【摘要】 [目的]研究尘肺患者的生存情况并进行死因分析。[方法]追踪观察386名已经被诊断为Ⅰ、Ⅱ、Ⅲ期的尘肺患者,记录死亡的137名尘肺患者的死亡时间,死因和尘肺的期别。用K-M法进行生存分析。[结果]已确诊为Ⅰ、Ⅱ、Ⅲ期的137名尘肺患者的生存时间分别为29.3年、27.3年、14.0年,Ⅰ、Ⅱ与Ⅲ比较,差别非常显著(P<0.001);与Ⅰ期相比,Ⅱ期患者的危险度为1.03倍(95％CI,0.77.1.36),Ⅲ期患者的危险度为1.57倍(95％CI1.09-2.16);冬季死亡63例,其次是春季40例,共103例,占75.1％;死因分别为肺炎37例(27.0％),肺结核21例(15.3％),非特异性肺感染7例(5.1％),肺癌22例(16.1％),其他癌症10例(7.3％),脑血管意外和其他病因12例(8.8％);386名尘肺患者并发肺结核占14.3％,在Ⅰ、Ⅱ、Ⅲ期矽肺患者中,分别有10.0％、20.2％、32.4％合并肺结核。[结论]冬春两季是尘肺患者死亡较多的季节;尘肺期别越高,生存时间越短;肺炎、肺结核、肺癌是尘肺患者的主要死因。更多还原

【Abstract】 [Objective] Many workers in China previously worked in places with high exposure to hazardous dusts such as asbestos,coal dust, and free silica. We followed a group of miners exposed to mining dust from 1963 to 2001 to determine their fatality and complications due to dust exposure. [Methods] In the yearly check up for metallurgical workers in GuiZhou Province,a total of 386 mining workers were diagnosed as having stage Ⅰ,Ⅱ,or Ⅲ pneumoconiosis from 1963 to 2001.These workers were then followed-up regularly. If fatality occurred, tune and cause of death and combined medical conditions were recorded. The stage of pneumoconiosis at death was also recorded.In 2001,all surviving workers were invited to have a follow-up physical examination, including chest radiography. Survival analysis with Kaplan-Meier method was conducted using stage as predictors and duration of follow-up as outcome. Cox’s regression model was done using stage and age at initial examination as X’s and duration of follow-up as Y. [Results] People with fibrotic change stages Ⅰ,Ⅱ,and Ⅲ at the initial examination had median survival time of 29.3,27.3,and 14.0 years,respectively. While adjusted for age at initial examination,risk ratio was1.03(95% CI 0.77-1.36) for stage Ⅱ,and 1.57(95%CI 1.09-2.16) for stage Ⅱ as compared to stage Ⅰ. Among 137 deceased workers, the direct causes of deaths included 37(27.0%) pneumoconiosis,21(15.3%) pulmonary tuberculosis, 7(5.1%) non-specified lung infection,22(16.1%) lung cancer,10(7.3%) other cancers, 12(8.8%)cerebrovascular accidents,and 28(20.4%) other causes.Lung tuberculosis frequently complicated pneumoconiosis and was found in 14.3% of followed workers.The prevalence of tuberculosis was associated with initial staging of pneumoconiosis,i.e., in stage Ⅰ,Ⅱ,and Ⅲ,10.0% ,20.0%,and 32.4% were later complicated with tuberculosis,respectively.[Conclusion] It was concluded that the mining workers’ survival time is correlated with the stage of the elementary X-ray examination for chest. In workers with more advanced radiographic stages,early intervention may be useful to decline fatality in later years.Tuberculosis is a common complication of pneumoconiosis and a significant cause of death.更多还原