CT和高分辨CT对煤工尘肺小阴影和阴影融合及肺气肿诊断的价值

目的 探讨CT和高分辨CT(HRCT)早期检测煤工尘肺小阴影、阴影融合与肺气肿的敏感性和准确性.方法 77例煤工尘肺患者、36例无尘肺煤工和37例健康非煤工接受多层螺旋CT机无间隔胸部容积扫描及HRCT扫描,对所获得的CT图像进行煤工尘肺小阴影密集度分级、平均肺密度值和肺气肿指数测定,并与其X线胸片诊断结果对照.结果 对77例煤工尘肺患者CT和HRCT诊断的尘肺小阴影密集度分级与X线胸片尘肺分期一致性较好(Kappa=0.771,P＜0.01).CT和HRCT诊断尘肺的敏感性达到98.70％,在X线胸片确诊的77例煤工尘肺患者中,CT和HRCT评估76例为煤工尘肺,可疑1例.CT和HRCT从36例X线胸片无尘肺煤工中检出8例(22.22％)达到小阴影密集度1级;从73例Ⅰ～Ⅱ期煤工尘肺患者中,检出26例(35.62％)阴影密集度≥3级,其中3级密集度阴影20例,4级密集度阴影6例;对4例X线胸片Ⅲ期煤工尘肺患者,CT和HRCT与X线胸片诊断结果相同.从113例煤工中,X线胸片检出肺气肿7例(6.19％),CT检出36例(31.86％).CT尘肺小阴影密集度1～2级组的CT平均肺密度值最高,明显高于健康对照组、无尘肺组和小阴影密集度4级组,差异有统计学意义(F1=-45.73、F2=-23.00和F3=57.72,P＜0.01或P＜0.05).结论 从多层螺旋CT获得的CT和HRCT影像,与X线胸片比较,对煤工尘肺小阴影、阴影融合与肺气肿识别的敏感性和准确性均较高,可为煤工尘肺及其并发症的早期诊断提供更先进的手段.     

8项氧化损伤指标筛检煤工尘肺患者作用比较

目的 探讨一氧化氮(NO)、丙二醛(MDA)等8项氧化损伤生化指标筛检煤工尘肺(CWP)的价值,为早期发现可疑患者和CWP的防治提供可能的线索.方法 分别采用硝酸还原酶法、硫代巴比妥酸显色法、亚硝酸盐形成法、改良Hafenan氏法、尿酸酶-过氧化物酶偶联法、对苯二胺盐酸盐法及化学比色法测定112例CWP患者(CWP组)和144例与CWP组同煤矿的健康接尘对照者(对照组)血浆氧化损伤指标NO、MDA、铜锌超氧化物歧化酶(CuZu-SOD)、谷胱甘肽过氧化物酶(GSH-Px)、尿酸(UA)、铜蓝蛋白(CP)、诱导型一氧化氮合酶(iNOS)及总抗氧化能力(T-AOC)的水平或活力.结果 CWP组与对照组比较,除CP差异无统计学意义(P>0.05)外,其他各项指标比较差异均有统计学意义(P<0.05).受试者工作特征(ROC)曲线下面积比较,MDA、T-AOC、NO和iNOS的曲线下面积大于基准线的面积,差异有统计学意义(P<0.05).T-AOC、iNOS、MDA及NO作为CWP的早期筛栓指标,以T-AOC最佳,其灵敏度达70.5%,特异度为68.1%.结论 T-AOC是8项CWP早期筛检指标的最佳指标.     

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.       

