职业性矽肺与石棉肺临床特征对比研究  

Comparative study on clinical features of occupational silicosis and asbestosis

作　　者：吴娜[1] 杨晓丽[2] 赵倩[3] 薛长江[1] 李安[1] 叶俏[1] WU Na;YANG Xiaoli;Zhao Qian;XUE Changjiang;LI An;YE Qiao(Departments of Occupational Medicine and Toxicology,Clinical Center for Interstitial Lung Diseases,Beijing Chaoyang Hospital,Capital Medical University,Beifing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院首都医科大学间质性肺疾病临床诊疗与研究中心职业病与中毒医学科,北京100020 [2]北京京煤集团总医院尘肺与结核病科,102300 [3]国家安全生产监督管理总局职业安全卫生研究中心,102308

出　　处：《中国职业医学》2018年第5期595-600,共6页China Occupational Medicine

基　　金：国家科技重大专项重大新药创制(2015ZX09J15104);北京市卫生系统高层次卫生技术人才项目(2015-3-024)

摘　　要：目的比较职业性矽肺(以下简称"矽肺")和职业性石棉肺(以下简称"石棉肺")的发病潜伏期、高千伏X射线胸片及肺脏病理生理学特征。方法对173例矽肺患者(矽肺组)和246例石棉肺患者(石棉肺组)的粉尘接触情况、高千伏X射线胸片、肺病理生理指标进行比较,分析疾病期别、胸片影像学改变程度与肺功能的相关性。结果与矽肺组比较,石棉肺组患者接尘工龄较短(P <0. 05),诊断年龄较大(P <0. 05),发病潜伏期较长(P <0. 05)。高千伏X射线胸片在矽肺组患者表现以双上、中肺区圆形小阴影为主,矽肺叁期以大阴影为主,胸膜较少受累;在石棉肺组患者表现以双下肺区不规则形小阴影为主,胸膜受累广泛。与同期别矽肺组患者比较,石棉肺组患者的用力肺活量百分比、肺总量百分比、一氧化碳总弥散量(DLCO)百分比和动脉血氧分压均降低(P <0. 01),复合生理指数均升高(P <0. 01)。随着矽肺或石棉肺期别的升高,患者的肺通气功能总异常率均呈上升趋势(P <0. 01)。矽肺组和石棉组患者中,X射线胸片影像学改变程度越严重,肺通气异常和DLCO异常的检出率越高(P <0. 01)。结论矽肺和石棉肺发病个体特征、影像学改变和肺脏病理生理学特征存在差异,但其期别和X射线胸片影像学改变程度均与肺功能改变程度呈正相关。Objective To compare the onset,high kilovolt X-ray chest film,and lung pathophysiology in the diagnosis of occupational silicosis and asbestosis. Methods The history of dust exposure,high kilovolt X-ray chest film and lung pathophysiology were compared between 173 silicosis cases（ silicosis group） and 246 asbestosis cases（ asbestosis group）.The correlation between the disease stage,degree of chest radiographic change and lung function were analyzed. Results The duration of exposure in patients of asbestosis group was shorter（ P〈0. 05）,while the age of diagnosis and the incubation period in patients of asbestosis group were longer compared with silicosis group（ P〈0. 05）. In patients with silicosis,the high kilovolt X-ray chest film was characterized by round small opacities in the upper and middle lung regions. The large opacity was mainly in the stage Ⅲ silicosis,and the pleura was less affected. High kilovolt X-ray chest film in asbestosis group showed mainly irregular small opacities,concentrated in the lower lung area,with extensive involvement of the pleura. Compare with asbestosis and silicosis subgroups,the forced vital capacity percentage,total lung capacity percentage,diffusing capacity for carbon monoxide（ DLCO） percentage and partial pressure of oxygen were decreased in asbestosis gruop compared with that of silicosis group at the same stage（ P〈0. 01）. Composite physiologic index in asbestosis subgroup increased（ P〈0. 01）. The total abnormalrates of pulmonary ventilatory function in patients increased with the disease stages of silicosis and asbestosis groups（ P〈0. 01）. In the silicosis group and the asbestosis group,the more severe change of X-ray chest film,the higher the abnormalrates of lung ventilation and DLCO（ P〈0. 01）. Conclusion There are differences in individual onset,imaging changes and pathophysiological characteristics of patients with silicosis and asbestosis. The disease stages and the degree of radiographic changes in X-ray are positivel

关 键 词：矽肺 石棉肺 潜伏期 高千伏 X射线 胸片 肺功能 相关性 

分 类 号：R135.2[医药卫生—劳动卫生]