• 1廣州醫(yī)學院第一附屬醫(yī)院廣州呼吸疾病研究所 呼吸疾病國家重點實驗室（廣東廣州 510120） 2首都醫(yī)科大學附屬北京朝陽醫(yī)院-北京呼吸疾病研究所3北京大學第三醫(yī)院呼吸內科4沈陽軍區(qū)總醫(yī)院呼吸內科5中國醫(yī)科大學附屬第一醫(yī)院呼吸疾病研究所6上海交通大學醫(yī)學院附屬瑞金醫(yī)院呼吸內科7天津醫(yī)科大學總醫(yī)院呼吸內科8第三軍醫(yī)大學新橋醫(yī)院呼吸內科9第四軍醫(yī)大學西京醫(yī)院呼吸內科10廣東韶關市第一人民醫(yī)院呼吸內科11廣州市荔灣區(qū)第二人民醫(yī)院呼吸內科12廣州醫(yī)學院公共衛(wèi)生與全科醫(yī)學學院;

目的 探究職業(yè)接觸粉塵和煙霧對COPD 及呼吸道癥狀的影響。方法 在中國7 省市( 北京、上海、廣東、遼寧、天津、重慶和陜西) 城鄉(xiāng)40 歲及以上人群的COPD 橫斷面調查的基礎上, 分析職業(yè)接觸粉塵和煙霧對COPD 及呼吸道癥狀的影響。對入選人群進行問卷調查和肺功能檢測。以支氣管舒張試驗后的FEV1 /FVC  lt;70% 作為COPD的診斷標準, 并排除其他不完全可逆氣流受限疾病?；颊咦晕覉蟾娼洺Ｓ锌人?、咳痰、氣喘或氣促癥狀之一, 定義為有呼吸道癥狀。結果 20. 5% 的被調查者曾經職業(yè)接觸粉塵和煙霧超過1 年。多因素分析顯示, 職業(yè)粉塵煙霧暴露是罹患COPD 的危險因素, 其OR值及95% CI 為1. 20( 1. 04, 1. 39) , 其中谷塵為COPD 可能的危險因素, 其OR 值及95% CI 為1. 48( 1. 18, 1. 86) ; 職業(yè)粉塵煙霧暴露、采礦、采石、水泥粉塵、油漆、化工和其他職業(yè)暴露為患呼吸道癥狀的危險因素, 其OR 值及95%CI 分別為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) ; 職業(yè)粉塵煙霧暴露與吸煙存在協(xié)同作用, 可使患呼吸道癥狀的危險度增加( P = 0. 006) ; 職業(yè)粉塵煙霧暴露對患COPD 和呼吸道癥狀的人群歸因危險度( PAR) 分別為3. 94%和7. 05%。結論 職業(yè)粉塵煙霧暴露與患COPD 和呼吸道癥狀有關; 職業(yè)粉塵煙霧暴露與吸煙對患呼吸道癥狀存在協(xié)同作用。

引用本文： 周玉民,王辰,姚婉貞,陳萍,康健,黃紹光,陳寶元,王長征,倪殿濤,王小平,王大禮,劉升明,呂嘉春,鄭勁平,鐘南山,冉丕鑫. 職業(yè)接觸粉塵和煙霧對慢性阻塞性肺疾病及呼吸道癥狀的影響. 中國呼吸與危重監(jiān)護雜志, 2009, 09(1): 6-11. doi: 復制

1. National Heart, Lung, and Blood Institute and World Health Organization.Global initiative for chronic obstructive lung disease: a collaborative project of the National, Heart, Lung, and Blood Institute and the World Health ganization. Bethesda, MD: National Institutes of Health, 2001.
2. 王曾禮. 更新對慢性阻塞性肺疾病認識的觀念. 中國呼吸與危重監(jiān)護雜志, 2007, 6: 401-402.
3. 白沖. 慢性阻塞性肺疾病的危險因素、流行情況及未來發(fā)展趨勢. 中國呼吸與危重監(jiān)護雜志, 2007, 6: 403-405.
4. 劉輝國, 徐永健. 慢性阻塞性肺疾病: 從氣道慢性炎癥到全身慢性炎癥. 中國呼吸與危重監(jiān)護雜志, 2007, 6: 410-4412.
