職業接觸粉塵和煙霧對慢性阻塞性肺疾病及呼吸道癥狀的影響_《中國呼吸與危重監護雜志》

作者：

周玉民 , 王辰 , 姚婉貞 , 陳萍 , 康健 , 黃紹光 , 陳寶元 , 王長征 , 倪殿濤 , 王小平 , 王大禮 , 劉升明 , 呂嘉春 , 鄭勁平 , 鐘南山 , 冉丕鑫

1廣州醫學院第一附屬醫院廣州呼吸疾病研究所呼吸疾病國家重點實驗室（廣東廣州 510120） 2首都醫科大學附屬北京朝陽醫院-北京呼吸疾病研究所3北京大學第三醫院呼吸內科4沈陽軍區總醫院呼吸內科5中國醫科大學附屬第一醫院呼吸疾病研究所6上海交通大學醫學院附屬瑞金醫院呼吸內科7天津醫科大學總醫院呼吸內科8第三軍醫大學新橋醫院呼吸內科9第四軍醫大學西京醫院呼吸內科10廣東韶關市第一人民醫院呼吸內科11廣州市荔灣區第二人民醫院呼吸內科12廣州醫學院公共衛生與全科醫學學院;

關鍵詞：

COPD 流行病學職業暴露粉塵煙霧

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目的探究職業接觸粉塵和煙霧對COPD 及呼吸道癥狀的影響。方法在中國7 省市( 北京、上海、廣東、遼寧、天津、重慶和陜西) 城鄉40 歲及以上人群的COPD 橫斷面調查的基礎上, 分析職業接觸粉塵和煙霧對COPD 及呼吸道癥狀的影響。對入選人群進行問卷調查和肺功能檢測。以支氣管舒張試驗后的FEV1 /FVC lt;70% 作為COPD的診斷標準, 并排除其他不完全可逆氣流受限疾病。患者自我報告經常有咳嗽、咳痰、氣喘或氣促癥狀之一, 定義為有呼吸道癥狀。結果 20. 5% 的被調查者曾經職業接觸粉塵和煙霧超過1 年。多因素分析顯示, 職業粉塵煙霧暴露是罹患COPD 的危險因素, 其OR值及95% CI 為1. 20( 1. 04, 1. 39) , 其中谷塵為COPD 可能的危險因素, 其OR 值及95% CI 為1. 48( 1. 18, 1. 86) ; 職業粉塵煙霧暴露、采礦、采石、水泥粉塵、油漆、化工和其他職業暴露為患呼吸道癥狀的危險因素, 其OR 值及95%CI 分別為1. 37( 1. 25, 1. 49) 、2. 31( 1. 67, 3. 20) 、1. 71( 1. 09, 2. 70) 、1. 92( 1. 47, 2. 52) 、1. 46( 1. 16, 1. 84) 、1. 58( 1. 37, 1. 83) 和1. 46( 1. 29, 1. 64) ; 職業粉塵煙霧暴露與吸煙存在協同作用, 可使患呼吸道癥狀的危險度增加( P = 0. 006) ; 職業粉塵煙霧暴露對患COPD 和呼吸道癥狀的人群歸因危險度( PAR) 分別為3. 94%和7. 05%。結論職業粉塵煙霧暴露與患COPD 和呼吸道癥狀有關; 職業粉塵煙霧暴露與吸煙對患呼吸道癥狀存在協同作用。

引用本文： 周玉民,王辰,姚婉貞,陳萍,康健,黃紹光,陳寶元,王長征,倪殿濤,王小平,王大禮,劉升明,呂嘉春,鄭勁平,鐘南山,冉丕鑫. 職業接觸粉塵和煙霧對慢性阻塞性肺疾病及呼吸道癥狀的影響. 中國呼吸與危重監護雜志, 2009, 09(1): 6-11. doi: 復制

