煤矿工人和煤工尘肺患者的肺功能与血清克拉拉细胞蛋白水平

Serum Clara Cell Protein Level and Pulmonary Function of Coal Workers and Coal Workers' Pneumoconiosis Patients

[目的]探讨肺功能、血清克拉拉细胞蛋白(CC16)水平用于煤尘致肺早期损伤监测和煤工尘肺(CWP)病况判断的可行性。[方法]选取某煤矿工人64名(掘进工34人作为煤尘高暴露组、采煤工13人作为中暴露组、辅助工17人作为对照组),CWP患者45例(Ⅰ期23例、Ⅱ期19例、Ⅲ期3例),检测肺功能指标,含肺活量(VC)、第一秒呼气容积(FEV1)、用力肺活量(FVC)、第一秒呼气容积占用力肺活量的百分比[FEV1/FVC(%)]及血清CC16水平。[结果]单因素分析结果显示,不同组煤矿工人间以及不同期别CWP患者间的肺功能及血清CC16水平差异均无统计学意义;与无CWP工人相比,Ⅰ期CWP患者VC、FEV1、FEV1/FVC(%)及Ⅱ期CWP患者VC、FEV1及Ⅲ期CWP患者FEV1均降低(P<0.05或P<0.01)。多因素回归分析结果显示,肺功能状况与CWP期别有关(P<0.05);工龄的增加与血清CC16水平降低有关(P<0.05),OR=0.900(95%CI:0.823～0.985)。[结论]肺功能指标可应用于CWP病况判断,用于煤尘致肺早期损伤监测可能不够敏感;尚不能确定血清CC16可否用于煤尘致肺早期损伤监测及CWP病况判断。

[ Objective ] To explore the feasibility of pulmonary function and serum Clara cell protein level in early monitoring of pulmonary injury caused by dust and judgment of coal workers＇ pneumoconiosis （ CWP ） patient conditions. [ Methods ] Sixty four coal workers and forty five CWP patients including 23 phase Ⅰ, 19 phase Ⅱ and 3 phase Ⅲ patients were selected as participants and their pulmonary function and serum Clara cell protein level were tested. Among the 64 coal workers, 34 tunneling workers were assigned as high exposure group, 13 coal hewers as moderate exposure group and 17 auxiliary workers as control group. [ Results ] In the single factor analysis, indices of pulmonary function and serum Clara cell protein level were not statistically different among different groups of workers. VC, FEV1 and FEV1/FVC of phase I patients, VC and FEV1 of phase Ⅱ patients and FEV1 of phase Ⅲ patients were lower than those of coal workers without CWP（ P〈0.05, P〈0.01）. Serum Clara cell protein levels were not statistically different between CWP patients and coal workers without CWP. In the multivariate regression analysis, pulmonary function were correlated with the phases of CWP （P〈 0.05 ）. Serum Clara cell protein level decreased with increasing of the length of service （P 〈 0.05 ）and the estimated OR was 0.900 （95%CI： 0.823-0.985 ）. [ Conclusion ] Pulmonary function could be used for judgment of CWP patient conditions, but was not a sensitive index for monitoring early pulmonary injury. Confirmative conclusion was not found yet whether the serum Clara cell protein level could be used for early monitoring of pulmonary injury caused by dust and judgment of CWP patient conditions.