Paris Christophe, Martin Aurélie, Letourneux Marc, Wild Pascal
Inserm ERI-11, Assessment and prevention of occupational and environmental risks Medical School, 9 av de la Forêt de Haye - BP 184, 54505 Vandoeuvre-les-Nancy Cedex, France.
Environ Health. 2008 Jun 20;7:30. doi: 10.1186/1476-069X-7-30.
CT-Scan is currently under assessment for the screening of asbestos-related diseases. However, to date no consensus exists as to how to select high-risk asbestos-exposed populations suitable for such screening programs. The objective of this study is to select the most relevant exposure variables for the prediction of pleural plaques and asbestosis in order to guide clinicians in their use of CT-Scan.
A screening program of non malignant asbestos-related diseases by CT-scan was conducted among asbestos-exposed volunteers in France. Precise assessments of asbestos exposure were obtained by occupational hygiene measurements and a job-exposure matrix. Several parameters were calculated (time since first exposure, duration, intensity and cumulative exposure to asbestos). Predictive parameters of prevalence and incidence were then estimated by standard logistic and a complementary log-log regression models.
1011 subjects were recruited in this screening program among them 474 (46.9%) presented with pleural plaques and 61 (6.0%) with interstitial changes compatible with asbestosis on CT-scan. Time since first exposure (p < 0.0001) and either cumulative or mean exposure (p < 0.0001) showed independent associations with both pleural plaques and asbestosis prevalence and pleural plaques incidence. Modelling incidence of pleural plaques showed a 0.8% to 2.4% yearly increase for a mean exposure of 1 f/ml.
Our findings confirmed the role played by time since first exposure and dose but not duration in asbestos-related diseases. We recommend to include these parameters in high-risk populations suitable for screening of these diseases. Short-periodicity of survey of pleural plaques by CT-Scan seemed not to be warranted.
目前正在评估CT扫描用于筛查石棉相关疾病的效果。然而，迄今为止，对于如何选择适合此类筛查项目的高危石棉暴露人群尚未达成共识。本研究的目的是选择最相关的暴露变量来预测胸膜斑和石棉肺，以指导临床医生使用CT扫描。
在法国对石棉暴露志愿者开展了一项通过CT扫描筛查非恶性石棉相关疾病的项目。通过职业卫生测量和工作暴露矩阵对石棉暴露进行了精确评估。计算了几个参数（首次暴露后的时间、持续时间、强度和石棉累积暴露量）。然后通过标准逻辑回归模型和互补对数-对数回归模型估计患病率和发病率的预测参数。
该筛查项目招募了1011名受试者，其中474名（46.9%）有胸膜斑，61名（6.0%）在CT扫描上有与石棉肺相符的间质改变。首次暴露后的时间（p<0.0001）以及累积暴露量或平均暴露量（p<0.0001）与胸膜斑和石棉肺的患病率以及胸膜斑的发病率均显示出独立相关性。胸膜斑发病率模型显示，平均暴露量为1 f/ml时，每年增加0.8%至2.4%。
我们的研究结果证实了首次暴露后的时间和剂量在石棉相关疾病中的作用，但持续时间并非如此。我们建议将这些参数纳入适合筛查这些疾病的高危人群。通过CT扫描对胸膜斑进行短期定期检查似乎没有必要。
