肺功能及高分辨CT在间质性肺疾病中的相关性研究

目的 对间质性肺疾病患者影像学、肺功能及临床表现进行相关分析，评价肺功能特别是脉冲振荡（IOS）测定呼吸阻抗在该疾病诊断中的意义。方法 对56例间质性肺疾病患者的呼吸阻抗、常规肺功能、静息时动脉血氧分压（PaO2）及肺部高分辨CT评分和呼吸困难评分进行分析。结果 振荡频率在5Hz时的电抗（X5）、在20Hz时的电抗（X20）与肺活量（VC）呈正相关（r=0．699、0．537，P〈0．05），与用力肺活量（FVC）呈正相关（r=0．690、0．473，P〈0．05），与一氧化碳弥散量（DLCO）呈正相关（r=0．494、0．301，P〈0．05），与PaO2呈负相关（r=-0．621、-0．411，P〈0．05）；响应频率与VC、FVC、DLCO呈负相关（r=-0．658、-0．639、-0．352，P〈0．05），与PaO2呈正相关（r=0．277，P〈0．05）；特发性肺间质纤维化患者的病程较结缔组织病所致间质性肺疾病患者的病程明显延长（P〈0．05），其余观察指标差异无统计学意义（P〉0．05）。结论 常规肺功能指标VC、FVC、DLCO及呼吸阻抗指标响应频率、X5对肺间质纤维化的诊断有一定的意义；IOS测定呼吸阻抗对间质性肺疾病患者肺功能损害的动态监测和疗效评价具有一定的应用前景；应重视结缔组织病患者的影像学和肺功能检查以便及时发现肺部早期病变。     

The value of computerised axial tomography in the assessment of workers exposed to asbestos

Nineteen men who had been exposed to asbestos for long periods were subjected to an examination of the lungs by means of computerised axial tomography (CT). Some features of asbestos-related disease are shown better on CT than on conventional roentgenograms, and occasionally features not shown at all on conventional films may be demonstrated on CT. It was concluded that CT may be useful in cases with borderline and doubtful signs on conventional films, and very occasionally in persons with long exposure who have normal conventional films.     

Relationship of lung geometry to the development of pleural abnormalities in insulation workers exposed to asbestos

The relationship of respiratory airway and airspace geometry to radiographic evidence of pleural abnormality consistent with asbestos exposure was studied in 178 construction insulators. Lung geometry was assessed from tracings of radiographic shadows, and the measures taken were tracheal length and diameter, subcarinal angle, right and left lung lengths, and upper, middle, and lower lung widths. Important modifying variables--age, height, weight, exposure estimates, and smoking history--were included in a logistic regression model to test the significance of the lung geometry measurements as predictors of the presence or absence of pleural abnormality. No such relationships were found. Neither were there any differences in prevalence or severity of pleural disease between the right and left sides which might have been found if airway geometry were a significant determinant of asbestos pleural disease. These results do not support the hypothesis that lung geometry is a host risk factor for the development of asbestos-related pleural disease.     

Computerized tomographic identification of visceral pleural changes other than in interlobar lung fissures

Computer window adjustments are possible when viewing the pictures obtained on computerized tomography (CT). A mediastinal window setting is used for pleural viewing (soft tissue), whereas a double-window adjustment allows pleura and lung substance to be viewed concomitantly. The lung can also be viewed on its own by using a corresponding window setting. Relevant cases with pleural changes were investigated by CT. With the window adjustments, it was possible to demonstrate pleural extrusions (tags) penetrating the lung substance and retracting the thickened or calcified overlying pleural areas. The areas of pleural retraction are identified as the pleura covering and encasing the lung itself, i.e., the visceral pleura.     

