Sanchez-Roman J, Wichmann I, Salaberri J, Varela J M, Nuñez-Roldan A
Department of Medicine, Hospital Universitario Virgen del Rocio, Seville, Spain.
Ann Rheum Dis. 1993 Jul;52(7):534-8. doi: 10.1136/ard.52.7.534.
A self referred group of four workers from a factory producing scouring powder with a high silica content showed a surprisingly high number of features compatible with a connective tissue disease. Further subjects working at the same factory were subsequently studied to evaluate the relation between this exposure and the development of autoimmune processes.
A total of 50 subjects (44 women, six men; mean (SD) age 43.7 (5.5) years; mean duration of employment 6.1 years) underwent a prospective study including clinical history and physical examination, an immunobiological study, HLA typing, radiological and functional oesophageal and respiratory examination, ophthalmological examination, and isotopic testing of salivary glands.
Symptoms of a systemic illness were present in 32 (64%) subjects: six with Sjögren's syndrome; five with the criteria for systemic sclerosis; three with systemic lupus erythematosus (SLE); five with an 'overlap syndrome'; and 13 with undifferentiated findings not meeting the criteria for a defined disease. Antinuclear antibodies were present in 36 (72%) subjects; four had antibodies to native DNA, including two subjects with SLE, one with systemic sclerosis associated with secondary Sjögren's syndrome, and one with overlap syndrome. Anticentromere antibodies were not detected. The frequency of HLA-DR3 was increased in the clinically affected subjects, but did not reach statistical significance.
This descriptive study emphasises the high probability of workers occupationally exposed to silica developing a multiple spectrum of clinical and serological autoimmune manifestations.
一组来自一家生产高硅含量擦洗粉工厂的四名工人自行前来就诊，他们表现出数量惊人的与结缔组织病相符的特征。随后对在同一家工厂工作的其他人员进行了研究，以评估这种接触与自身免疫过程发展之间的关系。
共有50名受试者（44名女性，6名男性；平均（标准差）年龄43.7（5.5）岁；平均工作年限6.1年）接受了一项前瞻性研究，包括临床病史和体格检查、免疫生物学研究、HLA分型、食管和呼吸的放射学及功能检查、眼科检查以及唾液腺同位素检测。
32名（64%）受试者出现全身性疾病症状：6名患有干燥综合征；5名符合系统性硬化症标准；3名患有系统性红斑狼疮（SLE）；5名患有“重叠综合征”；13名有未分化表现，不符合特定疾病的标准。36名（72%）受试者存在抗核抗体；4名有抗天然DNA抗体，其中2名患有SLE患者，1名患有与继发性干燥综合征相关的系统性硬化症患者，1名患有重叠综合征患者。未检测到抗着丝点抗体。在临床受累受试者中，HLA - DR3的频率有所增加，但未达到统计学意义。
这项描述性研究强调了职业性接触二氧化硅的工人出现多种临床和血清学自身免疫表现的高可能性。
