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[既往职业性接触温石棉工人肺部影像学改变及肺通气功能障碍分析]

[Analysis of changes in radiographic lung image and lung ventilation disorders in workers occupationally exposed to chrysotile in the past].

作者信息

Cwynar Elżbieta, Świątkowska Beata, Tomczyk Jarosław

机构信息

Dolnośląski Wojewódzki Ośrodek Medycyny Pracy we Wrocławiu, Oddział Jelenia Góra / Regional Centre of Occupational Medicine, Jelenia Góra Department, Wrocław, Poland (Dyrektor Oddziału / Head of the Department).

Instytut Medycyny Pracy im. prof. J. Nofera / Nofer Insttitute of Occupational Medicine, Łódź, Poland (Zakład Epidemiologii Środowiskowej / Department of Environmental Epidemiology).

出版信息

Med Pr. 2017 Mar 24;68(2):247-258. doi: 10.13075/mp.5893.00501. Epub 2017 Mar 17.

Abstract

BACKGROUND

The adverse health effects of occupational exposure to asbestos dust may occur several years after first exposure. The objective of the study was to assess the relationship between lesions in the respiratory system and the factors contributing to occupational exposure to asbestos described in the first medical examination as well as to analyze the factors responsible for the progression of these changes in further medical tests.

MATERIAL AND METHODS

The study group comprised 591 former workers of asbestos processing plant "Gambit" in Lubawka. The results of medical examinations carried out in 2001-2012 were assessed. Statistical inference was performed based on bilateral significance tests at the 0.05 level of significance.

RESULTS

A higher risk of interstitial lung changes along with an increase in the cumulative concentration of asbestos was indicated; for the employees with the highest exposure, the adjusted odds ratio (OR) was 1.63 (95% confidence interval (CI): 0.99-2.71), while for changes with the severity degree qualifying for asbestosis diagnosis, the risk was significantly increased, over fivefold higher, compared to subjects employed in the lowest exposure. The analysis of the relationship between the progression of interstitial changes and the exposure to asbestos dust showed a fourfold higher risk of the progression in workers employed in the highest exposure. Mean values of FEV1 (forced expiratory volume in 1 s), FVC (forced vital capacity), FEV1/FVC (forced expiratory volume in 1 s to forced vital capacity) were significantly lower in the subjects working in a higher asbestos exposure. The effect of tobacco smoking on the occurrence of interstitial lung changes and their progression was also confirmed.

CONCLUSIONS

The results of prophylactic medical examinations of the health status of workers formerly employed in the plants using chrysotile indicate the importance andthe need for a long-term clinical follow-up and the promotion of anti-smoking prevention in this group of former employees. Med Pr 2017;68(2):247-258.

摘要

背景

职业性接触石棉粉尘对健康的不良影响可能在首次接触数年之后才会出现。本研究的目的是评估呼吸系统病变与首次医学检查中描述的职业性接触石棉的相关因素之间的关系,并分析在后续医学检查中导致这些变化进展的因素。

材料与方法

研究组由卢巴乌卡“ Gambit”石棉加工厂的591名 former workers 组成。对2001年至2012年进行的医学检查结果进行了评估。基于双侧显著性检验在0.05显著性水平上进行统计推断。

结果

表明随着石棉累积浓度的增加,间质性肺改变的风险更高;对于接触量最高的员工,调整后的优势比(OR)为1.63(95%置信区间(CI):0.99 - 2.71),而对于符合石棉肺诊断严重程度的改变,与接触量最低的员工相比,风险显著增加,高出五倍多。对间质性改变进展与石棉粉尘接触之间关系的分析表明,接触量最高的工人进展风险高出四倍。在石棉接触量较高的受试者中,第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC(第1秒用力呼气容积与用力肺活量之比)的平均值显著较低。吸烟对间质性肺改变的发生及其进展的影响也得到了证实。

结论

对曾在使用温石棉的工厂工作的工人进行健康状况预防性医学检查的结果表明,对这组 former employees 进行长期临床随访以及推广戒烟预防措施的重要性和必要性。《医学实践》2017年;68(2):247 - 258 。

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