Radiographic abnormalities in asbestos insulators: effects of duration from onset of exposure and smoking. Relationships of dyspnea with parenchymal and pleural fibrosis

Chest radiographs and spirometry were evaluated in 2,907 active and retired asbestos insulators; most (86.8%) had greater than or equal to 30 years from onset of asbestos exposure. Testing was performed in 19 cities in the United States during 1981-1983. Complete demographic, smoking, clinical, and radiologic data were obtained for 2,790 workers. This is the largest single group of insulators that has been studied. Five hundred forty-eight (19.7%) had never smoked cigarettes, 942 (33.9%) were current cigarette smokers, and 1,300 (46.6%) were ex-smokers. Only 439 (15.7%) workers had no radiographic evidence of asbestos-related disease (normal chest X-ray); 668 (23.9%) had pleural fibrosis only, 325 (11.6%) had parenchymal fibrosis alone, and 1,358 (48.7%) had both parenchymal and pleural fibrosis. The prevalence of radiographic parenchymal changes increased significantly (p less than .001) from 38.6% (DURONSET less than 30 years) to 70% (greater than or equal to 40 years). For pleural changes the comparative prevalences were 55% and 82%. Those with no history of cigarette smoking were more likely to have normal films than those with a history of smoking (19.2% versus 14.4% for current smokers and 15.2% among ex-smokers), and were less likely to have parenchymal fibrosis (44.5% versus 69.7% for current smokers and 60.2% of ex-smokers). Dyspnea, MRC grade 3 and higher, was more prevalent when pleural fibrosis was associated with interstitial pulmonary fibrosis (at all profusion levels of small opacities) than when pleural fibrosis was absent. Logistic regression analysis of factors contributing to such dyspnea showed that the presence of combined parenchymal and pleural abnormalities was a significant explanatory variable, in addition to age, smoking, and body mass (Quetelet index); the presence of parenchymal changes only or of pleural changes only, as factors contributing to dyspnea, did not reach the level of statistical significance in the regression analysis. The results of these examinations show that pleural fibrosis is a frequent finding in asbestos-exposed groups with long-term follow-up and that its functional significance is not negligible. The contribution of cigarette smoking to prevalence and severity of interstitial fibrosis is an additional reason for smoking cessation among asbestos-exposed individuals.     

Asbestos-related lesions of the pleura: parietal plaques compared to diffuse thickening studied with chest roentgenography, computed tomography, lung function, and gas exchange

Lung function tests, tests of working capacity with gas exchange, and computed tomography (CT) with density measurements with the patient supine and prone were performed in 23 males with asbestos-related bilateral pleural lesions. Two had pulmonary asbestosis grade 1/0 or more; all the others had normal lung parenchyma. On x-ray, the pleural lesions were divided into plaques involving only the parietal pleura There was a and diffuse pleural fibrosis of various degrees involving the visceral pleura. There was a good correlation between the findings at plain chest roentgenography and CT, but more lesions were seen on the CT scan. However, a few pleural plaques seen on conventional films were not observed at CT. Individuals with plaques had slightly lowered lung function compared to reference subjects. Bilateral diffuse pleural fibrosis was associated with a marked decrease in pulmonary function. The two patients with radiologically evident pulmonary asbestosis were found in this group. Decreased lung function was also observed in subjects with pleural fibrosis of only grade 1 (involving less than one fourth of the hemithorax) and a normal exercise capacity. The study shows the importance of differentiation between various asbestos-related pleural lesions.     

正电子发射断层扫描/计算机断层扫描（PET/CT）成像在肿瘤筛查中的应用进展

我国是世界癌症发病最多的国家,筛查可以实现肿瘤早期诊断、改善患者预后、提高生存质量、降低死亡率。正电子发射断层扫描/计算机断层扫描（PET/CT）提供的代谢信息有助于肿瘤筛查初始分期、治疗计划、反应评估,并在较小程度上可用于肿瘤的随访;PET/CT成像在放射治疗中的渐进式整合在肿瘤间和肿瘤内恶性病变的生物异质性中具有其基本原理,需要单独调整辐射剂量以获得癌症患者的有效局部肿瘤控制;PET/CT提供有关肿瘤病变的生物学特征（如代谢、缺氧和增殖）的信息,可以识别放射性耐药区域并利用这些信息来优化治疗计划,PET/CT减少了肿瘤部位解剖学描绘的不确定性和可变性。本文主要就目前常见肿瘤在PET/CT研究中的应用进展进行综述。     

Early detection of interstitial lung disease in asbestos exposed non-smoking workers by mid-expiratory flow rate and high resolution computed tomography.

