职业性硬金属肺病一例并文献复习  

One Case Report and Literature Review of Occupational Hard Metal Lung Disease

作　　者：李颖 肖雄斌 肖云龙 肖友立 戴伟荣 阎永健 

机构地区：[1]湖南省职业病防治院职业病科,湖南长沙410007 [2]山东省职业卫生与职业病防治研究院,山东济南250062

出　　处：《环境与职业医学》2016年第1期73-76,共4页Journal of Environmental and Occupational Medicine

基　　金：卫生公益性行业科研专项(编号:201402021);卫生部卫生监督中心卫生标准研制与应用项目(编号:20140712);湖南省"225"高层次卫生人才培养项目

摘　　要：[目的]通过对湖南省首次诊断的职业性硬金属肺病病例特点进行分析,为职业性硬金属肺病诊断标准的制定提供参考依据。[方法]对湖南省首例职业性硬金属肺病确诊病例的职业史、临床表现、影像学改变、病理检查以及相关文献进行回顾性分析。[结果]职业性硬金属肺病临床症状以干咳、胸闷气促为主,肺功能检查显示限制性肺通气功能障碍和弥散功能降低,影像学检查显示两肺弥漫性分布的磨玻璃影和条索影。肺活检病理表现为肺泡腔内可见巨噬细胞和大量的多核巨细胞聚集,即巨细胞间质性肺炎(GIP),糖皮质激素治疗有效。[结论]职业性硬金属肺病的临床表现无特异性,GIP是其主要特征性病理改变。根据患者GIP临床诊断,结合患者接触硬金属的职业史,诊断为职业性硬金属肺病。［Objective］ To analyze the first case of occupational hard metal lung disease （OHMLD） diagnosed in Hunan Province and to provide reference for making corresponding diagnostic criteria. ［Methods］ The occupational history, clinical manifestations, radiological changes, and pathological data of a patient with confirmed OHMLD were presented, and relevant literatures were reviewed. ［Results］ The main clinical symptoms of the OHMLD patient included dry cough, dyspnea, and gasp; the pulmonary function testing results showed a restrictive ventilatory functional disturbance and diffusion dysfunction; the CT scans demonstrated diffuse bilateral ground-glass attenuations and fibrous strips. The lung biopsy specimens showed congregations of alveolar macrophages and numerous large multinucleated histiocytes in alveolar spaces, which were the typical presentation of giant cell interstitial pneumonia （GIP）. The results indicated that glucocorticoid treatment was effective for OHMLD. ［Conclusion］OHMLD shows no specific clinical manifestations, and GIP is the major pathognomonic change. A diagnosis of OHMLD could be well achieved based on the clinical diagnosis of GIP and the occupational history of hard metal exposure.

关 键 词：硬金属肺病 巨细胞间质性肺炎 病理特征 钴 职业史 

分 类 号：R135.2[医药卫生—劳动卫生]