Kilburn K H, Warshaw R H
University of Southern California School of Medicine, Environmental Sciences Laboratory, Los Angeles.
Chest. 1994 Oct;106(4):1061-70. doi: 10.1378/chest.106.4.1061.
To define the apparent steps in developing airways obstruction vs restrictive lung disease in men exposed to asbestos for more than 20 years who had never smoked vs cigarette smokers.
Physiologic signs of asbestosis were studied in cross-sectional age-matched groups of never, current, and ex-cigarette smoking workers.
The study included 8,720 asbestos-exposed construction and shipyard workers in the United States.
FVC, FEV1, FEF25-75, and FEF75-85 were measured by spirometry and total lung capacity (TLC) by planimetry of standard chest radiographs and adjusted for height, age, and duration of cigarette smoking and expressed as percentage of predicted. TLC minus FVC yielded RV. We compared means and mean residuals (measurement minus group mean) expiratory flows and lung volumes in 1,146 men with pulmonary asbestosis age matched to 1,146 without asbestosis who had similar durations of asbestos exposure and to 370 men without asbestos exposure. Next, flows and volumes were regressed against the International Labour Office (ILO) profusion scale of irregular opacities on chest radiographs (PIO) and the duration of asbestos exposure for 1,777 never smokers (NS), 4,550 current smokers, and 2,393 ex-smokers.
Asbestos exposure in NS men decreased expiratory flows and increased TLCs compared with unexposed NS men. Further reductions in flows and FVC and increases RV/TLC with radiographic asbestosis were not statistically significant. As the PIO increased from 1/1 to 3/3, obstruction and air trapping increased significantly but TLC did not.
Asbestos exposure reduced flows and produced air trapping after 20 years in workers who never smoked. Smoking increased these abnormalities.
明确在接触石棉超过20年的男性中，从不吸烟者与吸烟者发生气道阻塞性疾病和限制性肺病的明显步骤。
在年龄匹配的从不吸烟、当前吸烟和既往吸烟工人的横断面组中研究石棉肺的生理体征。
该研究纳入了美国8720名接触石棉的建筑工人和造船厂工人。
通过肺量计测量用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、25%-75%用力呼气流量（FEF25-75）和75%-85%用力呼气流量（FEF75-85），通过标准胸部X线片的平面测量法测量肺总量（TLC），并根据身高、年龄、吸烟持续时间进行校正，以预测值的百分比表示。TLC减去FVC得出残气量（RV）。我们比较了1146例患有肺石棉沉着病的男性与1146例无石棉沉着病但石棉接触时间相似的男性以及370例无石棉接触的男性的平均呼气流量和肺容积均值及平均残差（测量值减去组均值）。接下来，对1777名从不吸烟者（NS）、4550名当前吸烟者和2393名既往吸烟者，将呼气流量和肺容积与胸部X线片上不规则阴影的国际劳工组织（ILO）密集度分级（PIO）以及石棉接触持续时间进行回归分析。
与未接触石棉的NS男性相比，接触石棉的NS男性呼气流量降低，TLC增加。随着放射学上石棉肺的出现，呼气流量和FVC进一步降低，RV/TLC增加，但差异无统计学意义。随着PIO从1/1增加到3/3，阻塞和气体潴留显著增加，但TLC未增加。
在从不吸烟的工人中，接触石棉20年后呼气流量降低并出现气体潴留。吸烟会加重这些异常情况。
