McCunney R J, Godefroi R
Cabot Corporation, Waltham, MA 02254.
J Occup Med. 1989 Mar;31(3):233-7. doi: 10.1097/00043764-198903000-00008.
Pulmonary alveolar proteinosis developed in a 29-year-old white man within 2 years of working as a cement truck driver. Pulmonary alveolar proteinosis (PAP), an uncommon respiratory disorder characterized by the accumulation of phospholipid material within the alveoli, has been described in association with exposure to silica, aluminum oxide, and a variety of dusts and fumes. Although a link between exposure to Portland cement and PAP has not been previously noted, this type of cement contains nearly 20% silica. Lung biopsy material, originally used to diagnose PAP, was reviewed under electron dispersive spectroscopy. Analysis indicated the presence of silica particles within the alveolar fluid and macrophages. A number of items support a causal relationship between exposure to cement dust and PAP: (1) the temporal sequence between assuming job duties and the development of the illness, (2) improvement following removal from further exposure, (3) dusty, unprotected working conditions, (4) the presence of silica within the cement, and (5) the alveolar fluid from periodic acid-Schiff-positive lung tissue.
一名29岁的白人男性在担任水泥罐车司机两年内患上了肺泡蛋白沉积症。肺泡蛋白沉积症（PAP）是一种罕见的呼吸系统疾病，其特征是肺泡内磷脂物质的积累，此前已被描述与接触二氧化硅、氧化铝以及各种粉尘和烟雾有关。虽然此前尚未注意到接触波特兰水泥与PAP之间的联系，但这种水泥含有近20%的二氧化硅。最初用于诊断PAP的肺活检材料在电子色散光谱下进行了复查。分析表明肺泡液和巨噬细胞内存在二氧化硅颗粒。有多项因素支持接触水泥粉尘与PAP之间存在因果关系：（1）承担工作职责与疾病发生之间的时间顺序，（2）停止进一步接触后病情改善，（3）多尘且无防护的工作条件，（4）水泥中存在二氧化硅，以及（5）过碘酸-希夫染色阳性肺组织中的肺泡液。
