Labrecque Manon, Khemici Elyess, Cartier André, Malo Jean-Luc, Turcot Jules
Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.
J Occup Environ Med. 2006 Oct;48(10):1093-8. doi: 10.1097/01.jom.0000243399.81329.d0.
The objective of this project was to assess both the outcome for patients diagnosed with proven isocyanate-induced occupational asthma (IIOA) by specific inhalation challenge (SIC) and the functional impairment, 2 years after cessation of exposure to isocyanates, using the compensation insurance scale proposed in the province of Quebec.
We used a retrospective cohort of 233 patients diagnosed in the province of Quebec between 1985 and 2002 and randomly chose 105 of those patients. We kept 89 subjects with complete data at T0 (the time of diagnosis) and 79 were reevaluated at T2, approximately 2 years after their removal from exposure, for final impairment-disability assessment. At each evaluation (T0 and T2), a clinical examination and lung function tests, including spirometry and methacholine challenge, were performed.
At T2, 79 of 89 patients were reassessed (89%). The remaining patients were lost to follow up (8) or too unstable to be reassessed for final impairment-disability settlement (2). No statistical difference was observed for spirometry data and antiasthmatic medication use between T0 and T2 (P = 0.11). At T2, 73% of patients were still using short-acting beta2 agonists and 39% inhaled glucocorticoids. A forced expiratory volume in 1 second variation of +/-10% from T0 to T2 occurred in 31 subjects (40%). Forced expiratory volume in 1 second worsened in 14 (18%), remained significantly unchanged in 51 (64%), and improved in 14 (18%). Nonspecific bronchial hyperresponsiveness (BHR) improved in significantly in 19 (24%); the others remained unchanged. Both were not associated with smoking status (P > 0.05). Nonspecific BHR was normalized in nine of 79 (11%) patients. Clinical remission occurred in only four (5%) subjects. The mean impairment-disability score was 21% +/- 13% at 2 years according to the scale used by the Workers' Compensation Board.
These results show the generally poor medical outcome of IIOA and suggest the importance of early detection and withdrawal of the workers from exposure to isocyanates. They also emphasize the need for medical surveillance program and adequate treatment of patients with IIOA.
本项目的目的是使用魁北克省提出的工伤保险量表，评估经特异性吸入激发试验（SIC）确诊为异氰酸酯诱发的职业性哮喘（IIOA）的患者的预后以及停止接触异氰酸酯2年后的功能损害情况。
我们采用了一个回顾性队列，该队列包含1985年至2002年在魁北克省确诊为IIOA的233例患者，并从这些患者中随机选取了105例。我们保留了89例在T0（诊断时）具有完整数据的受试者，其中79例在脱离接触后约2年的T2时进行了重新评估，以进行最终的损伤-残疾评定。在每次评估（T0和T2）时，均进行了临床检查和肺功能测试，包括肺活量测定和乙酰甲胆碱激发试验。
在T2时，对89例患者中的79例进行了重新评估（89%）。其余患者失访（8例）或病情过于不稳定，无法进行最终的损伤-残疾评定重新评估（2例）。T0和T2之间的肺活量测定数据和抗哮喘药物使用情况未观察到统计学差异（P = 0.11）。在T2时，73%的患者仍在使用短效β2激动剂，39%的患者使用吸入性糖皮质激素。从T0到T2，31例受试者（40%）的1秒用力呼气容积变化为±10%。14例（18%）患者的1秒用力呼气容积恶化，51例（64%）患者的该指标保持显著不变，14例（18%）患者的该指标有所改善。19例（24%）患者的非特异性支气管高反应性（BHR）显著改善；其他患者保持不变。两者均与吸烟状况无关（P > 0.05）。79例患者中有9例（11%）的非特异性BHR恢复正常。仅4例（5%）受试者出现临床缓解。根据工人赔偿委员会使用的量表，2年时的平均损伤-残疾评分为21%±13%。
这些结果表明IIOA的总体医疗预后较差，并提示早期检测以及让工人脱离异氰酸酯接触的重要性。它们还强调了对IIOA患者进行医学监测计划和适当治疗的必要性。
