van der Molen H F, de Groene G J, Hulshof C T J, Frings-Dresen M H W
Amsterdam UMC, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
J Clin Med. 2018 Oct 9;7(10):335. doi: 10.3390/jcm7100335.
To support occupational physicians in their assessment and notification of occupational diseases, diagnostic registration guidelines are developed with information about associations between work-related risk factors and diseases. The objective of this review of systematic reviews is to examine whether work-related risk factors are associated with chronic pulmonary obstructive disease (COPD). We searched the electronic database of Medline for systematic reviews published between 1 January 2009 and 20 June 2017. Reviews were included when COPD was assessed by data on lung function and when work-related exposures to vapors, dusts, gases, or fumes (VDGF) were described. One author selected studies and extracted data; two authors assessed study quality using A MeaSurement Tool to Assess systematic Reviews (AMSTAR). In all eight systematic reviews included, various exposures to vapors, dusts, gases, and fumes (VGDF) at work are associated with COPD. Two-thirds of the included studies are cross-sectional and show a high heterogeneity in population, setting, and mostly self-reported-exposures. Two high-quality reviews (AMSTAR score ≥ 9) including meta-analyses show associations and excess risk of COPD for work-related general exposure to VDGF with a summary odds ratio of 1.4 (95% confidence interval (CI) 1.19⁻1.73) and to inorganic dust with a mean difference in predicted forced expiratory volume in one second (FEV₁) of -5.7% (95% CI: -8.62% to -2.71%). Exposure to VGDF at work is associated with a small but increased risk of COPD. More detailed workplace measurements of specific VGDF are warranted to gain an insight into dose⁻response relationships.
为协助职业医师对职业病进行评估和通报，制定了诊断登记指南，其中包含与工作相关风险因素和疾病之间关联的信息。本系统评价的综述旨在研究工作相关风险因素是否与慢性阻塞性肺疾病（COPD）相关。我们在Medline电子数据库中检索了2009年1月1日至2017年6月20日发表的系统评价。当通过肺功能数据评估COPD且描述了与工作相关的蒸气、粉尘、气体或烟雾（VDGF）暴露时，纳入这些综述。由一位作者选择研究并提取数据；两位作者使用评估系统评价的测量工具（AMSTAR）评估研究质量。在纳入的所有八项系统评价中，工作中接触各种蒸气、粉尘、气体和烟雾（VGDF）与COPD相关。纳入研究的三分之二为横断面研究，在人群、环境以及大多为自我报告的暴露方面显示出高度异质性。两项包括荟萃分析的高质量综述（AMSTAR评分≥9）显示，工作相关的VDGF总体暴露与COPD存在关联且风险增加，汇总比值比为1.4（95%置信区间（CI）1.19⁻1.73），与无机粉尘接触导致一秒用力呼气量（FEV₁）预测值平均差异为-5.7%（95%CI：-8.62%至-2.71%）。工作中接触VGDF与COPD风险小幅增加相关。有必要对特定VGDF进行更详细的工作场所测量，以深入了解剂量⁻反应关系。
