CT及高分辨率CT对煤工尘肺大阴影的诊断价值及临床应用

目的探讨CT／高分辨率CT（CT／HRCT）对煤工尘肺（CWP）大阴影的诊断价值。方法对62例CWP作胸部CT／HRCT扫描，并与X线胸片进行比较。结果62例CWPX线胸片检出大阴影19例，检出率为30．6％，共检出大阴影30个；CT／HRCT检出大阴影者43例，检出率为69．4％，共检出大阴影123个。CT／HRCT较X线胸片多检出大阴影93个（4．1倍）。2种检查方法的大阴影检出率比较，差异有统计学意义（Χ^2=18．58，P〈0．01）。无一例X线胸片上显示大阴影而CT／HRCT未能显示者。62例CWPX线胸片检出Ⅲ期大阴影（≥1.0cm×2．0cm）者17例，检出率为27．4％，共检出Ⅲ期大阴影27个；CT／HRCT检出Ⅲ期大阴影34例，检出率为54．8％，共检出Ⅲ期大阴影67个，CT／HRCT比X线胸片多检出Ⅲ期大阴影40个，2种检查方法的大阴影检出率比较，差异有统计学意义（Χ^2=-9．63，P〈0．01）。CT／HRCT对大阴影的形态、内部结构、边缘特征、尘肺微细病变及特殊位置的大阴影均具有良好的显示能力。结论CT／HRCT在复杂性尘肺的诊断能力明显优于X线胸片，可检出X线胸片所不能发现的大阴影，可作为尘肺的一种重要而有实用价值的辅助检查手段。     

煤矽肺患者肺通气功能与X线胸片小阴影表现的研究

目的 探索煤工尘肺（煤矽肺）患者X线胸片改变对肺通气功能测定结果的相关性。方法 选取146例煤工尘肺（煤矽肺）患者X线胸片和肺通气功能测定资料作统计分析。结果 煤工尘肺（煤矽肺）患者X线胸片表现的小阴影密集度，分布范围与肺通气功能障碍检出率呈正相关关系。而肺通气功能障碍类型与慢支改变有关。结论 X线胸片表现的小阴影密集度及分布范围等客观指标，在煤工尘肺（煤矽肺）患者肺通气功能测定结果的判定中，有其肯定的积极意义，尤其对Ⅰ期煤工尘肺（煤矽肺）患者显示突出。     

尘肺诊断标准中小阴影密集度的应用价值

目的探讨尘肺诊断标准中小阴影密集度的应用价值。方法采用职业流行病学的方法,参照1980ILO国际尘肺X线影像分类指南,分析比较了太钢耐火厂不同时期接尘工人X线胸片小阴影密集度小级的发生率、发生密度及其与工龄的关系。同时,选择了接触煤矽尘工人的X线胸片与之比较其胸片小阴影密集度小级的发展速度和特点。结果①不同时期接尘工人胸片小阴影密集度小级的发生率不同,统计学检验P＜0．05。②胸片小阴影密集度随工龄延长而呈现出由低到高的上升趋势。③接触不同性质粉尘的工人其小阴影密集度小级的晋级速度不同。结论小阴影密集度是观察尘肺发生发展、评价生产环境的质量和估测接触粉尘性质的指标。     

高分辨CT在尘肺诊断中的价值

[目的]评估HRCT在尘肺诊断中的价值。[方法]对照分析18例尘肺高仟伏(HkV)胸片和高分辨率CT(HRCT) 检查所见。[结果]HkV胸片在小阴影形态判定方面有2例得到校准;在密集度判定方面有4例得到校准。其中2例为HkV胸片上小阴影浅淡,另2例为细支气管炎重叠而增加了密度;在小阴影分布范围的判定方面,HkV胸片与HRCT的判定结果基本一致。[结论]HRCT对胸部淋巴结,胸膜病变,肺气肿等诊断能提供更多的,准确的。有价值的信息。     

