硬金属肺病临床分析  

Clinical analysis on hard metal lung disease

作　　者：李志辉[1] 王焕强[2] 李涛[2] 

机构地区：[1]中国疾病预防控制中心职业卫生与中毒控制所中国疾病预防控制中心研究生院,北京100050 [2]中国疾病预防控制中心职业卫生与中毒控制所,100050

出　　处：《中国职业医学》2016年第1期52-56,共5页China Occupational Medicine

基　　金：2014国家公益行业科研专项(201402021)

摘　　要：目的分析硬金属肺病（HMLD）病例的临床表现和诊断治疗方法。方法采用文献计量法,从中国医院知识仓库、万方数据知识服务平台和Pub Med数据库检索1980年1月至2015年10月国内外公开发表的HMLD相关文献,按照纳入和剔除标准,收集有硬金属粉尘接触史的病例资料进行分析。结果共纳入36例HMLD病例,发病年龄21.0~63.0（37.2±11.7）岁;硬金属粉尘接触工龄中位数为6.0（0.6~43.0）年,工种主要为硬金属工具打磨工。HMLD主要临床类型为巨细胞间质性肺炎（GIP）,亦可见过敏性肺炎和职业性哮喘等。HMLD临床表现无特异性,主要表现为干咳、劳力性呼吸困难、限制性肺通气功能损伤或伴弥散功能障碍;胸部影像学改主要表现为磨玻璃影、弥漫性小结节影和网状影,多见于双下肺区。24例（占66.7%）病例肺组织病理学检查可见GIP样改变。部分病例肺组织和支气管肺泡灌洗液可检测到钨和钴元素。22例病例脱离硬金属粉尘接触并接受糖皮质激素治疗,其中19例治疗有效;6例病例通过脱离接触硬金属粉尘后临床症状得到改善。结论 HMLD属于间质性肺疾病,其临床上缺乏特异性表现,糖皮质激素治疗对多数患者有效。明确的硬金属粉尘接触史对于明确诊断有重要意义。Objective To analyze the clinical features,and diagnostic and therapeutic method of hard metal lung disease（ HMLD）. Methods By using literature metrology method,the open published case reports associated with HMLD from January 1980 to October 2015 were searched using the China Hospital Knowledge Database,Wanfang Database and Pub Med Database. The data of patients with hard metal dust exposure history were collected and analyzed based on the inclusive and exclusive criteria. Results Thirty-six cases of HMLD were collected. The onset age of patients was 21. 0-63. 0（ 37. 2 ± 11. 7） years old. The median exposure time was 6. 0（ 0. 6-43. 0） years,and the major working type was hard metal grinder. The main clinical type of HMLD maily was giant cell interstitial pneumonia（ GIP）,hypersensitivity pneumonitis and occupational asthma were also seen. HMLD was lack of characteristic clinical manifestation. The clinical symptoms of HMLD mainly included dry cough,dyspnea on exertion,restrictive pulmonary ventilation,and diffuse pulmonary dysfunction. The imaging study showed ground-glass opacity,diffuse small nodule shadow and reticular opacity shadow,which were mainly seen in the lower lobes of both lungs. There were 24 cases（ 66. 7%） showed GIP in the lung tissue in pathological examination. The tungsten and cobalt elements were detected in lung tissue and bronchoalveolar lavage fluid in some cases. Among 22 patients treated with glucocorticoid after keeping away from hard metal dust exposure,the treatment was effective in 19 patients. The clinical symptoms of 6 patients were improved by avoiding hard metal dust exposure. Conclusion HMLD belongs to the interstitial lung disease and there is no specific clinical manifestation. Glucocorticoid therapy is effective in most of the patients. The history of exposure to hard metal dust has important significance in making the diagnosis.

关 键 词：硬金属 粉尘 硬金属肺病 间质性肺疾病 临床表现 诊断 治疗 

分 类 号：R135[医药卫生—劳动卫生]