电焊工尘肺与矽肺发病特点的比较及随访研究  

Comparison of welder＆#39;s pneumoconiosis with silicosis and follow-up study of welder＆#39;s pneumoconiosis

作　　者：施瑾[1] 毛翎[1] 陈子丹[1] 周韶炜[1] 卞陆琴[1] 孙道远[1] 

机构地区：[1]同济大学附属上海市肺科医院,上海200433

出　　处：《中华劳动卫生职业病杂志》2015年第11期826-829,共4页Chinese Journal of Industrial Hygiene and Occupational Diseases

摘　　要：目的 了解新发电焊工尘肺与矽肺的CT、病理以及肺功能的发病特征.方法 对我院2008年1月至2013年12月新诊断的185例电焊工尘肺和115例矽肺进行影像学、病理学以及临床特征的比较,并随访观察X线胸片及肺功能的变化.结果 电焊工尘肺组Ⅰ期病例占98.4％,无Ⅲ期病例;矽肺组Ⅰ期,Ⅱ期和Ⅲ期分别占56.5％、22.6％和20.9％.两组尘肺期别构成比的差异有统计学意义（P＜0.05）.电焊工尘肺组82.7％（105/127）病例表现为肺组织中度及以上粉尘沉积,97.6％（124/127）的病例表现为轻度肺间质纤维化,无纤维化占该组2.4％（3/127）,而矽肺组60.0％（27/45）的病例表现为中度及以上粉尘沉积,77.8％（35/45）的病例达到中度及以上纤维组织增生,两组比较,差异有统计学意义（P＜0.05）.电焊工尘肺CT表现为弥漫分布的小叶中央性分支状细线影（72例,38.9％）或密度较低、大小一致的小叶中央性结节（36例,19.5％）,或二者兼有（57例,30.8％）.12例（6.4％）病例表现为明显的磨玻璃密度小结节或广泛磨玻璃影.随访39例电焊工尘肺4-6年,10例期别下降,29例期别保持不变,达不到原诊断期别.结论 电焊烟尘导致的肺部改变,是表现为氧化铁金属肺沉着病和肺间质纤维化的共同表现特征。Objective To study the character of welder＇s pneumoconiosis on CT,pathology,and lung function.Methods To contrast 185 welder＇s pneumoconiosis and 115 silicosis on CT,pathology,and clinical characters which were diagnosed between Jan 2008 and Dec 2013.Chest X-ray and lung function of 39 welder＇s pneumoconiosis patients were followed up after diagnosed 4～6 years later.Results Average age and working years of welder＇s pneumoconiosis were 36.7 and 11.5,less than silicosis patients 58.8 and 22.1,respectively （P〈0.05）.Of all 185 welder＇s pneumoconiosis 98.4% were of stage Ⅰ and no stage Ⅲ,while in silicosis group stage Ⅰ,stage Ⅱ and stage Ⅲ were 56.5%,22.6% and 20.9%,respectively.The ratio differences between the two groups were statistically significant,P 〈0.05.82.7% of welder＇s pneumoconiosis patients were observed pathologically moderate or above dust deposition in lung tissue while interstitial fibrosis level was just mild （97.6% patients） or no fibrosis （2.4% patients）.By contrast,60.0% silicosis patients pathologically showed moderate or above dust deposition while 77.8% were of moderate or above fibrosis.CT findings in welder＇s pneumoconiosis were diffuse branching linear structure （38.9%）,low density consistent size centrilobular micronodules （19.5%）,or both （30.8%）.Poorly-defined ground-glass attenuation centrilobular micronodules or widely ground glass shadow were observed in 6.4% welder＇s pneumoconiosis patents.30.8% patients failed to reach the original stage when 39 welder＇s pneumoconiosis followed up chest radiograph.Conclusion Changes in welder＇ s lung caused by welding fume were not only siderosis,but also interstitial fibrosis.

关 键 词：尘肺 病理学 呼吸功能试验 

分 类 号：R135.2[医药卫生—劳动卫生]