职业性刺激性化学物致慢性阻塞性肺疾病41例  

41 cases of chronic obstructive pulmonary disease caused by occupational irritating chemicals

作　　者：袁瑞 丁帮梅[2] 朱秋鸿[3] 农康[4] 张华[5] 闫永建 Yuan Rui;Ding Bangmei;Zhu Qiuhong;Nong Kang;Zhang Hua;Yan Yongjian(Shandong Institute of Occupational Health and Disease Prevention,Shandong First Medical University(Shandong Academy of Medical Sciences),Jinan 250062,China;Jiangsu Center for Disease Control and Prevention,Nanjing 210009,China;National Institute of Occupational Health and Poison Control,Chinese Center for Disease Control and Prevention,Beijing 100050,China;Guangxi Institute of Occupational Disease Prevention,Nanning 530021,China;Qingdao Central Hospital Affiliated to Qingdao University,Qingdao 266042,China)

机构地区：[1]山东第一医科大学(山东省医学科学院)山东省职业卫生与职业病防治研究院,济南250062 [2]江苏省疾病预防控制中心,南京210009 [3]中国疾病预防控制中心职业卫生与中毒控制所,北京100050 [4]广西壮族自治区职业病防治研究院,南宁530021 [5]青岛大学附属青岛市中心医院,青岛266042

出　　处：《中华劳动卫生职业病杂志》2023年第4期294-298,共5页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：山东省重点研发计划(2019GSF111025);国家卫生健康委卫生健康标准修订项目(20202006);国家卫生健康委卫生健康标准制定项目(20210303);济南市科学技术局-临床医学科技创新计划(202019179)。

摘　　要：目的分析职业性刺激性化学物致慢性阻塞性肺疾病(OI-COPD)病例特点,为修订其诊断标准提供依据。方法于2021年6-12月,收集山东省职业卫生与职业病防治研究院、广西壮族自治区职业病防治研究院、青岛大学附属青岛市中心医院等诊断机构近5年确诊的OI-COPD患者信息,共41例。回顾性分析OI-COPD病例基本信息、职业危险因素接触信息、病史、吸烟史和临床症状等信息。计量资料符合正态分布者用±s描述,用t检验进行组间比较;不符合正态分布者用中位数[M(Q_(1),Q_(3))]描述,用非参数检验进行分析;计数资料用频数和率(%)表示,组间比较用χ^(2)检验。结果 41例病例中,男性33例,女性8例。患者诊断OI-COPD年龄为(49.5±10.3)岁,年龄最小为30岁;其中8例患者有明确长期吸烟史(5年以上);职业危险因素接触工龄为(18.6±10.3)年,其中有3例患者接触工龄<5年;导致OI-COPD的职业危险因素种类包括酸及成酸化合物、碱类、醛类、氮氧化物、氯及其化合物等。职业危险因素暴露水平与COPD气流受限程度有关(χ^(2)= 6.17,P<0.05)。诊断年龄<50岁者18人,为早发COPD。早诊COPD患者呼吸系统症状的发生率低于非早发COPD患者,一秒用力呼气容积占预计值的百分比明显高于非早发COPD患者,差异均有统计学意义(P<0.05),早诊COPD患者肺功能分级以Ⅰ-Ⅱ级为主(88.9%),非早诊COPD患者肺功能分级以Ⅱ-Ⅳ级为主(91.3%),两组间比较差异有统计学意义(P<0.01)。结论职业危险因素暴露水平可能是影响COPD气流受限程度的危险因素,随着COPD患者暴露水平的增加,呼吸道症状出现的比例也相应增加。Objective To analyze the case characteristics of Chronic obstructive pulmonary disease caused by occupational irritant chemicals(OI-COPD).To provide basis for revising its diagnostic criteria.Methods From June to December 2021,we investigated the information of OI-COPD patients confirmed by Shandong Institute of Occupational Health and Prevention of Occupational Diseases,Guangxi Zhuang Autonomous Region Institute of Occupational Disease Prevention and Control,Qingdao Central Hospital affiliated to Qingdao University and other diagnostic institutions in the past five years,a total of 41 cases.The basic information of OI-COPD cases,occupational risk factors exposure information,medical history,smoking history and clinical symptoms were analyzed retrospectively.The measurement data were tested for normal distribution,which was described by±s,and compared between groups by t test;Those who do not conform to the normal distribution are described by the median[M(Q_(1),Q_(3))]and analyzed by nonparametric test;The counting data were expressed in frequency and rate(%),and the comparison between groups was tested.Results Of the 41 cases,33 were male and 8 were female.The age of the patient diagnosed with OI-COPD was(49.5±10.3)years old,and the minimum age was 30 years old;Among them,8 patients had a definite long-term smoking history(more than 5 years);The exposure duration of occupational risk factors was(18.6±10.3)years,of which 3 patients had exposure duration of less than 5 years;The occupational risk factors leading to OI-COPD include acids and acid-forming compounds,bases,aldehydes,nitrogen oxides,chlorine and its compounds,etc.The exposure level of occupational risk factors is related to the degree of COPD airflow restriction(χ^(2)=6.17,P<0.05).18 patients with diagnosis age<50 years old were diagnosed as early-onset COPD.The incidence of respiratory symptoms in the early diagnosis COPD group was lower than that in the non-early diagnosis COPD group,and the FEV1%pred was significantly higher than that in the no

关 键 词：肺疾病 慢性阻塞性 职业卫生 刺激 化学性 职业危险因素 刺激性化学物 诊断标准 回顾性研究 

分 类 号：R563.9[医药卫生—呼吸系统] R135[医药卫生—内科学]