The Evaluation of IL-8 in the Serum of Pneumoconiotic patients / 결핵

Background: Many acute and chronic lung diseases including pneumoconiosis are characterized by the presence of increased numbers of activated macrophages. These macrophages generate several inflammatory cell chemoattractants, by which neutrophil migrate from vascular compartment to the alveolar space. Recruited neutrophils secrete toxic oxygen radicals or proteolytic enzymes and induce inflamatory response. Continuing inflammatory response results in alteration of the pulmonary structure and irreversible fibrosis. Recently, a polypeptide with specific neutrophil chemotactic activity, inlerleukin-8(IL-8), has been cloned and isolated from a number of cells including: monocytes, macrophages and fibroblasts. IL-1 and/or TNF-alpha preceded for the synthesis of IL-8, and we already observed high level of IL-1 and TNF- alpha in the pneumoconioses. So we hypothesized that IL-8 may be a central role in the pathogenesis of pneumoconiosis. In order to evaluate the clinical utility of IL-8 as a biomarker in the early diagnosis of pneumoconiosis, we investigated the increase of IL-8 in the pneumoconiotic patient and the correlation between IL-8 level and progression of pneumoconiosis Method: We measured IL-8 in the serum of 48 patients with pneumoconiosis and 16 persons without dust exposure history as a control group. Pneumoconiotic cases were divided into 3 groups according to ILO Classification: suspicious group(n=16), small opacity group(n=16) and large opacity group(n=16). IL-8 was measured by a sandwich enzyme immunoassay technique. All data were expressed as the mean +/- standard deviation. Results: 1) The mean value of age was higher in the small opacity and large opacity group than comparison group, but smoking history was even. Duration of dust exposure was not different among 3 pneumoconiosis groups. 2) IL-8 level was 70.50 +/-53.63 pg/ml in the suspicious group, 107.50+/-45.88 pg/ml in the small opacity group, 132.50+/-73.47 pg/ml in the large opacity group and 17.85+/- 33.85 pg/ml in the comparison group. IL-8 concentration in all pneumoconiosis group was significant higher than that in the comparison group(p<0.001). 3) IL-8 level tended to increase with the progression of pneumoconiosis. Multiple comparison test using Anova/Scheffe analysis showed a significant difference between suspicious group and large opacity group(p<0.05). 4) The level of IL-8 was correlated with the progression of pneumoconiosis(r=0.4199, p<0.05). Conclusion: IL-8 is thought to be a good biomarker for the early diagnosis of pneumoconiosis.

The Diagnostic Role of HRCT in Simple Pneumoconiosis / 예방의학회지

Early recognition of coalescence in pneumoconiotic lesions is important because such coalescence is associated with the respiratory symptoms and deterioration of lung function. This complicated form of pneumoconiosis also has worse prognosis than does simple pneumoconiosis. High resolution computerized tomography(HRCT) provides significant additional information on the stage of the pneumoconiosis because it easily detects coalescence of nodules and emphysema that may not be apparent on the simple radiograph. The Purpose of this study is to clarify the role of HRCT in detection of large opacity and the relationship of change between the coalescence of nodules or emphysema and lung function in dust exposed workers. 1. There was good correlation between the HRCT grade of pneumoconiosis and ILO category of profusion. 5(9.09%) in 55 study population had confluent nodule extending over two or more cuts on HRCT. HRCT could identify the pneumoconiotic nodules which was not found by simple radiography in 6 workers with category 0/0. 2. No significant difference was observed coalescence of nodules and emphysema by dust type. 3. There was no significant difference in pulmonary function according to ILO and HRCT classification. 4. HRCT could detect the significant reduction in FEV1, FEV1/FVC, PEER, FEF25, FEF50, and FEF75 and remarkable increase in RV and TLC in study persons with emphysema compared with non-emphysema group. 5. Emphysema was found more often in nodules-coalescence group than small opacity group by HRCT. We found that HRCT could easily detect areas of coalescence and complicated emphysema compared to plain chest X-ray. Also our data suggest that it is primarily the degree of emphysema rather than the degree of pneumoconiosis that determines the level of pulmonary function.

The Effect of Pleural Thickening on the Impairment of Pulmonary Function in Asbestos Exposed Workers / 결핵

BACKGROUND: Pleural abnormality is the the most common respiratory change caused by asbestos dust inhalation and also develp other asbestos related disease after cessation of asbestos exposure. So we conducted epidemiologic study to investigate if the pleural abnormality is associated with pulmonary function change and what factors are influenced on pulmonary function impairement. METHODS: Two hundred and twenty two asbestos workers from 9 industries using asbestos in Korea were selected to measure the concentration of sectional asbestos fiber. Questionnaire, chest X-ray, PFT were also performed. All the data were analyzed by student t-test and chi-square test using SAS. Regressional analysis was performed to evaluate importent factors, for example smoking, exposure concentration, period and the existence of pleural thickening, affecting to the change of pulmonary function. RESULTS: 1) All nine industries except two, airborn asbestos fiber concentration was less than an average permissible concentration. PFT was performed on 222 workers and the percentage of male was 88.3%, their mean age was 41+/-9 years old, and the duration of asbestos exposure was 10.6+/-7.8 yrs. 2) The chest X-ray showed normal(89.19%), pulmonary Tb(inactive)(2.7%), pleral thickening (7.66%), suspected reticulonodular shadow(0.9%). 3) The mean values of height, smoking status, concentration of asbestos fiberwere not different between the subjects with pleural thickening and others, but age, cumulative pack-years, the dura-tion of asbestos exposure were higher in subjects with pleural thickening. 4) All the PFT indices were lower in the subjects with pleural thickening than in the subjects without pleural thickening. 5) Simple regression analysis showed there was a significant correlation between FEF75 which is sensitive in small airway obstruction and cumulative smoking pack-years, the duration of asbestos exposure and the concentration of asbestos fiber. 6) Multiple regression analysis showed all the pulmonary function indices were decreased as the increase of cumulative smoking pack-years and especially in the indices those are sensitive in small airway obstruction. Pleural thickening was associated with reduction in FVC,FEV1, PEFR and FEF25. CONCLUSION: The more concentration of asbestos fiber and the more duration of asbestos exposure, the greater reduction in FEF50,FEF75. Therefore PFT was important in the evaluation of early detection for small airway obstuction. Furthermore pleural thickening without asbesto-related parenchymal lung disease is associated with reduction in pulmonary function.

A case of Asbestosis, Pleural Effusion and Lung Cancer Caused by Long-Term Occupational Asbestos Exposure / 결핵

Asbestos is widely used in the textile, asbestos cement, construction products, friction material, paper products, insulation products, chemical and plastic products because of its heat resistance, flexibility, tensile strength, and texturability. It is now generally recognized that longterm and excessive inhalation of asbestos dust causes asbestosis, lung cancer, malignant mesothelioma and malignancies in other organs such as cancer of gastrointestinal tract, leukemia, lymphoma. Although eighty thousand tons of asbestos has been annually consumed since 1979 in korea, it has not been reported asbestos and lung cancer by asbestos dust so far, while a case of mesothelioma was officially diagnosis as a occupational disease at 1993. We experienced firstly a case of asbestosis and lung cancer caused simultanously by occupational asbestos exposure 11 years, which was confirmed by chest x-ray, pulmonary function test, chest CT and HRCT, bronchoalveolar lavage, and gallium scan. And so We present a case of asbestosis, pleural effusion and lung cancer with a review literature.