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3.	白沖. 慢性阻塞性肺疾病的危險因素、流行情況及未來發展趨勢. 中國呼吸與危重監護雜志, 2007, 6: 403-405.
4.	劉輝國, 徐永健. 慢性阻塞性肺疾病: 從氣道慢性炎癥到全身慢性炎癥. 中國呼吸與危重監護雜志, 2007, 6: 410-4412.
5.	Meijer E, Kromhoult H, Heederik D. Respiratory effects of exposure to low levels of concrete dust containing crystalline silica. Am J Ind Med, 2001, 40: 133-140.
6.	Buist AS, Vollmer W, Weiss KB, et al. Burden of Obstructive Lung Disease ( BOLD) . Portland: University of Oregon, 2004. Available at: http: / /www. kpchr. org/ boldcopd/ apps / protocol. pdf ( accessed Apr 2005) .
7.	Rothman K, Greenland S. Modern epidemiology. Philadelphia:Lippin-456. cott-Raven, 1998, 295.
8.	Love RG, Miller BG. Longitudinal study of lung function in coalminers.Thorax, 1982, 37: 193-197.
9.	Hnizdo E, Baskind E, Sluis-Cremer GK. Combined effect of silica dust exposure and tobacco smoking on the prevalence of respiratory impairments among gold miners. Scand J Work Environ Health,1990, 16: 411-422.
10.	Ulvestad B, Bakke B, Eduard W, et al. Cumulative exposure to dust causes accelerated decline in lung function in tunnel workers. Occup Environ Med, 2001, 58: 663-669.
11.	Irslinger GB, Visser PJ, Spangenberg PA. Asthma and chronic bronchitis in vanadium workers. Am J Ind Med, 1999, 35: 366 -374.
12.	Wang ML, McCabe L, Hankison JL, et al. Longitudinal and crosssectional analyses of lung function in steelworkers. Am J Respir Crit Care Med, 1996, 153: 1907-1913.
13.	Nemery B, Van Leemputten R, Goemaere E, et al. Lung function measurements over 21 days shiftwork in steelworkers from a standcasting department. Br J Ind Med, 1985, 42: 601-611.
14.	Mastrangelo G, Tartari M, Fedeli U, et al. Ascertaining the risk of chronic obstructive pulmonary diseases in relation to occupation using a case-control design. Occup Med ( Lond ) , 2003, 53: 165 -172.
15.	Kirkhorn SR, Garry VF. Agriculture lung diseases. Environ Health Perspect, 2000, 108( suppl 4) : 705-712.
16.	Piirila PL, Nordman H, Korhonen OS, et al. A thirteen-year follow-up of respiratory effects of acute exposure to sulfur dioxide. Scand J Work Environ Health, 1996 , 22: 191 -196.
17.	Becklake MR, Goldman HI, Bosman AR, et al. The long-term effects of exposure to nitrous fumes. Am Rev Tuberc, 1957, 76: 398-409.
18.	Davison AG, Fayers PM, Newman Taylor AJ, et al. Cadmium fume inhalation and emphysema. Lancet, 1988, 1: 663-667.
19.	Nakadate T, Aizawa Y, Yagami T, et al. Change in obstructive pulmonary function as a result of cumulative exposure to welding fumes as determined by agnetopneumography in Japanese arc welders. Occup Environ Med, 1998, 55: 673-677.
20.	Hammond SK, Gold E, Baker R, et al. Respiratory Health Effects Related to Occupational Spray Painting and Welding. J Occup Environ Med, 2005, 47: 728-739.
21.	Bradshaw LM, Fishwick D, Slater T, et al. Chronic bronchitis, work related respiratory symptoms, and pulmonary function in welders in New Zealand. Occup Environ Med, 1998, 55: 150 -154.
22.	Sobaszek A, Boulenguez C, Frimat P, et al. Acute respiratory effects of exposure to stainless steel and mild steel welding fumes. J Occup Environ Med, 2000, 42: 923-931.
23.	劉春濤, 馮玉麟. 慢性阻塞性肺疾病全球創議慢性阻塞性肺疾病診斷、管理和預防袖珍指南( 2006 年修訂版) . 中國呼吸與危重監護雜志, 2007, 6: 230-237.
24.	Trupin L, Earnest G, San Pedro M, et al. The occupational burden of chronic obstructive pulmonary disease. Eur Respir J, 2003, 22:462 -469.
25.	Balmes J, Becklake M, Blanc P, et al. Occupational contribution to the burden of airway disease ( an official statement of the American Thoracic Society) . Am J Respir Crit Care Med, 2003, 167: 787-797.
26.	Hnizdo E, Sullivan PA, Bang KM, et al. Association between chronic obstructive pulmonary disease and employment by industry and occupation in the U. S. population: a study of data from the Third National Health and Nutrition Examination Survey. Am J Epidemiol, 2002 ,156: 738-746.
27.	Attfield MD. Longitudinal decline in FEV1 in United States coalminers. Thorax, 1985, 40: 132-137.
28.	Kauffmann F, Drouet D, Lellouch J, et al. Occupational exposure and 12 year spirometric changes among Paris area workers. Br J Ind Med,1982, 39: 221-232.
29.	Bergdahl IA, Toren K, Eriksson K, et al. Increased mortality in COPD among construction workers exposed to inorganic dust. Eur Respir J,2004, 23: 402-406.
30.	Leigh JP, Romano PS, Schenker MB, et al. Costs of occupational chronic obstructive pulmonary disease and asthma. Chest, 2002, 121:264 -272.
31.	Gomes J, Lloyd OL, Norman NJ, et al. Dust exposure and impairment of lung function at a small iron foundry in a rapidly developing country.Occup Environ Med, 2001, 58, 656-662.
32.	Olenchock SA,May JJ, Pratt DS, et al. Presence of endotoxins in different agriculture environments. Am J Ind Med, 1990, 18: 279-284.
33.	Jagielo PJ, Thorne PS, Watt JL, et al. dust and endotoxin inhalation challenges produce similar inflammatory responses in normal subjects. Chest, 1996, 110: 263-270.