小阴影类型的分类倾向

本课题旨在研究煤工X线胸片X线小阴影类型的分类倾向。资料为1970～1989年间88名B组阅片者的15403份1类煤工尘肺(CWP)的胸片。胸片分类归入1971 ILOU/C法,用最高密集度的类型作为小阴影的优势类型。胸片分类归入1980 ILO法,小阴影的优势类型由G组阅片者确定。在此期间,观察到最明显的分类倾向为,P型阴影占优势胸片的比例普遍下降,这种情况主     

螺旋CT在尘肺诊断中的辅助作用(附61例报告)

回顾受理申请尘肺病诊断病例的螺旋CT和高仟伏X线后前位胸片表现,对尘肺大阴影、小阴影和合并肺部病变的影像学表现对比分析。结果显示螺旋CT对尘肺大阴影的显示和合并肺气肿、肺大泡、纵隔淋巴结肿大钙化、胸膜增厚粘连等病变的检出优于X线胸片,对尘肺诊断和鉴别诊断具有重要的辅助作用。     

煤工尘肺CT影像特征与诊断价值

目的通过研究煤工尘肺CT影像特征,探讨运用CT辅助诊断煤工尘肺可行性。方法对随机选择的113例煤工拍摄高仟伏胸片和进行胸部CT扫描。胸片诊断依据GBZ70-2009《尘肺病诊断标准片》和GBZ70-2009《尘肺病诊断标准》,CT片读片在确定信息区后,按前后、左右分别进行尘肺小阴影计数。结果比较胸片与CT的小阴影形态,P=0.648,比较胸片与CT的小阴影聚集和大阴影,P=0.525,差异均无统计学意义(P>0.05)。当CT中信息区一侧肺内尘肺小阴影前后计数<14、左右计数<9时,建议诊断为无尘肺(观察对象),前后≥14、左右计数≥9时,建议作为诊断壹期尘肺的参考依据。结论 CT可作为诊断参考依据以帮助提高尘肺诊断正确性。     

CT在尘肺小阴影的诊断价值(附二例报告)

CT在诊断肺部疾患中的价值,早已为临床医师所接受,但在尘肺诊断中的意义,报道不多,尤其是小阴影在CT和后前位胸片所显示的差异以及在尘肺诊断上的价值未见报道。现将我院收治二例矽肺患者CT和胸片小阴影在范围和密集度上的差异报告如下,并分析其产生原因。病例报告 [例1] 男,68岁,1950～l952年铜矿掘进工,1953～1963年井下放炮工,无防护设施。接尘工龄共13年。1984年院外诊断为Ⅱ期矽肺(按1963年矽肺X线诊断标准)。因咳嗽20年,气短10年,于1990年6月5日收入院。20年前间断咳嗽,咳少量     

运动对慢性心理应激大鼠行为及血清皮质醇、IL-2、IL-8的影响

目的探讨螺旋CT和高分辨率CT（HRCT）检出煤工尘肺肺气肿与肺功能检测指标的相关性及两种CT在煤工尘肺肺气肿检出方面的差异。方法选择96例Ⅰ期煤工尘肺患者行64排螺旋CT和HRCT扫描检查,并进行肺气肿定性及定量分析。肺功能检查（PTT）采用比利时麦迪公司（Mdeisofi）Bodybox 5500体积描记仪测定通气功能和容积功能。用SPSS统计软件对两种CT与肺功能检查结果进行相关的统计学分析。结果64排螺旋CT和HRCT评分与肺功能检测指标中的RV、RV／TLC％、TIE有很好正相关（P〈0．001）;而FVC、DLCo、FEV1／FVC％、FEV1％、MVV均有很好负相关（P〈0．001）。肺气肿64排螺旋CT和HRCT诊断的阳性率高于肺功能检出阳性率（P〈0．005）,两种CT肺气肿检出率经配对计数资料卡方检验,χ^2=2．78,P〉0．05,说明两种检查方法对肺气肿检出率无明显差异。结论64排螺旋CT和HRCT对肺气肿检出,与肺功能检测指标有很好的相关性（P〈0．001）,即64排螺旋CT和HRCT与肺功能检出肺气肿方面有同样敏感性;CT诊断肺气肿的阳性检出率高于肺功能,说明对于早期肺气肿诊断64排螺旋CT和HRCT检查优于肺功能检查。     

