煤工尘肺临床表型研究  

Study on clinical phenotype of coal workers pneumoconiosis

作　　者：翟鹏勇[1] 李海学[1] 赵瑞峰[1] 李雪琴[1] 王焕强 Zhai Pengyong;Li Haixue;Zhao Ruifeng;Li Xueqin;Wang Huanqiang(General Hospital of Jincheng Coal Industry Group,Jincheng 048006,China)

机构地区：[1]晋城煤业集团总医院,048006 [2]中国疾病预防与控制中心职业卫生所,北京100050

出　　处：《中华劳动卫生职业病杂志》2020年第5期374-378,共5页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：十二五国家科技支撑计划课题(2014BA112B01)。

摘　　要：目的探讨煤工尘肺临床特征分类,以指导各类煤工尘肺患者个体化治疗。方法于2018年3月至5月,采用整群抽样方法选取2014年1月至2017年12月于晋城煤业集团总医院住院的煤工尘肺患者121人为研究对象,收集各期别煤工尘肺患者的临床资料,并划分临床变量,通过主成分因子分析及聚类分析方法从其16个临床变量中[年龄、抽烟指数、井下接尘作业年限、尘肺分期、工种、家族史、主要症状、次要症状、症状评估测试量表(CAT评分)、影像学表现、用力肺活量占预计值百分比(FVC%pred)、1秒呼气容积占用力肺活量百分比(FEV1/FVC)、1秒呼气容积占预计值百分比(FEV1%pred)、一氧化碳弥散量占预计值百分比(DLCO%pred)、呼吸衰竭合并症、肺心病合并症]提取出2个主成分、8个相关变量,根据"立方聚类条件"值(cubic clustering condition value,CCC值)将煤工尘肺患者分为3型,用方差分析或χ^2检验分析不同类型患者的临床资料特征,总结其临床资料特征。结果3型煤工尘肺患者中1型病例73例(占60.3%),以中年为主,肺功能损害小,临床症状轻微,影像学表现单一,壹、贰期尘肺为主;2型病例18例(占14.9%),以中老年为主,肺功能损害多以弥散功能下降为主,临床症状较重,影像学表现复杂,壹、贰、叁期尘肺均有;3型病例30例(占24.8%),以中老年为主,肺功能损害多(通气、弥散功能均下降),临床症状严重,影像学表现复杂,以贰、叁期尘肺为主。结论通过聚类分析方法根据临床特征将煤工尘肺患者分为3型,根据不同分型制定治疗方案在临床工作中有一定的指导价值。Objective To explore the clinical phenotypic characteristics of coal worker's pneumoconiosis for guiding the individualized treatment of various types of patients with coal worker's pneumoconiosis.Methods Collect clinical data of 121 cases of coal worker's pneumoconiosis in different stages,and select 16 clinical variables(age,smoking index,years of underground dust exposure,stages of pneumoconiosis,types of work,family history,main symptoms,secondary symptoms,CAT score,imaging manifestations,FVC%,FEV1/FVC,FEV1%,DLCO%,respiratory failure complications,pulmonary heart disease complications).Principal Component Factor Analysis(PCA)was used to analyze 16 clinical variables of 121 patients with coal worker's pneumoconiosis.Extracted 2 principal components and 8 related variables from 16 clinical variables,then coal worker's pneumoconiosis patients were divided into three types according to CCC values.Variance analysis orχ^2 test were used to analyze the characteristics of these three types of clinical data,then summarized the clinical phenotype composition ratio and clinical data characteristics.Results The patients with coal worker's pneumoconiosis were initially divided into three types,including 73 cases(60.3%)in type 1,18 cases(14.9%)in type 2 and 30 cases(24.8%)in type 3.Patients in type 1 are mainly middle-aged,with little damage to lung function and mild clinical symptoms,the imaging manifestations of type 1 patients are mainly diffuse nodules,and the stages of pneumoconiosis are mostly one-stage and second-stage.Patients in type 2 are mainly in middle-aged and elderly patients.the main pulmonary impairment is diffuse function decline.The clinical symptoms are severe and the imaging manifestations are complex.The stages of pneumoconiosis are one,second and third stages.Patients in type 3 are mainly middle-aged and elderly patients,with more pulmonary function impairment(decreased ventilation and diffusion),severe clinical symptoms,complex imaging manifestations(micro nodules,emphysema,mass shadow,fibrosis),an

关 键 词：煤工尘肺 临床 表型 

分 类 号：R135.2[医药卫生—劳动卫生]