Schwartz D A, Thorne P S, Yagla S J, Burmeister L F, Olenchock S A, Watt J L, Quinn T J
Department of Internal Medicine, University of Iowa, Iowa City, USA.
Am J Respir Crit Care Med. 1995 Aug;152(2):603-8. doi: 10.1164/ajrccm.152.2.7633714.
To identify the role of endotoxin in grain dust-induced lung disease, we conducted a population-based, cross-sectional investigation among grain handlers and postal workers. The study subjects were selected by randomly sampling all grain facilities and post offices within 100 miles of Iowa City. Our study population consisted of 410 grain workers and 201 postal workers. Grain workers were found to be exposed to higher concentrations of airborne dust (p = 0.0001) and endotoxin (p = 0.0001) when compared with postal workers. Grain workers had a significantly higher prevalence of work-related (cough, phlegm, wheezing, chest tightness, and dyspnea) and chronic (usual cough or phlegm production) respiratory symptoms than postal workers. Moreover, after controlling for age, gender, and cigarette smoking status, work-related respiratory symptoms were strongly associated with the concentration of endotoxin in the bioaerosol in the work setting. The concentration of total dust in the bioaerosol was marginally related to these respiratory problems. After controlling for age, gender, and cigarette smoking status, grain workers were found to have reduced spirometric measures of airflow (FEV1, FEV1/FVC, and FEF25-75) and enhanced airway reactivity to inhaled histamine when compared with postal workers. Although the total dust concentration in the work environment appeared to have little effect on these measures of airflow obstruction, higher concentrations of endotoxin in the bioaerosol were associated with diminished measures of airflow and enhanced bronchial reactivity. Our results indicate that the concentration of endotoxin in the bioaerosol may be particularly important in the development of grain dust-induced lung disease.
为了确定内毒素在谷物粉尘所致肺部疾病中的作用，我们在谷物加工工人和邮政工作人员中开展了一项基于人群的横断面调查。研究对象通过对爱荷华市100英里范围内的所有谷物加工厂和邮局进行随机抽样选取。我们的研究人群包括410名谷物加工工人和201名邮政工作人员。与邮政工作人员相比，发现谷物加工工人暴露于更高浓度的空气传播粉尘（p = 0.0001）和内毒素（p = 0.0001）中。谷物加工工人与工作相关的（咳嗽、咳痰、喘息、胸闷和呼吸困难）以及慢性的（经常咳嗽或咳痰）呼吸道症状的患病率显著高于邮政工作人员。此外，在对年龄、性别和吸烟状况进行控制后，与工作相关的呼吸道症状与工作环境中生物气溶胶内毒素浓度密切相关。生物气溶胶中总粉尘浓度与这些呼吸道问题的相关性较弱。在对年龄、性别和吸烟状况进行控制后，发现与邮政工作人员相比，谷物加工工人的肺功能气流指标（第一秒用力呼气容积、第一秒用力呼气容积/用力肺活量和25%-75%用力呼气流量）降低，对吸入组胺的气道反应性增强。尽管工作环境中的总粉尘浓度似乎对这些气流阻塞指标影响不大，但生物气溶胶中较高浓度的内毒素与气流指标降低和支气管反应性增强有关。我们的结果表明，生物气溶胶中的内毒素浓度在谷物粉尘所致肺部疾病的发生发展中可能尤为重要。