HRCT在电焊工尘肺及矽肺诊断中的应用价值

采用统计软件对105例电焊工尘肺患者、120例矽肺患者的高仟伏X线胸片与HRCT显示肺区小阴影数量、合并症及小阴影密集度肺区数进行配对χ~2检验,P0.05差异具有统计学意义。接尘无尘肺患者和壹期电焊工尘肺或矽肺患者中,HRCT的检出率均显著高于高仟伏X线(P=0.027)。对于贰期和叁期电焊工尘肺或矽肺患者,HRCT的检出率与高仟伏X线比较,两种方法差异均无统计学意义(P0.05)。     

Antioxidant response at early stages and low grades of simple coal worker's pneumoconiosis diagnosed by high resolution computed tomography

In miners exposed to coal dusts, coal worker's pneumoconiosis (CWP) can occur. The purpose of the present study is to better understand the relations between coal dust exposure and activities of blood plasma antioxidant enzymes, namely, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), and lipid peroxidation end product malondialdehyde (MDA) concentration in coal workers with early and low grade simple CWP diagnosed by high resolution computed tomography (HRCT). Forty-three coal workers who had profusions of 0/1-2/2 according to ILO 1980 chest X-ray (CXR) classification, 43 coal workers without CWP (control group 1) and 44 healthy subjects (control group 2) who were randomly selected from the population register or recruited from the hospital staff were enrolled. Coal workers were reevaluated by HRCT (Hosoda-Shida classification) due to its higher sensitivity than standard CXR. Then, blood plasma SOD and GSH-Px activities and MDA plasma levels were measured. CWP was found positive in 46 of 89 coal workers by HRCT evaluation. Profusion 0 (P0, CWP not present), profusion 1 (P1, early CWP) and profusion 2 (P2, low grade CWP) were found in 43, 23 and 19 of patients found to have CWP by HRCT, respectively. We had no worker with profusion 3 (P3). Complicated CWP was shown in four of 46 patients and thesecases were excluded as the study was restricted to early and low-grade pneumoconiosis. In respect to the plasma levels of MDA and plasma activities of SOD and GSH-Px, statistically significant differences were found between CWP cases and control groups (p < 0.01, p < 0.01, p < 0.001 respectively). Statistical differences were also obtained for the plasma activities of SOD and GSH-Px and levels of MDA in relation to HRCT profusions (p < 0.05). In conclusion, these findings suggest an oxidative stress due to increased free radicals and reactive oxygen metabolite production in early stages and low grades of simple CWP diagnosed by HRCT.     

尸检肺脏小结节的高分辨率CT表现及其病理学基础

目的评价煤工和煤工尘肺（CWP）尸检肺脏小结节影的高分辨率（HRCT）表现及其病理学基础。方法32例CWP和煤尘接触者（生前X线胸片诊断0^＋期3例、Ⅰ期4例、无尘肺25例）的尸检离体肺脏采用Heitzman法固定、充气干燥制成充气固定肺标本，进行冠状位MSCT／SSCT及HRCT扫描，然后行尘肺病理诊断。32例选取13例肺标本的17片厚切片进行厚度为80～150μm的大切片制作，大切片后剩余的薄片进行5μm组织学切片。分析HRCT图像，记录结节类型并记录小结节的分布特点及其与肺小叶固有结构的关系。结果（1）尸检病理诊断：无CWP14例，CWP18例（Ⅰ期5例、Ⅱ期11例、Ⅲ期2例）。（2）32例离体肺标本的HRCT图像均显示有结节存在，病理检查证实29例有结节存在。（3）CWP结节的HRCT有边缘清楚的圆形结节、模糊结节及星芒状结节。HRCT所见14个边缘清楚的圆形结节，病理检查12个为典型结节；HRCT所见26个模糊状结节，病理检查14个为非典型结节、11个为尘斑及1个为典型结节；HRCT所见9个星芒状结节6个为尘斑，3个为非典型结节。（4）HRCT可显示结节位于小叶肺动脉、增厚的小叶间隔和胸膜的邻近部位及胸膜下。结论HRCT可显示煤工和CWP患者肺脏的典型结节和非典型结节及部分尘斑，还可显示结节与肺小叶结构及其与胸膜的关系。     

