职业性三氯乙烯药疹样皮炎病例随访报告  

Report on the follow-up study of occupational medicamentosa-like dermatitis induced by trichloroethylene

作　　者：黄永顺[1] 金佳纯[1] 柳柳 黄健 李来玉[1] 夏丽华[1] 黄汉林[1,2] HUANG Yongshun;JIN Jiachun;LIU Liu;HUANG Jian;LI Laiyu;XIA Lihua;HUANG Hanlin(Guangdong Provincial Key Laboratory of Occupational Disease Prevention and Treatment, Guangzhou, Guangdong 510300, China)

机构地区：[1]广东省职业病防治院,广东省职业病防治重点实验室,广东广州510300 [2]广东省妇幼保健院,511400

出　　处：《中国职业医学》2019年第3期354-358,共5页China Occupational Medicine

基　　金：国家自然科学基金(81502769);国家“十二五”科技支撑计划(2014BAI12B01);国家临床重点专科建设项目(2011-09);广东省职业病防治重点实验室(2017B030314152)

摘　　要：目的了解职业性三氯乙烯药疹样皮炎(OMDT)康复患者的远期预后。方法采用电话、信件等方法对185例OMDT康复患者进行随访,安排19例随访患者(随访检查组)住院进行健康检查。结果成功随访71例患者,随访成功率为38. 4%(71/185)。64. 8%(46/71)成功随访患者自述出现皮肤瘙痒、易过敏、经常发生上呼吸道感染或发热、干眼症和股骨头缺血性坏死等。19例随访检查组患者存在不同程度的皮肤搔痒、干燥和轻度黑色素沉着;左、右眼泪液分泌试验异常率分别为42. 1%(8/19)、52. 6%(10/19);左、右眼泪膜破裂时间试验异常率均为84. 2%(16/19);斑贴试验阳性率最高为水合氯醛(100. 0%);体温、浅表淋巴结均无异常,未见新皮疹,血常规、尿常规、肝功能和自身免疫抗体检查均未见异常。结论 OMDT康复患者可发生不同程度的远期预后,干眼症和股骨头缺血性坏死可能是其主要后遗症之一。三氯乙烯主要代谢产物水合氯醛可能是OMDT的主要致敏物质。Objective To understand the long-term prognosis of patients with occupational medicamentosa-like dermatitis induced by trichloroethylene( OMDT) after recovery. Methods A total of 185 patients with OMDT were surveyed through landline and correspondence after recovery. Based on the individual’s wishes,19 patients( follow-up examination group)were followed up and arranged for health examination in hospital. Results Seventy-one cases of OMDT was successfully follow-up. The success rate was 38. 4%( 71/185). Among the 71 cases who were successfully followed up,64. 8%( 46/71)cases complained of physical discomfort. The main complain included skin itching,allergy,upper respiratory tract infection or frequent fever,xerophthalmus,osteonecrosis of femoral head. The 19 cases in the follow-up examination group had different degrees of skin itching,dryness and mild melanosis. The abnormal rates of schirmer I test were 42. 1%( 8/19)and 52. 6%( 10/19) in the left and right eye,respectively. The abnormal rate of tear break-up time in both left and right eyes was 84. 2%( 16/19). The highest positive rate of patch test was chloral hydrate( 100. 0%). There was no abnormality in body temperature,superficial lymph nodes,blood routine,urine routine,liver function and autoimmunity antibody. There was no new rash. Conclusion Different degree of long-term prognosis can occur in OMDT recovery patients. Xerophthalmus and osteonecrosis of femoral head are the major sequelae. Chloral hydrate,which is the main metabolite of trichloroethylene,may be the causative culprit compound for OMDT.

关 键 词：三氯乙烯 皮炎 肝功能 斑贴试验 随访 

分 类 号：R135.7[医药卫生—劳动卫生]