职业性铁及其化合物粉尘肺沉着病56例临床分析

Clinical analysis of 56 cases of occupational pulmonary thesaurosis induced by dust of iron and its compounds

目的分析职业性铁及其化合物粉尘肺沉着病(OPTIDIC)的临床表现与影像学特点。方法采用回顾性分析方法,选择山东省内4家职业病诊断机构2010—2017年诊断的230例职业性电焊工尘肺(OWP)或观察对象患者为研究对象,重新阅读其X射线高千伏或数字化摄影后前位胸片(以下简称“X射线胸片”),筛选OPTIDIC患者,并收集其临床资料进行分析。结果230例OWP和观察对象患者中,56例可诊断为OPTIDIC,占24.3%。56例OPTIDIC患者的临床症状主要为咳嗽、咳痰、胸闷、气短和呼吸困难等;体征主要为呼吸音低和呼吸音粗等。X射线胸片影像学主要表现为p影或q影等,共占98.2%;其中p/p影和q/q影共占62.5%。胸部电子计算机断层扫描(CT)可见弥漫性的点状/圆形小阴影和弥漫性的磨玻璃影。支气管纤维镜检查显示巨噬细胞见大量含铁血黄素颗粒。肺穿刺活检可见含铁血黄素沉积。结论OPTIDIC患者临床表现与OWP无差异。但其X射线胸片影像学表现主要为圆形小阴影,CT影像学表现主要为弥漫性的点状/圆形小阴影或磨玻璃影;这可作为其与OWP鉴别的依据。

Objective To analyze the clinical characteristics and imaging features of occupational pulmonary thesaurosis induced by dust of iron and its compounds(OPTIDIC).Methods A total of 230 cases of occupational welder′s pneumoconiosis(OWP) patients or observation subjects were selected as the research subjects using the retrospective analysis method.They were diagnosed in four occupational disease diagnosis institutions in Shandong Province from 2010 to 2017.The high kV X-ray chest radiography or chest digital radiograph(hereinafter referred to as X-ray) were re-read to screen OPTIDIC patients.The clinical data of OPTIDIC patients were collected and analyzed.Results Among the 230 cases,56 cases were diagnosed as OPTIDIC,accounting for 24.3%.The clinical symptoms of the 56 patients with OPTIDIC were cough,sputum,chest tightness,shortness of breath,and difficulty breathing,while their physical signs were low or coarse breath sounds in lungs and others.Most of the X-ray results showed p shadows or q shadows,accounted for 98.2%,of which p/p shadow and q/q shadow accounted for 62.5%.The result of chest computed tomography(CT) showed diffuse point/round shadow and diffuse glass shadow in OPTIDIC patients.The result of fibro-bronchoscopy showed that a large amount of iron lutein particles was accumulated in macrophages and biopsy of lung showed idiopathic pulmonary hemosiderosis in OPTIDIC patients.Conclusion The clinical characteristics of OPTIDIC patients showed no different from OWP.However,the result of X-ray of OPTIDIC patients mainly showed small circular shadows,and their CT images mainly showed diffuse point/round shadows or grinding glass shadow,which could be used to the differential diagnosis of OPTIDIC and OWP.