Huntley Christopher C, Patel Ketan, Mughal Aishah Z, Coelho Shirley, Burge P Sherwood, Turner Alice M, Walters Gareth I
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Occup Environ Med. 2023 Oct;80(10):580-589. doi: 10.1136/oemed-2022-108632. Epub 2023 Aug 28.
The aetiology and pathophysiology of sarcoidosis is ill defined-current hypotheses centre on complex genetic-immune-environmental interactions in an individual, triggering a granulomatous process. The aim of this systematic review is to define and describe which airborne occupational exposures (aOE) are associated with and precede a diagnosis of pulmonary sarcoidosis. The methodology adopted for the purpose was systematic review and meta-analyses of ORs for specified aOE associated with pulmonary sarcoidosis (DerSimonian Laird random effects model (pooled log estimate of OR)). Standard search terms and dual review at each stage occurred. A compendium of aOE associated with pulmonary sarcoidosis was assembled, including mineralogical studies of sarcoidosis granulomas. N=81 aOE were associated with pulmonary sarcoidosis across all study designs. Occupational silica, pesticide and mould or mildew exposures were associated with increased odds of pulmonary sarcoidosis. Occupational nickel and aluminium exposure were associated with a non-statistically significant increase in the odds of pulmonary sarcoidosis. Silica exposure associated with pulmonary sarcoidosis was reported most frequently in the compendium (n=33 studies) and was the most common mineral identified in granulomas. It was concluded that aOE to silica, pesticides and mould or mildew are associated with increased odds of pulmonary sarcoidosis. Equipoise remains concerning the association and relationship of metal dusts with pulmonary sarcoidosis.
结节病的病因和病理生理学尚不明确，目前的假说是基于个体中复杂的基因-免疫-环境相互作用引发肉芽肿形成过程。本系统评价的目的是确定并描述哪些空气传播的职业暴露（aOE）与肺结节病的诊断相关且早于该诊断。为此采用的方法是对与肺结节病相关的特定aOE的比值比（OR）进行系统评价和荟萃分析（DerSimonian Laird随机效应模型（OR的合并对数估计值））。在每个阶段都使用了标准检索词并进行了双人评审。汇编了与肺结节病相关的aOE简编，包括结节病肉芽肿的矿物学研究。在所有研究设计中，有81种aOE与肺结节病相关。职业性接触二氧化硅、杀虫剂以及霉菌或霉变与肺结节病的患病几率增加相关。职业性接触镍和铝与肺结节病患病几率的增加无统计学意义。在简编中，与肺结节病相关的二氧化硅暴露报道最为频繁（n = 33项研究），并且是肉芽肿中鉴定出的最常见矿物质。得出的结论是，接触二氧化硅、杀虫剂以及霉菌或霉变与肺结节病的患病几率增加相关。关于金属粉尘与肺结节病的关联及关系仍存在不确定性。
