职业性三氯乙烯药疹样皮炎病例随访报告
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摘要
目的了解职业性三氯乙烯药疹样皮炎(OMDT)康复患者的远期预后。方法采用电话、信件等方法对185例OMDT康复患者进行随访,安排19例随访患者(随访检查组)住院进行健康检查。结果成功随访71例患者,随访成功率为38. 4%(71/185)。64. 8%(46/71)成功随访患者自述出现皮肤瘙痒、易过敏、经常发生上呼吸道感染或发热、干眼症和股骨头缺血性坏死等。19例随访检查组患者存在不同程度的皮肤搔痒、干燥和轻度黑色素沉着;左、右眼泪液分泌试验异常率分别为42. 1%(8/19)、52. 6%(10/19);左、右眼泪膜破裂时间试验异常率均为84. 2%(16/19);斑贴试验阳性率最高为水合氯醛(100. 0%);体温、浅表淋巴结均无异常,未见新皮疹,血常规、尿常规、肝功能和自身免疫抗体检查均未见异常。结论 OMDT康复患者可发生不同程度的远期预后,干眼症和股骨头缺血性坏死可能是其主要后遗症之一。三氯乙烯主要代谢产物水合氯醛可能是OMDT的主要致敏物质。
Objective To understand the long-term prognosis of patients with occupational medicamentosa-like dermatitis induced by trichloroethylene( OMDT) after recovery. Methods A total of 185 patients with OMDT were surveyed through landline and correspondence after recovery. Based on the individual's wishes,19 patients( follow-up examination group)were followed up and arranged for health examination in hospital. Results Seventy-one cases of OMDT was successfully follow-up. The success rate was 38. 4%( 71/185). Among the 71 cases who were successfully followed up,64. 8%( 46/71)cases complained of physical discomfort. The main complain included skin itching,allergy,upper respiratory tract infection or frequent fever,xerophthalmus,osteonecrosis of femoral head. The 19 cases in the follow-up examination group had different degrees of skin itching,dryness and mild melanosis. The abnormal rates of schirmer I test were 42. 1%( 8/19)and 52. 6%( 10/19) in the left and right eye,respectively. The abnormal rate of tear break-up time in both left and right eyes was 84. 2%( 16/19). The highest positive rate of patch test was chloral hydrate( 100. 0%). There was no abnormality in body temperature,superficial lymph nodes,blood routine,urine routine,liver function and autoimmunity antibody. There was no new rash. Conclusion Different degree of long-term prognosis can occur in OMDT recovery patients. Xerophthalmus and osteonecrosis of femoral head are the major sequelae. Chloral hydrate,which is the main metabolite of trichloroethylene,may be the causative culprit compound for OMDT.
Objective To understand the long-term prognosis of patients with occupational medicamentosa-like dermatitis induced by trichloroethylene( OMDT) after recovery. Methods A total of 185 patients with OMDT were surveyed through landline and correspondence after recovery. Based on the individual's wishes,19 patients( follow-up examination group)were followed up and arranged for health examination in hospital. Results Seventy-one cases of OMDT was successfully follow-up. The success rate was 38. 4%( 71/185). Among the 71 cases who were successfully followed up,64. 8%( 46/71)cases complained of physical discomfort. The main complain included skin itching,allergy,upper respiratory tract infection or frequent fever,xerophthalmus,osteonecrosis of femoral head. The 19 cases in the follow-up examination group had different degrees of skin itching,dryness and mild melanosis. The abnormal rates of schirmer I test were 42. 1%( 8/19)and 52. 6%( 10/19) in the left and right eye,respectively. The abnormal rate of tear break-up time in both left and right eyes was 84. 2%( 16/19). The highest positive rate of patch test was chloral hydrate( 100. 0%). There was no abnormality in body temperature,superficial lymph nodes,blood routine,urine routine,liver function and autoimmunity antibody. There was no new rash. Conclusion Different degree of long-term prognosis can occur in OMDT recovery patients. Xerophthalmus and osteonecrosis of femoral head are the major sequelae. Chloral hydrate,which is the main metabolite of trichloroethylene,may be the causative culprit compound for OMDT.
引文
[1]李来玉,黄汉林,何家禧,等.广东150例职业性三氯乙烯药疹样皮炎病例的职业流行病学调查[J].中国职业医学,2006,33(5):333-336.
[2]赵金垣.临床职业病学[M].3版.北京:北京大学医学出版社,2017:362-367.
[3]HUANG Y,XIA L,WU Q,et al.Trichloroethylene hypersensitivity syndrome is potentially mediated through its metabolite chloral hydrate[J].PLo S One,2015,10(5):e127101.
[4]黄永顺,夏丽华,吴奇峰,等.职业性三氯乙烯药疹样皮炎致敏物筛查[J].中国职业医学,2018,45(6):669-674.