5. Meijer E, Kromhoult H, Heederik D. Respiratory effects of exposure to low levels of concrete dust containing crystalline silica. Am J Ind Med, 2001, 40: 133-140.
6. Buist AS, Vollmer W, Weiss KB, et al. Burden of Obstructive Lung Disease ( BOLD) . Portland: University of Oregon, 2004. Available at: http: / /www. kpchr. org/ boldcopd/ apps / protocol. pdf ( accessed Apr 2005) .
7. Rothman K, Greenland S. Modern epidemiology. Philadelphia:Lippin-456. cott-Raven, 1998, 295.
8. Love RG, Miller BG. Longitudinal study of lung function in coalminers.Thorax, 1982, 37: 193-197.
9. Hnizdo E, Baskind E, Sluis-Cremer GK. Combined effect of silica dust exposure and tobacco smoking on the prevalence of respiratory impairments among gold miners. Scand J Work Environ Health,1990, 16: 411-422.
10. Ulvestad B, Bakke B, Eduard W, et al. Cumulative exposure to dust causes accelerated decline in lung function in tunnel workers. Occup Environ Med, 2001, 58: 663-669.
11. Irslinger GB, Visser PJ, Spangenberg PA. Asthma and chronic bronchitis in vanadium workers. Am J Ind Med, 1999, 35: 366 -374.
12. Wang ML, McCabe L, Hankison JL, et al. Longitudinal and crosssectional analyses of lung function in steelworkers. Am J Respir Crit Care Med, 1996, 153: 1907-1913.
13. Nemery B, Van Leemputten R, Goemaere E, et al. Lung function measurements over 21 days shiftwork in steelworkers from a standcasting department. Br J Ind Med, 1985, 42: 601-611.
14. Mastrangelo G, Tartari M, Fedeli U, et al. Ascertaining the risk of chronic obstructive pulmonary diseases in relation to occupation using a case-control design. Occup Med ( Lond ) , 2003, 53: 165 -172.
15. Kirkhorn SR, Garry VF. Agriculture lung diseases. Environ Health Perspect, 2000, 108( suppl 4) : 705-712.
16. Piirila PL, Nordman H, Korhonen OS, et al. A thirteen-year follow-up of respiratory effects of acute exposure to sulfur dioxide. Scand J Work Environ Health, 1996 , 22: 191 -196.
17. Becklake MR, Goldman HI, Bosman AR, et al. The long-term effects of exposure to nitrous fumes. Am Rev Tuberc, 1957, 76: 398-409.
18. Davison AG, Fayers PM, Newman Taylor AJ, et al. Cadmium fume inhalation and emphysema. Lancet, 1988, 1: 663-667.
19. Nakadate T, Aizawa Y, Yagami T, et al. Change in obstructive pulmonary function as a result of cumulative exposure to welding fumes as determined by agnetopneumography in Japanese arc welders. Occup Environ Med, 1998, 55: 673-677.
20. Hammond SK, Gold E, Baker R, et al. Respiratory Health Effects Related to Occupational Spray Painting and Welding. J Occup Environ Med, 2005, 47: 728-739.
21. Bradshaw LM, Fishwick D, Slater T, et al. Chronic bronchitis, work related respiratory symptoms, and pulmonary function in welders in New Zealand. Occup Environ Med, 1998, 55: 150 -154.
22. Sobaszek A, Boulenguez C, Frimat P, et al. Acute respiratory effects of exposure to stainless steel and mild steel welding fumes. J Occup Environ Med, 2000, 42: 923-931.
23. 劉春濤, 馮玉麟. 慢性阻塞性肺疾病全球創(chuàng)議慢性阻塞性肺疾病診斷、管理和預防袖珍指南( 2006 年修訂版) . 中國呼吸與危重監(jiān)護雜志, 2007, 6: 230-237.
24. Trupin L, Earnest G, San Pedro M, et al. The occupational burden of chronic obstructive pulmonary disease. Eur Respir J, 2003, 22:462 -469.
25. Balmes J, Becklake M, Blanc P, et al. Occupational contribution to the burden of airway disease ( an official statement of the American Thoracic Society) . Am J Respir Crit Care Med, 2003, 167: 787-797.
