淮北矿业集团尘肺合并结核的现状及流行特征
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摘要
[背景]尘肺病是我国发病人数最多、危害最广的职业病,且尘肺病病情的进展不可逆转。由于尘肺患者的肺组织损伤,机体防御功能下降以及免疫功能障碍,极易合并肺结核。尘肺合并结核的病理基础复杂,并且该类患者往往对抗结核药物呈现较高的耐药性,治疗困难。[目的 ]为了更有针对性地制定尘肺结核的预防控制措施,调查淮北矿业集团尘肺合并结核的现状及流行特征。[方法 ]对淮北矿业集团从1963年11月1日至2017年12月31日在本职业病防治院确诊的全部尘肺病例的职业病诊断资料(包含死亡病例)进行调查,查阅尘肺病诊断档案及相关资料,内容包括用人单位、姓名、性别、出生日期、统计工种、开始接尘日期、接尘工龄、尘肺种类、诊断期别及时间、合并肺结核的时间及期别等。描述尘肺合并结核发生的三间分布特征,采用logistic回归分析其可能的影响因素。[结果 ]已确诊6 460例尘肺患者,发病年龄为(51.26±9.27)岁,开始接尘年龄为(23.29±4.88)岁,接尘工龄为(23.19±7.56)年。其中,尘肺合并结核患者共1 141名,发生率为17.66%(1 141/6 460)。尘肺合并结核的发生与接尘年代(OR=0.480)、接尘工龄(OR=0.801)、开始接尘年龄(OR=1.281)、尘肺期别(OR=2.167)有关。[结论 ]尘肺合并结核发生率随开始接尘年龄和尘肺期别的增加而升高,随接尘年代和接尘工龄的增加而降低。应从尘肺和结核的预防双管齐下,以更好地控制尘肺结核的发生。
[Background] Pneumoconiosis is the most prevalent and widest damaging occupational disease in China, and it is irreversible. Due to lung tissue damage, declined body defense, and immune dysfunction, pneumoconiosis patients are prone to developing tuberculosis. Pneumoconiosis complicated with tuberculosis shows complex pathological manifestations, and the patients are often highly resistant to antituberculous drugs, resulting in difficulties in treatment.[Objective] In order to make more tailored prevention and control measures against pneumoconiosis, we investigate the prevalence and epidemiological characteristics of pneumoconiosis complicated with tuberculosis in Huaibei Mining Group.[Methods] The data on occupational disease diagnosis of all pneumoconiosis cases(including deaths) in Huaibei Mining Group diagnosed by Huaibei Occupational Disease Prevention and Treatment Institute from 1 November 1963 to 31 December 2017 were retrospectively analyzed, including work unit, name, gender, date of birth, type of work, date of first dust exposure, length of dust exposure, pneumoconiosis type, diagnosis time and stage of pneumoconiosis, diagnosis time and stage of concurrent tuberculosis. The temporal, spatial, and population distributions of the disease were described and related factors were evaluated.[Results] In a total of 6 460 confirmed pneumoconiosis patients, the age of onset was(51.26±9.27) years, the age of first dust exposure was(23.29±4.88) years, the length of dust exposure was(23.19±7.56) years. Among them, 1 141(17.66%) were pneumoconiosis patients complicated with tuberculosis. Pneumoconiosis accompanied by tuberculosis was associated with the year of dust exposure(OR=0.480), length of dust exposure(OR=0.801), age of first dust exposure(OR=1.281), and pneumoconiosis stage(OR=2.167). [Conclusion] The prevalence rate of pneumoconiosis accompanied by tuberculosis increases with older age of first dust exposure and increased pneumoconiosis stage, and decreases with prolonged year of dust exposure and length of dust exposure. Therefore, a twopronged approach combining both pneumoconiosis and tuberculosis prevention is suggested for the control of the coinfection.
[Background] Pneumoconiosis is the most prevalent and widest damaging occupational disease in China, and it is irreversible. Due to lung tissue damage, declined body defense, and immune dysfunction, pneumoconiosis patients are prone to developing tuberculosis. Pneumoconiosis complicated with tuberculosis shows complex pathological manifestations, and the patients are often highly resistant to antituberculous drugs, resulting in difficulties in treatment.[Objective] In order to make more tailored prevention and control measures against pneumoconiosis, we investigate the prevalence and epidemiological characteristics of pneumoconiosis complicated with tuberculosis in Huaibei Mining Group.[Methods] The data on occupational disease diagnosis of all pneumoconiosis cases(including deaths) in Huaibei Mining Group diagnosed by Huaibei Occupational Disease Prevention and Treatment Institute from 1 November 1963 to 31 December 2017 were retrospectively analyzed, including work unit, name, gender, date of birth, type of work, date of first dust exposure, length of dust exposure, pneumoconiosis type, diagnosis time and stage of pneumoconiosis, diagnosis time and stage of concurrent tuberculosis. The temporal, spatial, and population distributions of the disease were described and related factors were evaluated.[Results] In a total of 6 460 confirmed pneumoconiosis patients, the age of onset was(51.26±9.27) years, the age of first dust exposure was(23.29±4.88) years, the length of dust exposure was(23.19±7.56) years. Among them, 1 141(17.66%) were pneumoconiosis patients complicated with tuberculosis. Pneumoconiosis accompanied by tuberculosis was associated with the year of dust exposure(OR=0.480), length of dust exposure(OR=0.801), age of first dust exposure(OR=1.281), and pneumoconiosis stage(OR=2.167). [Conclusion] The prevalence rate of pneumoconiosis accompanied by tuberculosis increases with older age of first dust exposure and increased pneumoconiosis stage, and decreases with prolonged year of dust exposure and length of dust exposure. Therefore, a twopronged approach combining both pneumoconiosis and tuberculosis prevention is suggested for the control of the coinfection.