1. National Heart, Lung, and Blood Institute and World Health Organization.Global initiative for chronic obstructive lung disease: a collaborative project of the National, Heart, Lung, and Blood Institute and the World Health ganization. Bethesda, MD: National Institutes of Health, 2001.
2. 王曾禮. 更新對慢性阻塞性肺疾病認識的觀念. 中國呼吸與危重監護雜志, 2007, 6: 401-402.
3. 白沖. 慢性阻塞性肺疾病的危險因素、流行情況及未來發展趨勢. 中國呼吸與危重監護雜志, 2007, 6: 403-405.
4. 劉輝國, 徐永健. 慢性阻塞性肺疾病: 從氣道慢性炎癥到全身慢性炎癥. 中國呼吸與危重監護雜志, 2007, 6: 410-4412.
5. Meijer E, Kromhoult H, Heederik D. Respiratory effects of exposure to low levels of concrete dust containing crystalline silica. Am J Ind Med, 2001, 40: 133-140.
6. Buist AS, Vollmer W, Weiss KB, et al. Burden of Obstructive Lung Disease ( BOLD) . Portland: University of Oregon, 2004. Available at: http: / /www. kpchr. org/ boldcopd/ apps / protocol. pdf ( accessed Apr 2005) .
7. Rothman K, Greenland S. Modern epidemiology. Philadelphia:Lippin-456. cott-Raven, 1998, 295.
8. Love RG, Miller BG. Longitudinal study of lung function in coalminers.Thorax, 1982, 37: 193-197.
9. Hnizdo E, Baskind E, Sluis-Cremer GK. Combined effect of silica dust exposure and tobacco smoking on the prevalence of respiratory impairments among gold miners. Scand J Work Environ Health,1990, 16: 411-422.
10. Ulvestad B, Bakke B, Eduard W, et al. Cumulative exposure to dust causes accelerated decline in lung function in tunnel workers. Occup Environ Med, 2001, 58: 663-669.
11. Irslinger GB, Visser PJ, Spangenberg PA. Asthma and chronic bronchitis in vanadium workers. Am J Ind Med, 1999, 35: 366 -374.
12. Wang ML, McCabe L, Hankison JL, et al. Longitudinal and crosssectional analyses of lung function in steelworkers. Am J Respir Crit Care Med, 1996, 153: 1907-1913.
13. Nemery B, Van Leemputten R, Goemaere E, et al. Lung function measurements over 21 days shiftwork in steelworkers from a standcasting department. Br J Ind Med, 1985, 42: 601-611.
14. Mastrangelo G, Tartari M, Fedeli U, et al. Ascertaining the risk of chronic obstructive pulmonary diseases in relation to occupation using a case-control design. Occup Med ( Lond ) , 2003, 53: 165 -172.
15. Kirkhorn SR, Garry VF. Agriculture lung diseases. Environ Health Perspect, 2000, 108( suppl 4) : 705-712.
16. Piirila PL, Nordman H, Korhonen OS, et al. A thirteen-year follow-up of respiratory effects of acute exposure to sulfur dioxide. Scand J Work Environ Health, 1996 , 22: 191 -196.
17. Becklake MR, Goldman HI, Bosman AR, et al. The long-term effects of exposure to nitrous fumes. Am Rev Tuberc, 1957, 76: 398-409.
18. Davison AG, Fayers PM, Newman Taylor AJ, et al. Cadmium fume inhalation and emphysema. Lancet, 1988, 1: 663-667.
