GB 16380-1996 Diagnostic criteria and treatment principles for occupational acute allergic alveolitis
Some standard content:
National Standard of the People's Republic of China
Occupational acute allergic alveolitis
Diagnostic criteria and principles of management ofoccupational acute allergic alveolitisGB 16380--1996
Occupational acute allergic alveolitis is a respiratory disease characterized by alveolar allergic changes caused by inhalation of certain antigenic organic dusts during the production process.
1 Subject content and scope of application
This standard specifies the diagnostic criteria and management principles of occupational acute allergic alveolitis. This standard is applicable to the diagnosis and management of acute alveolitis caused by contact with mold spores, fungal spores or other protein organic dusts. Such as farmers' lung, bagasse lung, humidifiers and other acute patients. 2 Diagnostic principles
According to the occupational history of re-inhalation of allergens, clinical symptoms, signs and chest X-ray manifestations mainly of respiratory system damage appear after a certain incubation period, combined with the results of on-site hygiene surveys, referring to the results of pulmonary function, arterial blood gas and serum precipitation antibody tests, and excluding similar lesions caused by other causes, a comprehensive analysis can be made before diagnosis. 3 Diagnosis and grading standards
3.1 Contact reaction
Long chills, fever, cough, chest pain and shortness of breath appear 4 to 8 hours after inhalation of allergens, and chest X-ray examination shows no changes in lung parenchyma. The above symptoms can disappear within 1 week after discontinuation of contact.
3.2 Mild
There is moderate to severe cough, accompanied by chest tightness, shortness of breath, chills, fever, and crepitus can be heard in both lower lungs. In addition to the enhancement of the texture of both lungs, the chest X-ray also has 1~~5 mm blurred edges and low density point shadows. The range of the lesion does not exceed 2 lung areas; serum precipitation reaction can be positive.
3.3 Severe
The above clinical manifestations are aggravated, with weight loss and fatigue; chest sound increases, and chest X-ray shows patchy shadows, which are distributed over more than 2 lung areas. Or merge into a large blurred shadow. Serum precipitation reaction may be positive. 4 Treatment principles
4.1 Those with contact reactions should temporarily leave the scene, undergo necessary examinations and treatment, and be closely observed for 24~72 hours. 4.2 Those with mild symptoms should temporarily leave the production environment for rest, and receive symptomatic treatment such as cough suppressants, flat mouth, oxygen inhalation, and appropriate glucocorticoid therapy. Pay attention to follow-up.
4. 3 Those with severe symptoms should rest in bed, and use sufficient glucocorticoids and symptomatic treatment in the early stage. Approved by the State Bureau of Technical Supervision on May 23, 1996, and implemented on December 1, 1996
5 Assessment of labor capacity
GB16380-1996
Those with mild symptoms can return to work after recovery. Those with severe symptoms who relapse within a short period of time after returning to work should be transferred from their original jobs and given appropriate work arrangements based on their degree of recovery. 6 Requirements for health monitoring
6.1 Those who work in harmful environments and frequently inhale certain organic dusts are required to undergo a physical examination once a year before and after employment. 6.2 Inquire about and record occupational history and medical history in detail. 6.3 The physical examination should include detailed internal medicine, otolaryngology examinations, and chest X-ray examinations. Units with conditions may conduct tests on pulmonary ventilation function, diffusion function, and serum precipitation antibodies as needed. 7 General occupational prohibition certificate
Patients with obvious chronic respiratory diseases, such as chronic bronchitis (asthmatic type), obstructive emphysema, active pulmonary tuberculosis, bronchiectasis, etc. a.
Tracheal dilatation, etc.;
b. People with atopic constitution, such as allergic rhinitis, bronchitis asthma, etc. 322
A1 Purpose
GB16380-1996
Appendix A
Bidirectional immunodiffusion test for serum precipitation antibodies (supplement)
The pathogenesis of occupational acute allergic alveolitis mainly involves type I allergic reaction. Specific antibodies corresponding to pathogen antigens can often be detected in the blood of patients or those who have contact with relevant pathogens. Therefore, the detection of serum precipitation antibodies is helpful for etiological diagnosis of patients.
