关键因素在煤矿工人职业性慢性腰骶神经根病发病机制中的作用。

A. Basanets, I. Andrusyshyna, О. N. Lashko
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引用次数: 1

摘要

煤矿工人。疾病早期和临床前阶段的诊断问题对于预防职业病及其并发症非常重要,因为这是及时开始治疗、实施预防措施的关键。慢性腰骶神经根病(CLSR)或腰痛(LBP)是乌克兰职业病理结构中最常见的疾病之一,通常发生在与体力活动、强迫工作姿势、高水平一般振动的影响等相关的工作职业中。职业发病率最高的是煤炭行业,约占乌克兰职业病理的80%。该国每年诊断出1600多例CLRS病例。CLSR发展的一个危险因素是骨质疏松症,骨质疏松症是由于骨组织的定量和定性特征受损而引起的,其特征是其强度下降,微结构受损,骨折风险进一步增加。现代评价骨组织状况的方法之一是测定患者生物环境中宏量元素和微量元素(MaE和ME)的含量。钙、铝、镁、硼、磷在骨骼和结缔组织的形成和发育中是最重要的。迄今为止,尚未对专业病因CLSR患者的骨组织状态进行研究(数量较少)。目的:确定血清和尿液中必需元素Ca、Al、Mg、B、P在矿工职业性CLSR形成中的作用。研究对象为顿巴斯和利沃夫-沃林盆地煤矿行业的20名CLRS(屠宰工、清理工作面工人、漂泊工)矿工。结果分为两组进行分析:І组为10-15年工作经验的患者(n=10), II组为16-32年工作经验的患者(n=10)。对照组22例无肌肉骨骼系统及结缔组织病变。采用电感耦合等离子体原子发射光谱法(ICPAE)测定了MaE和ME的浓度。研究发现,职业性CLSR矿工血清铝(Al)平均浓度(115.07 μ mol/l)是对照组(3.3 μ mol/l)的近30倍(p<0.05)。两组血清硼(B)浓度分别为25.90 μ Mol/l和19.43 μ Mol/l,均低于对照组的62.90 μ Mol/l (p<0.05)。职业性CLSR患者平均血钙(Ca)浓度(2.82 mmol/l)是对照组(2.16 mmol/l)的1.3倍,两组间差异有统计学意义(p<0.05)。结果显示,职业性CLSR患者尿液中磷(P)的平均含量(19.0 mmol/l)显著高于对照组(11.96 mmol/l) (P <0.05)。两组CLSR患者尿Al浓度分别为1.26 μ Mol/l和1.334 μ Mol/l,高于对照组(0.85 μ Mol/l),差异有统计学意义(p<0.05)。建立了在有害工作条件下工作经验增加的矿工血清中Ca和Mg水平降低,超过患者血液中铝的平均浓度,与对照组患者的正常值和指标相比。
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Essential elements role in pathogenesis of occupational chronic lumbosacral radiculopathy in coal miners.
coal miners. The problem of diagnosis in the early and preclinical stages of diseases is important in the prevention of occupational diseases and their complications, because this is the key to the timely initiation of treatment, the implementation of preventive measures. Chronic lumbosacral radiculopathy (CLSR) or low back pain (LBP) is one of the most common diseases in the structure of occupational pathology in Ukraine, which usually develops in those of working professions associated with physical activity, forced work posture, effect of high levels of general vibration, etc. The highest levels of occupational morbidity are recorded in the coal industry, which accounts for about 80% of occupational pathology in Ukraine. Above 1600 cases of CLRS are diagnosed annually in the country. A risk factor for the development of the CLSR is osteoporosis, which arises due to the impairment of quantitative and qualitative characteristics of bone tissue and is characterized by a decrease in its strength, an impairment of microarchitecture with a further increase in risk of fractures. One of the modern methods of assessing condition of bone tissue is determination of the content of macro- and trace elements (MaE and ME) in the biological environments of patients. Ca, Al, Mg, B, P are the most important in the formation and development of bone and connective tissue. To date, studies of bone tissue status in patients with CLSR of professional etiology have not been conducted (small in numbers). Goal – to determine the role of essential elements Ca, Al, Mg, B, P in serum and urine in the formation of occupational CLSR in miners. The research was conducted in 20 miners with CLRS (slaughterer, mining worker of a clearing face (MWCF), drifter) of coal mining industry of Donbass and Lviv-Volyn basins. The results were analyzed in two groups: І group consisted of patients with 10-15 years of work experience (n=10), II group with 16-32 years of work experience (n=10). The control group included 22 patients without pathology of the musculoskeletal system and connective tissue. The inductively coupled plasma atomic emission spectroscopy method (ICPAE) was used to determine the MaE and ME concentrations. The study revealed that the average serum aluminum (Al) concentration in miners with occupational CLSR (115.07 μ mol/l) exceeded control group level (3.3 μ mol/l) by almost 30 times (p<0.05). Serum boron (B) concentration in both age groups (25.90 μ Mol/l and 19.43 μ Mol/l, respectively) were lower than in the control (62.90 μ Mol/l), (p<0.05). The average serum calcium (Ca) concentration in patients with occupational CLSR (2.82 mmol/l) was 1.3 times higher than the same indicator in the control group (2.16 mmol/l), with a significant difference between the two age groups (p<0.05). It was revealed that the average level of phosphorus (P) in the urine of patients with occupational CLSR (19.0 mmol/l) significantly exceeded its content in patients of control group (11.96 mmol/l) (p<0.05). The concentration of Al in the urine of patients with CLSR in both age groups (1.26 μ Mol/l and 1.334 μ Mol/l, respectively) was higher that in control (0.85 μ Mol/l), (p<0.05). Reduction of Ca and Mg levels in the serum of miners in increasing work experience in harmful working conditions, exceeding average concentration of aluminum in patients' blood compared to the normative value and indicators of the control group patients was established.
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