Artificial Stone Silicosis Rapid Progression Following Exposure Cessation
Artificial Stone Silicosis Rapid Progression Following Exposure Cessation
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DOI：
10.1016/j.chest.2020.03.026
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发表时间：
2020-09-01
期刊：
影响因子：
9.6
通讯作者：
Antonio Cordoba-Dona, Juan
中科院分区：
文献类型：
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作者：
Leon-Jimenez, Antonio;Hidalgo-Molina, Antonio;Antonio Cordoba-Dona, Juan
背景：随着人造石替代天然石，硅肺病在高收入国家迅速出现，特别是在厨房和浴室台面的制造和安装中。停止接触后这种形式的矽肺的进展情况尚不清楚。研究问题：本研究的目的是确定人造石矽肺患者的放射学进展和肺功能。研究设计和方法：2009 年至 2018 年间，加的斯湾地区（西班牙南部）共有 106 名患者被诊断患有人造石矽肺，占 14.15%通过使用活检结果和其余的根据胸部 放射线照相和高分辨率 CT 成像。随访包括呼吸功能测试和放射学研究。所有患者在诊断后均停止从事石材行业工作。 结果：所有患者均为男性；他们诊断时的平均+/- SD年龄为36.2 +/- 7.0岁，平均暴露时间为12.0 +/- 4.3年。诊断时，99 名患者被认为患有单纯性硅肺病 (93.4%)，7 名患者被认为患有进行性大块纤维化 (PMF) (6.6%)。经过平均 4.01 +/- 2.1 年的随访后，56% 的患者疾病进展为国际劳工局的两个或多个亚类，PMF 患者人数增加至 40 人（37.7%）。肺功能方面，FVC和FEV1下降，平均每年分别下降86.8和83.4 mL； 25% 的患者 FVC 每年下降 > 157 mL，FEV1 每年下降 > 133 mL。多变量分析表明，诊断时较低的 FVC 和接触二氧化硅的持续时间较长与进展为 PMF 相关。解释：即使停止接触，人造石硅肺也会迅速进展为 PMF，并且很大比例的患者会经历肺功能的快速下降。
BACKGROUND: Silicosis is rapidly emerging in high-income countries in relation to the replacement of natural stone with artificial stone, especially in the manufacturing and installation of kitchen and bathroom countertops. Progression of this form of silicosis following the cessation of exposure is unknown.RESEARCH QUESTION: The objective of this study was to determine the radiologic progression and lung function in individuals with artificial stone silicosis.STUDY DESIGN AND METHODS: Between 2009 and 2018, a total of 106 patients were diagnosed with artificial stone silicosis in the Bay of Cadiz area (southern Spain), 14.15% by using biopsy results and the remainder according to chest radiography and high-resolution CT imaging. Follow-up consisted of respiratory function tests and radiographic studies. All patients stopped working in the stone industry following diagnosis.RESULTS: All patients were men; their mean +/- SD age at diagnosis was 36.2 +/- 7.0 years, and the mean duration of exposure was 12.0 +/- 4.3 years. At diagnosis, 99 patients were considered to have simple silicosis (93.4%) and seven to have progressive massive fibrosis (PMF) (6.6%). After a mean follow-up of 4.01 +/- 2.1 years, disease in 56% of patients had progressed two or more International Labour Office subcategories, and the number of patients with PMF had increased to 40 (37.7%). Regarding lung function, there was a decrease in FVC and FEV1, with an average decrease of 86.8 and 83.4 mL per year, respectively; in 25% of patients, the annual decrease was > 157 mL in FVC and > 133 mL in FEV1. Multivariable analysis showed that lower FVC at diagnosis and longer duration of exposure to silica were associated with progression to PMF.INTERPRETATION: Artificial stone silicosis rapidly progresses to PMF even following exposure cessation, anda significant percentage of patients experience a very rapid decrease in lung function.