Cohen Robert A C, Patel Aiyub, Green Francis H Y
Department of Environmental and Occupational Health Sciences, University of Illinois School of Public Health, Chicago, USA.
Semin Respir Crit Care Med. 2008 Dec;29(6):651-61. doi: 10.1055/s-0028-1101275. Epub 2009 Feb 16.
Susceptible workers exposed to coal mine and silica dust may develop a variety of pulmonary diseases. The prime example is classical pneumoconiosis, a nodular interstitial lung disease that, in severe cases, may lead to progressive massive fibrosis (PMF) . Exposure to silica and coal mine dusts may also result in pulmonary scarring in a pattern that mimics idiopathic pulmonary fibrosis, and in chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis, that appears indistinguishable from obstructive lung disease caused by exposure to tobacco smoke. Coal mine and silica dust may therefore result in restrictive, obstructive, or mixed patterns of impairment on pulmonary function testing. Most physicians are aware of the nodular fibrosing pulmonary tissue reactions in response to retained dust, but they may not realize that these other reactions of the pulmonary parenchyma and airways to dust exist and can result in significant respiratory dysfunction in sensitive individuals. This article discusses current data on exposure to coal mine and silica dust in the United States, the epidemiology of the diseases caused by these exposures, and new concepts of causation and pathogenesis. We also review the patterns of pulmonary disease and impairment that may result.
接触煤矿粉尘和矽尘的易感工人可能会患上多种肺部疾病。典型的例子是经典尘肺病，这是一种结节性间质性肺病，在严重情况下可能会导致进行性大块纤维化（PMF）。接触矽尘和煤矿粉尘还可能导致肺部瘢痕形成，其模式类似于特发性肺纤维化，以及慢性阻塞性肺疾病（COPD），包括肺气肿和慢性支气管炎，这些疾病与接触烟草烟雾引起的阻塞性肺病似乎难以区分。因此，煤矿粉尘和矽尘可能导致肺功能测试出现限制性、阻塞性或混合性损伤模式。大多数医生都知道肺部组织对残留粉尘的结节性纤维化反应，但他们可能没有意识到肺实质和气道对粉尘的这些其他反应的存在，并且这些反应可能会在敏感个体中导致严重的呼吸功能障碍。本文讨论了美国目前关于接触煤矿粉尘和矽尘的数据、这些接触所导致疾病的流行病学以及病因和发病机制的新概念。我们还回顾了可能由此导致的肺部疾病和损伤模式。
