Bernstein J A
University of Cincinnati Medical Center, Department of Medicine, OH 45267, USA.
Toxicology. 1996 Jul 17;111(1-3):181-9. doi: 10.1016/0300-483x(96)03375-6.
Surveillance programs established around the world have determined that diisocyanate chemicals are the most common cause of occupational asthma. In the United States approximately 100,000 workers are exposed to these chemical compounds in the workplace each year and 5-10% of these workers will develop occupational asthma. There are no known reliable risk factors or biomarkers which can be used to predict which exposed worker will develop diisocyanate-occupational asthma. Diisocyanate-occupational asthma workers manifest characteristic physiologic responses after specific bronchoprovocation which correlate with pathologic changes in their airways. However, the mechanism(s) for diisocyanate-occupational asthma remains unclear. Specific IgE antibody production to diisocyanates is found in only 10-30% of these workers. Bronchial biopsies and bronchoalveolar lavage have confirmed the presence of T-lymphocytes and eosinophils in the airways of these workers suggesting that T-cell mediated immune responses are more likely to play a central role in this disease. It is essential to diagnose diisocyanate-occupational asthma as early as possible in order to prevent or reduce the significant asthma morbidity associated with continuous long term exposure to these chemicals. Treatment of choice is removal of the worker from further exposure. Prospective studies evaluating larger populations of diisocyanate-exposed workers is essential for a better understanding of the pathogenesis and natural course of diisocyanate-occupational asthma.
世界各地建立的监测项目已确定，二异氰酸酯类化学物质是职业性哮喘最常见的病因。在美国，每年约有10万名工人在工作场所接触这些化合物，其中5%至10%的工人会患上职业性哮喘。目前尚无已知的可靠风险因素或生物标志物可用于预测哪些接触者会患上二异氰酸酯所致职业性哮喘。二异氰酸酯所致职业性哮喘患者在特定支气管激发试验后表现出特征性的生理反应，这与他们气道的病理变化相关。然而，二异氰酸酯所致职业性哮喘的发病机制仍不清楚。这些工人中只有10%至30%的人会产生针对二异氰酸酯的特异性IgE抗体。支气管活检和支气管肺泡灌洗已证实这些工人的气道中存在T淋巴细胞和嗜酸性粒细胞，这表明T细胞介导的免疫反应更有可能在这种疾病中起核心作用。尽早诊断二异氰酸酯所致职业性哮喘至关重要，以便预防或减少与长期持续接触这些化学物质相关的严重哮喘发病率。治疗的首选方法是让工人脱离进一步接触。评估更多二异氰酸酯接触工人的前瞻性研究对于更好地了解二异氰酸酯所致职业性哮喘的发病机制和自然病程至关重要。
