石棉肺严重程度的评价指标探讨  

Discussion on assessment indices for severity of asbestosis

作　　者：杜旭芹[1] 薛长江[1] 朱晓莉[1] 李安[1] 叶俏[1] 

机构地区：[1]首都医科大学附属北京朝阳医院职业病科,北京100020

出　　处：《中国工业医学杂志》2017年第2期102-105,共4页Chinese Journal of Industrial Medicine

基　　金：国家自然科学基金面上项目(81370159);北京市自然科学基金面上项目(7142058);北京市卫生系统高层次卫生技术人才项目(2015-3-024)

摘　　要：目的通过分析72例石棉肺患者胸片分期与肺功能等临床因素,探讨石棉肺严重程度的临床评价指标。方法选择首诊的石棉肺患者72例,采用体积描记法和一氧化碳弥散法测定肺通气和气体交换情况,根据胸片进行病情分期;运用Spearman等级相关分析探讨石棉肺胸片小阴影密集度、分布范围,控制接尘年限和吸烟指数等混杂因素后,应用多元逐步回归分析、主成因分析对石棉肺胸片分期与肺功能等临床因素关系进行统计学分析。结果不同期别石棉肺患者均以限制性通气障碍为主,随着期别升高,混合性通气障碍的比例增加;石棉肺胸片小阴影总体密集度或分布肺区与肺通气功能异常率无显著的相关性;肺总量(TLC)占预计值%、一氧化碳总弥散量(TLCO SB)占预计值%、胸膜斑与胸片分期在第一主成分中因子负荷系数较高。结论综合TLC占预计值%、TLCO占预计值%、胸膜斑与胸片分期等4项指标的状况,可以作为石棉肺严重程度的评价指标。Objective Through the analysis on pulmonary function states and X-ray staging in 72 cases of asbestosis patients, to explore the assessment indices for severity of asbestosis lesion. Methods Seventy-two first diagnosed asbestosis patients in our hospital were enrolled as subjects of this study, their pulmonary ventilation and gas exchange situations were measured by plethysmography and CO diffusion techniques, and the severity classification of asbestosis was made according to the diagnostic criteria of pneumoconiosis. Then, using Spearman rank correlation analysis to analyze the relationship among asbestosis stages and lung function, after control the confounding factors such as duration of dust exposure, smoking years, etc, the multiple regression analysis and principal cause analysis were used to analyze the relationship between lung function and X-ray stages. Results The results showed that the main change of pulmonary function in all the asbestosis patients enrolled was restrictive ventilatory dysfunction, and with the rise of severity stage, the ratio of mixed ventilation disturbances also increased; both the overall density of or the distribution range of small shadows were not significantly correlated with the incidence of abnormal lung function in asbestosis patients ; and the percentage of total lung capacity in predicted value （TLC%） , the percentage of total carbon monoxide diffusing capacity in predicted value （TLCO%） , the pleural plaques and the X-ray staging were the top four indices with high factor loading coefficients in the first principal components. Conclusion It was suggested that the comprehensive consideration of the four indices mentioned above, such as TLC%, TLCO%, pleural plaques and X-ray staging, may be the basis for the quantitative evaluation of the severity of asbestosis.

关 键 词：石棉肺 肺功能 胸片分期 主成因分析 

分 类 号：R135.2[医药卫生—劳动卫生]