引文
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[11]张晖,陈胜利,方伟军,等.尘肺结核的胸部数字化X线摄影和螺旋CT表现分析[J].现代医用影像学,2013,22(4):272-275.
[12]孙治平,李宝平,高丽妮,等.尘肺合并肺结核诊断方法的研究进展[J].职业与健康,2015,31(23):3356-3358.
[13]李俊国,常利民.两煤矿1 107例尘肺病患者合并结核情况的调查分析[J].职业与健康,2010,26(10):1106-1107.
[14]丁丽,王伟,许雪春,等.矽肺患者结核分枝杆菌临床分离培养与抗结核药物敏感检测[J].中国职业医学,2015,42(1):46-48.
[15]CHAUDHURY N,PALIWAL R,PHATAK A,et al.Comorbidities among silicotics at Shakarpur:a follow up study[J].Lung India,2012,29(1):6-10.
[16]唐桂钰.河北钢铁集团接尘工人尘肺结核流行规律及其发病影响因素研究[D].唐山:河北联合大学,2011.
[17]靳妍.煤工尘肺结核潜伏感染现况及发病影响因素研究[D].北京:中国疾病预防控制中心,2018.
[18]王一丹,唐浩,陈卉,等.尘肺病合并肺结核发生情况的meta分析[J].职业与健康,2015,31(1):16-19.
[19]赵杰,姜海强,李晓然.2005-2014年辽宁省某地区尘肺并发肺结核病例特征[J].中国疗养医学,2018,27(1):12-14.
[2]SCHELDE J,AUTHRIED G,MADSEN H D,et al.Working as a sandblaster can cause silicosis[J].Ugeskr Laeger,2015,177(2A):46-47.
[3]ALTIN?Z H,?ELIKKALKAN C,HORASAN G D,et al.Sociodemographic and clinical characteristics of Turkish workers with pneumoconiosis[J].Cent Eur J Public Health,2016,24(3):231-233.
[4]张敏,王丹,郑迎东,等.中国1997至2009年报告尘肺病发病特征和变化趋势[J].中华劳动卫生职业病杂志,2013,31(5):321-334.
[5]马英华,邵华.我国煤矿接尘工人尘肺合并结核的现状及防治[J].职业与健康,2015,31(5):710-713.
[6]苏冬梅.150例I期煤工尘肺患者肺功能检测与分析[J].中国工业医学,2004,17(2):114-115.
[7]杨力,张钊,左云.尘肺合并肺结核的诊治研究进展概述[J].职业卫生与病伤,2015,30(6):381-383.
[8]詹凤侠.尘肺合并肺结核的诊治研究进展(综述)[J].安徽卫生职业技术学院学报,2014,13(1):24-25.
[9]崔风涛,许洁,沈福海,等.某矿业集团1 977例尘肺病患者死因分析[J].职业与健康,2014,30(22):3196-3198.
[10]荣城.尘肺合并肺结核的X线及CT诊断回顾性分析[J].江西医药,2012,47(1):71,40.
[11]张晖,陈胜利,方伟军,等.尘肺结核的胸部数字化X线摄影和螺旋CT表现分析[J].现代医用影像学,2013,22(4):272-275.
[12]孙治平,李宝平,高丽妮,等.尘肺合并肺结核诊断方法的研究进展[J].职业与健康,2015,31(23):3356-3358.
[13]李俊国,常利民.两煤矿1 107例尘肺病患者合并结核情况的调查分析[J].职业与健康,2010,26(10):1106-1107.
[14]丁丽,王伟,许雪春,等.矽肺患者结核分枝杆菌临床分离培养与抗结核药物敏感检测[J].中国职业医学,2015,42(1):46-48.
[15]CHAUDHURY N,PALIWAL R,PHATAK A,et al.Comorbidities among silicotics at Shakarpur:a follow up study[J].Lung India,2012,29(1):6-10.
[16]唐桂钰.河北钢铁集团接尘工人尘肺结核流行规律及其发病影响因素研究[D].唐山:河北联合大学,2011.
[17]靳妍.煤工尘肺结核潜伏感染现况及发病影响因素研究[D].北京:中国疾病预防控制中心,2018.
[18]王一丹,唐浩,陈卉,等.尘肺病合并肺结核发生情况的meta分析[J].职业与健康,2015,31(1):16-19.
[19]赵杰,姜海强,李晓然.2005-2014年辽宁省某地区尘肺并发肺结核病例特征[J].中国疗养医学,2018,27(1):12-14.
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