Schreiber J, Knolle J, Sennekamp J, Schulz K T, Hahn J U, Hering K G, Raulf-Heimsoth M, Merget R
Dept for Pneumonology, Otto-von-Guericke-University, Leipziger Str. 44, D-39120 Magdeburg, Germany.
Eur Respir J. 2008 Sep;32(3):807-11. doi: 10.1183/09031936.00060507.
There is virtually no information in the literature about the exposure levels needed to induce hypersensitivity pneumonitis (HP) by diisocyanates. The present study reports a case of occupational HP due to diisocyanates after low-level exposure. A 53-yr-old female never-smoker developed progressive shortness of breath on exertion, cough, fatigue and flu-like symptoms shortly after she began work as a secretary of a car body repair shop. A diagnosis of HP was made 2 yrs later, based on a restrictive ventilatory defect, a reticulonodular and discrete ground-glass pattern on high-resolution computed tomography, lymphocytosis in bronchoalveolar lavage and specific immunoglobulin G antibodies to diisocyanate human serum albumin conjugates in the patient's serum. The diagnosis was confirmed by recovery after exposure cessation and deterioration after re-exposure. Ambient monitoring revealed air concentrations of different diisocyanate monomers below the detection limit in both the patient's work station and in front of the paint spray booths, with the exception of one measurement that showed 4,4-methylenediphenyl diisocyanate concentrations of 3 microg x m(-3) in front of one booth (corresponding to a total reactive isocyanate group concentration of 1 microg x m(-3)). The present authors conclude that concentrations of diisocyanates far below current exposure limits may induce hypersensitivity pneumonitis in susceptible subjects.
关于二异氰酸酯诱发超敏性肺炎（HP）所需的暴露水平，文献中几乎没有相关信息。本研究报告了一例低水平暴露后因二异氰酸酯导致的职业性HP病例。一名53岁从不吸烟的女性，在开始担任汽车车身修理店秘书后不久，出现了进行性劳力性气短、咳嗽、疲劳及类似流感的症状。两年后，基于限制性通气功能障碍、高分辨率计算机断层扫描显示的网状结节及散在磨玻璃影、支气管肺泡灌洗中的淋巴细胞增多以及患者血清中针对二异氰酸酯人血清白蛋白结合物的特异性免疫球蛋白G抗体，做出了HP的诊断。通过停止暴露后病情恢复及再次暴露后病情恶化，确诊得到了证实。环境监测显示，在患者工作场所及喷漆 booths 前，不同二异氰酸酯单体的空气浓度均低于检测限，但有一次测量显示，一个 booth 前4,4 - 亚甲基二苯基二异氰酸酯浓度为3μg x m(-3)（相当于总反应性异氰酸酯基团浓度为1μg x m(-3)）。作者得出结论，远低于当前暴露限值的二异氰酸酯浓度可能会在易感个体中诱发超敏性肺炎。
