不同的影像学方法在Ⅱ期矽肺中诊断价值对比研究

目的：观察胸部高分辨CT（HRCT）与高千伏X线胸片在诊断Ⅱ期矽肺中的价值。方法：选取70例Ⅱ期矽肺患者,分别进行HRCT与高千伏X线胸片检查,分析两种检查指标。结果：主要影像指标方面,两组检查在斑片条、小阴影聚集、空洞等检测方面比较,差异无统计学意义（P〉0.05）;而其他如发白区、大结节影、钙化等检测上,HRCT与高千伏X线胸片比较,差异具有统计学意义（P〈0.05）;HRCT与高千伏X线胸片在小阴影密集度肺区数显示能力、矽肺分期方面比较,差异具有统计学意义（P〈0.05）。结论：HRCT与高千伏X线胸片在主要影像指标检测方面,均存在较大的差异。两种影像学检查具有较强的诊断互补性。     

低剂量螺旋CT在矽肺诊断中的应用

目的探讨低剂量螺旋CT在矽肺诊断中的应用价值。资料与方法 60例矽肺患者分别采用螺旋CT常规剂量(130mA)、低剂量(20mA)进行扫描,比较两种扫描条件下矽肺阴影大小、密集度及矽肺分期情况。结果 20mA与130mA螺旋CT扫描均显示≥20mm阴影16例,大阴影5例,小阴影39例。130mA扫描1级密集度35例,2级密集度10例,3级密集度15例;20mA扫描1级密集度33例,2级密集度12例,3级密集度15例。20mA与130mA螺旋CT扫描均显示矽肺Ⅰ期26例,Ⅱ期12例,Ⅲ期22例,两者在显示矽肺阴影大小、密集度以及矽肺分期方面差异均无统计学意义(P>0.05)。结论 20mA低剂量与130mA常规剂量螺旋CT扫描在显示矽肺阴影大小、密集度以及矽肺分期方面无显著差异,20mA低剂量螺旋CT扫描可作为矽肺筛查的手段之一在临床应用。     

尘肺管理工作的回顾与控制策略的探讨

本文回顾了我国矽肺预防和控制的历史，重点阐述了有关矽肺预防的管理方法诸如１９４９年以来的有关法律和法规的建立方面。虽然几十年来取得了很大成绩，但矽肺仍是危害工人健康的最大威胁。主要问题是执法力度不够，各部门之间缺乏必要的协作，防治矽肺的策略有待改进。由此作者提出对矽肺的预防和控制应是②贯彻预防矽肺的综合措施，坚持“八字”方针；②向矽肺病人提供综合治疗，而不仅仅是特殊疗法；③加大执法力度；④把预防矽     

螺旋CT结合呼吸门控对矽肺形态与功能变化的研究

目的 探讨呼吸门控定量CT在评价矽肺形态与功能改变中的应用价值。方法 46例矽肺病人在50％肺活量（VC）状态下行全肺螺旋CT扫描，在20％VC、80％VC呼吸水平下于隆突层、隆突上、下各5cm处行高分辨率CT（HRCT）扫描。用Pulmo软件评估全肺各区间像素指数（PI），并与临床肺功能指标进行相关分析。结果 CT能清晰地显示矽肺的病变特征，HRCT能更好地显示肺间质病变。随着期别的增高，分布在＜－910HU（A区间，API）和＞－60HU（E区间，EPI）的PI增加（P＜0．05或P＜0．01）。API、EPI与第1秒用力呼气容积（FEV1．0）和VC呈中至高度相关（r=-0.801-0.690)。结论 呼吸门控定量CT能反映矽肺形态和功能异常的变化趋势，并有利于病变的追踪观察，为矽肺的研究提供了一种新的诊断方法。     

Characterization of airborne mineral dusts associated with farming activities in rural Alberta,Canada

Summary The dry and windy climate of the Western Canadian prairie provinces, combined with large scale agricultural acitivities, results in aerosolization or organic and mineral dusts. The purpose of this study was to conduct an environmental and minerological analysis of these dusts in order to estimate the risk for pneumoconiosis in exposed farmer populations. Two districts in central/southern Alberta were chosen for study. One of these regions was representative of a predominantly grain growing district with minimal use of irrigation; the other region was largely devoted to forage and irrigated crop production. Air pollution statistics showed a bi-modal distribution of total suspended particulates (TSP) with peaks corresponding with maximal farm activities in the spring and early fall. Analysis of bulk dust samples obtained from tractor cab filters showed that the majority of particles from both districts were within the respirable range (< 5 gm). Samples from the forage-crop region contained more organic material, a greater water soluble fraction and had particles that were, on average, smaller and rounder than particles from the grain district. These differences were thought to reflect differences in irrigation patterns and use of fertilizers between the two districts. Free silica (quartz) content was also very variable and ranged from 1 to 17% on a mass basis. Respirable fibrous minerals were occasionally identified, however, no asbestos fibres, fibrous tremolite, or fibrous zeolites were identified. The results indicate that there is potential risk for mineral dust pneumoconiosis in heavily exposed farmer populations and that this risk will be influenced by local and regional factors.     