Ten years of lung function and radiological findings in six non-smoking asbestos exposed subjects who had increased mid-expiratory flow rate (FEF 25-75%) as the only functional abnormality were prospectively analysed. A biphasic change in FEF25-75% was noted. It initially increased up to the fifth year, and then a decrease was seen. In the final three years of the study, FEF25-75% reduction correlated well with a decrease in pulmonary capacity for CO (DLCO). During that time high resolution computed tomography (HRCT) probability scores correlated inversely with FEF25-75% and with DLCO, whereas chest radiography was unchanged (International Labour Organisation (ILO) profusion below 1/1). For five of the six subjects HRCT probability of asbestosis was intermediate. An increase in FEF25-75% in some asbestos exposed non-smoking workers may be one of the earliest functional signs indicative of future development of parenchymal asbestosis. Early asbestos related parenchymal abnormalities are seen more frequently on HRCT than on chest radiography.     

Early detection of interstitial lung disease in asbestos exposed non-smoking workers by mid-expiratory flow rate and high resolution computed tomography.

Ten years of lung function and radiological findings in six non-smoking asbestos exposed subjects who had increased mid-expiratory flow rate (FEF 25-75%) as the only functional abnormality were prospectively analysed. A biphasic change in FEF25-75% was noted. It initially increased up to the fifth year, and then a decrease was seen. In the final three years of the study, FEF25-75% reduction correlated well with a decrease in pulmonary capacity for CO (DLCO). During that time high resolution computed tomography (HRCT) probability scores correlated inversely with FEF25-75% and with DLCO, whereas chest radiography was unchanged (International Labour Organisation (ILO) profusion below 1/1). For five of the six subjects HRCT probability of asbestosis was intermediate. An increase in FEF25-75% in some asbestos exposed non-smoking workers may be one of the earliest functional signs indicative of future development of parenchymal asbestosis. Early asbestos related parenchymal abnormalities are seen more frequently on HRCT than on chest radiography.     

A diagnostic approach to asbestosis,utilizing clinical criteria,high resolution computed tomography,and gallium scanning

Seventy-five individuals known to have significant exposure to asbestos were evaluated by physical exam, pulmonary function tests (PFT), chest radiographs, high resolution computed tomography (HRCT), gallium-67 scanning, and various laboratory exams. Sixteen subjects met three of the following four criteria and were considered to have clinical asbestosis: 1) bibasilar rales, 2) FVC < 80% of predicted, 3) DLCO < 80% of predicted, and 4) an abnormal chest radiograph. Evaluations which included HRCT and Ga scanning detected pulmonary disease in these asbestos-exposed individuals in many cases where other modalities were unable to demonstrate significant abnormalities. While only 21% of the subjects satisfied commonly accepted criteria for the diagnosis of asbestosis, 75% had evidence of disease by both HRCT and gallium scanning. These data suggest that it may be time to include HRCT and Ga scanning when evaluating asbestos-exposed individuals, especially in cases where evaluations by physical exam, PFTs, and chest radiographs are non-diagnostic. © 1993 Wiley-Liss, Inc.     