[5]YANG X Q,LI W X,LI P M,et al.Cytokine expression and cytokine-based T-cell profiling in occupational medicamentosa-like dermatitis due to trichloroethylene[J].Toxicol Lett,2018,288:129-135.
[6]HUANG Y S,HUANG H L,WU Q F,et al.Follow-up assessment of two cases of trichloroethylene hypersensitivity syndrome:a case report[J].Exp Ther Med,2016,12(2):895-900.
[7]吴奇峰,夏丽华,曾子芳,等.职业性三氯乙烯药疹样皮炎临床路径研制[J].中国职业医学,2017,44(4):420-424,429.
[8]CHIU W A,JINOT J,SCOTT C S,et al.Human health effects of trichloroethylene:key findings and scientific issues[J].Environ Health Perspect,2013,121(3):303-311.
[9]BUHAGEN M,GRNSKAG A,RAGDE S F,et al.Association between kidney cancer and occupational exposure to trichloroethylene[J].J Occup Environ Med,2016,58(9):957-959.
[10]中华人民共和国卫生部.职业性三氯乙烯药疹样皮炎诊断标准:GBZ 185-2006[S].北京:人民卫生出版社,2007.
[11]中华医学会眼科学分会角膜病学组.干眼症临床诊疗专家共识(2013年)[J].中华眼科杂志,2013,49(1):73-75.
[12]李武.青少年社会化阅读动机研究:以上海初高中生微信阅读为例[J].中国图书馆学报,2014,40(6):115-128.
[13]宋全成.论自媒体的特征、挑战及其综合管制问题[J].南京社会科学,2015(3):112-120.
[14]曾平,梁景超,周怡,等.激素性股骨头坏死血清差异蛋白质组学研究[J].实用医学杂志,2015,31(10):1617-1620.
[15]惠银银,刘又斌,王晶,等.非创伤性股骨头坏死病因的研究进展[J].中医正骨,2018,30(2):33-36,40.
[16]周燕琳,杜晓刚.糖皮质激素相关性股骨头坏死早期防治的研究进展[J].医学综述,2018,24(4):672-676.
[17]张龙,韦标方.激素性股骨头坏死发病机制的研究进展[J].风湿病与关节炎,2018,7(3):73-76.
[18]高宏生,王世鑫,曹霞,等.SARS患者康复期股骨头缺血性坏死的巢式病例对照研究[J].武警医学院学报,2005,14(1):11-13.
[19]李玉明,王世鑫,高宏生,等.严重急性呼吸综合征患者康复期股骨头缺血性坏死和骨质疏松的影响因素[J].中华医学杂志,2004,84(16):1348-1353.
[20]WU H,WANG Y,DONG N,et al.Meibomian gland dysfunction determines the severity of the dry eye conditions in visual display terminal workers[J].PLo S One,2014,9(8):e105575.
[21]唐颖,田甜,葛红岩.干眼症发病机制与发病因素的研究进展[J].医学综述,2019,25(11):2196-2201.
[22]王姝丹,张红,金鑫,等.干眼症的免疫调节机制及相关治疗新进展[J].现代生物医学进展,2019,19(3):572-575.
[23]何彦,张爱雪,王智群,等.45例Stevens-Johnson综合征眼部并发症的临床分析[J].眼科,2016,25(6):382-386.
[24]SOTOZONO C,UETA M,YOKOI N.Severe dry eye with combined mechanisms is involved in the ocular sequelae of SJS/TEN at the chronic stage[J].Invest Ophthalmol Vis Sci,2018,59(14):DES80-DES86.
[25]ZHANG J X,LI N,WANG H,et al.The immune response in trichloroethylene hypersensitivity syndrome:a review[J].Toxicol Ind Health,2017,33(11):876-883.
[26]吴洁,王海兰,吴奇峰,等.三氯乙烯对人活化T细胞免疫毒性作用及机制研究[J].中国职业医学,2017,44(1):1-6,13.
[27]WATANABE H,TOHYAMA M,KAMIJIMA M,et al.Occupational trichloroethylene hypersensitivity syndrome with human herpesvirus-6 and cytomegalovirus reactivation[J].Dermatology,2010,221(1):17-22.
[28]VARSHNEY M,CHANDRA A,CHAUHAN L K,et al.Micronucleus induction by oxidative metabolites of trichloroethylene in cultured human peripheral blood lymphocytes:a comparative genotoxicity study[J].Environ Sci Pollut Res Int,2013,20(12):8709-8716.
[2]赵金垣.临床职业病学[M].3版.北京:北京大学医学出版社,2017:362-367.
[3]HUANG Y,XIA L,WU Q,et al.Trichloroethylene hypersensitivity syndrome is potentially mediated through its metabolite chloral hydrate[J].PLo S One,2015,10(5):e127101.
