Departamento de Medicina Clínica, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brasil.
Environ Health Perspect. 2010 Feb;118(2):249-52. doi: 10.1289/ehp.0901110.
Man-made vitreous fibers (MMVFs) are noncrystalline inorganic fibrous material used for thermal and acoustical insulation (e.g., rock wool, glass wool, glass microfibers, and refractory ceramic fibers). Neither epidemiologic studies of human exposure nor animal studies have shown a noticeable hazardous effect of glass wools on health. However, MMVFs have been anecdotally associated with granulomatous lung disease in several case reports.
Here, we describe the case of a patient with multiple bilateral nodular opacities who was exposed to glass wool fibers and coating materials for 7 years. Bronchoalveolar lavage fluid revealed an increased total cell count (predominantly macrophages) with numerous cytoplasmic particles. Lung biopsy showed peribronchiolar infiltration of lymphoid cells and many foreign-body-type granulomas. Alveolar macrophages had numerous round and elongated platelike particles inside the cytoplasm. X-ray microanalysis of these particles detected mainly oxygen/aluminum/silicon and oxygen/magnesium/silicon, compatible with kaolinite and talc, respectively. No elemental evidence for glass fibers was found in lung biopsy.
The contribution of analytical electron microscopy applied in the lung biopsy was imperative to confirm the diagnosis of pneumoconiosis associated with a complex occupational exposure that included both MMVFs and coating materials.
This case study points out the possible participation of other components (coating materials), beyond MMVFs, in the etiology of pneumoconiosis.
人造玻璃纤维（MMVF）是一种用于热绝缘和声学绝缘的非晶态无机纤维材料（如岩棉、玻璃棉、玻璃微纤维和耐火陶瓷纤维）。人类接触的流行病学研究和动物研究均未显示玻璃棉对健康有明显的危害作用。然而，有几例病例报告将 MMVF 与肉芽肿性肺病联系起来。
在此，我们描述了一名患者的病例，该患者因接触玻璃棉纤维和涂层材料长达 7 年而出现双侧多发性结节性混浊。支气管肺泡灌洗液显示总细胞计数增加（主要为巨噬细胞），并伴有许多细胞质颗粒。肺活检显示细支气管周围有淋巴细胞浸润和许多异物型肉芽肿。肺泡巨噬细胞的细胞质内有许多圆形和长形的板状颗粒。这些颗粒的 X 射线微分析主要检测到氧/铝/硅和氧/镁/硅，分别与高岭土和滑石相符。在肺活检中未发现玻璃纤维的元素证据。
应用于肺活检的分析电子显微镜的贡献对于证实与包括 MMVF 和涂层材料在内的复杂职业暴露相关的尘肺诊断至关重要。
本病例研究指出，除 MMVF 外，其他成分（涂层材料）可能参与尘肺病的病因。
