自身抗体阳性的尘肺病患者五年随访研究  

A 5-year follow-up study of pneumoconiosis patients with positive autoantibody

作　　者：蒋文中[1] 张婷婷 陈育全[1] 罗兆环 林静茹 王海霞[1] 刘移民[1] Jiang Wenzhong;Zhang Tingting;Chen Yuquan;Luo Zhaohuan;Lin Jingru;Wang Haixia;Liu Yimin(Guangzhou 12th People's Hospital,Guangzhou 510620,China)

机构地区：[1]广州市第十二人民医院,510620

出　　处：《中华劳动卫生职业病杂志》2020年第6期401-405,共5页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：广州市卫生健康委临床重点专科(穗卫函[2019]1555号);广东省医学科研基金项目(A2016429)。

摘　　要：目的探讨自身抗体阳性的尘肺病患者小阴影进展及肺功能的变化,为尘肺病的临床治疗提供依据。方法选择2013年1月1日至2019年6月1日入住广州市职业病防治院尘肺科患者756例,剔除合并感染者,依据自身抗体是否阳性分为阳性组和阴性组,每组25例。对尘肺病患者的X射线胸片、胸部CT、第一秒用力呼气容积(FEV1)和用力呼气50%肺活量时的最大呼气流速(MEF50)等指标追踪观察5年,分析自身抗体阳性对尘肺小阴影形态学、5年尘肺晋期和肺功能的影响。结果自身抗体阳性组男性22例、女性3例,年龄(53.14±10.51)岁;阴性组男性23例、女性2例,年龄(53.88±8.10)岁。5年的观察期内,自身抗体阳性组与阴性组尘肺病患者小阴影形态、尘肺分期和5年尘肺晋期差异均无统计学意义(P>0.05),自身抗体阳性组胸部CT的小阴影面积增量高于自身抗体阴性组(P<0.05);自身抗体阳性组的FEV1和MEF50分别在第4和3年开始低于自身抗体阴性组(P<0.05);自身抗体阳性与FEV1和MEF50均呈负相关(P<0.05)。结论 5年的观察期内,自身抗体阳性未促进尘肺病患者X射线胸片的进展,但胸部CT上呈现出更多的小阴影;自身抗体阳性可能加剧肺功能的减退。Objective To explore the progress of small shadow and the change of lung function in pneumoconiosis with positive autoantibody,so as to provide basis for clinical treatment of pneumoconiosis.Methods A total of 756 patients were admitted to the pneumoconiosis department of the Guangzhou Occupational Disease Prevention Hospital from January 1,2013 to June 1,2019.The patients with combined infection were excluded.According to whether the autoantibody was positive,they were divided into positive group and negative group,25 cases in each group.Follow-up observation of X-ray chest radiographs,chest CT,forced expiratory volume in one second(FEV1)and forced expired flow at 50%of FVC(MEF50)of pneumoconiosis patients for 5 years,to analyze the influence of positive autoantibody on the morphology of X-ray chest film,the pneumoconiosis promotion in 5 years and lung function.Results There were 22 males and 3 females in the autoantibody positive group,aged 53.14±10.51 years.In the autoantibody negative group,there were 23 males and 2 females,aged 53.88±8.10 years.During the 5-year observation period,there was no significant difference of small shadow shape,pneumoconiosis stage,and the pneumoconiosis promotion in 5 years between the autoantibody positive group and the autoantibody negative group(P>0.05).However,the increment of small shadow area in the autoantibody positive group was higher than that in the autoantibody negative group(P<0.05).FEV1 and MEF50 of the autoantibody positive group were significantly lower than those of the autoantibody negative group in the fourth and third years,respectively(P<0.05).Positive autoantibody was negatively correlated with FEV1 and MEF50(P<0.05).Conclusion The positive autoantibody can't promote the progress of X-ray,but show more small shadows on chest CT;the positive autoantibody may aggravate the decline of lung function.

关 键 词：尘肺 自身抗体 小阴影 肺功能 随访研究 

分 类 号：R135.2[医药卫生—劳动卫生]