结核病后慢性病的阻塞表型--职业接触是否起作用?

I. Arghir, Mihaela Trenchea, Cristiana Libu Calboreanu, Ileana Ion, A. Fildan, M. Oțelea
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引用次数: 0

摘要

摘要 结核病(TB)是可以治疗的,但曾经接受过治疗的患者在结核病后出现肺部疾病却是不容忽视的现实。本病例报告了一名 52 岁的男性患者,重度吸烟(50 包年),酗酒,职业暴露于化学危害(如汽油蒸汽、馏分燃料和工业溶剂)、物理危害(极端热量、噪音、振动、紫外线辐射)、人体工程学危害(手工操作活动)和社会心理危害(如超负荷工作、与家人和朋友隔离),1999 年被延迟诊断为严重的广泛空洞型肺结核病,治疗至 2001 年。在抗结核治疗结束前后,对肺功能的评估被忽视了,因此慢性阻塞性肺病一直被忽视到 2009 年,当时患者住进了一家肺科医院。此外,还发现了其他长期的肺结核后疾病,如左肺纤维化、支气管扩张、空洞性开放肺综合征等。肺结核后慢性肺病(PTLD)以慢性阻塞性肺病(COPD)为中心,呈不利的进行性发展,直至 2022 年 9 月患者过早死亡。总之,PTLD 的阻塞性表型诊断延迟,并有多种风险因素,如吸烟、职业暴露和严重结核病本身。应通过职业医师和胸科医师之间的合作,对石油工业工人,尤其是确诊为肺结核病的工人的阻塞性肺部疾病监测方案进行适当调整。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The obstructive phenotype of chronic posttuberculosis disease - is there a role for the occupational exposure?
Abstract Tuberculosis (TB) disease is treatable, but the postTB lung disease in previously treated patients is a reality which must not be ignored. A case report of a 52-year-old male patient, heavy smoker (50 pack-years), alcoholic, with occupational exposure to chemical hazards (such as gaz oil vapors, distillate fuels and industrial solvents), physical hazards (thermal extremes, noise, vibration, UV radiation), ergonomic hazards (manual handling activities); and psychosocial hazards (e.g. overload, isoloation from family and friends), was delayed diagnosed with severe extensive cavitary pulmonary TB disease in 1999, treated till 2001. The assessment of lung function was neglected before or after antiTB therapy ended, so COPD was ignored till 2009, when the patient was admitted in a Pneumology Hospital. Other long term postTB disorders, as left fibrothorax, bronchiectasis, cavitary open healling syndrome, were also identified. Chronic postTB lung disease (PTLD), centered on COPD, had unfavorable progressive evolution till September 2022, when premature death occured. In conclusion, the obstructive phenotype of PTLD was delayed diagnosed and had multiple risk factors as tobacco smoking, occupational exposure and severe TB disease itself. A protocol for monitoring obstructive lung disorders among workers in oil industry, especially those diagnosed with TB disease, should be properly adapted through a collaborative approach between the occupational and the chest physician.
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