淮北矿业集团尘肺合并结核的现状及流行特征

[背景]尘肺病是我国发病人数最多、危害最广的职业病，且尘肺病病情的进展不可逆转。由于尘肺患者的肺组织损伤，机体防御功能下降以及免疫功能障碍，极易合并肺结核。尘肺合并结核的病理基础复杂，并且该类患者往往对抗结核药物呈现较高的耐药性，治疗困难。

[目的]为了更有针对性地制定尘肺结核的预防控制措施，调查淮北矿业集团尘肺合并结核的现状及流行特征。

[方法]对淮北矿业集团从1963年11月1日至2017年12月31日在本职业病防治院确诊的全部尘肺病例的职业病诊断资料（包含死亡病例）进行调查，查阅尘肺病诊断档案及相关资料，内容包括用人单位、姓名、性别、出生日期、统计工种、开始接尘日期、接尘工龄、尘肺种类、诊断期别及时间、合并肺结核的时间及期别等。描述尘肺合并结核发生的三间分布特征，采用logistic 回归分析其可能的影响因素。

[结果]已确诊6 460 例尘肺患者，发病年龄为（51.）岁，开始接尘年龄为（23.29± 4.88）岁，接尘工龄为（23.）年。其中，尘肺合并结核患者共1 141 名，发生率为17.66%（1 141/6 460）。尘肺合并结核的发生与接尘年代（OR=0.480）、接尘工龄（OR=0.801）、开始接尘年龄（OR=1.281）、尘肺期别（OR=2.167）有关。

[结论]尘肺合并结核发生率随开始接尘年龄和尘肺期别的增加而升高，随接尘年代和接尘工龄的增加而降低。应从尘肺和结核的预防双管齐下，以更好地控制尘肺结核的发生。

国家重点研究计划课题（2017YFC0）

唐桂钰（1985—），女，硕士，主治医师；

E-

唐桂钰，E-

[Background]Pneumoconiosis is the most prevalent and widest damaging occupational disease in China,and it is to lung tissue damage,declined body defense,and immune dysfunction,pneumoconiosis patients are prone to developing complicated with tuberculosis shows complex pathological manifestations,and the patients are often highly resistant to antituberculous drugs,resulting in difficulties in treatment.

[Objective]In order to make more tailored prevention and control measures against pneumoconiosis,we investigate the prevalence and epidemiological characteristics of pneumoconiosis complicated with tuberculosis in Huaibei Mining Group.

[Methods]The data on occupational disease diagnosis of all pneumoconiosis cases (including deaths) in Huaibei Mining Group diagnosed by Huaibei Occupational Disease Prevention and Treatment Institute from 1 November 1963 to 31 December 2017 were retrospectively analyzed,including work unit,name,gender,date of birth,type of work,date of first dust exposure,length of dust exposure,pneumoconiosis type,diagnosis time and stage of pneumoconiosis,diagnosis time and stage of concurrent temporal,spatial,and population distributions of the disease were described and related factors were evaluated.

[Results]In a total of 6 460 confirmed pneumoconiosis patients,the age of onset was (51.) years,the age of first dust exposure was (23.) years,the length of dust exposure was (23.) them,1 141 (17.66%) were pneumoconiosis patients complicated with accompanied by tuberculosis was associated with the year of dust exposure (OR=0.480),length of dust exposure (OR=0.801),age of first dust exposure (OR=1.281),and pneumoconiosis stage (OR=2.167).

[Conclusion]The prevalence rate of pneumoconiosis accompanied by tuberculosis increases with older age of first dust exposure and increased pneumoconiosis stage,and decreases with prolonged year of dust exposure and length of dust ,a twopronged approach combining both pneumoconiosis and tuberculosis prevention is suggested for the control of the coinfection.

尘肺病是由于在职业活动中长期吸入生产性粉尘并在肺内潴留而引起的以肺组织弥漫性纤维化为主的全身性疾病［1］，其潜伏期长，且病情的进展不可逆转，发病机制至今尚未阐明，亦无根治办法，一旦发病将无法治愈［2-3］。尘肺病在我国也是发病人数最多、危害最广的职业病，给劳动者和国家带来了重大的经济负担［4］。肺结核是由结核分枝杆菌（mycobacterium tuberculosis，MTB）引起的一种慢性传染病［5］。煤矿工人长期处于粉尘浓度较高的工作环境中，长时间吸入高浓度的粉尘会引起肺部的循环不良，给 MTB创造了适宜的生长和繁殖条件［6］。早在19世纪30年代，尘肺与肺结核的关系已得到证实［7］。国外研究提示，10%～30%的矽肺合并肺结核患者病情加速恶化，病死率极高［8］。也有研究显示肺结核为尘肺患者死亡的主要原因［9］，肺结核作为尘肺病患者的常见合并症［10］，发生率可以达到30%～60%［11］。尘肺合并肺结核的患者不仅比单纯尘肺患者病情进展快，容易恶化，预后不良，死亡率也高出很多［12］。

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