Badorrey M I, Monsó E, Teixidó A, Pifarré R, Rosell A, Llatjós M
Servicio de Neumología. Hospital Universitario Germans Trias i Pujol. Badalona. Barcelona.
Med Clin (Barc). 2001 Jun 9;117(1):1-6.
The goal of this study was to determine the prevalence of asbestos-related lung cancer and the importance of the occupational exposure to this inorganic fibre as a risk factor.
We performed a cross-sectional study of 82 patients with lung cancer (mean age 62 SD 9 years) and 53 patients without pleuropulmonary disease (63 SD 13 years). The occupational exposure to asbestos was determined by a questionnaire. We determined the concentration of asbestos bodies (AB) in bronchoalveolar lavage (BAL) (93 patients) or lung tissue (42 patients) after chemical digestion, with the results being expressed as AB/mL BAL or AB/g dry lung, respectively. A concentration higher than 1 AB/mL or 1,000 AB/g was considered as marker of high asbestos burden in lung tissue, which could be potentially responsible for pleuropulmonary disease. The importance of asbestos occupational exposure as a risk factor for lung cancer was determined using logistic regression models.
25 patients with lung cancer reported occupational exposure to asbestos (30%) and in 13 out of them AB were detected in BAL or lung tissue (24%), at high concentrations in 3 cases (4%). Six patients from the group without pleuropulmonary disease reported occupational exposure to asbestos (11%) and in 13 out of them AB were found in some samples (24%), with no case having high concentrations. In the univariate logistic regression analysis, diagnosis of bronchial neoplasia was associated with both smoking (OR 10.10, 95% CI 3.50-29.13) and occupational exposure to asbestos (OR 3.69, 95% CI 1.39-9.77). The association between asbestos exposure and lung cancer persisted statistically significant after adjustment for smoking (OR 2.80, 95% CI 1.00-7.84).
In Spain, lung cancer was related to occupational exposure to asbestos in 4% of cases, and it appeared to exist a synergistic effect of smoking. Occupational exposure to this inorganic fibre doubles the risk of suffering from lung cancer.
本研究的目的是确定石棉相关肺癌的患病率以及职业接触这种无机纤维作为危险因素的重要性。
我们对82例肺癌患者（平均年龄62岁，标准差9岁）和53例无胸膜肺部疾病的患者（63岁，标准差13岁）进行了横断面研究。通过问卷调查确定职业性石棉接触情况。化学消化后，我们测定了支气管肺泡灌洗（BAL）液（93例患者）或肺组织（42例患者）中石棉小体（AB）的浓度，结果分别以每毫升BAL液中的AB数量或每克干肺中的AB数量表示。浓度高于1个AB/mL或1000个AB/g被视为肺组织中高石棉负荷的标志物，这可能是胸膜肺部疾病的潜在原因。使用逻辑回归模型确定职业性石棉接触作为肺癌危险因素的重要性。
25例肺癌患者报告有职业性石棉接触（30%），其中13例在BAL液或肺组织中检测到AB（24%），3例浓度较高（4%）。无胸膜肺部疾病组的6例患者报告有职业性石棉接触（11%），其中13例在一些样本中发现AB（24%），无高浓度病例。在单变量逻辑回归分析中，支气管肿瘤的诊断与吸烟（比值比10.10，95%可信区间3.50 - 29.13）和职业性石棉接触（比值比3.69，95%可信区间1.39 - 9.77）均相关。调整吸烟因素后，石棉接触与肺癌之间的关联在统计学上仍具有显著意义（比值比2.80，95%可信区间1.00 - 7.84）。
在西班牙，4%的肺癌病例与职业性石棉接触有关，且似乎存在吸烟的协同作用。职业接触这种无机纤维会使患肺癌的风险加倍。
