溶胶的工艺的微生物特性进行了鉴定。测定患者血清中针对这些病原体的抗体。在病例工厂和对照工厂的两个区域进行了问卷调查，其中一个区域有金属加工液暴露，另一个没有。
39名（79.6%）患者描述了与职业性肺病相符的症状，8名患者得到了其他诊断，2名患者未完成检查。16名患者经活检确诊为过敏性肺炎。在16例经活检确诊的过敏性肺炎病例中，工作前后1秒用力呼气量和用力肺活量的平均下降幅度（-6.3%；-7.2%）与19例有症状但未进行活检的患者（-11.2%，-10.1%）相似。病例工厂的症状比无金属加工液暴露的对照厂区更为常见。确定了三种产生类似微生物菌群的水基气溶胶来源。尽管机械加工增加了空气中细菌水平，但这种增加与油槽中活菌浓度无关。抗体检测未发现特定的单一病原体。病例工厂和金属加工液暴露对照工厂的内毒素水平相似。
有水基气溶胶的环境中肺部疾病可能比通常认为的更为常见。过敏性肺炎患者通常仅表现出细微异常，如果需要多种临床异常才能确诊疾病，可能会被漏诊。