煤矽肺患者血中微量元素和脂质过氧化的改变

目的 了解煤矽肺患质过氧化水平。方法 检测煤矽肺患血清中微量元素Cu、Zn含量及MDA、SOD和GSH的水平。结果 煤矽肺患血清中Cu、Zn、MDA、SOD明显高于对照组,GSH明显低于对照组。煤矽肺患工龄、期别不同,其脂质过氧化水平也不同。吸烟可促进脂质过氧化发生改变。结论 煤尘可引起接触人群脂质过氧化紊乱。脂质过氧化可能是影响煤矽肺发生、发展的主要因素之一。     

煤工尘肺患者氧化损伤指标的早期筛检

目的探讨煤工尘肺氧化损伤生化指标的早期筛检。方法选择112例煤工尘肺患者作为病例组,144例接尘作业的健康工人作为对照组,采用硝酸还原酶法测定血浆一氧化氮(NO)、硫代巴比妥酸法测定丙二醛(MDA)、亚硝酸盐形成法测定铜锌超氧化物歧化酶(CuZn-SOD)、改良Hafenan氏法测定谷胱甘肽过氧化物酶(GSH-Px)、尿酸酶-过氧化物酶偶联法测定尿酸(UA)、对苯二胺盐酸盐法测定铜蓝蛋白(CP)、化学比色法测定诱导型一氧化氮合酶(iNOS)及总抗氧化能力(T-AOC)。结果病例组与对照组除CP外,其他各项指标差异均有显著性(P<0.05)。ROC曲线下面积比较,MDA、T-AOC、NO和iNOS的曲线下面积大于基准线的面积(P<0.05)。三项氧化损伤指标MDA、T-AOC和iNOS联合构建的判别方程,筛检煤工尘肺的特异度为89.1%,灵敏度为77.7%,符合率为84.0%,均高于单一指标和T-AOC与MDA的串联(P<0.05)T-AOC、iNOS、MDA及NO作为煤工尘肺的早期筛检指标,其中T-AOC最佳,灵敏度70.5%,特异度为68.1%。结论 MDA、T-AOC和iNOS联合筛检较综合反映了煤工尘肺患者的氧化损伤和抗氧化水平,与单一指标及MDA+T-AOC相比降低了误判率。     

煤矿粉尘接触和人群脂质过氧化水平的观察

目的 为了解煤矿粉尘接触和人群脂质过氧化水平。方法 检测煤矿粉尘接触量和人群脂质过氧化水平。结果 矿井巷道和采煤面粉尘浓度低于国家标准装渣,放炮作业和各工种一次最高浓度均超国标。除矿井出风口外,地面各监测点可吸入粉尘均在容许范围,粉尘接触人群ＳＯＤ活性降低,井下工人ＭＤＡ增加,吸烟者更显著,煤工尘肺患者两项指标同时提高,结论 提示煤尘接触引起人群脂质过氧化代谢紊乱,紊乱程度和粉尘接触量有关,吸烟是     

煤工尘肺患者脂质过氧化状态的研究

研究了163例不同期别煤工尘肺患者及90例非尘肺健康者脂质过氧化状态。结果显示各期别煤工尘肺患者的过氧化脂质水平及唾液酸含量均较对照组显著升高，而抗氧化体系中的过氧化氢酶、谷胱甘肽过氧化物酶活力均显著降低。超氧化物歧化酶活力、还原型谷胱甘肽及铜兰蛋白含量呈代偿性增加。表明煤工尘肺的发生与机体自由基、脂质过氧化代谢的失衡有关。     

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。     

丙二醛、总抗氧化能力和诱导型一氧化氮合酶筛检煤工尘肺价值的探讨

目的 探讨丙二醛(MDA)、总抗氧化能力(T- AOC)等氧化损伤生化指标筛检煤工尘肺的价值,为早期发现可疑患者和煤工尘肺的防治提供可能的线索.方法 分别采用硝酸还原酶法、硫代巴比妥酸显色法和化学比色法测定112例煤工尘肺患者和144例健康接尘对照血浆氧化损伤指标MDA、T-AOC及诱导型一氧化氮合酶(iNOS)的含量...     

