人造石矽肺流行病学和临床特征与粉尘防护的系统性综述

A systematic review of the epidemiology and clinical characteristics of artificial stone-related silicosis and dust protection

目的探讨人造石矽肺患者的流行病学、临床特征、现场粉尘监测与个体防护。方法于2022年3月,在中国期刊全文数据库、万方数据库、维普数据库、EMbase和PubMed中检索1965年1月至2022年2月发表的有关人造石矽肺的文献,中英文检索词包括"矽尘""二氧化硅粉尘""人造石矽肺""矽肺""silica dust""silicon dioxide dust""artificial stone""pneumoconiosis"等。按照入选和排除标准纳入文献,并提取数据;采用系统性综述方法分析人造石矽肺患者的流行病学特征、自然病程,以及工作场所粉尘浓度与个体防护水平。结果纳入文献30篇,其中队列研究7篇、横断面研究14篇、病例对照研究3篇和病例报道6篇,共1358例人造石矽肺患者,年龄平均为41.5岁,接尘时间平均为11.3年,诊断时间为1997至2020年。其中36.2%(282/778)首诊为进展性大块纤维化或快速进展性矽肺。患者胸部影像表现为弥漫性小结节影、肺纤维化和矽性肺泡蛋白沉着症,肺功能表现为限制或混合性通气障碍伴或不伴弥散量下降,病情进展迅速,出现进展性大块纤维化、呼吸衰竭,甚至死亡。患者从事人造石英石加工,接触矽尘浓度高,超细颗粒物多,多为干式作业,现场通风设施缺乏,无有效的个体防护用品。结论人造石加工工人因干式作业、缺乏现场除尘设施和个体防护措施,罹患人造石矽肺,病情进展迅速,导致不良预后。

Objective To investigate the epidemiology,clinical characteristics,on-site dust monitoring and individual protection of the patients with artificial stone-related silicosis.Methods In March 2022,the literature on artificial stone-related silicosis published from January 1965 to February 2022 was searched in China Journal Full-text Database,Wanfang Database,VIP Database,EMbase and PubMed.Chinese and English search terms include"silica dust""silica dust""silicosis""artificial stone""pneumoconiosis",etc.References were included according to inclusion and exclusion criteria,and data were extracted.The epidemiological characteristics,natural course of disease,workplace dust concentration and individual protection level of patients with artificial stone-related silicosis were analyzed by systematic review.Results A total of 30 literatures were included,including 7 cohort studies,14 cross-sectional studies,3 case-control studies and 6 case reports.A total of 1358 patients with artificial stone-related silicosis were diagnosed from 1997 to 2020,with an average age of 41.5 years old and an average dust exposure time of 11.3 years.Among them,36.2%(282/778)had progressive mass fibrosis or accelerated progressive silicosis at first diagnosis.Chest imaging showed diffuse small nodule shadow,pulmonary fibrosis,and silico-alveolar proteinosis.Pulmonary function showed restricted or mixed ventilation disorder with or without decreased diffusion volume.The disease progressed rapidly,with progressive mass fibrosis,respiratory failure,and even death.Patients engaged in artificial quartz stone processing,with high concentration of silica including ultra-fine particles,most of which were dry operation,lack of on-site ventilation measures and no effective personal protection.Conclusion The artificial stone processing workers suffer from artificial stone-related silicosis due to dry cutting,lack of on-site dust removal facilities and personal protective measures,and the disease progresses rapidly,leading to poor prognosis.