预测石棉肺疾病进展的胸部高分辨率CT影像特征分析  

Chest high-resolution CT features analysis in predicting the progression of asbestosis

作　　者：李双 包娜[3] 范亚丽 叶俏[1] Li Shuang;Bao Na;Fan Yali;Ye Qiao(Beijing Chaoyang Hospital,Capital Medical University,Beijing Institute of Respiratory Medicine,Department of Occupational Medicine and Toxicology,Clinical Center for Interstitial Lung Diseases,Beijing 100020,China;Department of Respiratory and Critical Care Medicine,Beijing Shunyi Hospital,Beijing 101300,China;Department of Radiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院,北京呼吸疾病研究所,职业病与中毒医学科,间质性肺疾病临床诊疗与研究中心,北京100020 [2]北京市顺义区医院呼吸与危重症医学科,北京101300 [3]首都医科大学附属北京朝阳医院放射科,北京100020

出　　处：《中华劳动卫生职业病杂志》2022年第1期1-6,共6页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：中国工程院咨询研究项目(2019-XZ-70)。

摘　　要：目的分析石棉肺患者疾病进展的胸部高分辨率CT(HRCT)影像特征,探讨预测石棉肺疾病进展的征象。方法采用前瞻性研究方法,纳入2013至2016年规律随访的68例石棉肺患者,根据职业和环境相关性呼吸疾病HRCT国际分类描述石棉肺患者的影像特征,比较观察期内疾病进展者与非进展者的异同。经Cox比例风险模型分析预测石棉肺疾病进展的胸部HRCT影像征象。结果纳入研究的石棉肺患者年龄为(65.5±7.8)岁,其中64.7%(44/68)为女性,29.4%(20/68)有吸烟史。疾病进展石棉肺患者(20.6%,14/68)与无进展石棉肺患者(79.4%,54/68)年龄、性别、吸烟和石棉接触等差异均无统计学意义(P>0.05)。石棉肺患者胸部HRCT均有不规则和(或)线状影,其中5.9%(4/68)伴有蜂窝影,以下肺分布为主;可伴有磨玻璃影、马赛克征。98.5%(67/68)合并胸膜异常,其中39.7%(27/68)为弥漫性胸膜增厚伴实质带和(或)球形肺不张。多因素Cox比例风险模型分析显示,不规则和(或)线状影评分增加(HR=1.184,95%CI:1.012~1.384,P=0.034)和蜂窝影(HR=6.488,95%CI:1.447~29.097,P=0.015)是石棉肺疾病进展的危险因素。结论基于胸部HRCT的不规则和(或)线状影评分和蜂窝影是预测石棉肺疾病进展的独立影响因素。Objective To analyze the radiological characteristics of chest high-resolution computed tomography(HRCT)of patients with asbestosis,and to investigate the signs of predicting the disease progression of asbestosis.Methods A prospective method was used to enroll 68 patients with asbestosis who were regularly followed up from 2013 to 2016.The radiological characteristics of patients with asbestosis were described by the International Classification of HRCT for Occupational and Environmental Respiratory Diseases(ICOERD),and the differences between patients with and without progression were compared during the observation period.The Cox proportional hazards regression model was used to analyze the chest HRCT radiological signs predicting the progression of asbestosis.Results The study included 68 patients with asbestosis aged(65.5±7.8)years old,of which 64.7%(44/68)were female,29.4%(20/68)had a history of smoking.There was no significant difference in age,sex,smoking and asbestos exposure between patients with progressive asbestosis(20.6%,14/68)and patients without progressive asbestosis(79.4%,54/68)(P>0.05).Chest HRCT of patients with asbestosis showed irregular and/or linear opacities,of which 5.9%(4/68)were accompanied by honeycombing.Irregular and/or linear opacities were mainly lower lung preponderant,often accompanied with ground glass opacity and mosaic perfusion.98.5%(67/68)had pleural abnormalities,of which 39.7%(27/68)had diffuse pleural thickening with parenchymal bands and/or rounded atelectasis.The analysis of multivariable Cox proportional hazard regression showed that the risk of the progression of asbestosis was increased with higher irregular and/or linears opacities cores(HR=1.184,95%CI:1.012-1.384,P=0.034)and the appearance of honeycombing(HR=6.488,95%CI:1.447-29.097,P=0.015).Conclusion The irregular and/or linear opacities scores and honeycombing on chest HRCT are independent influencing factors for predicting the disease progression of asbestosis.

关 键 词：石棉 石棉肺 高分辨率CT 线状影 蜂窝影 

分 类 号：R135.2[医药卫生—劳动卫生] R816.4[医药卫生—公共卫生与预防医学]