Severe asthma and death in a worker using methylene diphenyl diisocyanate MDI asthma death.
Severe asthma and death in a worker using methylene diphenyl diisocyanate MDI asthma death.
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使用亚甲基二苯基MDI哮喘死亡的工人中的严重哮喘和死亡。
DOI：
10.1002/ajim.23323
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发表时间：
2022-03
影响因子：
3.5
通讯作者：
Redlich CA
中科院分区：
文献类型：
--
作者：
Wisnewski AV;Cooney R;Hodgson M;Giese K;Liu J;Redlich CA
众所周知，二异氰酸酯会引起职业性哮喘，但二异氰酸酯哮喘的诊断和与其他过敏原引起的哮喘的鉴别具有挑战性。本研究评估了二苯基甲烷二异氰酸酯（MDI）对工作场所死亡的潜在贡献。对死亡工人的医疗记录、组织和血液进行了检查。福尔马林固定石蜡包埋的肺组织切片通过组织学和免疫化学染色进行评估。采用ELISA和/或Western blot法检测血清MDI特异性IgE、IgG和总IgE。雇主通过与同事的面谈提供了关于工作场所潜在化学品接触和工业流程的信息。对该工人的医疗记录、职业史和尸检结果的审查表明，死亡原因与严重哮喘一致，并排除了心脏病、肺栓塞或中风。肺病理学显示哮喘的特征，包括平滑肌肥大、嗜酸性粒细胞增多、基底膜增厚和细支气管粘液堵塞。MDI免疫组化染色在炎症气道增厚的基底膜中呈阳性。MDI特异性血清IgE和IgG显著升高，并证明MDI与其他二异氰酸酯相比具有特异性，但总血清IgE正常（24 IU/mL）。该工作场所最近将MDI引入铸造厂，作为新工艺的一部分，但尚未测量MDI的空气水平。不需要呼吸器。总之，尸检结果支持二异氰酸酯哮喘和工作中严重哮喘发作作为铸造工人死亡原因的诊断。
Diisocyanates are well recognized to cause occupational asthma, yet diisocyanate asthma can be challenging to diagnose and differentiate from asthma induced by other allergens. The present study assesses the potential contribution of methylene diphenyl diisocyanate (MDI) to a workplace fatality. Examination of medical records, tissue, and blood from the deceased worker were undertaken. Formalin fixed paraffin-embedded lung tissue sections were assessed through histologic and immunochemical stains. Serum MDI-specific IgE and IgG and total IgE, were measured by ELISA and/or Western blot. Information about potential chemical exposures and industrial processes in the workplace were provided by the employer and through interviews with co-workers. Review of the worker’s medical records, occupational history, and autopsy findings were consistent with severe asthma as the cause of death, and ruled out cardiac disease, pulmonary embolism, or stroke. Lung pathology revealed hallmarks of asthma including smooth muscle hypertrophy, eosinophilia, basement membrane thickening, and mucus plugging of bronchioles. Immunochemical staining for MDI was positive in the thickened basement membrane of inflamed airways. MDI-specific serum IgE and IgG were significantly elevated and demonstrated specificity for MDI vs. other diisocyanates, however, total serum IgE was normal (24 IU/mL). The workplace had recently introduced MDI into the foundry as part of a new process, but MDI air levels had not been measured. Respirators were not required. In summary, post-mortem findings support the diagnosis of diisocyanate asthma and a severe asthma attack at work as the cause of death in a foundry worker.
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影响因子：
2.2
作者：
Wisnewski, Adam V.;Liu, Jian
通讯作者：
Liu, Jian
影响因子：
2.2
作者：
Zhang, Cuili;Hu, Jinlian;Ji, Fenglong
通讯作者：
Ji, Fenglong
影响因子：
3.7
作者：
Meca O;Cruz MJ;Sánchez-Ortiz M;González-Barcala FJ;Ojanguren I;Munoz X
通讯作者：
Munoz X
影响因子：
--
作者：
Liljelind, I.;Norberg, C.;Nylander-French, L. A.
通讯作者：
Nylander-French, L. A.
影响因子：
3.4
作者：
Arnold, Scott M.;Collins, Michael A.;Woolhiser, Michael R.
通讯作者：
Woolhiser, Michael R.