Shin Mu Young, Park Jong Soo, Park Hae Dong, Lee Jihye
1Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Ulsan, Republic of Korea.
2Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, 478, Munemi-ro, Bupyeong-gu, Incheon, 21417 Republic of Korea.
Ann Occup Environ Med. 2018 Mar 28;30:20. doi: 10.1186/s40557-018-0231-2. eCollection 2018.
Exposure to sustained high concentrations of HCFC-123 is known to be hepatotoxic. We report two simultaneous cases of toxic hepatitis related to exposure to 2,2-dichloro-1,1,1-trifluoroethane (HCFC-123), a common refrigerant, at a Korean fire extinguisher manufacturing facility.
Patients A and B were men aged 21 and 22 years, respectively, with no notable medical histories. They had recently started working for a manufacturer of fire extinguishers. During the third week of their employment, they visited the emergency center of a general hospital due to fever, lack of appetite, and general weakness. At the time of their visit, they were suspected as having hepatitis due to elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and total bilirubin levels and were hospitalized. However, as their condition did not improve, they were moved to a tertiary general hospital. After conservative treatment, one patient improved but the other died from acute hepatic failure. Assessments of the work environment showed that the short-term exposure levels of HCFC-123 for valve assembly processes were as high as 193.4 ppm. A transjugular liver biopsy was performed in patient A; the results indicated drug/toxin-induced liver injury (DILI). Given the lack of a medical history and the occupational exposure to high levels of HCFC-123, a hepatotoxic agent, the toxic hepatitis of the workers was likely related to HCFC-123 exposure.
Work environment assessments have not included this agent. To the best of our knowledge, we are the first to report a case of death related to HCFC-123-induced liver damage. Our findings suggest that exposure standards and limits for HCFC-123 must be developed in Korea; work environments will have to be improved based on such standards.
已知持续暴露于高浓度的HCFC - 123会产生肝毒性。我们报告了在一家韩国灭火器制造工厂同时发生的两例与接触常见制冷剂2,2 - 二氯 - 1,1,1 - 三氟乙烷（HCFC - 123）相关的中毒性肝炎病例。
患者A和患者B分别为21岁和22岁的男性，均无明显病史。他们最近刚开始在一家灭火器制造商工作。在工作的第三周，他们因发热、食欲不振和全身乏力前往一家综合医院的急诊中心就诊。就诊时，由于天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、碱性磷酸酶（ALP）、γ - 谷氨酰转移酶（GGT）和总胆红素水平升高，他们被怀疑患有肝炎并住院治疗。然而，由于病情没有改善，他们被转至一家三级综合医院。经过保守治疗，一名患者病情好转，但另一名患者死于急性肝衰竭。对工作环境的评估显示，阀门组装过程中HCFC - 123的短期暴露水平高达193.4 ppm。对患者A进行了经颈静脉肝活检；结果表明为药物/毒素性肝损伤（DILI）。鉴于缺乏病史以及职业性接触高浓度的肝毒性物质HCFC - 123，这些工人的中毒性肝炎可能与接触HCFC - 123有关。
工作环境评估未涵盖该物质。据我们所知，我们是首个报告与HCFC - 123引起的肝损伤相关死亡病例的。我们的研究结果表明，韩国必须制定HCFC - 123的暴露标准和限值；必须基于此类标准改善工作环境。
