胸部HKV片和HRCT的联合应用在尘肺诊断中的价值

Combined use of HKV and HRCT in the diagnosis of pneumoconiosis

目的通过胸部高仟伏平片摄影(HKV片)和胸部高分辨率电子计算机X射线断层扫描(HRCT)联合应用的方法研究尘肺的早期诊断。方法 在粉尘作业职业健康监护对象中选择显示肯定或可疑尘肺X线表现的HKV片共计178例,通过比对国家尘肺诊断标准片,分别划分出尘肺壹期(22例)、无尘肺(51例)、观察期A组(65例)、观察期B组(40例)共四组。HKV片检查后2～4周内进行HRCT检查,并结合HRCT表现再分组,比较仅根据单独HKV片与结合HRCT检查结果两种判断方法在尘肺诊断上的区别。结果 HRCT在诊断中对HKV片具有验证作用,有减少假阳性和假阴性的作用;HKV片结合HRCT进行诊断分组可使尘肺的诊断正确率明显提高(且具有统计学意义),使无尘肺组受检者早期小阴影改变得以明确(共28例,占总例数15.73%)。结论在粉尘作业职业性健康监护中,HKV片和HRCT的联合应用,不仅能提高尘肺的诊断率,而且能在无尘肺对象中发现、验证或确定尘肺小阴影的存在,有助于尘肺的早期影像学诊断。

Objective To explore the method of early diagnosis on pneumoconiosis by combining the use of high kilovolt chest photography（HKV）and high resolution computerized tomography（HRCT）.Methods The 178 HKV chest films with definite or suspicious characteristics of pneumoconiosis out of the occupational health surveillance subjects were analyzed,and divided into four groups：22 cases were considered as first stage of pneumoconiosis,51 cases were considered as none-pneumoconiosis,65 cases were assigned as observation objects of group A,and 40 cases were assigned as observation objects of group B,they all were given HRCT chest examination within 2 to 4 weeks after HKV chest examination,then the diagnosis for pneumoconiosis was performed according to the results from HRCT chest examination.Results Diagnosis of pneumoconiosis determined by HKV chest film could be validated by HRCT chest examination,the false positive rate and false negative rate in diagnosis could also be reduced by HRCT technique,which obviously rose the correct rate of pneumoconiosis diagnosis.On the other hand,28 cases of pulmonary small opacities out of none-pneumoconiosis group were confirmed.Conclusion Combined use of HKV chest film and HRCT chest examination in the occupational health surveillance for pneumoconiosis could not only rise the correct rate of diagnosis for pneumoconiosis,but also discover or validate the existence of the small opacities,which would be quite helpful for the early diagnosis of pneumoconiosis by imaging technique.