人造石英石板材加工矽肺患者临床特征及其作业环境调查

Investigation of clinical features and working environment of silicosis patients caused by agglomerated quartz stone processing dust

[背景]人造石英石板材是一种广受欢迎的新型石材,其加工工人矽肺已多次见报道。[目的 ]了解人造石英石板材加工所致矽肺患者的临床特征及其相关作业环境和防护措施,以提高对该行业所致矽肺严重性的认识。[方法 ]以2015年1月—2018年12月期间在上海市肺科医院就诊,从事人造石英石板材加工,并且胸部CT异常的患者为对象,调查相应用人单位的作业环境、粉尘性质和浓度、粉尘防护情况以及患者接尘工龄、临床症状以及胸部影像学、肺功能情况。[结果] 98名患者均为进城务工农民,86例(87.8%)在未经注册的加工作坊工作,没有任何粉尘防护设备。5家加工作坊和安装现场的空气中粉尘质量浓度分别为(351.0±30.76)mg/m3和(127.6±17.36)mg/m3,粉尘中α-石英含量在70%~99%之间。79例(80.6%)的患者因咳嗽、劳力性呼吸困难等明显呼吸系统症状就诊。在2个月~2年间复查胸片的患者23例;其中,13例(56.5%)病例晋期,晋期时间最短的2个月,最长的2年,平均0.8年。98例患者CT主要表现为广泛小结节影、磨玻璃影、融合团块、斑片影/小阴影聚集、肺气肿/肺大泡。22例(22.4%)患者并发气胸,8例(8.2%)患者出现肺内空洞。在2个月~2年期间复查胸部CT的67例中,60例(89.6%)病例CT表现小结节影增多、出现团块影、肺气肿加重或出现空洞等。[结论 ]人造石英石板材加工粉尘所致快进型矽肺,接尘工龄短,病情严重,并发症多,进展快,预后差。亟待普及职业卫生知识和加强新型建材行业职业病防治监管力度。

[Background]Agglomerated quartz stone is a popular new stone material,and silicosis associated with its processing has been reported many times.[Objective]This article aims to improve the understanding of the severity of silicosis in that industry by analysis of clinical characteristics of silicosis caused by agglomerated quartz stone processing,related working environment,and installed protective measures.[Methods]Workplace environment,air dust components and concentrations,dust protective measures,as well as patients’dust exposure duration,symptoms,radiological images,and lung functions were retrospectively analyzed in agglomerated quartz associated silicosis patients with abnormal CT scan results from January 2015 to December 2018 in Shanghai Pulmonary Hospital.[Results]All subjects(n=98)were migrant workers,and 86 cases(87.8%)worked in unregistered workshops without any dust protective equipment.The average air dust concentrations in workshops and countertop installation sites were(351.0±30.76)mg/m3 and(127.6±17.36)mg/m3,respectively.The content ofα-quartz in the dust samples ranged from 70%to 99%.Respiratory symptoms such as cough and exertional dyspnea were the main causes of hospital visit in 79(80.6%)patients.There were 23 patients who reexamined chest X-ray 2 months to 2 years after the first chest radiograph;among them 13(56.5%)patients were advanced from a lower stage to a higher stage with a median time(range)of 0.8 years(from 2 months to 2 years).The manifestations of CT scans in all subjects were mainly extensive nodules,ground glass opacities,massive fibrosis,patchy shadows,nodule coalescence,emphysema,and bullae.Besides,22 cases(22.4%)were complicated with pneumothorax and 8 cases(8.2%)with cavity in lung.Among the 67 patients who reexamined chest CT scan 2 months to 2 years after the first chest CT scan,60(89.6%)patients showed increased nodules,massive fibrosis shadows,aggregated emphysema,or cavity in lung in CT scans.[Conclusion]Accelerated silicosis caused by agglomerated quartz plate processing dust is a serious disease of short dust exposure duration,severe results,frequent complications,rapid progress,and poor prognosis;therefore,it is urgent to conduct occupational health education and strengthen legal supervision in the new type stone materials industry.