Lobe of origin and histologic type of lung cancer associated with asbestos exposure in the carotene and retinol efficacy trial (CARET)

Lower lobe origin and histologic diagnosis of adenocarcinoma have been described as useful parameters for attributing lung cancer to prior asbestos exposure. To assess whether these characteristics differed between asbestos-exposed individuals and smokers, we evaluated lobe of origin and histologic type of tumors in 78 asbestos-exposed and 214 nonexposed heavy smokers developing lung cancer during the Carotene and Retinol Efficacy Trial (CARET), a prospective cancer chemoprevention trial. Most tumors in both cohorts, regardless of radiographic fibrosis at baseline, originated in upper lobes, representing 67% in asbestos-exposed and 80% in smokers, respectively (adjusted OR for lower lobe = 1.41; 95%CI = 0.69–2.91). Adenocarcinoma represented 32% of lung tumors in the asbestos cohort, and 30% in the smoking cohort (adjusted OR = 0.78; 95%CI = 0.40–1.55), and was inversely associated with radiographic fibrosis (adjusted OR = 0.19; 95%CI = 0.06–0.62). We conclude that neither anatomic site nor histologic cell type of tumors distinguishes effectively between smoking and asbestos as causal factors in development of lung cancer. Am. J. Ind. Med. 32:582-591, 1997. © 1997 Wiley-Liss, Inc.     

天津市电焊烟尘接触人群分布特征及肺功能异常情况分析

目的 了解天津市电焊烟尘接触人群分布特征及肺功能异常情况,为指导和实施干预措施提供科学依据。方法 通过天津市重点职业病监测,收集2019年天津市电焊烟尘接触人群分布特征和肺通气功能检查资料,χ2检验比较不同分组间肺功能指标的差别。结果 天津市电焊烟尘接触人群以18～40岁男性为主,接触工龄多数在10年以下,主要分布在远郊辖区及滨海新区,以外商经济和私有经济为主,大型企业、汽车制造业人数最多。肺功能检查指标FVC%、FEV1%和FEV1/FVC异常率分别为1.27%、1.88%和1.42%,三项指标异常率均随年龄增长和接触工龄延长呈上升趋势（χ2 = 3.432,χ2 = 3.439,χ2 = 3.112,χ2 = 7.501,χ2 = 10.449,χ2 = 12.851,P＜0.001）,不具有性别差异;不同行业间肺功能指标异常率差异具有统计学意义(χ2 = 369.743,χ2 = 439.315,χ2 = 724.460,P＜0.001）,石油和天然气开采业FEV1 / FVC 异常率达11.77%。结论 通过开展重点职业病监测工作,初步掌握重点职业病危害电焊烟尘接触人群的分布特征及不同因素间肺功能指标异常情况,找出应关注的重点行业和重点人群,为实施精准职业病防控措施提供依据。     

Relationship of mortality, occupation, and pulmonary diffusing capacity to pleural thickening in the First National Health and Nutrition Examination Survey

We studied the relationship of pleural thickening consistent with asbestos exposure to mortality, career employment in asbestos-related jobs, and pulmonary diffusing capacity among participants in the first National Health and Nutrition Examination Survey. Three "B" readers examined chest X-rays to identify 59 individuals with such pleural abnormalities. From 1975 to 1984, the all-cause mortality rate ratio (RR) comparing males with and without occupational pleural thickening was 1.3 (95% C.I. 0.8-2.2). For lung cancer, the mortality RR for males was 3.0 (95% C.I. 1.0-9.1). Career asbestos work was not associated with occupational pleural thickening among men, probably because some with the condition had only short-term exposure to asbestos. Pulmonary diffusing capacity was lower in those with occupational pleural thickening, taking smoking into account. These results suggest that individuals in the general population who have occupational pleural thickening are at risk for some of the health consequences of asbestos work, including lung cancer, even if they were not career asbestos workers.     

The importance of lung function, non-malignant diseases associated with asbestos, and symptoms as predictors of ischaemic heart disease in shipyard workers exposed to asbestos.

