石棉致职业性肺癌和间皮瘤的系统评价  

Comprehensive analysis of asbestos-induced occupational lung cancer and mesothelioma

作　　者：黄丽[1] 戴俊明[1] 傅华[1] 

机构地区：[1]复旦大学公共卫生学院预防医学教研室公共卫生安全教育部重点实验室,上海200032

出　　处：《中华劳动卫生职业病杂志》2013年第1期19-23,共5页Chinese Journal of Industrial Hygiene and Occupational Diseases

摘　　要：目的了解石棉暴露与职业性肺癌和间皮瘤的关系，为现行的石棉致职业性肺癌、间皮瘤的诊断标准的修订提供依据。方法采用系统综述和文献检索的信息收集方法，凡满足职业性石棉暴露人员且有肺癌死亡或发病的队列研究资料均被纳入为研究对象，同时收集国际上其他国家相关的诊断信息。采用meta分析的统计方法进行统计分析。结果共有21个队列符合人选标准，间皮瘤的死亡百分比为0～36．36％。接触石棉原料的队列中主要为温石棉暴露（47．6％，10／21），另外有7个队列（33．3％，7／21）未给出石棉暴露的类型。在15篇文献中有13篇文献得出的结果是石棉暴露使患肺癌的危险f生增加（肺癌SMR为1．6-6．52，P〈0．05），对其进行meta分析的结果为meta-SMR=2．09（95％CI1．73-2．52）。当石棉纤维累计接触年限〈1年时，患肺癌的危险性增加（SMR为1．6-1．82，P〈0．05）。当肺癌潜隐期在15年以上时，患肺癌的危险性增加（SMR为2．08～3．75，P〈0．05）。在石棉纤维累计接触年限分级与间皮瘤SMR的关系分析中，有3个队列研究显示当石棉纤维累计接触年限〈1年时，患间皮瘤的危险性增加（SMR为18．0～20．0，P〈0．05）；当间皮瘤潜隐期在15年以上时，患间皮瘤的危险性增加。结论在新版石棉致肺癌和间皮瘤的诊断标准修订中，应重点讨论累计接触工龄和潜隐期的年限规定问题。Objective To revise diagnosis criteria of asbestos-induced occupational lung cancer. Methods All literatures which met the criteria of Cohort studies with results of lung cancer incidence or mortality among workers exposed to asbestos would incorporate into the systematic review. Meanwhile, the information about diagnosis criteria on asbestos-induced lung cancer in other countries was collected. Meta analysis was used to calculate meta-SMR and its 95% confidence interval. Results 21 asbestos-exposed cohorts were summarized. The percentage of all deaths due to mesothelioma was 0 to 36.36%. The main kind of asbestos-exposed raw material was chrysotile which accounted for 47.6%, and 7 cohorts （33.3%） didn＇t provide the information. There were 13 cohorts in 15 which concluded that the lung cancer risk of workers with asbestos exposure had increased （lung cancer SMR=1.6-6.52, P〈0.05）. Meta-SMR of 10 included cohorts is 2.09, with 95%CI 1.73 to 2.52 by using Meta analysis. When cumulative asbestos exposure years were less than one year, the risk of lung cancer had increased （lung cancer SMR=1.6-1.82, P〈0.05）. When latent period of lung cancer was more than 15 years, the risk of lung cancer had increased （lung cancer SMR=2.08-3.75, P〈0.05）. There were three studies, which had analyzed the relation between cumulative asbestos exposure years and the risk of mesothelioma, showing that when cumulative asbestos exposure years were less than one year, the risk of mesothelioma had increased （mesothelioma SMR =18.0 -20.0, P〈0.05）. When latent period of mesothelioma was more than 15 years, the risk of mesothelioma had increased. Conclusion The emphasis of the new version of asbestos-induced lung cancer and mesothelioma diagnosis criteria should focus on cumulative asbestos exposure years and latent period.

关 键 词：石棉 肺肿瘤 间皮瘤 诊断 

分 类 号：R734.2[医药卫生—肿瘤]