【摘要】 目的探究职业接触粉尘和烟雾对COPD及呼吸道症状的影响。方法在中国7省市(北京、上海、广东、辽宁、天津、重庆和陕西)城乡40岁及以上人群的COPD横断面调查的基础上,分析职业接触粉尘和烟雾对COPD及呼吸道症状的影响。对入选人群进行问卷调查和肺功能检测。以支气管舒张试验后的FEV1/FVC<70%作为COPD的诊断标准,并排除其他不完全可逆气流受限疾病。患者自我报告经常有咳嗽、咳痰、气喘或气促症状之一,定义为有呼吸道症状。结果20.5%的被调查者曾经职业接触粉尘和烟雾超过1年。多因素分析显示,职业粉尘烟雾暴露是罹患COPD的危险因素,其OR值及95%CI为1.20(1.04,1.39),其中谷尘为COPD可能的危险因素,其OR值及95%CI为1.48(1.18,1.86);职业粉尘烟雾暴露、采矿、采石、水泥粉尘、油漆、化工和其他职业暴露为患呼吸道症状的危险因素,其OR值及95%CI分别为1.37(1.25,1.49)、2.31(1.67,3.20)、1.71(1.09,2.70)、1.92(1.47,2.52)、1.46(1.16,1.84)、1.58(1.37,1.83)和1.46(1.29,1.64);职业粉尘烟雾暴露与吸烟存在协同作用,可使患呼吸道症状的危险度增加(P=0.006);职业粉尘烟雾暴露对患COPD和呼吸道症状的人群归因危险度(PAR)分别为3.94%和7.05%。结论职业粉尘烟雾暴露与患COPD和呼吸道症状有关;职业粉尘烟雾暴露与吸烟对患呼吸道症状存在协同作用。更多还原

【Abstract】 Objective To investigate the contribution of occupational exposure to dusts/gases/fumes to chronic obstructive pulmonary disease(COPD) and respiratory symptoms in China.Methods Based on the cross-sectional survey of COPD which was conducted in urban and rural areas of Beijing,Shanghai,Guangdong,Liaoning,Tianjin,Chongqing and Shanxi for residents aged 40 years or older,the association between the occupational exposure to dusts/gases/fumes and COPD and respiratory symptoms was analyzed.The recruited populations were interviewed with questionnaire and were tested with spirometry.The post-bronchodilators FEV1/FVC<70% was used as diagnostic criteria of COPD.Having any cough,sputum,wheezing and dyspnea was defined as having respiratory symptoms.Results The prevalence of occupational exposure to dusts/gases/fumes was 20.5%.As shown by multiple-variables Logistic regression analyses,occupational exposure to dusts/fumes/gases [OR=1.20(1.04,1.39)] and dusts of grain [1.48(1.18,1.86)]were associated with COPD;occupational exposure to dusts/fumes/gases [OR=1.37(1.25,1.49)],hard-rock mining [OR=2.31(1.67,3.20)],coal mining [OR=1.71(1.09,2.70)],dusts of cement [OR=1.92(1.47,2.52)],chemical or plastics manufacturing [OR=1.58(1.37,1.83)],spray painting [OR=1.46(1.16,1.84)],and other dusts or fumes [OR=1.46(1.29,1.64)]were associated with the respiratory symptoms.Smoking and occupational exposure to dusts/gases/fumes had synergic effects on the increasing risk of respiratory symptoms.The population-attributable risk(PAR) of exposure to dusts/gases/fumes was 3.94% and 7.05% for COPD and respiratory symptoms respectively.Conclusions Occupational exposure to dusts/gases/fumes is associated with COPD and respiratory symptoms.Smoking and occupational exposure to dusts/gases/fumes may have synergic effects on respiratory symptoms.更多还原