三氧化二锑尘肺临床动态观察研究

A clinical dynamic observation on pneumoconiosis of antimony trioxide

目的探讨三氧化二锑(Sb2O3)粉尘职业接触对人体肺组织的损伤作用及脱离粉尘作业后病变的转归、机体对Sb2O3的清除作用。方法采用现场职业流行病学调查及临床动态观察的方法进行研究。结果包装岗位锑及其化合物平均浓度为3.03mg/m3。39例包装工中咳嗽、咯痰、慢性咽炎、胸片异常的发生率明显较对照组高(P<0.05),高千伏X射线胸片15例异常,其中3例确诊Ⅰ期Sb2O3尘肺,4例确诊为无尘肺(0+)。3例Sb2O3尘肺患者支气管肺活组织病理检查显示肺组织弥漫性炎性病变和少量胶原纤维形成。脱离粉尘作业的3例Sb2O3尘肺和4例无尘肺(0+)病例经住院治疗后,症状较前有所改善;高千伏X射线胸片观察见肺门密度增高影较前有增加,但肺野中弥漫性分布的圆形或不规则形影的分布范围与4年前比较无明显改变,肺区密集度仍在1/0级以上(病例)或0/1级[无尘肺(0+)病例]。其中4例自身前后比较,尿锑在脱尘第3年时(平均69.12mg/L)比脱尘第2年时(平均为212.5mg/L)明显减少(P<0.05)。结论人体对吸入并潴留于肺内的Sb2O3粉尘有一定的自净作用,但这一过程比较长,在此过程中Sb2O3粉尘可致肺组织弥漫性炎性病变、肺间质纤维化和少量胶原纤维形成,高千伏X射线胸片表现有1级密集度p或s影,Sb2O3粉尘可致尘肺。

Objective To investigate the harmful effects of antimony trioxide dust on lung, and the changes of pneumoconiosis in the workers after they were no longer exposed to the dust, and self-purification of the lung. Methods The study was carried out by an on site occupational epidemiological survey and a clinical dynamic observation. Results The average concentration of 3.03 mg/m^3 antimony and its＇ compound was found in the package post. In 39 packers, the incidence rates of cough, expectoration, chronic pharyngitis, abnormal X-ray findings were higher than those of the control group （ P 〈 0.05）. Among the 39 packers, 15 were found abnormal by X-ray. 3 of the packers were diagnosed antimony trioxide pneumoconiosis at stage Ⅰ , and 4 were at non-pneumoconiosis（ 0^＋ ）. The workers who had antimony trioxide pneumoconiosis were found light mesh and collagenous fibers hyperplasy in lung interstitium by lung biopsy. The clinical dynamic observation showed that the symptoms of 7 workers who had left the dust environment, and had been diagnosed antimony trioxide pneumoconiosis at stage 0^＋～ I improved compared to those four yeats ago, X-ray results showed that shadow of metal type in hilar lymph node were deepened than before, but the distribution range of punctiform, opacitas, mottled shadows of round or irregularity polygonal were not changed obviously compared to those found five years ago. Urine Sb was decrease obviously（P 〈 0. 01 ） in the third year（ average concentration 69. 12 mg/L） compared to the result in the second year（ average concentration 212.5 mg/L）. Conclusion Slight self-purification of antimony trioxide that was inhaled and retention in the lungs is found in human body, but it lasts a very long course. The dust can cause chronic alveolar and interstitium proliferous inflammation and slightly interstitium fibrous degeneration. X-ray showed s or p type shadows at the density of class 1. Antimony trioxide dust can induce pneumoconiosis.