轮班工作对职业性哮喘的连续 PEF 测量的影响。

Shift work effects on serial PEF measurements for occupational asthma.

机构信息

Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK.

出版信息

Occup Med (Lond). 2012 Oct;62(7):525-32. doi: 10.1093/occmed/kqs097. Epub 2012 Jul 9.

DOI:10.1093/occmed/kqs097

PMID:22778240

Abstract

BACKGROUND

Diurnal variation (DV) affects lung function but the changes are thought to be related to sleep patterns rather than time of day. When diagnosing occupational asthma (OA), serial peak expiratory flow (PEF) measurements are the recommended first line investigation, but could be confounded by shift work.

AIMS

The aim of the study was to investigate the effects of shift work on PEF measurements used for diagnosing OA.

METHODS

PEF records containing more than one shift pattern with ≥ 4 days per shift were identified. OA diagnosis was based on an Oasys-2 score ≥ 2.51 and non-OA on having an alternative clinical diagnosis and Oasys-2 score <2.51. The mean area between curves (ABC) score, mean PEF DV and cross-shift PEF changes were calculated for each shift.

RESULTS

Records from 123 workers with OA and 69 without OA satisfied inclusion criteria. In the OA group, PEF declined more on afternoon and night shifts than days (P < 0.001). The ABC score was lower in the OA group on night (P < 0.05) and afternoon shifts (P < 0.05) as compared with days, without significant differences in DV. Among those without OA, cross-shift PEF increased more on day shifts (mean + 25 l/min) than afternoon or night shifts (+1 l/min) (P < 0.001). The sensitivity for the ABC score and DV were good and similar across shifts, but specificity was reduced using DV (DV mean 39%; ABC 98%).

CONCLUSIONS

PEF responses between work and rest show small differences according to shift type. The ABC score has a high sensitivity and specificity for all shifts; differences in DV have lower specificity.

摘要

背景

昼夜变化（DV）会影响肺功能，但这些变化被认为与睡眠模式有关，而与一天中的时间无关。在诊断职业性哮喘（OA）时，推荐使用系列呼气峰流速（PEF）测量作为一线检查，但轮班工作可能会对此造成干扰。

目的

本研究旨在探讨轮班工作对用于诊断 OA 的 PEF 测量的影响。

方法

确定包含≥4 天/班次且具有多种班次模式的 PEF 记录。OA 诊断基于 Oasys-2 评分≥2.51，而非 OA 则基于其他临床诊断和 Oasys-2 评分<2.51。为每个班次计算平均曲线下面积（ABC）评分、平均 PEF DV 和跨班次 PEF 变化。

结果

符合纳入标准的 OA 患者记录有 123 份，非 OA 患者记录有 69 份。在 OA 组中，PEF 在下午和夜间班次下降幅度大于白天（P<0.001）。与白天相比，OA 组夜间（P<0.05）和下午班次（P<0.05）的 ABC 评分更低，DV 无显著差异。在非 OA 组中，日间班次的跨班次 PEF 增加更多（平均增加 25 l/min），而下午或夜间班次则增加较少（+1 l/min）（P<0.001）。ABC 评分和 DV 的敏感性在所有班次中均较好且相似，但 DV 的特异性降低（DV 平均 39%；ABC 98%）。