The mortality from ischaemic heart disease was studied in a prospective cohort of 1725 shipyard workers exposed to asbestos. The analyses were stratified for age and smoking habits and restricted to men. In agreement with other findings, men with impaired lung function had a significantly higher risk (relative risk (RR) = 3.5) of dying from ischaemic heart disease than men with normal lung function. Men with asbestosis or suspected asbestosis had a significantly higher risk (RR = 3.1) of dying from ischaemic heart disease than men without asbestosis. Thus asbestosis or suspected asbestosis also seemed to be a risk factor for ischaemic heart disease. This finding was independent of respiratory function. There was no increased risk for ischaemic heart disease in men with compared with men without pleural plaques. Men with production of phlegm or sputum and wheezing or whistling had no increased risk for ischaemic heart disease compared with men without these symptoms. In the group with normal lung function men with dyspnoea had a significantly higher risk of dying from ischaemic heart disease than men without dyspnoea. The findings for men with asbestosis or suspected asbestosis indicated a further risk factor besides impaired lung function, in persons exposed to asbestos. Perhaps this risk factor is due to lesions of the pericardium with consequences for heart function.     

Accelerated loss of lung function and alveolitis in a longitudinal study of non-smoking individuals with occupational exposure to asbestos.

Long-term asbestos workers who insulate pipes and boilers may develop interstitial lung disease associated with loss of lung function. To quantitate annual loss of lung function, 77 individuals with chest X-rays greater than or equal to 1/0 ILO category who were life-long non-smokers or ex-smokers for greater than 5 years were evaluated. Study parameters included pulmonary function tests and bronchoalveolar lavage for a mean of 3 visits over 30 +/- 2 months. The study participants were 56 +/- 1 years old and had 31 +/- 1 years' occupational exposure to asbestos. At the first visit, multiple regression analysis revealed significant associations between rales or radiographic opacities and VC, FEV1, and total lung capacity; significant associations were also found between neutrophils/ml lavage fluid with FEV1 and diffusing capacity (all p less than 0.05). Annual declines for the asbestos-exposed were VC -92 +/- 28 ml/yr and FEV1 -66 +/- 21 ml/yr. Declines in VC and FEV1 were less in those with reduced lung function at the initial visit. There were no significant associations between any of the annual declines and cells recovered by bronchoalveolar lavage. Compared to other asbestos-exposed cohorts followed longitudinally, asbestos insulators with radiographs greater than or equal to 1/0 and exposure greater than or equal to 20 years have larger rates of FVC and FEV1 decline for both non-smokers and ex-smokers.     

Pleural thickening: a comparison of oblique chest radiographs and high-resolution computed tomography in subjects exposed to low levels of asbestos pollution

Summary The present study was conducted to investigate the value of oblique chest radiographs, compared with high-resolution computed tomography (HRCT), in the assessment of pleural asbestosis in a group of subjects exposed to low levels of asbestos pollution. The study population consisted of 23 people derived from a previously reported cohort of subjects working in university buildings insulated with asbestos-containing material. Subjects were selected on a voluntary basis from among patients whose initial oblique chest X-rays showed pleural thickening. Sixteen patients were maintenance workers occupationally exposed to asbestos; the remaining seven were environmentally exposed to asbestos. For each subject, two standard chest radiographs [posteroanterior (PA) and right anterior oblique (RAO) views] were taken and HRCT was performed. Films were interpreted after agreement by three chest physicians and a radiologist. Pleural thickening was considered present in all 23 patients on RAO films and in six patients on PA films. HRCT revealed unequivocal pleural plaques in three maintenance workers and doubtful pleural abnormalities in three other maintenance workers. Considering HRCT as the gold standard, the positive predictive value of RAO film was only 13%–26%. Most of the 17 false-positive diagnoses of pleural fibrosis were due to significant subpleural fat. These results suggest that the routine use of oblique radiographs as a screening test in cohorts of subjects exposed to low levels of pollution by asbestos should be reevaluated.