煤工尘肺患者多层螺旋计算机体层成像影像特征OA北大核心CSTPCD
Multi-slice spiral computerized tomography image characteristics of coal workers with pneu-moconiosis
[背景]多层螺旋计算机体层成像(MSCT)诊断尘肺时可作为胸片的辅助诊断,但目前已有的文献中少有煤工尘肺肺间质影像与期别间相关性的研究. [目的]探讨煤工尘肺及并发症的MSCT影像学表现及其分布特征,分析煤工尘肺期别与肺间质病变的相关性,为尘肺肺间质病变提供可靠的影像诊断依据. [方法]本研究对象来自 2022年 6月—2023年 6月于应急总医院职业病科筛选经尘肺诊断鉴定组确诊的 1002例煤工尘肺患者.应用MSCT检查,观察煤工尘肺患者肺部各种异常的影像学表现以及与自身疾病有关的肺纤维化本质的疾病(小叶间隔增厚、支气管血管周围间质增厚、肺实质带状影,胸膜下线、小叶内间质增厚、蜂窝、胸膜下间质增厚)、煤工尘肺及并发症的发生情况(陈旧性肺结核、活动性肺结核、肺炎、肺不张、肺癌、支气管扩张)以及尘肺结节的密度、大小以及位置的分布,对影像学资料进行分析及统计学处理. [结果]本次研究中1002患者均为男性,平均年龄(60.71±6.87)岁,平均接尘时间(23.01±7.80)年.其中壹期患者 470例,贰期患者 422例,叁期患者 110例.小叶间隔增厚、支气管血管周围间质增厚、肺实质带状影、小叶内间质增厚、胸膜下间质增厚、蜂窝在不同期别的分布上差异有统计学意义(P<0.05).圆形小阴影p、q、r型在不同期别尘肺患者中差异均有统计学意义(P<0.05).结节类型包括实性结节、纯磨玻璃影结节和部分实性结节.肺结核、支气管扩张在不同期别的分布上差异有统计学意义(P<0.05).在尘肺合并肺炎的分型中间质影和斑片合并间质影在不同期别的分布上差异有统计学意义(P<0.05). [结论]MSCT影像表现可以反映煤工尘肺病情变化进展,并与煤工尘肺的期别有一定的关系,有利于临床早期制定合理的治疗方案.因此,在尘肺病诊断和治疗中,应重视胸部计算机体层成像的影像技术手段,特别是MSCT检查的运用.
[Background]Multi-slice spiral computerized tomography(MSCT)can be used as an auxiliary di-agnosis of chest radiography in diagnosis of pneumoconiosis,but there are few studies on the correlations between interstitial images and stage classification of coal workers'pneumoconiosis in the existing literature. [Objective]To present MSCT imaging manifestations and distribution characteristics of coal workers'pneumoconiosis and complications,evaluate correlations between coal workers'pneu-moconiosis stages and pulmonary interstitial lesions,and provide a reliable imaging diagnosis basis for pneumoconiosis interstitial lesions. [Methods]From June 2022 to June 2023,a total of 1002 patients with coal workers'pneumoconiosis confirmed by the pneumoconiosis diagnostic and identification group in the Department of Occupational Diseases of the Emergency General Hospital were enrolled.MSCT was used to observe the abnormal imaging manifestations of the lungs of coal workers'pneumoconiosis patients and the diseases of pul-monary fibrosis related to their own diseases(thickening of the interlobular septum,bronchial perivascular interstitial mass thickening,parenchymal banding,subpleural line,intralobular interstitial thickening,honeycomb,and subpleural interstitial thickening),the occur-rence of coal workers'pneumoconiosis and complications(old tuberculosis,active tuberculosis,pneumonia,atelectasis,lung cancer,bronchiectasis),and the density,size,and location of pneumoconiosis nodules.Imaging data were analyzed and statistically processed. [Results]All 1002 patients were male,with an average age of(60.71±6.87)years and an average dust exposure time of(23.01±7.80)years.Among them,there were 470 patients with stage I,422 patients with stage Ⅱ,and 110 patients with stage Ⅲ.There were significant differences in the distribution of thickening of the interlobular septum,bronchial perivascular interstitial mass thickening,parenchymal banding,intralobular interstitial thickening,subpleural interstitial thickening,and honeycomb across different stages(P<0.05).Statistically significant differences in p,q,and r subsets of round nodules were found in patients with pneumoconiosis at different stages(P<0.05).Observed nodule types included solid nodules,pure ground-glass shadow nodules,and partial solid nodules.There were statistically sig-nificant differences in pulmonary tuberculosis and bronchiectasis among different stages of coal workers'pneumoconiosis(P<0.05).There were statistically significant differences in interstitial shadows and patches combined with interstitial shadows among different stages of pneumoconiosis complicated with pneumonia(P<0.05). [Conclusion]MSCT provides images of the progression of coal workers'pneumoconiosis and have a certain relationship with the stages of coal workers'pneumoconiosis,which is conducive to the formulation of reasonable treatment plans in the early clinical stage.There-fore,in the diagnosis and treatment of pneumoconiosis,a great attention should be paid to the imaging technology of chest computerized tomography,especially the use of MSCT examination.
李欣宇;李宝平;沈福海;孙治平;侯博文;高丽妮;李倩倩;刘晓璐;马超逸
华北理工大学公共卫生学院,河北,唐山 063210||应急总医院职业病科,北京 100028应急总医院职业病科,北京 100028||山西医科大学第一医院国家卫生健康委员会尘肺病重点实验室,山西太原 030001华北理工大学公共卫生学院,河北,唐山 063210||华北理工大学河北省煤矿卫生与安全重点实验室,河北,唐山 063210应急总医院职业病科,北京 100028
预防医学
煤工尘肺多层螺旋计算机体层成像肺间质病变小阴影影像学特点
coal worker's pneumoconiosismulti-slice spiral computerized tomographypulmonary interstitial lesionssmall shadowra-diographic feature
《环境与职业医学》 2024 (007)
774-779 / 6
国家卫生健康委员会尘肺病重点实验室开放课题基金资助项目(NHC202305)
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