104例尘肺病患者的CT肺纤维化评分与肺通气功能相关性分析  

Correlation between CT pulmonary fibrosis score and pulmonary ventilatory function in 104 pneumoconiosis patients

作　　者：纪娅娟 李进丹 袁贵斌 阮斌 王瑞[2] 温勇坚 廖承德[2] JI Ya-juan;LI Jin-dan;YUAN Gui-bin;RUAN Bin;WANG Rui;WEN Yong-jian;LIAO Cheng-de(Department of Radiology Medical Imaging,the Occupational Disease Hospital of Yunnan Province,the Third People’s Hospital of Yunnan Province,Kunming,Yunnan 650011,China;不详)

机构地区：[1]云南省第三人民医院/云南省职业病医院放射医学影像科,云南昆明650011 [2]昆明医科大学第三附属医院/云南省肿瘤医院放射科,云南650118 [3]云南省第三人民医院职业病科

出　　处：《工业卫生与职业病》2022年第4期297-301,共5页Industrial Health and Occupational Diseases

基　　金：云南省教育厅科学研究基金项目(2021J0345);云南省卫生健康委员会医学学科带头人培养计划(D-2018009)。

摘　　要：目的在尘肺病患者中,定量评价肺间质纤维化程度,并了解肺间质纤维化与肺通气功能变化的规律及相关性。方法回顾性收集2016年7月至2019年7月职业性尘肺病患者资料,采用“Camiciottoli视觉评分法”对入组病例的CT图像进行肺间质纤维化程度定量评分,分析不同期别尘肺病患者肺通气功能指标与CT肺纤维化评分的变化规律及其相关性。结果随尘肺病期别提高,肺功能指标(FEV_(1)、FEV_(1)/VCmax、PEF、MMEF75、MMEF50)呈下降趋势,FEV_(1)/VCmax及PEF在不同分期间差异有统计学意义(t=4.012、3.117,P<0.05);而CT肺纤维化评分则呈上升趋势,其中纤维化评分总分、不规则的胸膜边缘、小叶间隔不规则增厚及胸膜下肺大疱在不同分期间差异有统计学意义(Z=20.604、28.890、19.251、12.919,P<0.05)。指标间相关性分析显示肺通气功能指标与CT肺纤维化评分总体呈负相关关系(r值为-0.192~-0.441)。单因素分析显示多项指标与尘肺病分期相关;有序多分类logistic回归分析显示,仅有不规则的胸膜边缘、小叶间隔不规则增厚两项评分指标与尘肺病分期显著相关(P<0.05,OR=1.767及1.385)。结论胸部CT影像及视觉评分法可对尘肺病患者的肺间质纤维化程度进行准确的量化评价,且肺纤维化评分与肺通气功能指标、尘肺病分期相关。Objective To accurately evaluate the degree of pulmonary interstitial fibrosis,and to evaluate the regularity and correlation of pulmonary interstitial fibrosis and pulmonary ventilatory function changes in pneumoconiosis patients.Methods Retrospectively review of 178 patients clinical data from July 2016 to July 2019,all patients were diagnosed with occupational pneumoconiosis and had their clinical staging.“Camiciottoli’s visual score”was used for staging the degree of pulmonary interstitial fibrosis,and the changes and correlation between the pulmonary interstitial fibrosis score and the pulmonary function test(PFTs)results in the same staging were analyzed.Results With the increase of the pneumoconiosis stages,the pulmonary ventilatory function indexes(FEV_(1),FEV_(1)/VCmax,PEF,MMEF75,MMEF50)had a tendency to reduction,FEV_(1)/VCmax and PEF had statistical difference(t=4.012,3.117,P<0.05).Among the CT pulmonary fibrosis visual score,four indexes(total score,irregular pleural margins,septal and subpleural lines,and subpleural cysts)had a good positive correlation with each stage of pneumoconiosis,and the difference was statistically significant(Z=20.604,28.890,19.251,12.919,P<0.05).Pulmonary ventilatory function indexes were negatively correlated with the CT pulmonary fibrosis score(r ranged from-0.192 to-0.441).By the univariate regression analysis,seven indexes were related to the stage of pneumoconiosis.By the multivariate logistic regression analysis,only two factors(irregular pleural margins,septal/subpleural lines)were significantly correlated with the stage of pneumoconiosis(P<0.05,OR 1.767 and 1.385,respectively).Conclusion The degree of pulmonary interstitial fibrosis in pneumoconiosis patients could be accurately evaluated by chest CT image,and the pulmonary fibrosis score was correlated with the pulmonary ventilatory function indexes and pneumoconiosis stage.

关 键 词：尘肺病 肺间质纤维化 胸部CT 肺纤维化评分 肺通气功能 

分 类 号：R135.2[医药卫生—劳动卫生]