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职业性空气暴露与慢性阻塞性肺疾病(COPD)及无儿童喘息病史个体肺功能的关系:一项 50 年队列研究。

Occupational airborne exposure in relation to Chronic Obstructive Pulmonary Disease (COPD) and lung function in individuals without childhood wheezing illness: A 50-year cohort study.

机构信息

School of Dentistry, University of Central Lancashire, Preston PR1 2EH, UK.

Occupational and Environmental Medicine, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.

出版信息

Environ Res. 2017 Feb;153:126-134. doi: 10.1016/j.envres.2016.11.018. Epub 2016 Dec 8.

Abstract

BACKGROUND

Evidence from longitudinal population-based studies relating occupational exposure to the full range of different forms of airborne pollutants and lung function and airway obstruction is limited.

OBJECTIVE

To relate self-reported COPD and lung function impairment to occupational exposure to different forms of airborne chemical pollutants in individuals who did not have childhood wheeze.

METHODS

A prospective cohort study was randomly selected in 1964 at age 10-15 years and followed up in 1989, 1995, 2001 and 2014 (aged 58-64) by spirometry and respiratory questionnaire. Occupational histories were recorded in 2014 and occupational exposures assigned using an airborne chemical job exposure matrix. The risk of COPD and lung function impairment was analyzed in subjects, who did not have childhood wheeze, using logistic and linear regression and linear mixed effects models.

RESULTS

237 subjects without childhood wheeze (mean age 60.6 years, 47% male) were analyzed. There was no association between any respiratory outcomes and exposure to gases, fibers, mists or mineral dusts and no consistent associations with exposure to fumes. Reduced FEV was associated with longer duration (years) of exposure to any of the six main pollutant forms - vapors, gases, dusts, fumes, fibers and mists (VGDFFiM) with evidence of a dose-response relationship (p-trend=0.004). Exposure to biological dusts was associated with self-reported COPD and FEV<Lower Limit of Normal (LLN) (adjusted odds ratio [95%CI] 4.59 [1.15,18.32] and 3.54 [1.21,10.35] respectively), and reduced FEF (adjusted regression coefficients [95% CIs] -9.11 [-17.38, -0.84] respectively). Exposure to vapors was associated with self-reported COPD and FEV<LLN (adjOR 6.46 [1.18,35.37] and 4.82 [1.32,17.63]). Longitudinal analysis demonstrated reduced FEV and FEF associated with exposure to biological dusts or vapors.

CONCLUSIONS

People with no history of childhood wheezing who have been occupationally exposed to biological dusts or vapors or had longer duration of lifetime exposure to any VGDFFiM are at a higher risk of reduced lung function at age 58-64 years. Occupational exposure to biological dusts or vapors also increased the risk of self-reported COPD.

摘要

背景

关于职业暴露与各种形式的空气传播污染物以及肺功能和气道阻塞之间的纵向人群研究证据有限。

目的

在没有儿童期喘息的个体中,将自我报告的 COPD 和肺功能损害与职业暴露于不同形式的空气中化学污染物相关联。

方法

1964 年在 10-15 岁时随机选择了一项前瞻性队列研究,并在 1989 年、1995 年、2001 年和 2014 年(58-64 岁)通过肺活量测定和呼吸问卷进行了随访。2014 年记录了职业史,并使用空气传播化学职业暴露矩阵进行了职业暴露评估。在没有儿童期喘息的受试者中,使用逻辑回归和线性回归以及线性混合效应模型分析了 COPD 和肺功能损害的风险。

结果

共分析了 237 名没有儿童期喘息的受试者(平均年龄 60.6 岁,47%为男性)。未发现任何呼吸道结局与气体、纤维、雾或矿物粉尘暴露之间存在关联,也未发现与烟雾暴露之间存在一致的关联。较长时间(年)暴露于任何六种主要污染物形式(蒸汽、气体、粉尘、烟雾、纤维和雾)与 FEV 降低有关,且存在剂量-反应关系(趋势 p 值=0.004)。生物粉尘暴露与自我报告的 COPD 和 FEV<正常下限(LLN)相关(调整后的比值比[95%CI]分别为 4.59[1.15,18.32]和 3.54[1.21,10.35]),并与 FEF 降低相关(调整后的回归系数[95%CI]分别为-9.11[-17.38,-0.84])。蒸汽暴露与自我报告的 COPD 和 FEV<LLN 相关(调整后的比值比分别为 6.46[1.18,35.37]和 4.82[1.32,17.63])。纵向分析显示,暴露于生物粉尘或蒸汽与 FEV 和 FEF 降低有关。

结论

在没有儿童期喘息史的人群中,职业暴露于生物粉尘或蒸汽,或一生中暴露于任何 VGDFFiM 的时间较长的人群,在 58-64 岁时肺功能下降的风险更高。职业暴露于生物粉尘或蒸汽也增加了自我报告的 COPD 的风险。

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