患有快速进展性尘肺病的美国煤矿工人的肺部病理学表明与二氧化硅和硅酸盐有关。
Lung Pathology in U.S. Coal Workers with Rapidly Progressive Pneumoconiosis Implicates Silica and Silicates.
作者信息
Cohen Robert A, Petsonk Edward L, Rose Cecile, Young Byron, Regier Michael, Najmuddin Asif, Abraham Jerrold L, Churg Andrew, Green Francis H Y
机构信息
1 Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
2 School of Medicine and.
出版信息
Am J Respir Crit Care Med. 2016 Mar 15;193(6):673-80. doi: 10.1164/rccm.201505-1014OC.
RATIONALE
Recent reports of progressive massive fibrosis and rapidly progressive pneumoconiosis in U.S. coal miners have raised concerns about excessive exposures to coal mine dust, despite reports of declining dust levels.
OBJECTIVES
To evaluate the histologic abnormalities and retained dust particles in available coal miner lung pathology specimens, and to compare these findings with those derived from corresponding chest radiographs.
METHODS
Miners with severe disease and available lung tissue were identified through investigator outreach. Demographic as well as smoking and work history information was obtained. Chest radiographs were interpreted according to the International Labor Organization classification scheme to determine if criteria for rapidly progressive pneumoconiosis were confirmed. Pathology slides were scored by three expert pulmonary pathologists using a standardized nomenclature and scoring system.
MEASUREMENTS AND MAIN RESULTS
Thirteen cases were reviewed, many of which had features of accelerated silicosis and mixed dust lesions. Twelve had progressive massive fibrosis, and 11 had silicosis. Only four had classic lesions of simple coal workers' pneumoconiosis. Four had diffuse interstitial fibrosis with chronic inflammation, and two had focal alveolar proteinosis. Polarized light microscopy revealed large amounts of birefringent mineral dust particles consistent with silica and silicates; carbonaceous coal dust was less prominent. On the basis of chest imaging studies, specimens with features of silicosis were significantly associated (P = 0.047) with rounded (type p, q, or r) opacities, whereas grade 3 interstitial fibrosis was associated (P = 0.02) with the presence of irregular (type s, t, or u) opacities.
CONCLUSIONS
Our findings suggest that rapidly progressive pneumoconiosis in these miners was associated with exposure to coal mine dust containing high concentrations of respirable silica and silicates.
理论依据
近期有关美国煤矿工人出现进行性大块纤维化和快速进展性尘肺病的报告引发了人们对煤矿粉尘过度暴露的担忧，尽管有报告称粉尘水平在下降。
目的
评估现有煤矿工人肺病理标本中的组织学异常和留存的粉尘颗粒，并将这些发现与相应胸部X线片的结果进行比较。
方法
通过研究人员联系确定患有严重疾病且有可用肺组织的矿工。获取人口统计学以及吸烟和工作史信息。根据国际劳工组织分类方案解读胸部X线片，以确定是否符合快速进展性尘肺病的标准。由三名专业肺病理学家使用标准化命名法和评分系统对病理切片进行评分。
测量结果和主要结果
共审查了13例病例，其中许多具有加速性矽肺和混合性粉尘病变的特征。12例有进行性大块纤维化，11例有矽肺。只有4例有单纯煤工尘肺的典型病变。4例有伴有慢性炎症的弥漫性间质纤维化，2例有局灶性肺泡蛋白沉积症。偏光显微镜显示大量与二氧化硅和硅酸盐一致的双折射矿物粉尘颗粒；含碳煤尘则不太明显。根据胸部影像学研究，具有矽肺特征的标本与圆形（p、q或r型）阴影显著相关（P = 0.047），而3级间质纤维化与不规则（s、t或u型）阴影的存在相关（P = 0.02）。
结论
我们的研究结果表明，这些矿工的快速进展性尘肺病与接触含有高浓度可吸入二氧化硅和硅酸盐的煤矿粉尘有关。
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