职业接触粉尘和烟雾对慢性阻塞性肺疾病及呼吸道症状的影响  

Occupational Exposure to Dusts/Gases/Fumes Is Contributed to Chronic Obstructive Pulmonary Disease and Respiratory Symptoms

作　　者：周玉民[1] 王辰[2] 姚婉贞[3] 陈萍[4] 康健[5] 黄绍光[6] 陈宝元[7] 王长征[8] 倪殿涛[9] 王小平 王大礼[11] 刘升明[1,12] 吕嘉春[13] 郑劲平[1] 钟南山[1] 冉丕鑫[1] 

机构地区：[1]广州医学院第一附属医院广州呼吸疾病研究所呼吸疾病国家重点实验室,广东广州510120 [2]首都医科大学附属北京朝阳医院-北京呼吸疾病研究所,北京100020 [3]北京大学第三医院呼吸内科,北京100083 [4]沈阳军区总医院呼吸内科,辽宁沈阳110016 [5]中国医科大学附属第一医院呼吸疾病研究所,辽宁沈阳110001 [6]上海交通大学医学院附属瑞金医院呼吸内科,上海200025 [7]天津医科大学总医院呼吸内科,天津300052 [8]第三军医大学新桥医院呼吸内科,重庆400037 [9]第四军医大学西京医院呼吸内科,陕西西安710032 [10]韶关市第一人民医院呼吸内科,广东韶关512000 [11]广州市荔湾区第二人民医院呼吸内科,广东广州510160 [12]暨南大学附属第一医院呼吸内科 [13]广州医学院公共卫生与全科医学学院,广东广州510182

出　　处：《中国呼吸与危重监护杂志》2009年第1期6-11,共6页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家“十五”攻关项目[编号:2001BA703B03(A)];广东省“十五”重点支持项目(编号:B30301)

摘　　要：目的探究职业接触粉尘和烟雾对COPD及呼吸道症状的影响。方法在中国7省市(北京、上海、广东、辽宁、天津、重庆和陕西)城乡40岁及以上人群的COPD横断面调查的基础上,分析职业接触粉尘和烟雾对COPD及呼吸道症状的影响。对入选人群进行问卷调查和肺功能检测。以支气管舒张试验后的FEV1/FVC<70%作为COPD的诊断标准,并排除其他不完全可逆气流受限疾病。患者自我报告经常有咳嗽、咳痰、气喘或气促症状之一,定义为有呼吸道症状。结果20.5%的被调查者曾经职业接触粉尘和烟雾超过1年。多因素分析显示,职业粉尘烟雾暴露是罹患COPD的危险因素,其OR值及95%CI为1.20(1.04,1.39),其中谷尘为COPD可能的危险因素,其OR值及95%CI为1.48(1.18,1.86);职业粉尘烟雾暴露、采矿、采石、水泥粉尘、油漆、化工和其他职业暴露为患呼吸道症状的危险因素,其OR值及95%CI分别为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);职业粉尘烟雾暴露与吸烟存在协同作用,可使患呼吸道症状的危险度增加(P=0.006);职业粉尘烟雾暴露对患COPD和呼吸道症状的人群归因危险度(PAR)分别为3.94%和7.05%。结论职业粉尘烟雾暴露与患COPD和呼吸道症状有关;职业粉尘烟雾暴露与吸烟对患呼吸道症状存在协同作用。Objective To investigate the contribution of occupational exposure to dusts/gases/fumes to chronic obstructive pulmonary disease（COPD） and respiratory symptoms in China. Methods Based on the crosssectional survey of COPD which was conducted in urban and rural areas of Beijing, Shanghai, Guangdong, Liaoning, Tianjin, Chongqing and Shanxi for residents aged 40 years or older, the association between the occupational exposure to dusts/gases/fumes and COPD and respiratory symptoms was analyzed. The recruited populations were interviewed with questionnaire and were tested with spirometry. The post-bronchodilators FEV1/ FVC 〈 70% was used as diagnostic criteria of COPD. Having any cough, sputum, wheezing and dyspnea was defined as having respiratory symptoms. Results The prevalence of occupational exposure to dusts/gases/fumes was 20. 5%. As shown by multiple-variables Logistic regression analyses, occupational exposure to dusts/fumes/ gases [OR = 1.20（1.04, 1.39）] and dusts of grain [ 1.48 （1.18, 1.86）] were associated with COPD; occupational exposure to dusts/fumes/gases [ OR = 1.37 （ 1.25,1.49 ） ], hard-rock mining [ OR = 2. 31 （ 1.67, 3.20）],coal mining [OR = 1. 71（1. 09 , 2. 70 ） ] , dusts of cement [OR = 1.92（1.47,2.52）],chemical or plastics manufacturing [ OR = 1.58 （ 1.37,1.83 ） ], spray painting [ OR = 1.46 （1.16,1.84） ], and other dusts or fumes [ OR = 1.46 （ 1.29, 1.64 ） ] were associated with the respiratory symptoms. Smoking and occupational exposure to dusts/gases/fumes had synergic effects on the increasing risk of respiratory symptoms. The populationattributable risk （PAR） of exposure to dusts/gases/fumes was 3.94% and 7. 05% for COPD and respiratory symptoms respectively. Conclusions Occupational exposure to dusts/gases/fumes is associated with COPD and respiratory symptoms. Smoking and occupational exposure to dusts/gases/fumes may have synergic effects on respiratory symptoms.

关 键 词：慢性阻塞性肺疾病 流行病学 职业暴露 粉尘 烟雾 

分 类 号：R563.9[医药卫生—呼吸系统]