[4]黄永顺,夏丽华,吴奇峰,等.职业性三氯乙烯药疹样皮炎致敏物筛查[J].中国职业医学,2018,45(6):669-674.
[5]YANG X Q,LI W X,LI P M,et al.Cytokine expression and cytokine-based T-cell profiling in occupational medicamentosa-like dermatitis due to trichloroethylene[J].Toxicol Lett,2018,288:129-135.
[6]HUANG Y S,HUANG H L,WU Q F,et al.Follow-up assessment of two cases of trichloroethylene hypersensitivity syndrome:a case report[J].Exp Ther Med,2016,12(2):895-900.
[7]吴奇峰,夏丽华,曾子芳,等.职业性三氯乙烯药疹样皮炎临床路径研制[J].中国职业医学,2017,44(4):420-424,429.
[8]CHIU W A,JINOT J,SCOTT C S,et al.Human health effects of trichloroethylene:key findings and scientific issues[J].Environ Health Perspect,2013,121(3):303-311.
[9]BUHAGEN M,GRNSKAG A,RAGDE S F,et al.Association between kidney cancer and occupational exposure to trichloroethylene[J].J Occup Environ Med,2016,58(9):957-959.
[10]中华人民共和国卫生部.职业性三氯乙烯药疹样皮炎诊断标准:GBZ 185-2006[S].北京:人民卫生出版社,2007.
[11]中华医学会眼科学分会角膜病学组.干眼症临床诊疗专家共识(2013年)[J].中华眼科杂志,2013,49(1):73-75.
[12]李武.青少年社会化阅读动机研究:以上海初高中生微信阅读为例[J].中国图书馆学报,2014,40(6):115-128.
[13]宋全成.论自媒体的特征、挑战及其综合管制问题[J].南京社会科学,2015(3):112-120.
[14]曾平,梁景超,周怡,等.激素性股骨头坏死血清差异蛋白质组学研究[J].实用医学杂志,2015,31(10):1617-1620.
[15]惠银银,刘又斌,王晶,等.非创伤性股骨头坏死病因的研究进展[J].中医正骨,2018,30(2):33-36,40.
[16]周燕琳,杜晓刚.糖皮质激素相关性股骨头坏死早期防治的研究进展[J].医学综述,2018,24(4):672-676.
[17]张龙,韦标方.激素性股骨头坏死发病机制的研究进展[J].风湿病与关节炎,2018,7(3):73-76.
[18]高宏生,王世鑫,曹霞,等.SARS患者康复期股骨头缺血性坏死的巢式病例对照研究[J].武警医学院学报,2005,14(1):11-13.
[19]李玉明,王世鑫,高宏生,等.严重急性呼吸综合征患者康复期股骨头缺血性坏死和骨质疏松的影响因素[J].中华医学杂志,2004,84(16):1348-1353.
[20]WU H,WANG Y,DONG N,et al.Meibomian gland dysfunction determines the severity of the dry eye conditions in visual display terminal workers[J].PLo S One,2014,9(8):e105575.
[21]唐颖,田甜,葛红岩.干眼症发病机制与发病因素的研究进展[J].医学综述,2019,25(11):2196-2201.
[22]王姝丹,张红,金鑫,等.干眼症的免疫调节机制及相关治疗新进展[J].现代生物医学进展,2019,19(3):572-575.
[23]何彦,张爱雪,王智群,等.45例Stevens-Johnson综合征眼部并发症的临床分析[J].眼科,2016,25(6):382-386.
[24]SOTOZONO C,UETA M,YOKOI N.Severe dry eye with combined mechanisms is involved in the ocular sequelae of SJS/TEN at the chronic stage[J].Invest Ophthalmol Vis Sci,2018,59(14):DES80-DES86.
[25]ZHANG J X,LI N,WANG H,et al.The immune response in trichloroethylene hypersensitivity syndrome:a review[J].Toxicol Ind Health,2017,33(11):876-883.
[26]吴洁,王海兰,吴奇峰,等.三氯乙烯对人活化T细胞免疫毒性作用及机制研究[J].中国职业医学,2017,44(1):1-6,13.
[27]WATANABE H,TOHYAMA M,KAMIJIMA M,et al.Occupational trichloroethylene hypersensitivity syndrome with human herpesvirus-6 and cytomegalovirus reactivation[J].Dermatology,2010,221(1):17-22.
[28]VARSHNEY M,CHANDRA A,CHAUHAN L K,et al.Micronucleus induction by oxidative metabolites of trichloroethylene in cultured human peripheral blood lymphocytes:a comparative genotoxicity study[J].Environ Sci Pollut Res Int,2013,20(12):8709-8716.