Erythrocyte antioxidant enzyme activities in coal miners from three French regions

This study investigated whether differences in the prevalence and severity of coal workers' pneumoconiosis (CWP) between three coal mines could be related to differences in oxidative stress exposure as evaluated in vivo through red-blood-cell antioxidant enzyme activities. Blood samples were obtained from 229 miners selected according to their occupation and their pneumoconiotic status. The following biomarkers were evaluated: erythrocyte catalase, Cu²⁺/Zn²⁺ superoxide dismutase (Cu²⁺/Zn²⁺ SOD), and glutathione peroxidase activities. Antioxidant enzyme activities did not differ significantly between the group of surface workers in Lorraine and the group of underground miners without CWP in Lorraine and in the other coal mines. Erythrocyte Cu²⁺/Zn²⁺ SOD activity was slightly decreased in the group of active underground miners with simple pneumoconiosis as compared with the group of miners without CWP in Nord/Pas-de-Calais. No effect was seen between retired miners at different stages of CWP. Our findings indicate that differences in the prevalence and severity of CWP do not seem to be related to various oxidative activities of coal dust particles, at least as reflected by measurements of antioxidant enzyme activities in circulating erythrocytes in this study. Received: 3 March 1997 / Accepted: 14 October 1997     

Relationships (I) of International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases with the ILO International Classification of Radiographs of Pneumoconioses for parenchymal abnormalities

The International Classification of High-resolution Computed Tomography (HRCT) for Occupational and Environmental Respiratory Diseases (ICOERD) has been developed for the screening, diagnosis, and epidemiological reporting of respiratory diseases caused by occupational hazards. This study aimed to establish a correlation between readings of HRCT (according to the ICOERD) and those of chest radiography (CXR) pneumoconiotic parenchymal opacities (according to the International Labor Organization Classification/International Classification of Radiographs of Pneumoconioses [ILO/ICRP]). Forty-six patients with and 28 controls without mineral dust exposure underwent posterior-anterior CXR and HRCT. We recorded all subjects’ exposure and smoking history. Experts independently read CXRs (using ILO/ICRP). Experts independently assessed HRCT using the ICOERD parenchymal abnormalities grades for well-defined rounded opacities (RO), linear and/or irregular opacities (IR), and emphysema (EM). The correlation between the ICOERD summed grades and ILO/ICRP profusions was evaluated using Spearman’s rank-order correlation. Twenty-three patients had small opacities on CXR. HRCT showed that 21 patients had RO; 20 patients, IR opacities; and 23 patients, EM. The correlation between ILO/ICRP profusions and the ICOERD grades was 0.844 for rounded opacities (p<0.01). ICOERD readings from HRCT scans correlated well with previously validated ILO/ICRP criteria. The ICOERD adequately detects pneumoconiotic micronodules and can be used for the interpretation of pneumoconiosis.     

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。     

Gallium-67 citrate imaging in underground coal miners

Twenty-two underground coal workers with 27 or more years of coal dust exposure were studied with gallium-67 citrate (Ga-67) imaging. Radiographic evidence of coal workers pneumoconiosis (CWP) was present in 12 subjects. The Ga-67 scan was abnormal in 11 of 12 with, and 9 of 10 without, CWP. The Ga-67 uptake index was significantly correlated with total dust exposure (p less than 0.01) and approached significant correlation with the radiographic profusion of the nodules (0.10 greater than p greater than 0.05). There was no correlation between Ga-67 uptake and spirometric function, which was normal in this group of patients; furthermore, increased lung uptake of gallium did not indicate a poor prognosis in subjects no longer exposed to coal dust. While coal dust exposure may be associated with positive Ga-67 lung scan in coal miners with many years of coal dust exposure, the scan provided no information not already available from a careful exposure history and a chest radiograph. Since Ga-67 scanning is a relatively expensive procedure we would recommend that its use in subjects with asymptomatic CWP be limited to an investigative role and not be made part of a routine evaluation.     

