Bolund Anneli Cs, Miller Martin R, Sigsgaard Torben, Schlünssen Vivi
Section for Environment, Occupation and Health, Department of Public Health and Danish Ramazzini Centre, University of Aarhus, Aarhus, Denmark.
Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK.
Occup Environ Med. 2017 Jul;74(7):531-542. doi: 10.1136/oemed-2016-103963. Epub 2017 Apr 12.
Lung function is a predictor of morbidity and mortality, and the chronic nature of lung function decline allows for preventive initiatives. Proinflammatory constituents of organic dust are considered a possible cause of compromised respiratory health. The aim of this systematic review was to reveal the impact of organic dust exposure on long-term change in lung function. The literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Predefined criteria concerned study design: longitudinal, ≥1 year follow-up, ≥50 exposed; exposure measures: organic dust, measured or estimated, in different occupational settings; and outcome measures: change in lung function measured by spirometry. Based on these criteria, 1580 potentially relevant publications were narrowed down to 20 included publications. Quality was evaluated and discussed based on six objectively defined criteria. Overall, 14 studies found some type of association between exposure to organic dust and long-term change in lung function. However, the results were inconsistent and no specific work exposure showed more clear associations to change in lung function. Meta-analysis revealed an overall small significant excess loss in forced expiratory volume in the 1st s for exposed compared with controls of 4.92 mL/year (95% CI 0.14 to 9.69). No significant association was seen overall for forced vital capacity. 12 studies revealed a significant exposure-response relation between organic dust and change in lung function. The results were inconsistent across varying study design and different exposure measures and outcomes. We therefore conclude that there is limited evidence of a causal association between general exposure to organic dust and long-term excess decline in lung function.
肺功能是发病率和死亡率的一个预测指标，并且肺功能下降的慢性性质使得预防措施成为可能。有机粉尘中的促炎成分被认为是呼吸健康受损的一个可能原因。本系统评价的目的是揭示有机粉尘暴露对肺功能长期变化的影响。文献检索按照系统评价和Meta分析的首选报告项目（PRISMA）标准进行。预定义的标准涉及研究设计：纵向研究，随访≥1年，暴露者≥50名；暴露测量：在不同职业环境中测量或估算的有机粉尘；以及结局测量：通过肺活量测定法测量的肺功能变化。基于这些标准，1580篇潜在相关出版物被筛选至20篇纳入出版物。根据六个客观定义的标准对质量进行了评估和讨论。总体而言，14项研究发现有机粉尘暴露与肺功能长期变化之间存在某种类型的关联。然而，结果并不一致，没有特定的工作暴露显示与肺功能变化有更明确的关联。Meta分析显示，与对照组相比，暴露组第1秒用力呼气量总体上有小幅度但显著的额外损失，为每年4.92毫升（95%置信区间0.14至9.69）。用力肺活量总体上未发现显著关联。12项研究揭示了有机粉尘与肺功能变化之间存在显著的暴露-反应关系。不同研究设计、不同暴露测量和结局的结果并不一致。因此，我们得出结论，关于一般有机粉尘暴露与肺功能长期过度下降之间存在因果关联的证据有限。
