Chiappino G
Research Center on the Biological Effects of Inhaled Dusts, University of Milan, Italy.
Sci Total Environ. 1994 Jun 30;150(1-3):65-8. doi: 10.1016/0048-9697(94)90130-9.
On the basis of the data available in the literature and of our experience, the clinical patterns of respiratory troubles which can be observed in workers exposed to inhalation of hard metal dusts can be schematized as follows: Irritation forms, mild and transient, or severe up to pulmonary oedema, dose-correlated, which occur in all subjects exposed to sufficiently high atmospheric concentrations; Asthmatic forms, either reversible after cessation of exposure or persistent after stopping the exposure, which occur in a relatively low percentage of exposed subjects and also apply to the states quoted below; Dyspnoic patterns due to alveolitis (lymphocytic alveolitis with inverted helper/suppressor ratio, or giant cell-eosinophilic alveolitis, with or without fibrotic changes of pulmonary interstitium); Interstitial sclerotic lung disease, associated with or without an alveolitic component. The present diagnostic potentialities, particularly bronchoalveolar lavage (BAL), have helped in defining the clinical patterns and have confirmed the fundamental role of individual susceptibility in the occurrence of clinical manifestations (with the exception of the irritation forms), but so far have not yet enabled us to clarify whether the different clinical patterns are the results of a single pathogenetic mechanism or constitute pathogenetically distinct entities.
根据文献中的现有数据以及我们的经验，在接触硬质金属粉尘吸入的工人中可观察到的呼吸问题临床模式可概括如下：刺激型，轻度且短暂，或严重至肺水肿，与剂量相关，出现在所有暴露于足够高大气浓度的受试者中；哮喘型，在接触停止后要么可逆，要么在停止接触后持续存在，出现在相对较低比例的暴露受试者中，也适用于以下所述情况；由肺泡炎引起的呼吸困难模式（辅助性/抑制性T细胞比例倒置的淋巴细胞性肺泡炎，或巨细胞 - 嗜酸性肺泡炎，伴有或不伴有肺间质纤维化改变）；间质性硬化性肺病，伴有或不伴有肺泡炎成分。目前的诊断潜力，特别是支气管肺泡灌洗（BAL），有助于明确临床模式，并证实了个体易感性在临床表现发生中的基本作用（刺激型除外），但到目前为止，我们尚未能够阐明不同的临床模式是单一发病机制的结果还是构成发病机制上不同的实体。