铁法大隆矿煤工尘肺预防效果评价

目的评价40年来大隆矿煤工尘肺的预防效果,为进一步改善防尘降尘措施提供理论依据。方法采用"煤工尘肺调查表"和"接尘工人未患尘肺者调查表"对所有曾接尘的该矿工人进行个案调查,用单因素方差分析、寿命表法、Log-rank检验等统计学方法,分析了其中所有接尘工人的资料。结果大隆矿1959年前、1960～1964年、1965～1969年、1970～1979年不同年代接尘作业工人至2004年底尘肺累积发病率分别为:67.50%、15.07%、11.64%、0.00%,年平均发病率分别为:1.41%、0.36%、0.31%、0.00%。不同年代诊断的尘肺病人平均发病年龄与平均接尘工龄分别由80年代以前的40.94岁与16.11年,延长到80～90年代为49.04岁与22.04年,90年代进一步延长为63.30岁与27.70年。推行综合防尘措施后参加接尘作业矿工较之推行前,在相同观察周年内,累积发病率比较,差别有显著性(P<0.0001)。假设1980年后各年尘肺发病率与1980年前参加者相同,计算得预期发病人数为21人,而实际发病人数为0人。结论大隆矿煤工尘肺的发病情况逐渐减轻,1980年推行综合防尘降尘措施后发病情况减轻。     

石棉作业女工血脂质过氧化与抗氧化活性的研究

为探讨温石棉对人体的脂质过氧化作用机制，对４７名接触温石棉的女工和１５名女性石棉肺病人血清ＭＤＡ、ＳＯＤ、ＧＳＨ－Ｐｘ进行了研究，并分别与１５名无石棉接触女工和接尘女工对照，采用ｔ检验、相关分析。结果可见接尘组女工血清中ＭＤＡ、ＳＯＤ、ＧＳＨ－Ｐｐｘ等显著高于对照组（Ｐ＜０．００１），接尘组与石棉肺病人组血清ＭＤＡ、ＳＯＤ、ＧＳＨ－ｐｘ等各项指标均无显著差别（Ｐ＞０．０５）。提示温石棉可引起接触女工和石棉肺患者的脂质过氧化和抗氧化荫等的变化，表明脂质过氧化在温石棉致病中起着重要作用。ＭＤＡ及抗氧化酶如ＳＯＤ等有望成为早期诊断和动态观察的敏感指标。     

煤矿工人和煤工尘肺患者的肺功能与血清克拉拉细胞蛋白水平

[目的]探讨肺功能、血清克拉拉细胞蛋白（CC16）水平用于煤尘致肺早期损伤监测和煤工尘肺（CWP）病况判断的可行性。[方法]选取某煤矿工人64名（掘进工34人作为煤尘高暴露组、采煤工13人作为中暴露组、辅助工17人作为对照组），CWP患者45例（I期23例、Ⅱ期19例、Ⅲ期3例），检测肺功能指标，含肺活量（VC）、第一秒呼气容积（FEV1）、用力肺活量（FVC）、第一秒呼气容积占用力肺活量的百分比[FEV1／FVC（％）]及血清CC16水平。[结果]单因素分析结果显示，不同组煤矿工人间以及不同期别CWP患者间的肺功能及血清CC16水平差异均无统计学意义；与无CWP工人相比，I期CWP患者VC、FEV1、FEV1／FVC（％）及Ⅱ期CWP患者VC、FEV1及Ⅲ期CWP患者FEV1均降低（P〈0．05或P〈0．01）。多因素回归分析结果显示，肺功能状况与CWP期别有关（P〈0．05）；工龄的增加与血清CC16水平降低有关（P〈0．05），OR=0．900（95％CI：0．823-0．985）。[结论]肺功能指标可应用于CWP病况判断，用于煤尘致肺早期损伤监测可能不够敏感；尚不能确定血清CC16可否用于煤尘致肺早期损伤监测及CWP病况判断。     

