摘要目的 观察三氯乙烯(TCE)接触工人及职业性TCE药疹样皮炎(OMDT)患者体内补体相关免疫指标的变化情况,为其发病机制研究提供线索.方法 收集8例确诊为OMDT患者入院时、入院第1、2、3、4、5周和出院时共7次血液样本,进行肝功能、免疫球蛋白和补体相关指标检测,同时以39名未发病的TCE接触工人为接触组,检测车间空气中TCE浓度以及工人8h TCE时间加权平均浓度；收集工人尿液和血液样本,检测尿液中三氯乙酸(TCA)含量；分析接触工人血液中补体相关免疫指标与病例组的差异.结果 与入院时[C3d-CIC:(92.86±44.80)mg/L,C3:(0.91±0.19)mg/L]相比,OMDT患者出院时C3d-CIC水平[(52.41±17.75)mg/L]降低,C3含量[(1.14±0.22) mgL]升高,差异均有统计学意义(P＜0.05).其中C3含量随着病情好转逐渐上升.4家调查工厂空气中TCE浓度为(351.96±36.72)mg/m3,均超过国家规定的职业接触限值,接触工人8hTCE时间加权平均浓度与尿中TCA含量超过国家规定职业接触限值的人数分别占调查总人数的28.21％和56.41％.与OMDT患者出院时[IgG:(10.03±l.21)mg/L；CIC:(103.50±29.17 )mg/L]相比,TCE接触组IgG[( 17.21±1.85 )mg/L]和CIC[(227.46±111.67) mU/L]含量增高,差异均有统计学意义(P＜0.01).其他指标比较,差异无统计学意义(P＞0.05).结论 OMDT发病机制中可能涉及Ⅱ型和Ⅲ型变态反应,从而引起脏器损伤.

abstractsObjective To explore the mechanism of occupational medicamentosa-like dermatitis (OMDT) induced by trichloroethylene (TCE) and some immunity indexes in workers occupationally exposed to TCE.Methods The blood samples from 8 cases with medicamentosa-like dermatitis in 1st,2nd,3rd,4th and 5th weeks after admitting to hospital were examined for liver function,immunoglobulin and some complement indexes.Thirty nine workers occupationally exposed to TCE were investigated for urinary TCE and some immuno-complement indexes.The TCE concentrations of air in workplaces were monitored.Results C3d-CIC and C3 of patients before admission were (92.86±44.80) mg/L and 0.91±0.19 mg/L,respectively.C3d-CIC and C3 of patients before discharge were (52.41±17.75) mg/L and (1.14±0.22) mg/L,respectively.There were significant differences between admission and discharge (P＜0.05).The average TCE concentration in 4 workplaces was (351.96±36.72) mg/m3,which was higher than the occupational exposure limits (OELs).The number of workers exposed to the TCE concentration-time weighted and TCA in urine over OELs were 28.21％ and 56.41％ of total subjects,respectively.The serum IgG and CIC levels of patients before discharge were ( 10.03±1.21) mg/L and 103.50±29.17 mU/L,which were significantly lower than those (17.21±1.85) mg/L and (227.46±111.67) mU/L of patients before admission (P＜0.01).Conclusion The type Ⅱ and Ⅲ hypersensitivity may be associated with OMDT and the organ injure induced by TCE.