矽肺的个体矽尘接触和效应的预警值研究

In the case of the present situation that silica dust over standard in workplaces can not be eliminated and health surveillance can not reduce silicosis cases, silicosis early warning value of individual silica dust exposure and x-rays is worth studying. In this project, meta analysis, animal experiment and occupational epidemiological methods are used to analyze dose response relation of silica dust exposure and silicosis and silica dust exposure limits data at home and abroad, investigate the dose response relations between different content of free silica dust exposure and lung fibrosis and between respirable silica dust cumulative exposure and silicosis, and analyze the relationship between small shadow level in X-ray chest radiograph of workers who haven't suffered from silicosis when they cease expose to silica dust and the incidence and onset time of silicosis. Through those investigation and reference to documents at home and abroad and epidemiological verification, we expected obtain the individual early warning value for the respiratory silica dust accumulated exposure and different concentrations dust accumulated exposure time, and also can get the X-ray chest radiograph small shadow index as early warning values of silicosis. This will provide scientific basis for the relevant departments of state to revise and perfect silica dust occupational exposure limit and health surveillance indexes and its management. It will also provide new ideas and clues for our country and the international community to effective control and eliminate silicosis. At the same time, it can be used as new strategies and measures for enterprise self control silicosis and provide reference for early warning research of other pneumoconiosis.

在目前不能消除作业场所矽尘超标和健康监护不能降低矽肺发病率的情况下，个体矽尘接触量和X线的矽肺预警值值得探讨。本项目拟采用meta分析、动物实验和职业流行病学的方法，分析国内外矽尘接触与矽肺的剂量-反应关系和矽尘接触限值资料；研究不同游离二氧化硅矽尘暴露与肺组织纤维化的剂量-效应关系，呼吸性矽尘累积接触量与矽肺的剂量-反应关系；并分析脱离矽尘接触时未患矽肺者的X线胸片小阴影级别与矽肺的发生、发病时间等的关系。预期获得作为矽肺个体预警值的呼吸性矽尘累积接触量和不同浓度下累积接触时间，也能获得作为矽肺效应预警值的X线胸片小阴影指标值。并通过参考国内外资料和流行病学的验证，提出预警值。研究结果将为国家有关部门修订和完善矽尘职业接触限值和健康监护指标及其管理提供科学依据，为我国和国际社会有效控制和消除矽肺提供新的思路和线索；同时，可作为企业自我控制矽肺新的策略和措施，为其他尘肺的预警研究提供参考。

按项目的年度研究计划，各年度基本达到计划预期，达到预期目标。提出个体呼吸性矽尘接触量预警值以及效应指标预警值。研究获得：呼吸性粉尘组回归方程：Y=3.163X+1.435；呼吸性矽尘组回归方程：Y=2.691X+2.841；总粉尘各剂量组（SiO2含量10%-50%、50.01%-80%、80.01%以上）的回归方程分别为：Y=4.186X-3.780，Y=2.237X，Y=2.805X。提出建议：在接触含游离SiO2粉尘作业中，要限制接尘人群终身的矽肺发病率在1%左右，呼吸性粉尘（游离SiO2 10%-50%）累积接触剂量不能超过2.46mg• a/m3；呼吸性矽尘累积接触剂量不能超过0.87mg•a/m3；SiO2含量在10%-50%、50.01%-80%、80.01%以上总粉尘累积接触剂量分别不能超过34.81 mg•a/m3、15.68 mg•a/m3、8.98 mg•a/m3。据此，除了作业场所矽尘浓度的职业接触限值外，还制定出个体累积剂量的限值或超过职业接触限值作业场所的接触时间限值，将有利于解决目前国内外矽尘作业场所不能达到接触限值要求情况下有效控制和消除矽肺的问题。.对63例患者接受CT引导下经皮肺穿刺活检术，病理检查发现尘肺样改变阳性率达95.24%，与尘肺诊断符合率98.41%。该方法操作简便、尘肺病检阳性率，病理诊断与尘肺病诊断的符合率高，作为一种理想的方法,在尘肺病的诊断与鉴别诊断中具有较高的应用价值。.血清特异性microRNA作为尘肺不同期别诊断及预警标志物研究，对住院尘肺病人124例（矽肺62例，煤工尘肺62例），健康对照24人。检测血清miRNAs总表达：共检测到1079条miRNAs，上调406条，下调117条。miRNAs差异性表达：上调32条；下调17条。实时定量PCR，检测目的miRNA：hsa-let-7d-5p、hsa-miR-451a等，已经完成。大量临床样品验证以明确microRNA作为分子标志物正在进行。在结余经费下，将继续研究。.项目研究年度内，参加8次国内学术会议，进行了学术交流；在该项目资助下，研究年度内发表期刊论文21篇，SCI：8篇；国内核心期刊（CSCD):10篇。在该项目资助下，培养毕业硕士研究生11名，博士研究生3名。