叶开友, 陆辰汝, 刘晓晓, 潘引君, 赵锦江, 徐瑞芳. 黑刚玉粉尘所致铝尘肺发病的流行病学调查[J]. 环境与职业医学, 2019, 36(8): 750-754. DOI: 10.13213/j.cnki.jeom.2019.19116
引用本文: 叶开友, 陆辰汝, 刘晓晓, 潘引君, 赵锦江, 徐瑞芳. 黑刚玉粉尘所致铝尘肺发病的流行病学调查[J]. 环境与职业医学, 2019, 36(8): 750-754. DOI: 10.13213/j.cnki.jeom.2019.19116
YE Kai-you, LU Chen-ru, LIU Xiao-xiao, PAN Yin-jun, ZHAO Jin-jiang, XU Rui-fang. Epidemiologic investigation of aluminosis caused by black fused alumina dust[J]. Journal of Environmental and Occupational Medicine, 2019, 36(8): 750-754. DOI: 10.13213/j.cnki.jeom.2019.19116
Citation: YE Kai-you, LU Chen-ru, LIU Xiao-xiao, PAN Yin-jun, ZHAO Jin-jiang, XU Rui-fang. Epidemiologic investigation of aluminosis caused by black fused alumina dust[J]. Journal of Environmental and Occupational Medicine, 2019, 36(8): 750-754. DOI: 10.13213/j.cnki.jeom.2019.19116

黑刚玉粉尘所致铝尘肺发病的流行病学调查

Epidemiologic investigation of aluminosis caused by black fused alumina dust

  • 摘要: 背景 上海市青浦区某矿粉厂曾发生过多起黑刚玉粉尘所致的铝尘肺病,直至近年仍不断出现晚发铝尘肺病例。

    目的 分析黑刚玉粉尘所致铝尘肺尤其是晚发铝尘肺病例的发病特点和规律,以引起重视。

    方法 将上海市青浦区某矿粉厂1989—2014年初次诊断的83例铝尘肺病例作为研究对象,铝尘肺诊断的期别为初次诊断的结论。通过历史记录了解企业基本情况及现场粉尘暴露浓度。采用焦磷酸法测定黑刚玉粉尘游离SiO2含量。对不同工种尘肺累计发病情况、晚发(脱尘2年后诊断病例)壹期病例的潜伏期进行统计分析。

    结果 该厂使用的黑刚玉化学成分为Al2O3(75%)、Fe2O3(>15%)、TiO2(3%)、SiO2(7%);粉尘中游离SiO2含量为1.5%。现场粉尘浓度在同一工种中波动明显,在不同工种间差异亦较大,中位数在37.3~105.7 mg/m3。历年确诊的83例铝尘肺中,男17例,女66例;发病年龄为55.2(32.5~79.9)岁,接尘工龄为10.26(3.0~19.0)年。初次诊断壹期尘肺43例,发生晋期9例;贰期尘肺26例,发生晋期9例;叁期尘肺14例。截至2014年调查结束时,83例铝尘肺患者死亡20例(其中死亡时壹期10例,贰期8例,叁期2例),存活63例(其中壹期尘肺24例,贰期尘肺18例,叁期尘肺21例)。发病工人包括粉碎(轧砂)工、筛砂工、开档工和分档工,累计发病率依次为75.0%(21/28)、49.3%(35/71)、34.4(11/32)、30.2(16/53)。83例病例中有77例为晚发病例,晚发发生率高达92.8%。初次诊断43例壹期病例中有41例为晚发病例,晚发病例潜伏期最长为42.78年,最短为10.08年,平均潜伏期为(22.49±7.51)年;潜伏期为20~25年者占比最高(11/43,25.6%),潜伏期>30年者占比最低(5/43,11.6%)。不同工种晚发壹期铝尘肺潜伏期表现为粉碎工(17.80年)h筛砂工(20.97年)h开档工(25.99年)h分档工(27.30年)。

    结论 黑刚玉粉尘所致铝尘肺发病呈现累计发病率高、病例晚发现象、工种聚集性等特点,预测后续还将有铝尘肺病例出现。应加强脱尘工人职业健康监护,做到早发现、早诊断和早治疗。

     

    Abstract: Background Aluminosis cases caused by black fused alumina were reported in a mining powder factory in Qingpu District of Shanghai, and late-onset cases in the factory are stll emerging in recent years.

    Objectve This study is conducted to describe the epidemiologic characteristcs of aluminosis, especially late-onset aluminosis, caused by black fused alumina dust, and to bring the issue to the forefront.

    Methods A total of 83 cases of aluminum pneumoconiosis diagnosed for the frst tme from 1989 to 2014 in a mining powder factory in Qingpu District of Shanghai were taken as study subjects, and the diagnosed stage of pneumoconiosis was the conclusion of the frst diagnosis. Historical records were collected to understand the basic settings of the factory and the concentratons of worker's dust exposure in workplace air. The concentraton of free SiO2 in black fused alumina dust was determined by pyrophosphate method. Work type-specifc cumulatve aluminosis incidences and latent period of late-onset aluminosis (cases diagnosed afer 2 years of dust removal) were analyzed.

    Results The chemical compositon of black fused alumina used in this factory included Al2O3 (75%), Fe2O3 (>15%), TiO2 (3%), and SiO2 (7%); the content of free SiO2 in dust was 1.5%. The dust concentration fluctuated obviously in the same type of workstations, and had great differences among different types of workstations, with medians of 37.32-105.7 mg/m3. There were a total of 83 cases of aluminosis diagnosed in the past years, including 17 males and 66 females; the average (range) age of onset was 55.2 (32.5-79.9) years, and the average (range) duraton of dust exposure was 10.26 (3.0-19.0) years. Among them, 43 cases were diagnosed with frst-stage pneumoconiosis, and progression to advance pneumoconiosis occurred in 9 cases; 26 cases were second-stage pneumoconiosis, and progression to advance pneumoconiosis occurred in 9 cases; 14 cases were third-stage pneumoconiosis. By the end of investigation in 2014, 20 cases died (including 10 first-stage pneumoconiosis cases, 8 second-stage pneumoconiosis cases, and 2 third-stage pneumoconiosis cases) and 63 cases survived (including 24 frst-stage pneumoconiosis cases, 18 second-stage pneumoconiosis cases, and 21 third-stage pneumoconiosis cases). The diagnosed patents were with the job ttles of grinding, screening, fling, and grading, and the cumulatve incidence rates were 75.0% (21/28), 49.3% (35/71), 34.4 (11/32), and 30.2 (16/53), respectvely. Among the 83 cases, 77 cases (92.8%) were late-onset patents. Of the 43 cases frst diagnosed with frst-stage pneumoconiosis, 41 cases were late-onset pneumoconiosis, and their average (range) latent period was (22.49±7.51) (10.08-42.78) years. The 20-25 years latent period group (11/43, 25.6%) was the largest, while the > 30 years latent period group (5/43, 11.6%) was the smallest. The sequence of latent period among workers with different job ttles was as follows:grinders (17.80 years) < screening workers (20.97 years) < fling workers (25.99 years) < grading workers (27.30 years).

    Conclusion Aluminosis caused by black fused alumina dust is characterized by high cumulatve incidence, late onset, agglomeraton of work types, and is predicted to repeatedly occur in the future. Therefore, it is necessary to strengthen occupatonal health surveillance of dust removal workers and to achieve early detecton, diagnosis, and treatment.

     

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