胸膜增厚对石棉工人肺功能的影响

[目的]探讨胸膜增厚对石棉工人肺功能的影响。[方法]接触组为某温石棉厂134名男性工人，对照组为同一地区不接触粉尘、劳动强度与接触组大体相似的某仪表厂135名男性工人。对两组对象的肺功能测定和后前位X射线胸片检查结果进行对比分析。[结果]与对照组相比，在控制了肺内小阴影改变和累积吸烟量等混杂因素的影响后，石棉接触工人中胸膜正常细和双侧胸膜增厚组用力肺活量（FVC）和一秒钟用力呼气容积（FEV1）均显著下降（P〈0．05），单侧胸膜增厚组仅FVC显著下降（P〈0．05）；而与胸膜正常组相比，在控制了肺内小阴影改变、累积吸烟量和接尘年限等混杂因素的影响后，双侧胸膜增厚组FVC和FEV1显著下降（均为P〈0．05）；在控制了肺内小阴影改变、累积吸烟量和接尘年限等混杂因素的影响后，胸膜增厚范围与FVC呈负相关，与弥散系数（Kco）呈正相关（均为P〈0．05）。[结论]胸膜增厚范围越大，肺功能损害也越严重，呈限制性肺功能障碍的特征。

Effects of Pleural Thickening on Pulmonary Function among Asbestos Workers

[Objective] To explore the effects of pleural thickening on pulmonary function among asbestos workers. [Methods] 134 male workers(mean age 57.3 years,and mean duration of asbestos exposure of 24.1 years)were selected from a chrysotile products factory as the exposed to asbestos dust group,and 135 dust-unexposed male workers(mean age 50.1 years, and mean duration of work of 22.4 years)in the same region were selected as control. The pulmonary function tests were performed and post-anterior chest radiographs were taken in both groups. Pulmonary function tests comprised measurements of forced vital capacity(FVC),forced expiratory volume in 1 second(FEV1),FEV1/FVC,diffusing capacity for carbon monoxide(DLco),and diffusing capacity for carbon monoxide per liter of alveolar volume(Kco). Pulmonary ventilation was measured by routine method, and the diffusing capacity was measured by the single-breath method. Statistical methods used including t test,multiple linear regression analyses,analysis of covariance,and partial correlation analyses. [Results] Analysis of covariance revealed,when compared with the control,while controlling for the confounding variables of pulmonary parenchymal abnormalities and pack- years of smoking,those with normal pleura and those with bilateral pleural thickening showed a significant decrement in FVC and FEV1,those with unilateral pleural thickening showed a significant decrement in FVC only(P < 0.05). When compared with those with normal pleura,while controlling for the same as above confounding variables,those with bilateral pleural thickening had a significant decrement in FVC and FEV(1P < 0.05). Analysis of partial correlation revealed,the extent of pleural thickening was negatively correlated with FVC,positively correlated with Kco(P < 0.05). [Conclusion] The larger the extent of pleural thickening,the severer the pulmonary function defect showing restricted pulmonary function disorder existed in the observed workers with pleural thickening.