职业性黑变病69例临床表现分析  

Analysis of the clinical characteristics of 69 cases of occupational melanosis

作　　者：龙李洁 刘欣 闫永建[2] 夏丽华[3] 杨惠敏 余音 叶绿素 贺炜 李静渝 夏安莉 李倩 王永义 LONG Lijie;LIU Xin;YAN Yongjian;XIA Lihua;YANG Huimin;YU Yin;YE Lüsu;HE Wei;LI Jingyu;XIA Anli;LI Qian;WANG Yongyi(The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College,Chongqing 400060,China;不详)

机构地区：[1]重庆医药高等专科学校附属第一医院,重庆400060 [2]山东省职业卫生与职业病防治研究院,山东济南250002 [3]广东省职业病防治院,广东广州510300 [4]黑龙江省第二医院,黑龙江哈尔滨150007 [5]重庆市第一人民医院(重庆市皮肤病研究所),重庆400021

出　　处：《中国职业医学》2023年第4期436-440,共5页China Occupational Medicine

基　　金：中国疾病预防控制中心职业卫生与中毒控制所财政项目(20210301);重庆市公共卫生重点专科(学科)建设经费资助。

摘　　要：目的总结职业性黑变病患者的临床特点。方法采用回顾性分析方法,收集69例职业性黑变病患者的诊断资料,进行回顾性分析。结果69例职业性黑变病患者接触的职业病危害因素以煤焦油、石油及其分馏产品、颜料与染料及其中间体、橡胶添加剂及橡胶制品为主。接触职业病危害因素工龄和疾病潜伏期中位数分别为8.0和6.0年,两者呈高度正相关(Spearman相关系数为0.962,P<0.01)。皮损主要好发于患者面颈部和四肢等暴露部位,检出率分别为94.2%和75.4%;78.3%的患者皮损出现部位≥2个。皮损形态多呈不规则片状(占59.4%),皮损颜色多为灰黑色(占44.9%);43.5%的患者有皮肤瘙痒。患者血常规、肝功能和肾功能检查均未见异常。皮肤活检可见表皮角化过度,棘层变薄,基底细胞液化变性,真皮浅层噬黑素细胞增加,毛细血管周围有淋巴细胞、组织细胞与噬黑素细胞浸润。反射式共聚焦显微镜(RCM)检查可见皮损处基底细胞灶状液化变性,真皮乳头和浅表层可见大量噬黑色素细胞与炎细胞浸润。结论职业性黑变病靶器官主要为皮肤,目前尚未发现其他器官的损害。皮肤活检和RCM检查结果可作为鉴别诊断的依据。Objective To summarize the clinical characteristics of patients with occupational melanosis.Methods Diagnostic data of 69 patients with occupational melanosis was analyzed using retrospective analysis.Results The main occupational hazards for the 69 patients with occupational melanosis were coal tar,petroleum and its fractionated products,pigments and dyes and their intermediates,rubber additives and rubber products.The median length of occupational exposure and disease latency were 8.0 and 6.0 years,respectively,with a highly positive correlation between them(Spearman correlation coefficients=0.962,P<0.01).Skin lesions were mainly found on exposed areas such as the face-to-neck and limbs,prevalence of 94.2%and 75.4%respectively.And 78.3%of patients had skin lesion on more than two sites.The lesions were mostly in the form of irregular flakes(59.4%),with a gray-black color(44.9%).About 43.5%of patients experienced skin itching.Complete blood count,liver function,and kidney function were all within normal ranges.Skin biopsy results showed that epidermal hyperkeratosis,thinning of the spinous layer,liquefaction degeneration of basal cells,increased superficial dermal melanocytes,and infiltration of lymphocytes,histiocytes,and melanocytes around the blood vessels.Reflectance confocal microscopy(RCM)detection showed focal liquefaction degeneration of basal cells in the lesions,with a significant infiltration of melanocytes and inflammatory cells in the dermal papillae and superficial layers.Conclusion The primary target organ of occupational melanocytes is the skin,and no damage to other organs was identified thus far.Results from skin biopsies and RCM examinations can be used for differential diagnosis.

关 键 词：职业病 黑变病 危害因素 工龄 潜伏期 临床特点 活检 反射式共聚焦显微镜 

分 类 号：R135.7[医药卫生—劳动卫生]