Hubbard R, Lewis S, Richards K, Johnston I, Britton J
University of Nottingham, Division of Respiratory Medicine, City Hospital, UK.
Lancet. 1996 Feb 3;347(8997):284-9. doi: 10.1016/s0140-6736(96)90465-1.
We have previously suggested that cryptogenic fibrosing alveolitis (CFA) may be caused by occupational exposures, particularly to metal or wood dust. We have specifically investigated this hypothesis in a case-control study of patients with CFA.
We obtained lifetime occupational histories by postal questionnaire from 218 patients with CFA and 569 controls matched for age, sex, and community, living in the Trent region of the UK. Information was subsequently verified by telephone interview in 165 cases and 408 controls. Serum IgE, rheumatoid factor, and antinuclear antibodies and skin sensitivity to common allergens were measured in cases and in one matched control for each.
The relative risk of CFA, after adjustment for smoking, was significantly increased in relation to questionnaire-reported exposure to metal dust (odds ratio 1.68 [95% CI 1.07-2.65], p = 0.024) or to wood dust (1.71 [1.01-2.92], p = 0.048). Similar results were obtained with the telephone interview data. Significant exposure-response effects were found for both metal-dust and wood-dust exposure. CFA was also associated with the presence of rheumatoid factor or antinuclear antibodies, but not with positive allergen skin tests or raised IgE concentrations. There was no evidence of interaction between the effects of rheumatoid factor, antinuclear antibodies, positive skin allergen tests, or IgE concentrations and exposure to metal or wood dust. The combined aetiological fraction attributable to exposure to metal or wood dust was of the order of 20%.
Occupational exposures to metal or wood dust are independent risk factors for CFA. Avoidance or limitation of these exposures may provide an opportunity to prevent the disease.
我们之前曾提出，隐源性纤维性肺泡炎（CFA）可能由职业暴露引起，尤其是接触金属或木屑粉尘。我们在一项针对CFA患者的病例对照研究中专门对这一假设进行了调查。
我们通过邮政问卷，获取了居住在英国特伦特地区的218例CFA患者以及569名年龄、性别和社区匹配的对照者的终生职业史。随后，通过电话访谈对165例患者和408名对照者的信息进行了核实。对病例组以及每个病例匹配的一名对照者测定了血清IgE、类风湿因子、抗核抗体以及对常见过敏原的皮肤敏感性。
在对吸烟进行校正后，问卷报告接触金属粉尘（比值比1.68 [95%可信区间1.07 - 2.65]，p = 0.024）或木屑粉尘（1.71 [1.01 - 2.92]，p = 0.048）的CFA相对风险显著增加。电话访谈数据也得出了类似结果。对于金属粉尘和木屑粉尘暴露均发现了显著的暴露 - 反应效应。CFA还与类风湿因子或抗核抗体的存在相关，但与过敏原皮肤试验阳性或IgE浓度升高无关。没有证据表明类风湿因子、抗核抗体、皮肤过敏原试验阳性或IgE浓度的效应与接触金属或木屑粉尘之间存在相互作用。归因于接触金属或木屑粉尘的综合病因分数约为20%。
职业性接触金属或木屑粉尘是CFA的独立危险因素。避免或限制这些接触可能为预防该疾病提供机会。
