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{新型职业病之爆米花尘肺病}
2000年美国堪萨斯州一位职业病医师向密苏里州卫生行政部门报告了8例混合性气道阻塞可疑病例。这些患者都是爆米花生产厂的工人，都很年轻，因此烟草不太可能是致病因素。有些患者病情严重甚至需要接受肺移植。这些病人的胸部X线片没有什么明显异常，且这些病人对支气管扩张剂或抗炎药没有什么反应，能够排除哮喘。因此，研究人员开始怀疑这些病人可能是患了闭塞性细支气管炎，后者是一种很少见的小气道炎症。
4年后，谜底终于被揭开。美国国立职业安全与健康研究所(NIOSH)Kreiss等在第14届欧洲呼吸学会年会上报告了她们的研究成果。为了查明原因，NIOSH小组深入病人曾工作过的爆米花生产厂，对工厂中劳工人员的调查结果显示，这8例患者仅仅是冰山一角。
研究者通过分析不同工种工人可能暴露的各种物质，最终鉴定出主要的可疑物质：在爆米花中使用的香料。然后再通过气相色谱技术在香料中鉴定出100多种挥发性物质，在这100多种物质中，最主要的“元凶”是丁二酮(2?3-丁二酮)，一种使爆米花有黄油样香味的物质。
在爆米花加工过程中负责混合香料的工人丁二酮暴露量最高，所呼吸的空气中丁二酮浓度为32.3 ppm，当打开盛放香料的容器时，丁二酮浓度高达1200 ppm。NIOSH工作组对曾在爆米花厂工作过的工人进行的回顾性调查表明，大约三分之一的工人出现了阻塞性肺疾病。对6家爆米花生产厂进行的研究均得出了相同结论。
Kreiss研究组通过长期的临床检查为丁二酮的致病作用提供了强有力的证据。在本次年会上，研究者报告了一项针对爆米花生产厂中122名工人的横断面研究结。研究结果显示，这些工人发生呼吸系统疾病的几率比一般人群高2.6倍，发生混合性气道阻塞的几率比一般人群高3.3倍。
77名工人接受了至少3次肺功能检查，他们的肺容量平均每年下降55 mk。此外，接受该研究所有8项检查的27名工人中，第1年第1秒用力呼气量(FEV1)下降了144 mk，随后由于香料暴露物减少，第3年仅下降了21 mk。
NIOSH专家还利用动物模型验证了他们的流行病学结论。通过让老鼠呼吸爆米花工厂中使用的香料，然后检测老鼠气道状况，能够客观地观察到丁二酮对老鼠鼻黏膜和大气道造成的损害以及小气道的坏死。
Kreiss等认为，通过该项研究应吸取以下两点教训。第一，爆米花工厂没有采取保护措施以防止这些可挥发物质对工人的损害，建议工厂使用能够提供净化空气的通气设备;工厂内部应该考虑到提供更好的通风设备和将混合区和休息区隔开的双门系统，香料的运送应该完全密闭以保护混合香料操作者。其次，研究者提醒大家，应当对除爆米花工业以外的其它许多生产活动进行重新认识。
众所周知，仅有15%吸烟者将发展为阻塞性肺疾病，20%患有肺气肿和慢性支气管炎(COPD)的病人从不吸烟，他们的疾病也许与职业因素相关。人们会不禁想到，一定有很多生产环境与爆米花工厂相似的企业，但是还没有引起流行病学家的重视。今后的重点应该放在食品工业、加油站和军事企业。毫无疑问，仍有许多“爆米花病例”有待发现
自由空间 2013-1-12 10:09:00 | 阅读全文 | 回复(16) | 引用通告 | 编辑
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