From the Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo.
From the Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo.
Chest. 2014 Nov;146(5):1166-1175. doi: 10.1378/chest.13-2484.
Dose-dependent adverse lung effects due to indium exposure have been reported in a cross-sectional study. This is a 5-year longitudinal cohort study of indium-exposed and unexposed workers, assessing indium exposure levels and its clinical lung effects.
From 2008 to 2011, a 5-year follow-up study was conducted on 40 unexposed and 240 workers formerly or currently exposed to indium at 11 factories. Indium exposure was assessed by serum indium (In-S) (μg/L). Lung effects were assessed by subjective symptoms, serum biomarkers, spirometry, and chest high-resolution CT scan. Effect biomarkers used were Krebs von den Lungen and surfactant protein D.
Mean values of In-S, Krebs von den Lungen, and surfactant protein D among the workers exposed to indium at baseline declined during the 5-year follow-up by 29.8%, 27.2%, and 27.5%, respectively. Of the exposed subjects with In-S levels > 20 μg/L, 26.3% experienced emphysematous progression on high-resolution CT scan. Ninety percent (18 of 20) of workers with emphysematous progression during follow-up were current smokers at baseline, and a trend of increasing incidence of emphysematous progression at higher In-S levels was observed among the smokers (P = .005). Emphysematous changes among subjects with In-S levels > 20 μg/L were likely to progress, after adjusting for age, mean duration since initial indium exposure, and smoking history (OR = 10.49, 95% CI = 1.54-71.36).
Long-term adverse effects on emphysematous changes were observed. The results suggest workers exposed to indium with In-S levels > 20 μg/L should be immediately removed from exposure.
在一项横断面研究中报道了铟暴露导致的剂量依赖性肺部不良反应。这是一项对暴露于铟和未暴露于铟的工人进行的为期 5 年的纵向队列研究，评估了铟暴露水平及其对肺部的临床影响。
2008 年至 2011 年，对 11 家工厂的 40 名未暴露于铟和 240 名以前或现在暴露于铟的工人进行了为期 5 年的随访研究。通过血清铟（In-S）（μg/L）评估铟暴露情况。通过主观症状、血清生物标志物、肺活量测定和胸部高分辨率 CT 扫描评估肺部影响。使用的效应生物标志物是 Krebs von den Lungen 和表面活性剂蛋白 D。
在基线时，暴露于铟的工人的 In-S、Krebs von den Lungen 和表面活性剂蛋白 D 的平均值在 5 年的随访期间分别下降了 29.8%、27.2%和 27.5%。在 In-S 水平>20μg/L 的暴露人群中，有 26.3%的人在高分辨率 CT 扫描上出现肺气肿进展。在随访期间出现肺气肿进展的 18 名工人（90%）在基线时为当前吸烟者，在吸烟者中观察到随着 In-S 水平升高，肺气肿进展的发生率呈上升趋势（P=0.005）。在 In-S 水平>20μg/L 的人群中，在调整年龄、初始铟暴露后的平均时间和吸烟史后，肺气肿变化可能会进展（OR=10.49，95%CI=1.54-71.36）。
观察到长期的肺气肿变化不良影响。结果表明，暴露于铟的工人，In-S 水平>20μg/L 时，应立即脱离接触。