26. Hnizdo E, Sullivan PA, Bang KM, et al. Association between chronic obstructive pulmonary disease and employment by industry and occupation in the U. S. population: a study of data from the Third National Health and Nutrition Examination Survey. Am J Epidemiol, 2002 ,156: 738-746.
27. Attfield MD. Longitudinal decline in FEV1 in United States coalminers. Thorax, 1985, 40: 132-137.
28. Kauffmann F, Drouet D, Lellouch J, et al. Occupational exposure and 12 year spirometric changes among Paris area workers. Br J Ind Med,1982, 39: 221-232.
29. Bergdahl IA, Toren K, Eriksson K, et al. Increased mortality in COPD among construction workers exposed to inorganic dust. Eur Respir J,2004, 23: 402-406.
30. Leigh JP, Romano PS, Schenker MB, et al. Costs of occupational chronic obstructive pulmonary disease and asthma. Chest, 2002, 121:264 -272.
31. Gomes J, Lloyd OL, Norman NJ, et al. Dust exposure and impairment of lung function at a small iron foundry in a rapidly developing country.Occup Environ Med, 2001, 58, 656-662.
32. Olenchock SA,May JJ, Pratt DS, et al. Presence of endotoxins in different agriculture environments. Am J Ind Med, 1990, 18: 279-284.
33. Jagielo PJ, Thorne PS, Watt JL, et al. dust and endotoxin inhalation challenges produce similar inflammatory responses in normal subjects. Chest, 1996, 110: 263-270.
  1. 1. National Heart, Lung, and Blood Institute and World Health Organization.Global initiative for chronic obstructive lung disease: a collaborative project of the National, Heart, Lung, and Blood Institute and the World Health ganization. Bethesda, MD: National Institutes of Health, 2001.
  2. 2. 王曾禮. 更新對慢性阻塞性肺疾病認識的觀念. 中國呼吸與危重監(jiān)護雜志, 2007, 6: 401-402.
  3. 3. 白沖. 慢性阻塞性肺疾病的危險因素、流行情況及未來發(fā)展趨勢. 中國呼吸與危重監(jiān)護雜志, 2007, 6: 403-405.
  4. 4. 劉輝國, 徐永健. 慢性阻塞性肺疾病: 從氣道慢性炎癥到全身慢性炎癥. 中國呼吸與危重監(jiān)護雜志, 2007, 6: 410-4412.
  5. 5. Meijer E, Kromhoult H, Heederik D. Respiratory effects of exposure to low levels of concrete dust containing crystalline silica. Am J Ind Med, 2001, 40: 133-140.
  6. 6. Buist AS, Vollmer W, Weiss KB, et al. Burden of Obstructive Lung Disease ( BOLD) . Portland: University of Oregon, 2004. Available at: http: / /www. kpchr. org/ boldcopd/ apps / protocol. pdf ( accessed Apr 2005) .
  7. 7. Rothman K, Greenland S. Modern epidemiology. Philadelphia:Lippin-456. cott-Raven, 1998, 295.
  8. 8. Love RG, Miller BG. Longitudinal study of lung function in coalminers.Thorax, 1982, 37: 193-197.
  9. 9. Hnizdo E, Baskind E, Sluis-Cremer GK. Combined effect of silica dust exposure and tobacco smoking on the prevalence of respiratory impairments among gold miners. Scand J Work Environ Health,1990, 16: 411-422.
  10. 10. Ulvestad B, Bakke B, Eduard W, et al. Cumulative exposure to dust causes accelerated decline in lung function in tunnel workers. Occup Environ Med, 2001, 58: 663-669.
  11. 11. Irslinger GB, Visser PJ, Spangenberg PA. Asthma and chronic bronchitis in vanadium workers. Am J Ind Med, 1999, 35: 366 -374.
  12. 12. Wang ML, McCabe L, Hankison JL, et al. Longitudinal and crosssectional analyses of lung function in steelworkers. Am J Respir Crit Care Med, 1996, 153: 1907-1913.
  13. 13. Nemery B, Van Leemputten R, Goemaere E, et al. Lung function measurements over 21 days shiftwork in steelworkers from a standcasting department. Br J Ind Med, 1985, 42: 601-611.