Relations between occupational exposure to coal mine dusts,erythrocyte catalase and Cu++/Zn++ superoxide dismutase activities,and the severity of coal workers' pneumoconiosis

OBJECTIVES: To better understand the relations between occupational exposure, blood antioxidant enzyme activities, total plasma antioxidant concentration, and the severity of coal workers'' pneumoconiosis (CWP). METHODS: Blood samples were obtained from miners without CWP exposed to low dust concentrations for > or = 4 years at the time of the study (n = 105), or exposed to high dust concentrations for > or = 14 years at the time of the study (n = 58), and from retired miners with CWP (n = 19). Miners without CWP were classified into three subgroups according to their estimated cumulative exposure to dust. Chest x ray films were obtained for each miner. Miners were classified in five subgroups according to their International Labour Organisation (ILO) profusion grades. Univariate tests were completed by multiple linear regression analyses. RESULTS: The estimated cumulative exposure to dust was strongly positively related to erythrocyte catalase activity and strongly negatively related to Cu++/Zn++ SOD activity only in miners exposed to high dust concentrations for > or = 14 years at the time of the study (F tests p = 0.006 and p = 0.004 respectively). Moreover, catalase activity was strongly related to the severity of CWP expressed as five subgroups of ILO profusion grades (F test p = 0.003); the greatest difference in the mean values was found between the group of 1/1 to 1/2 ILO profusion grades and the group of 2/1 to 3/3 ILO profusion grades. CONCLUSION: These results are in good agreement with the hypothesis that production of reactive oxygen species may be an important event in the exposure to coal mine dusts and the severity of CWP. Erythrocyte catalase and Cu++/Zn++ SOD activities are more closely related to recent exposure to high dust concentrations than to cumulative exposure, and could be considered as biological markers of exposure rather than as markers of early adverse biological effect.       

A new high resolution computed tomography scoring system for pulmonary fibrosis, pleural disease, and emphysema in patients with asbestos related disease.

The aim of this study was to describe a scoring system for high resolution computed tomographic (HRCT) scans analogous to the International Labour Office (ILO) scoring system for plain chest radiographs in patients with asbestos related disease. Interstitial fibrosis, pleural disease, and emphysema were scored, the reproducibility and the interobserver agreement using this scoring system were examined, and the extent of the various types of disease was correlated with measurements of lung function. Sixty asbestos workers (five women and 55 men) mean age 59 (range 34-78) were studied. The lungs were divided into upper, middle, and lower thirds. An HRCT score for the extent of pleural disease and pulmonary disease in each third was recorded in a way analogous to the International Labour Office (ILO) method of scoring pleural and parenchymal disease on chest radiographs. A CT score for the extent of emphysema was also recorded. Pleural disease and interstitial fibrosis on the plain chest radiographs were assessed according to the ILO scoring system. A chest radiographic score for emphysema analogous to that used for HRCT was also recorded. Two independent readers assigned HRCT scores that differed by two categories or less in 96%, 92%, and 85% compared with 90%, 78%, and 79% of cases for chest radiographs for fibrosis, emphysema, and pleural disease respectively. There was better intraobserver repeatability for the HRCT scores than for the chest radiograph scores for all disorders. Multiple regression analysis showed that scores for interstitial fibrosis, emphysema, and pleural disease on chest radiographs and HRCT correlated to a similar degree with impairment of lung function.     

Rapidly progressive coal workers' pneumoconiosis in the United States: geographic clustering and other factors