Development of a chronic inhalation reference level for respirable crystalline silica

Chronic inhalation exposure of workers to crystalline silica can result in silicosis. The general public can also be exposed to lower levels of crystalline silica from quarries, sand blasting, and entrained fines particles from surface soil. We have derived an inhalation chronic reference exposure level for silica, a level below which no adverse effects due to prolonged exposure would be expected in the general public. Incidence of silicosis and silica exposure data from a cohort of 2235 white South African gold miners yielded a reference level of 3 microg/m3) for respirable silica (particle size as defined occupationally) using a benchmark concentration approach. Data from cohorts of American gold miners, Chinese tin miners, diatomaceous earth workers, and black South African gold miners yielded similar results with a range of 3-10 microg/m3. Strengths of the chronic reference exposure level include the availability of several large long-term studies of inhalation in workers at varying exposure concentrations, adequate histopathological and radiologic analysis, adequate follow-up of exposed workers, a dose-response effect in several studies, observation of a No Observed Adverse Effect Level in the key study, and the power of the key study to detect a small effect. Uncertainties include the general underestimation of silicosis by radiography alone and the uncertainties in exposure estimation.     

矽肺患者周围血淋巴细胞亚群、TNF-α、sIL-2R水平分析

【摘要】目的分析不同期别矽肺患者周围血淋巴细胞亚群和肿瘤坏死因子（TNF-仅）、血清可溶性白细胞介素_2受体（sIL-2R）的变化,探讨不同期别矽肺患者免疫水平的差异。方法应用直接免疫荧光-流式细胞技术检测86例矽肺患者（I期32例、Ⅱ期30例、Ⅲ期24例）周围血淋巴细胞亚群,同时应用酶联免疫吸附法（ELISA）检测血清中TNF．d和sIL-2R的水平,与30例正常健康人作比较。结果周围血CD3、CIM比例和CD4／CD8水平矽肺患者组低于正常人组（P〈0．05）,随着矽肺期别的升高,CD3、CD4比例和CD4／CD8下降,但无统计学差异（P〉0．05）;各期矽肺患者周围血TNF-α、sIL-2R的水平高于正常对照组（P〈O．05）,随着矽肺期别的升高,sIL-2R明显升高（P〈0．05）,TNF-α明显下降（P〈0．05）。结论矽肺患者周围血细胞免疫功能低下,TNF-α和sIL-2R协同参与矽肺发生和发展过程。     

硅沉着病患者胸部CT分析

目的对硅沉着病患者胸部CT影像学表现进行描述,为临床诊断硅沉着病提供参考。方法以鞍山市职业病防治院收治的32例硅沉着病患者的胸部CT为研究样本,对现有的影像资料进行回顾性分析,探讨硅沉着病的特点。结果胸部CT可清晰显示硅沉着病患者肺部矽结节的形态和密度、肺纹理、肺气肿以及肺门、纵隔淋巴结的改变。结论胸部CT对于硅沉着病患者的诊断具有重要价值。     

金属矿工与煤工尸检肺内粉尘及金属元素含量分析

目的 研究金属矿工与煤工尘肺尸检肺内偻尘、游主二氧化硅及元素的含量。方法 ３６例矿工尸检双肺样品,分别用Ｇｕｅｒｔ法、式外分光扫描法、原子吸收人姚光度法测定肺内粉尘、游离二氧化硅及金属元素含量。结果 随肺内滞留汾尘、游离二氧化硅含量的增加,尘病变加重;相同期别的金属矿工与采煤工尘肺,肺内粉法坦前者低于后者,游离二氧化硅量二者基本接近,肺组织中元素含量金属矿工高于采煤工,并与肺期别无关。结论 肺内粉     

长沙市花岗岩石材加工业矽肺流行病学调查

目的探讨花岗岩石材加工业矽肺的发病现状和规律,预测流行趋势,为制定防治对策提供科学依据。方法采用回顾性调查方法,制定调查方案,收集长沙市自1963年1月—2010年12月该行业所有矽肺病例资料,建立数据库,用SPSS17.0进行统计分析。结果 47年来,长沙市该行业新发矽肺病118例,其中Ⅰ期矽肺78例(66.10%),Ⅱ期矽肺35例(29.66%),Ⅲ期矽肺5例(4.24%)。好发工种为石工(81.51%)、凿岩工(9.24%)、运输工(1.68%)、其他工种(7.56%)。平均发病工龄约为34 a,平均发病年龄约为55岁。结论该市花岗石矽肺病新发病例1960—1980年呈逐渐增长趋势,1990年后病例明显减少。2000年后未出现新发病例。需加大粉尘危害监测与风险控制,建立粉尘暴露人群健康监护机制。