粉尘作业人员发生肺动脉高压的多因素分析

Multivariate analysis of pulmonary artery hypertension in workers exposed to dust

目的探讨粉尘作业人员发生肺动脉高压（PAH）的影响因素。方法选取工种、接尘时间、融合块形成以及肺气肿征象、肺大泡、继发性肺结核等尘肺病常见并发症为观察指标,进行非条件Logistic回归分析。多分类变量进行组内对照比较。结果粉尘作业人员发生PAH的独立危险因素包括：工种（P=0.036,OR=1.134）、接尘时间（P=0.016,OR=1.145）、融合块形成（P=0.001,OR=1.777）、肺气肿征象（P=0.004,OR=1.679）、继发性肺结核（P=0,OR=2.065）。工种组内比较显示,石匠与石料开采加工、石英砂接尘组发生PAH的可能性是其他组的1.59~2.545倍。随着接尘时间的增长,发生PAH的可能性成倍增加。结论接尘工人出现肺气肿征象、继发性肺结核等并发症应及时进行临床干预,阻止PAH的进展;不同工种的危险性、接尘时间的累积效应、融合块形成是预防PAH和改善预后中应引起重视的因素。

Objective To investigate the influential factors involved pulmonary artery hypertension（ PAH） in workers exposed to dust. Methods Work type,duration of dust exposure,masses formation and some complications such as emphysema,pulmonary bulla and secondary pulmonary tuberculosis etc. were selected as observation indeices. Multivariate analysis was performed to determine independent individual variables by Logistic regression analysis,meanwhile,the multiple categorical variables control comparison was performed as well within same group. Results The results showed that the independent risk factors of PAH were follows： work type（ P = 0. 036,OR = 1. 134）,duration of dust exposure（ P = 0. 016,OR = 1. 145）,masses formation（ P = 0. 001,OR = 1. 777）,emphysema（ P = 0. 004,OR = 1. 679） and secondary pulmonary tuberculosis（ P= 0,OR = 2. 065）. The odds of PAH in the group of stonemason,stone mining and processing workers and quartz sands exposed workers was 1. 59—2. 545 times of other work type group. Additionally,there was multipling increase with the prolongation of dust exposure. Conclusion The results suggested that the prompt intervention was required for some complications,such as emphysema,secondary pulmonary tuberculosis for avoiding the progression of PAH; additionally,the work obviously exposed to dusts,longer exposure duration to dustsand masses formation should be the factors worth attention in prevention of PAH and improvement of its prognosis.