Background: Despite significant progress made in reducing dust exposures in underground coal miners in the United States, severe cases of coal workers'' pneumoconiosis (CWP), including progressive massive fibrosis (PMF), continue to occur among coal miners. Aims: To identify US miners with rapidly progressive CWP and to describe their geographic distribution and associated risk factors. Methods: Radiographic evidence of disease progression was evaluated for underground coal miners examined through US federal chest radiograph surveillance programmes from 1996 to 2002. A case of rapidly progressive CWP was defined as the development of PMF and/or an increase in small opacity profusion greater than one subcategory over five years. County based prevalences were derived for both CWP and rapidly progressive cases. Results: A total of 886 cases of CWP were identified among 29 521 miners examined from 1996 to 2002. Among the subset of 783 miners with CWP for whom progression could be evaluated, 277 (35.4%) were cases of rapidly progressive CWP, including 41 with PMF. Miners with rapidly progressive CWP were younger than miners without rapid progression, were more likely to have worked in smaller mines (<50 employees), and also reported longer mean tenure in jobs involving work at the face of the mine (in contrast to other underground mining jobs), but did not differ with respect to mean underground tenure. There was a clear tendency for the proportion of cases of rapidly progressive CWP to be higher in eastern Kentucky, and western Virginia. Conclusions: Cases of rapidly progressive CWP can be regarded as sentinel health events, indicating inadequate prevention measures in specific regions. Such events should prompt investigations to identify causal factors and initiate appropriate additional measures to prevent further disease.     

A new high resolution computed tomography scoring system for pulmonary fibrosis, pleural disease, and emphysema in patients with asbestos related disease.

The aim of this study was to describe a scoring system for high resolution computed tomographic (HRCT) scans analogous to the International Labour Office (ILO) scoring system for plain chest radiographs in patients with asbestos related disease. Interstitial fibrosis, pleural disease, and emphysema were scored, the reproducibility and the interobserver agreement using this scoring system were examined, and the extent of the various types of disease was correlated with measurements of lung function. Sixty asbestos workers (five women and 55 men) mean age 59 (range 34-78) were studied. The lungs were divided into upper, middle, and lower thirds. An HRCT score for the extent of pleural disease and pulmonary disease in each third was recorded in a way analogous to the International Labour Office (ILO) method of scoring pleural and parenchymal disease on chest radiographs. A CT score for the extent of emphysema was also recorded. Pleural disease and interstitial fibrosis on the plain chest radiographs were assessed according to the ILO scoring system. A chest radiographic score for emphysema analogous to that used for HRCT was also recorded. Two independent readers assigned HRCT scores that differed by two categories or less in 96%, 92%, and 85% compared with 90%, 78%, and 79% of cases for chest radiographs for fibrosis, emphysema, and pleural disease respectively. There was better intraobserver repeatability for the HRCT scores than for the chest radiograph scores for all disorders. Multiple regression analysis showed that scores for interstitial fibrosis, emphysema, and pleural disease on chest radiographs and HRCT correlated to a similar degree with impairment of lung function.     

Comparison of radiographic appearances with associated pathology and lung dust content in a group of coalworkers

The pathology and dust content of lungs from 261 coalminers in relation to the appearances of their chest radiographs taken within four years of death were examined. Radiological opacities of coalworkers' pneumoconiosis were more profuse the more dust was retained in lungs. Among the men who had mined low rank coal--that is, with a relatively high proportion of ash--the increase in profusion was most closely related to the ash component of the dust, whereas in men who had mined high rank coal both coal and ash increased in the lungs in relation to radiological profusion. The fine p type of opacity was found to be associated with more dust and a higher proportion of coal and less ash than the nodular r opacity, and was also more likely to be associated with emphysema. The pathological basis of the different types of opacity found on the radiographs of coalminers related to the number, size, and nodularity of the dust lesions. Larger fibrotic lesions were likely to appear as r opacities, whereas fine reticular dust deposition was most likely to present as p opacities, q opacities showing a mixture of appearances. The study has shown that the composition of dust retained in the lung, as well as its amount, makes an important contribution to the radiographic appearances of pneumoconiosis. In particular, the r type of lesion on the radiograph of a low rank coalminer indicates the possibility of a silicotic like lesion.     