  14. 14. Mastrangelo G, Tartari M, Fedeli U, et al. Ascertaining the risk of chronic obstructive pulmonary diseases in relation to occupation using a case-control design. Occup Med ( Lond ) , 2003, 53: 165 -172.
  15. 15. Kirkhorn SR, Garry VF. Agriculture lung diseases. Environ Health Perspect, 2000, 108( suppl 4) : 705-712.
  16. 16. Piirila PL, Nordman H, Korhonen OS, et al. A thirteen-year follow-up of respiratory effects of acute exposure to sulfur dioxide. Scand J Work Environ Health, 1996 , 22: 191 -196.
  17. 17. Becklake MR, Goldman HI, Bosman AR, et al. The long-term effects of exposure to nitrous fumes. Am Rev Tuberc, 1957, 76: 398-409.
  18. 18. Davison AG, Fayers PM, Newman Taylor AJ, et al. Cadmium fume inhalation and emphysema. Lancet, 1988, 1: 663-667.
  19. 19. Nakadate T, Aizawa Y, Yagami T, et al. Change in obstructive pulmonary function as a result of cumulative exposure to welding fumes as determined by agnetopneumography in Japanese arc welders. Occup Environ Med, 1998, 55: 673-677.
  20. 20. Hammond SK, Gold E, Baker R, et al. Respiratory Health Effects Related to Occupational Spray Painting and Welding. J Occup Environ Med, 2005, 47: 728-739.
  21. 21. Bradshaw LM, Fishwick D, Slater T, et al. Chronic bronchitis, work related respiratory symptoms, and pulmonary function in welders in New Zealand. Occup Environ Med, 1998, 55: 150 -154.
  22. 22. Sobaszek A, Boulenguez C, Frimat P, et al. Acute respiratory effects of exposure to stainless steel and mild steel welding fumes. J Occup Environ Med, 2000, 42: 923-931.
  23. 23. 劉春濤, 馮玉麟. 慢性阻塞性肺疾病全球創(chuàng)議慢性阻塞性肺疾病診斷、管理和預防袖珍指南( 2006 年修訂版) . 中國呼吸與危重監(jiān)護雜志, 2007, 6: 230-237.
  24. 24. Trupin L, Earnest G, San Pedro M, et al. The occupational burden of chronic obstructive pulmonary disease. Eur Respir J, 2003, 22:462 -469.
  25. 25. Balmes J, Becklake M, Blanc P, et al. Occupational contribution to the burden of airway disease ( an official statement of the American Thoracic Society) . Am J Respir Crit Care Med, 2003, 167: 787-797.
  26. 26. Hnizdo E, Sullivan PA, Bang KM, et al. Association between chronic obstructive pulmonary disease and employment by industry and occupation in the U. S. population: a study of data from the Third National Health and Nutrition Examination Survey. Am J Epidemiol, 2002 ,156: 738-746.
  27. 27. Attfield MD. Longitudinal decline in FEV1 in United States coalminers. Thorax, 1985, 40: 132-137.
  28. 28. Kauffmann F, Drouet D, Lellouch J, et al. Occupational exposure and 12 year spirometric changes among Paris area workers. Br J Ind Med,1982, 39: 221-232.
  29. 29. Bergdahl IA, Toren K, Eriksson K, et al. Increased mortality in COPD among construction workers exposed to inorganic dust. Eur Respir J,2004, 23: 402-406.
  30. 30. Leigh JP, Romano PS, Schenker MB, et al. Costs of occupational chronic obstructive pulmonary disease and asthma. Chest, 2002, 121:264 -272.
  31. 31. Gomes J, Lloyd OL, Norman NJ, et al. Dust exposure and impairment of lung function at a small iron foundry in a rapidly developing country.Occup Environ Med, 2001, 58, 656-662.
  32. 32. Olenchock SA,May JJ, Pratt DS, et al. Presence of endotoxins in different agriculture environments. Am J Ind Med, 1990, 18: 279-284.
  33. 33. Jagielo PJ, Thorne PS, Watt JL, et al. dust and endotoxin inhalation challenges produce similar inflammatory responses in normal subjects. Chest, 1996, 110: 263-270.

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