Abstract
Workers processing nephrite, antigorite, or talc may be exposed to paragenetic asbestos minerals. An effective screening method for pneumoconiosis in workers exposed to asbestos-contaminated minerals is still lacking. The objective of this study was to assess the diagnostic accuracy of serum and urinary biomarkers for pneumoconiosis in workers exposed to asbestos-contaminated minerals. We conducted a case-control study in a cohort of stone craft workers in Hualien, where asbestos, nephrite, antigorite, and talc are produced. A total of 140 subjects were screened between March 2013 and July 2014. All subjects received a questionnaire survey and a health examination that included a physical examination; chest X-ray; and tests for standard pulmonary function, fractional exhaled nitric oxide, serum soluble mesothelin-related peptide (SMRP), fibulin-3, carcinoembryonic antigen (CEA), and urinary 8-Oxo-2'-deoxyguanosine (8-OHdG)/creatinine. After excluding subjects with uraemia and chronic obstructive pulmonary disease (COPD), we included 48 subjects with pneumoconiosis and 90 control subjects without pneumoconiosis for analysis. In terms of occupational history, 43/48 (90%) case subjects and 68% (61/90) of the control subjects had processed asbestos-contaminated minerals, including nephrite, antigorite, and talc. The case group had decreased pulmonary function in forced vital capacity (FVC), forced expiratory volume in one second, and forced expiratory flow between 25% and 75% of the FVC. The levels of SMRP, fibulin-3, urinary 8-OHdG/creatinine, and CEA were higher in the case group than in the control group. Subjects exposed to nephrite had significantly higher SMRP levels (0.84 ± 0.52 nM) than subjects exposed to other types of minerals (0.60 ± 0.30 nM). A dose-response relationship was observed between the SMRP level and the severity of pneumoconiosis. Machine learning algorithms, including variables of sex, age, SMRP, fibulin-3, CEA, and 8-OHdG/creatinine, can predict pneumoconiosis with high accuracy. The areas under the receiver operating characteristic curves ranged from 0.7 to 1.0. We suggest that SMRP and fibulin-3 could be used as biomarkers of pneumoconiosis in workers exposed to asbestos-contaminated minerals.
Highlights
Pneumoconiosis is an important occupational lung disease caused primarily by inhalation of mineral dust from asbestos and crystalline silica
The objective of this study was to assess the diagnostic accuracy using the serum and urinary biomarkers for pneumoconiosis in workers exposed to asbestos-contaminated minerals
The case group had decreased pulmonary function in forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and forced expiratory flow between 25% and 75% of the FVC (FEF25-75)
Summary
Pneumoconiosis is an important occupational lung disease caused primarily by inhalation of mineral dust from asbestos and crystalline silica. Recent studies have shown that workers processing nephrite jade, a non-asbestiform tremolite-actinolite asbestos mineral, can release asbestiform fibre, increasing the risk of pneumoconiosis and lung cancer [5]. Antigorite, or talc, which could contain paragenetic asbestos, they are exposed to non-asbestiform and a proportion of asbestiform elongated mineral particles (EMPs) and have an increased risk of cancer [7, 11]. Similar exposures to both non-asbestiform and asbestiform EMPs in occupational settings have been reported among taconite miners in Minnesota [12] and talc miners in upstate New York [13]. The occupational hazards remain unclear, and no regulations exist regarding the mixed asbestiform and non-asbestiform EMP exposure environment [3]
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