Risk of pulmonary tuberculosis relative to silicosis and exposure to silica dust in South African gold miners
Risk of pulmonary tuberculosis relative to silicosis and exposure to silica dust in South African gold miners
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DOI：
10.1136/oem.55.7.496
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发表时间：
1998-07-01
影响因子：
4.9
通讯作者：
Murray, J
中科院分区：
文献类型：
--
作者：
Hnizdo, E;Murray, J
目的：探讨以下问题。(1)在没有矽肺的情况下，二氧化硅粉尘本身是否与接触二氧化硅粉尘的工人患肺结核（PTB）的风险增加有关？(2)在没有矽肺的情况下，过量的风险剂量是否与之相关？(3)接尘结束后，肺结核的发生和矽肺的发生之间的主要时间顺序是什么？方法：从1968年至1971年，对2255名南非白色金矿工人（年龄45-55岁）的PTB发病率进行了随访，直至1995年12月31日。在随访期间，1592名（71%）男性死亡。其中，1296例（81%）在国家职业卫生中心（NCOH）进行尸检，以确定是否存在矽肺和PTB。研究了队列中PTB的发病率与累积粉尘暴露和矽肺发病的关系。对于矿工尸检，发病率为PTB进行了研究，相对于尸检时发现的矽肺的严重程度。随访总人年为39 319。对于整个队列，与PTB风险增加相关的因素是累积粉尘暴露（mg/m3.y）（调整后的比率为1.07;（95%置信区间（95% CI）1.04至1.10））、放射学诊断的矽肺（3.96（2.59至6.06））和烟草包-年（1.02（1.01至1.03））。PTB的RR（95%CI）随累积粉尘暴露的四分位数增加而增加1.0、1.51（0.78至2.91）、2.35（1.28至4.32）和3.22（1.75至5.90）。在没有放射学诊断为矽肺的矿工中（n=1934，PTB=74），PTB和累积粉尘暴露的校正RR（95%CI）为1.10（1.06 ~ 1.13），随累积接尘量四分位数的增加而增加，分别为1.00、1.46（0.70 ~ 3.03）、2.67（1.37 ~ 5.23）和4.01（2.04 ~ 7.88）。对于进行尸检的受试者（n=1296，PTB=70），PTB的调整RR（95%CI）随尸检发现的矽肺严重程度而增加;无矽肺1.0，可忽略1.88（0.97 ~ 3.64），轻度2.69（1.35 ~ 5.37），中度或显著矽肺3.30（1.16 ~ 4.58）。对于进行尸检且无硅肺的受试者（n=577，PTB=18），调整后的RR（95%CI）略有增加，累积粉尘的四分位数为1.0，1.11（0.31至4.00）、1.42（0.43至4.72）和1.38（0.33 ~ 5.62）.结论：在无矽肺的情况下，即使在接触硅尘结束后，接触硅尘也是PTB发展的危险因素。肺结核的危险性随着矽肺的存在而增加，在没有放射性矽肺的矿工中，暴露于粉尘的四分位数。尸检时诊断的矽肺的严重程度与肺结核的风险增加相关，
Objectives-To investigate the following questions. (1) Is silica dust on its own, without the presence of silicosis, associated with an increased risk of pulmonary tuberculosis (PTB) in workers exposed to silica dust? (2) In the absence of silicosis is the excess risk dose related? (3) What is the predominant chronological sequence between the development of PTB and the development of silicosis after the end of exposure to dust?Methods-A cohort of 2255 white South African gold miners has been followed up from 1968 to 1971, when they were 45-55 years of age, to 31 December 1995 for the incidence of PTB. During the follow up 1592 (71%) men died. Of these, 1296 (81%) had a necropsy done at the National Centre for Occupational Health (NCOH) to determine the presence of silicosis and PTB. The incidence of PTB in the cohort was studied relative to cumulative exposure to dust and the onset of silicosis. For the miners with necropsy, the incidence for PTB was studied relative to the severity of silicosis found at necropsy.Results-There were 115 subjects who developed PTB. The total person-years of follow up was 39 319. For the whole cohort, the factors associated with increased risk of PTB were cumulative exposure to dust (mg/m(3).y) (the adjusted rate ratio (RR)1.07; (95% confidence interval (95% CI) 1.04 to 1.10)), silicosis diagnosed radiologically (3.96 (2.59 to 6.06)), and tobacco pack-years (1.02 (1.01 to 1.03)). The RR (95% CI) for PTB increased with increasing quartiles of cumulative exposure to dust 1.0, 1.51 (0.78 to 2.91), 2.35 (1.28 to 4.32), and 3.22 (1.75 to 5.90). In miners who did not have radiologically diagnosed silicosis (n=1934, PTB=74), the adjusted RR (95% CI) for PTB and cumulative exposure to dust was 1.10 (1.06 to 1.13), and increased with quartiles of cumulative exposure to dust as 1.00, 1.46 (0.70 to 3.03), 2.67 (1.37 to 5.23), and 4.01 (2.04 to 7.88). For the subjects who had a necropsy (n=1296, PTB=70), the adjusted RR (95% CI) for PTB increased with the severity of silicosis found at necropsy; 1.0 for no silicosis, 1.88 (0.97 to 3.64) for negligible, 2.69 (1.35 to 5.37) for slight, and 3.30 (1.16 to 4.58) for moderate or marked silicosis. For subjects who had a necropsy and no silicosis (n=577, PTB=18), the adjusted RR (95% CI) increased slightly with quartiles of cumulative dust 1.0, 1.11 (0.31 to 4.00), 1.42 (0.43 to 4.72), and 1.38 (0.33 to 5.62).Conclusion-Exposure to silica dust is a risk factor for the development of PTB in the absence of silicosis, even after exposure to silica dust ends. The risk of PTB increases with the presence of silicosis, and in miners without radiological silicosis, with quartiles of exposure to dust. The severity of silicosis diagnosed at necropsy was associated with increasing risk of PTB and even