19. Nakadate T, Aizawa Y, Yagami T, et al. Change in obstructive pulmonary function as a result of cumulative exposure to welding fumes as determined by agnetopneumography in Japanese arc welders. Occup Environ Med, 1998, 55: 673-677.
20. Hammond SK, Gold E, Baker R, et al. Respiratory Health Effects Related to Occupational Spray Painting and Welding. J Occup Environ Med, 2005, 47: 728-739.
21. Bradshaw LM, Fishwick D, Slater T, et al. Chronic bronchitis, work related respiratory symptoms, and pulmonary function in welders in New Zealand. Occup Environ Med, 1998, 55: 150 -154.
22. Sobaszek A, Boulenguez C, Frimat P, et al. Acute respiratory effects of exposure to stainless steel and mild steel welding fumes. J Occup Environ Med, 2000, 42: 923-931.
23. 劉春濤, 馮玉麟. 慢性阻塞性肺疾病全球創議慢性阻塞性肺疾病診斷、管理和預防袖珍指南( 2006 年修訂版) . 中國呼吸與危重監護雜志, 2007, 6: 230-237.
24. Trupin L, Earnest G, San Pedro M, et al. The occupational burden of chronic obstructive pulmonary disease. Eur Respir J, 2003, 22:462 -469.
25. Balmes J, Becklake M, Blanc P, et al. Occupational contribution to the burden of airway disease ( an official statement of the American Thoracic Society) . Am J Respir Crit Care Med, 2003, 167: 787-797.
26. Hnizdo E, Sullivan PA, Bang KM, et al. Association between chronic obstructive pulmonary disease and employment by industry and occupation in the U. S. population: a study of data from the Third National Health and Nutrition Examination Survey. Am J Epidemiol, 2002 ,156: 738-746.
27. Attfield MD. Longitudinal decline in FEV1 in United States coalminers. Thorax, 1985, 40: 132-137.
28. Kauffmann F, Drouet D, Lellouch J, et al. Occupational exposure and 12 year spirometric changes among Paris area workers. Br J Ind Med,1982, 39: 221-232.
29. Bergdahl IA, Toren K, Eriksson K, et al. Increased mortality in COPD among construction workers exposed to inorganic dust. Eur Respir J,2004, 23: 402-406.
30. Leigh JP, Romano PS, Schenker MB, et al. Costs of occupational chronic obstructive pulmonary disease and asthma. Chest, 2002, 121:264 -272.
31. Gomes J, Lloyd OL, Norman NJ, et al. Dust exposure and impairment of lung function at a small iron foundry in a rapidly developing country.Occup Environ Med, 2001, 58, 656-662.
32. Olenchock SA,May JJ, Pratt DS, et al. Presence of endotoxins in different agriculture environments. Am J Ind Med, 1990, 18: 279-284.
33. Jagielo PJ, Thorne PS, Watt JL, et al. dust and endotoxin inhalation challenges produce similar inflammatory responses in normal subjects. Chest, 1996, 110: 263-270.

《中國呼吸與危重監護雜志》

職業接觸粉塵和煙霧對慢性阻塞性肺疾病及呼吸道癥狀的影響

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《中國呼吸與危重監護雜志》

職業接觸粉塵和煙霧對慢性阻塞性肺疾病及呼吸道癥狀的影響

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