通气和弥散联合检查对老年0~+期矽肺患者肺功能损伤诊断的意义

目的初步探讨通气和弥散联合检查对老年0+期矽肺患者肺功能损伤诊断的意义。方法采用德国Master Screen肺功能仪对185例老年0+期矽肺患者进行肺通气和弥散功能测定,记录相关指标。阳性率比较采用四格表卡方检验,相关关系采用秩和检验。结果肺功能指标单项阳性率依次为残气肺总量比(RV/TLC)84.3%,一氧化碳弥散量(DLCO)43.2%,肺总量(TLC)25.9%,用力肺活量(FVC)20.5%,1 s肺活量(FEV1)20.5%,一氧化碳弥散率(KCO)20.0%,肺活量(VC)15.7%,1 s率(FEV1/FVC)11.9%;通气功能障碍72例(38.9%),弥散功能障碍85例(45.9%),两者无相关关系,P=0.137。弥散检查相关指标的阳性率(93.5%)高于通气检查相关指标(30.3%),P=0.018。两者有相关关系,P<0.001。导致弥散检查相关指标的阳性率远高于通气检查相关指标的主要原因是RV/TLC阳性率过高。结论通气和弥散联合检查有助于提高老年0+期矽肺患者肺功能异常的检出率,对维护职业病患者的合法权益有着积极的临床意义。但是RV/TLC阳性率过高,对老年矽肺患者采用此标准作为诊断肺功能有无损伤的指标可能是不适宜的。

Significance of ventilation and dispersion combination test in diagnosing lung function impairment of senile silicosis patient in 0+ stages

Objective It is to initially discuss the significance of ventilation and dispersion combination test in diagnosing lung function impairment of senile silicosis patient in 0 stages.Methods The lung ventilation and dispersion function of 185 senile silicosis patients in 0 stages were determined with Germany Master Screen pulmonary function apparatus and the related indexes were recorded.The positive rates were compared with chi-square test of four-fold table and the related relation was analyzed with rank-sum test.Results The positive rates of lung function parameters were respectively RV/TLC 84.3%,DLCO 43.2%,TLC 25.9%,FVC 20.5%,FEV1 20.5%,KCO 20.0%,VC 15.7% and FEV1/FVC 11.9%.The ventilation dysfunction was 72 cases(38.9%) and the dispersion dysfunction was 85 cases(45.9%),and there was no related relation(P=0.137).The positive rate of dispersion parameter(93.5%) was higher than that of ventilation parameters(30.3%),P=0.018.There was related relation(P<0.01).The reason was excessive high positive rate of RV/TLC.Conclusion Ventilation and dispersion combination test conduces to elevate the detection rate of pulmonary function abnormality in senile silicosis patient in 0 stages,which has energetic clinical important in attending legal interests of occupational disease patients.But it may be inappropriate to take RV/TLC as an index for diagnosing lung function impairment in senile silicosis patient in 0 stages because that RV/TLC positive rate is excessively high.