高分辨率CT检查粉尘作业人员早期肺气肿

[目的]分析应用高分辨率电子计算机断层扫描（HRCT）对粉尘作业人员早期肺气肿的检出情况,为实施职业健康监护干预提供依据。[方法]对312例粉尘作业职业健康监护观察对象进行分析,其中136例接触电焊粉尘,119例接触其他致尘肺粉尘,57例接触不引起法定尘肺的其他粉尘。全部人员经内科胸部检查、高千伏胸片、HRCT及肺功能检查。[结果]高千伏胸片检查均未见肺气肿表现。HRCT检查发现早期肺气肿51例,其中电焊作业人员29例,其他致尘肺粉尘作业人员18例,不致法定尘肺的其他粉尘作业人员4例,检出率分别为21-3％、15．1％和7．0％（x2=6．30,P〈0．05）;且接尘工龄越长,检出率越高（x2=14．59,P〈0．001）;年龄≥50岁组早期肺气肿检出率高于〈50岁组。[结论]粉尘作业人员早期肺气肿的检出率与年龄、接尘时间、接尘种类有关,电焊工早期肺气肿检出率高。建议对年龄≥50岁的接触电焊粉尘工人优先开展HRCT检查。     

煤工尘肺患者一氧化氮、丙二醛、超氧化物歧化酶的测定分析

目的探讨一氧化氮(NO)、丙二醛(MDA)和超氧化物歧化酶(SOD)在煤工尘肺发生发展中的意义。方法分别采用硝酸还原酶法、硫代巴比妥酸显色法、黄嘌呤氧化酶法测定50例煤工尘肺患者与50例健康对照血清NO、MDA的含量及SOD的活力。结果煤工尘肺患者血清中NO和MDA的含量分别为高于对照组,SOD活力低于对照组,差异均有统计学意义(P<0.05)。3指标相关性分析表明,煤工尘肺患者血清NO与SOD呈负相关关系(P<0.05),而NO与MDA、MDA与SOD之间均无相关关系(P>0.05);在健康对照组中,3指标均无相关关系(P>0.05)。结论煤工尘肺患者体内氧自由基反应异常、氧化/抗氧化状态失衡可能与尘肺的发生发展有关。     

煤工尘肺患者恶性肿瘤死亡原因调查

目的探讨煤工尘肺患者因恶性肿瘤死亡的规律,加强煤工尘肺患者恶性肿瘤的早发现、早诊断、早治疗。方法对868例煤工尘肺患者中死于恶性肿瘤的162例患者按死亡年代进行统计学分析。结果煤工尘肺患者死于恶性肿瘤中肺癌始终占首位,其次是消化道肿瘤,且呈逐年上升趋势。结论恶性肿瘤是煤工尘肺患者主要死因之一,肺癌始终占首位,要重视煤工尘肺患者定期全面查体。     

Epidemiological evaluation of release of monocyte TNF-alpha as an exposure and effect marker in pneumoconiosis: a five year follow up study of coal workers.

OBJECTIVES--To determine (a) reproducibility with previous cross sectional findings, and (b) the predictive value of initial release of tumour necrosis factor-alpha (TNF-alpha) towards later progression of coalworkers' pneumoconiosis (CWP). METHODS--Release of monocyte TNF-alpha after in vitro stimulation with coal mine dust, silica, and endotoxin was measured in 104 retired miners and was related to stage of CWP (chest radiograph) and cumulative exposure. A subgroup of 46 miners was screened by high resolution computed tomography (HRCT). Prospective analysis of TNF-alpha (40 out of 104 miners involved in the previous TNF-alpha study) was done by relating initial TNF-alpha to five year progression of CWP measured by comparison of paired chest radiographs. RESULTS--As observed previously, dust stimulated release of TNF-alpha was increased in miners, especially in the early stages of pneumoconiosis. Cumulative exposure was related to pneumoconiotic stage but not to release of TNF-alpha. This excluded TNF-alpha as an exposure marker. Initial concentrations (1987) of TNF-alpha were related to later progression of CWP. Miners who showed abnormally high dust stimulated release of TNF-alpha had an increased risk of progression in CWP (relative risk 8.1). CONCLUSIONS--These results show (a) the significant involvement of TNF-alpha in pneumoconiosis in humans induced by coal dust and (b) that this routine test possibly constitutes a powerful tool to estimate individual prognosis of pneumoconiotic disease, even after the end of occupational exposure.