This standard specifies the diagnostic criteria and treatment principles for occupational acute allergic alveolitis. This standard applies to acute alveolitis caused by contact with mold spores, fungal spores or other protein organic dust. Such as the diagnosis and treatment of acute patients with farmer's lung, bagasse lung, humidifiers, etc. GBZ 60-2002 Diagnostic criteria for occupational acute allergic alveolitis GBZ60-2002 Standard download decompression password: www.bzxz.net

1CS13.100
National Occupational Health Standard of the People's Republic of China GBZ60-2002
Diagnostic Criteria of Occupational Acute Allergic Alveolitis2002-04-08 Issued
2002-06-01 Implementation
Ministry of Health of the People's Republic of China
Article 5.1 of this standard is recommended, and the rest are mandatory. This standard is formulated in accordance with the "Law of the People's Republic of China on the Prevention and Control of Occupational Diseases". From the date of implementation of this standard, if the original standard GB16380-1996 is inconsistent with this standard, this standard shall prevail. After exposure to mold, fungus or other protein organic dust in occupational activities, acute alveolitis with changes in alveolar allergic reactions may occur. This standard is formulated to enable early diagnosis and correct treatment to protect the health of workers. Appendix A of this standard is an informative appendix, and Appendix B is a normative appendix. This standard is proposed and managed by the Ministry of Health of the People's Republic of China. This standard was drafted by Huashan Hospital of Fuzhou University and Guangdong Institute of Occupational Disease Prevention and Treatment. This standard is interpreted by the Ministry of Health of the People's Republic of China. Occupational acute allergic alveolitis diagnostic standard GBZ60-2002
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 Scope
This standard specifies the diagnostic criteria and treatment principles for occupational acute allergic alveolitis. This standard is applicable to acute alveolitis caused by contact with mold spores, fungal spores or other protein organic dusts. Such as the diagnosis and treatment of acute patients with farmer's lung, swallow's dregs lung, humidifiers, etc. 2 Diagnostic principles
Based on 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, refer to the results of pulmonary function, arterial blood gas and serum precipitation antibody tests, and exclude similar lesions caused by other causes. A comprehensive analysis can be made before diagnosis. 3 Contact reaction
Chills, fever, cough, chest tightness 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. 4 Diagnosis and grading standards
4.1 Mild
Moderate to severe cough, accompanied by chest tightness, shortness of breath, chills and fever; crepitus can be heard in both lower lungs; chest X-ray shows enhanced texture of both lungs, and there are 1 to 5 mm blurred edges and low density dot-shaped shadows, and the lesion range does not exceed 2 lung areas; serum precipitation reaction can be positive. 4.2 Severe
The above clinical manifestations are aggravated, with weight loss and fatigue: chest snoring increases: chest X-ray shows patchy shadows, which are distributed over more than 2 lung areas, or merge into large blurred shadows. Serum precipitation reaction may be positive. 5 Treatment principles
5.1 Treatment principles
5.1.1 Those with contact reactions should temporarily leave the scene, undergo necessary examinations and treatment, and be closely observed for 24 to 72 hours. 5.1.2 Those with mild symptoms should temporarily leave the production environment for rest, and receive symptomatic treatment such as cough suppressants, asthma relievers, oxygen inhalation, and appropriate glucocorticoid treatment. Pay attention to follow-up.
5.1.3 Those with severe symptoms should rest in bed, and use adequate glucocorticoids and symptomatic treatment in the early stage. 5.2 Other treatments
Mild patients can return to work after recovery. If they relapse again in a short period of time after returning to work, as well as those with severe symptoms, they should be transferred from their original jobs and arranged for appropriate work according to the degree of recovery. 6 Instructions for the correct use of this standard
See Appendix A (Informative Appendix) and Appendix B (Normative Appendix). ..com Appendix A
(Informative Appendix)
Instructions for the correct use of this standard
A.1 This standard is only applicable to the diagnosis and treatment of acute patients with farmer's lung, fried residue fungus spore lung, mushroom lung, etc. A.2
Arterial blood gas analysis should be performed for patients with purple or suspected severe disease. The positive results and dynamic changes of serum specific precipitation antibodies are helpful for diagnosis, but negative results do not negate the diagnosis. A.3
Cough condition judgment criteria:
Mild (+): intermittent cough during the day, which does not affect normal life and work. Moderate (++): Symptoms are between mild (+) and severe (+++) Severe (+++): Frequent coughing or paroxysmal coughing at night, affecting work and sleep. B.1 Purpose
Appendix B
(Normative Appendix)
Bidirectional Immunodiffusion Test for Serum Precipitation Antibodies The pathogenesis of occupational acute allergic alveolitis mainly involves type IIIII allergic reactions. Specific antibodies corresponding to pathogen antigens can often be detected in the blood of patients or those who have been exposed to relevant pathogens. Therefore, the detection of serum precipitation antibodies is helpful for etiological diagnosis of patients.
B.2 Principle
Soluble antigens and antibodies are added to the corresponding wells on the agar plate, and the two diffuse to the surroundings. If the antigen and antibody are corresponding, a white precipitation line can be formed at the place where the ratio of the two is appropriate. When the test substance contains more than one antigen and antibody system, due to the different diffusion coefficients of various antigens, the optimal ratio between each pair of antigens and antibodies is different. After diffusion, several precipitation lines can be formed in different areas, and whether the two adjacent precipitation lines are connected or crossed can be used to understand 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. B.3 Materials
B.3.1 Whole serum of the subject.
B.3.2 Known antigens: Select relevant pathogen antigens according to the needs of the test, such as soluble antigens of thermophilic actinomycetes and streptomyces or soluble antigen substances extracted from production environment samples (such as mold grass compost). B.3.3 Chemical reagents
pH7.5 boric acid buffer:
boric acid 2.48g
citric acid 10g
b) agarose (for electrophoresis);
1% phenol.
B3.4 Other equipment
NaCI6.96g
70minx60mm glass slide;
Sodium borate
Deionized water
Metal puncher with outer diameter of 5mm and 11mm: large injection needle, narrow-mouthed pipette.
B.4 Operation steps
1000mLbzxz.net
Add 0.8g agarose to 100mL of boric acid buffer, heat to melt and mix, then pour on the glass plate, thickness 2mm, B.4.1
Each piece is about 8.4mL.
B.4.2 After the agarose cools down, use a puncher to make a series of holes, which can be plum blossom-shaped or triangular (see Figure B1). The large aperture is 11mm, the small aperture is 5mm, and the distance between the two sides is 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 holes, be careful not to allow bubbles to form between the bottom of the agar and the glass plate, and pay attention to sealing the bottom. B.4.3 Add the serum to be tested to the large hole, and add the known antigen to the small hole, until it is about level with the hole mouth. Put the above double-diffusion plate horizontally into 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 form a film for long-term storage. B.5 Result determination
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).
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Schematic diagram of double-diffusion plate punching
A and B indicate that two serum samples can be tested on one plate. 1 to 6: Different antigen numbers, that is, one serum can be tested with 6 antigens at the same time. A and B can share antigens 1 and 2.
During the measurement, glass plates of different sizes can be used according to actual needs, and the arrangement of holes on a plate can also be designed according to the above-mentioned spacing and aperture principles.
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