A2 Principle
Add soluble antigen and antibody to the corresponding wells on the agar plate, and diffuse them to the surroundings. If the antigen and antibody are corresponding, a white precipitation line can be formed at the appropriate ratio of the two. When the test substance contains more than one antigen and antibody system, due to the different diffusion coefficients of various antigens, the optimal ratios between each pair of antigens and antibodies are different. After diffusion, several precipitation lines can be formed in different areas. And according to whether the figures of two adjacent precipitation lines are connected or crossed, it can be understood whether the two antigens are of the same nature. Therefore, this test can be used to check the purity of antigens or antibodies. And use known antigens (or antibodies) to detect and analyze unknown antibodies (or antigens). Since the content of antibodies in bacteria in serum is usually low, the positive detection rate of the general Ouchterlony method is low. This test uses a modified two-way diffusion method, which can increase the sensitivity of the reaction by nearly 10 times and has a higher specificity. A3 Materials
A3.1 Whole serum of the subject.
A3.2 Known antigens: Select relevant pathogen antigens according to the detection needs, such as soluble antigens of thermophilic actinomycetes and streptomyces or soluble antigen substances extracted from production environment samples (such as mold grass compost). A3.3 Chemical reagents
pH7.5 boric acid buffer:
boric acid 2.48 g
citric acid 10 g
agarose (for electrophoresis);
c. 1% phenol.
A3.4 Other equipmentwww.bzxz.net
NaCl 6. 96 g
NaOH 3. 5 g
70mmX60 mm glass slide,
metal puncher with outer diameter of 5mm and 11mm; large injection needle, narrow-mouthed pipette.
A4 Change to step
Sodium borate
Deionized water 1000mL
A4.1 Add 0.8g agarose to 100mL of boric acid buffer, heat to melt and mix, then pour on a glass plate, 2mm thick, about 8.4mL per piece.
A4.2 After the agarose cools down, use a hole puncher to punch a series of holes, which can be plum blossom or triangle (see Figure A1). The large hole diameter is 11mm, the small hole diameter is 5mm, and the two side distances are 5mm. Use a syringe needle to pick out the agar in the hole, and use a pipette to suck out the remaining agar in the hole. When punching, be careful not to have bubbles between the bottom of the agar and the glass plate, and pay attention to the bottom seal. A4.3 Add the serum to be tested to the large hole and the known antigen to the small hole, until it is about level with the hole mouth. Place the above double diffusion plate horizontally in a wet box containing 1% phenol, place it at room temperature (25℃), and observe the results for 24 to 72 hours. If necessary, it can be stained and observed, or dried to make a film for long-term storage. A5 Result determination
GB16380—1996
Antigen and antibody (serum) diffuse with each other. If a white precipitation line is formed, it is determined to be a positive result (see schematic diagram). 70mm
Figure A1 Schematic diagram of the arrangement of holes in the double diffusion plate A and B indicate that two serum samples can be measured on one plate. 1 to 6: Different antigen numbers, that is, one serum can be measured with 6 antigens at the same time. A and B can share antigens 1 and 2. When measuring, different sizes of glass plates can be used according to actual needs, and the arrangement of holes on a plate can also be designed by yourself according to the above spacing and aperture principles.
Appendix B
Instructions for the correct use of standards
(reference)
B1 This standard is only applicable to the diagnosis and treatment of acute patients such as farmer's lung, spore lung of saccharomyces cerevisiae, and mushroom lung. B2 Arterial blood gas analysis should be performed for patients with purpura or suspected severe disease. B3 The positive results and dynamic changes of serum specific precipitation antibodies are helpful for diagnosis, but negative results do not negate the diagnosis. B4 Cough condition judgment criteria:
Mild (+): intermittent cough during the day, which does not affect normal life and work. Moderate (+10): Symptoms are between mild (+) and severe (++10). Severe (+1000): Frequent coughing or paroxysmal coughing during the day and night, affecting work and sleep. Additional instructions:
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by Huashan Hospital of Shanghai Medical University and Guangdong Provincial Institute of Occupational Disease Prevention and Control. This standard was interpreted by the Institute of Labor Hygiene and Occupational Diseases, Chinese Academy of Preventive Medicine, which is the technical management unit entrusted by the Ministry of Health. 324
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