Pneumoconiosis and advanced occupational lung disease among surface coal miners--16 states, 2010-2011

Coal workers' pneumoconiosis (CWP) is a chronic occupational lung disease caused by long-term inhalation of dust, which triggers inflammation of the alveoli, eventually resulting in irreversible lung damage. CWP ranges in severity from simple to advanced; the most severe form is progressive massive fibrosis (PMF). Advanced CWP is debilitating and often fatal. To prevent CWP, the Coal Mine Health and Safety Act of 1969 established the current federal exposure limit for respirable dust in underground and surface coal mines. The Act also established a surveillance system for assessing prevalence of pneumoconiosis among underground coal miners, but this surveillance does not extend to surface coal miners. With enforcement of the exposure limit, the prevalence of CWP among underground coal miners declined from 11.2% during 1970-1974 to 2.0% during 1995-1999, before increasing unexpectedly in the last decade, particularly in Central Appalachia. Exposure to respirable dust is thought to be less in surface than underground coal miners. Although they comprise 48% of the coal mining workforce, surface coal miners have not been studied since 2002. To assess the prevalence, severity, and geographic distribution of pneumoconiosis among current surface coal miners, CDC obtained chest radiographs of 2,328 miners during 2010-2011 through the Coal Workers' Health Surveillance Program of the National Institute for Occupational Safety and Health (NIOSH). Forty-six (2.0%) of 2,257 miners with >1 year of surface mining experience had CWP, including 37 who had never worked underground. Twelve (0.5%) had PMF, including nine who had never worked underground. A high proportion of the radiographs suggested silicosis, a disease caused by inhalation of crystalline silica. Surface coal mine operators should monitor worker exposures closely to ensure that both respirable dust and silica are below recommended levels to prevent CWP. Clinicians should be aware of the risk for advanced pneumoconiosis among surface coal miners, in addition to underground coal miners, to facilitate prompt disease identification and intervention.     

粉尘作业者肺部小阴影的高千伏胸片与高分辨率CT对比研究

[目的]比较高分辨率CT(HRCT)和高千伏胸片对粉尘接触者肺部小阴影的显示能力。[方法]对137例(男性125例,女性12例)HRCT和高千伏胸片资料完整者的影像学资料进行回顾性分析。其中,接触焊尘者56例,接触矽尘者37例,接触其他粉尘(包括铝尘、炭黑、水泥等)者44例。HRCT采用2mm层厚、10mm间隔从肺尖至膈肌扫描,采用-700HU/1500HU的窗位/窗宽进行摄片和观察。HRCT和高千伏胸片在不知晓职业史的前提下分别进行读片。对胸片和HRCT评估获得的各肺区小阴影的密集度进行一一比较,并对小阴影总体密集度进行比较。[结果]HRCT对小阴影总体密集度的评估与胸片评估密切相关(r=0.655,P<0.01),但HRCT对小阴影的评估分辨率高于胸片(P<0.01)。115例HRCT显示小阴影,其中s影86例,p影5例,p/s影8例,s/p影15例,q影1例。86例胸片显示小阴影,其中s影25例,p影5例,p/s影28例,s/p影24例,q/p影3例,q/s影2例。86例胸片显示小阴影的工人中6例HRCT显示正常。50例胸片无小阴影的工人中,34例(68%)HRCT显示异常小阴影。HRCT显示了上肺区及背部小阴影的分布优势。[结论]胸部HRCT在小阴影早期检测方面可弥补胸片的不足,对于准确评估小阴影有一定价值。     

Comparison of radiographic appearances with associated pathology and lung dust content in a group of coalworkers.

The pathology and dust content of lungs from 261 coalminers in relation to the appearances of their chest radiographs taken within four years of death were examined. Radiological opacities of coalworkers' pneumoconiosis were more profuse the more dust was retained in lungs. Among the men who had mined low rank coal--that is, with a relatively high proportion of ash--the increase in profusion was most closely related to the ash component of the dust, whereas in men who had mined high rank coal both coal and ash increased in the lungs in relation to radiological profusion. The fine p type of opacity was found to be associated with more dust and a higher proportion of coal and less ash than the nodular r opacity, and was also more likely to be associated with emphysema. The pathological basis of the different types of opacity found on the radiographs of coalminers related to the number, size, and nodularity of the dust lesions. Larger fibrotic lesions were likely to appear as r opacities, whereas fine reticular dust deposition was most likely to present as p opacities, q opacities showing a mixture of appearances. The study has shown that the composition of dust retained in the lung, as well as its amount, makes an important contribution to the radiographic appearances of pneumoconiosis. In particular, the r type of lesion on the radiograph of a low rank coalminer indicates the possibility of a silicotic like lesion.