Wang X, Yano E, Nonaka K, Wang M, Wang Z
Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
Am J Ind Med. 1997 May;31(5):495-502. doi: 10.1002/(sici)1097-0274(199705)31:5<495::aid-ajim2>3.0.co;2-t.
We conducted a comparative study of pulmonary dysfunction among workers who were exposed to silica, asbestos, or coalmine dust. The results showed that all three groups of dust-exposed workers, even those without radiographic signs of pneumoconiosis, had decreased spirometric parameters and diffusing capacity (DLco) in both nonsmokers and smokers. Pulmonary function was further decreased when pneumoconioses were present in the three groups. In accord with increasing radiographic categories, pulmonary function in the workers with either silicosis or asbestosis was even lower, whereas in those with coal workers' pneumoconiosis (CWP), it changed relatively little. Workers with mild to moderate (radiographic category I-II) silicosis or asbestosis showed similarly decreased DLco, but those with silicosis showed lower FEV1/FVC than those with abestosis. The workers with CWP also showed a lower FEV1/FVC than those with asbestosis. The major impairment patterns for silica workers, asbestos workers, and coal miners were mixed, restrictive and mixed, and obstructive, respectively. Smoking obviously increased the prevalence of obstruction for all the groups. We conclude from the present study that all the three dusts cause functional abnormalities that precede radiographic changes of pneumoconiosis. We should pay more attention to respiratory impairment in the initial stage of silicosis and CWP.
我们对接触二氧化硅、石棉或煤矿粉尘的工人进行了肺功能障碍的比较研究。结果显示，所有三组接触粉尘的工人，即使是那些没有尘肺病影像学表现的工人，无论吸烟与否，其肺量计参数和弥散能力（DLco）均下降。当三组工人出现尘肺病时，肺功能进一步下降。随着影像学分类的增加，患有矽肺病或石棉肺的工人肺功能更低，而患有煤工尘肺（CWP）的工人肺功能变化相对较小。轻度至中度（影像学分类I-II）矽肺病或石棉肺的工人DLco同样下降，但矽肺病患者的FEV1/FVC低于石棉肺患者。CWP工人的FEV1/FVC也低于石棉肺患者。矽尘工人、石棉工人和煤矿工人的主要损伤模式分别为混合型、限制型和阻塞型。吸烟明显增加了所有组别的阻塞性疾病患病率。我们从本研究得出结论，所有这三种粉尘都会导致在尘肺病影像学改变之前出现功能异常。我们应该更加关注矽肺病和CWP早期阶段的呼吸功能损害。
