Meral UYAR, Osman ELBEK, Nazan BAYRAM, Nevhiz GÜNDOĞDU, Hüseyin SÜYÜR, Neriman AYDIN

Polivinil klorür maruziyetinin pulmoner sisteme etkileri

Polivinil klorür maruziyetinin pulmoner sistem üzerine etkisini araştıran ulusal bir çalışma yoktur. Bu çalışma PVC imalatı yapan iki fabrikada Temmuz 2008-Temmuz 2009 tarihleri arasında yürütülmüştür. Çalışanlar anket eşliğinde sorgulanmış ve solunum fonksiyon testleri, DLCO ve peak flow metre takibi ile değerlendirilmişlerdir. Çalışmada toz analizleri İş Sağlığı ve Güvenliği Müdürlüğü tarafından yapılmış, veriler SPSS 13.0 kullanılarak analiz edilmiştir. Çalışmaya alınan 147 çalışanın 9 (%6.1)’u kadındı. Öksürük idari grupta anlamlı oranda daha fazlaydı. Çalışanların %59.1’i sigara içicisiydi. Tütün bağımlılığı öksürük ve nefes darlığını [sırasıyla OR= 1.10 (1.00-1.20, %95 GA), p= 0.007 ve OR= 1.08 (1.02-1.14, %95 GA), p= 0.008); toz maruziyeti öksürüğü [OR= 0.20 (0.04-0.80, %95 GA), p= 0.008]; çalışma süresi de balgam yakınmasını [OR= 1.00 (1.00-1.02, %95 GA) p= 0.044] artırmaktaydı. FVC% idari grupta, FEV1/FVC ve difüzyon ölçümleri maruziyet grubunda anlamlı oranda yüksekti. Sigara tüketimi FEV1/FVC < %70 ve FEF25-75 < %50 riskini artırmaktaydı [sırasıyla OR= 1.15 (1.06-1.25, %95 GA), p= 0.001 ve OR= 1.09 (1.02-1.17, %95 GA), p= 0.010]. DLCO maruziyet grubunda sigara tüketimi ve çalışma süresiyle negatif koreleydi (sırasıyla r= -0.270 ve r= -0.210; p= 0.025 ve p= 0.037). Maruziyet grubunda çalışma günlerinde PEF değişkenliği tatil günlerine kıyasla anlamlı oranda daha yüksekti. Bu çalışma tütün bağımlılığının hava yolu patolojisi açısından PVC tozuna kıyasla çok daha önemli olduğuna işaret etmektedir. Ayrıca, PVC tozuna ortanca 36 aylık maruziyetin solunum fonksiyon test parametreleri üzerinde anlamlı değişikliğe yol açmadığını, ancak DLCO ve PEF değişkenliğini etkilediğini göstermektedir.

Pulmonary manifestations of polyvinyl chloride exposure

There is currently no national data on the effects of polyvinyl chloride (PVC) exposure on pulmonary function. In this study we recruited workers and administrative staff from two PVC plants between July 2008 and July 2009. A questionnaire, pulmonary function tests, carbon monoxide diffusion capacity, and peak flows were recorded. Particulate matter analyses were performed by the Adana Central Laboratory of the Directorate of Occupational Health and Safety. Data were analyzed with SPSS 13.0 software. Nine of the 147 subjects were female. The incidence of a cough was more common in the administrative group. Of the study population, 59.1% were smokers. Tobacco addiction significantly increased cough and dyspnea [OR= 1.10 (1.00-1.20, 95% CI) p= 0.007 and OR= 1.08 (1.02-1.14, 95% CI), p= 0.008, respectively]. Dust exposure was correlated with the incidence of a cough [OR= 0.20 (0.04-0.80, 95% CI) p= 0.008]. The period of work correlated with sputum production [OR= 1.00 (1.00-1.02, 95% CI) p= 0.044]. The FVC% was significantly higher in the administrative group, and FEV1/FVC and DLCO were higher in the exposed group. Tobacco addiction increased the risk of airflow limitation, as evaluated by FEV1/FVC < 70% and FEF25-75 < 50% [OR= 1.15 (1.06-1.25, 95% CI) p= 0.001 and OR= 1.09 (1.02-1.17, 95% CI) p= 0.010, respectively]. Tobacco addiction and increasing duration of work had a negative influence on DLCO in the exposed group (r= -0.270, p= 0.025 and r= -0.210, p= 0.037). In the exposed group PEF variability was significantly greater on workdays, compared with rest days. This study shows that tobacco consumption has a greater affect on the airways than PVC dust exposure. A median of 36 months exposure to PVC dust had no significant impact on pulmonary function parameters, except for DLCO and PEF variability.

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