Barbieri Pietro Gino, Sommigliana Anna Benedetta
nessuna.
Med Lav. 2016 Jul 26;107(4):315-26.
Asbestos-related diseases among shipyard workers are well known in Italy but descriptive long-term studies are limited; asbestos has been extensively used but the past exposure intensity has never been estimated because data from environmental and biological monitoring are almost absent.
To describe the asbestos-related dis-eases (1996-2015) diagnosed among shipbuilding workers from a very important shipyard in Northern Italy, and to assess past asbestos exposure levels by cumulative dose indices, fibres and asbestos bodies.
The cases of workers suffering from asbestos-related diseases diagnosed from 1996 to 2015 were collected on the occasion of some legal trials; the diagnosis, and the asbestos occupational and non-occupational exposure, were carefully evaluated.Lung samples were obtained from subjects, taking advantage of the autopsies; asbestos fibers were counted by means of a Scanning Electron Microscope, equipped with x-ray fluorescence microanalyses at 12.0000 amplification, and asbestos bodies by means of an Optical Microscope at 500 amplification.
192 malignant mesotheliomas (6 in women), 196 lung cancers and 14 asbestosis (without cancer) were observed (1996-2015); autopsies were carried out on 80% of all subjects and 98% of mesotheliomas were confirmed by autopsies. Pleural plaques occurred on 90% of mesotheliomas and 87% of lung cancers; histologically mild asbestosis were diagnosed on 28% of mesotheliomas and 48% of lung cancers. In malignant mesothelioma and lung cancer cases respectively, the duration of occupational exposure was on average 24 and 23 ys, the latency time 48 and 46 ys, hiring at the shipyard before 1970 24 and 23 ys. Out of 114 lung analysis, the burden of asbestos fibres was >10 million for 33.3% of subjects and out of 99 lung analysis asbestos bodies was >10.000 for 71.7%; the average time since last exposure was 31 ys. Both asbestos fibres and asbestos bodies concentrations were significantly higher (GMR 2,5) among mesothelioma vs lung cancer.
A relevant number of asbestos-related diseases among shipbuilding workers, mainly mesothelioma and lung cancer, exposed in shipyard until the 1980's were identified by an active search. Thanks to several autopsies, the diagnoses of cancer are confirmed as a cause of death, and a high frequency of histological asbestosis, previously ignored,was shown. The lung burden analysis of asbestos bodies and asbestos fibres, the largest ever performed among ship-building workers, confirms the spread and relevance of asbestos exposure. The best estimate of past exposure intensity was provided by both biological indices.
在意大利，造船厂工人中与石棉相关的疾病广为人知，但长期描述性研究有限；石棉曾被广泛使用，但由于几乎没有环境和生物监测数据，过去的接触强度从未得到估算。
描述意大利北部一家重要造船厂造船工人中（1996 - 2015年）诊断出的与石棉相关的疾病，并通过累积剂量指数、纤维和石棉小体评估过去的石棉接触水平。
在一些法律审判期间收集了1996年至2015年诊断出患有与石棉相关疾病的工人病例；对诊断以及石棉职业和非职业接触情况进行了仔细评估。利用尸检从受试者获取肺样本；通过配备120000倍放大倍数的x射线荧光显微分析的扫描电子显微镜对石棉纤维进行计数，通过500倍放大倍数的光学显微镜对石棉小体进行计数。
观察到192例恶性间皮瘤（6例女性）、196例肺癌和14例石棉肺（无癌症）（1996 - 2015年）；对所有受试者的80%进行了尸检，98%的间皮瘤通过尸检得到证实。90%的间皮瘤和87%的肺癌出现胸膜斑；28%的间皮瘤和48%的肺癌在组织学上被诊断为轻度石棉肺。在恶性间皮瘤和肺癌病例中，职业接触的平均时长分别为24年和23年，潜伏期分别为48年和46年，1970年前在造船厂就业的时长分别为24年和23年。在114例肺部分析中，33.3%的受试者石棉纤维负荷>1000万，在99例肺部分析中，71.7%的受试者石棉小体>10000；自上次接触以来的平均时间为31年。间皮瘤患者的石棉纤维和石棉小体浓度均显著高于肺癌患者（GMR 2.5）。
通过积极筛查，识别出了大量直到20世纪80年代在造船厂接触石棉的造船工人中与石棉相关的疾病，主要是间皮瘤和肺癌。多亏了多次尸检，癌症诊断被确认为死亡原因，并且显示出以前被忽视的组织学石棉肺的高发生率。对造船工人进行的有史以来最大规模的石棉小体和石棉纤维肺部负荷分析，证实了石棉接触的广泛存在和相关性。两种生物指标都提供了对过去接触强度的最佳估计。
