大棚肺308例临床特征分析

Clinical analysis of greenhouse farmer's lung in 308 patients

目的探讨大棚作业农民肺(简称大棚肺)的临床特征及影像学特点,减少误诊率。方法采用整群随机抽样方法,对2006年8月至2009年6月沈阳市、新民市、朝阳市及锦州市郊区从事塑料大棚作业的5880例农民进行流行病学调查及肺功能检测,共筛查出大棚肺患者308例,分析其临床表现、体征及影像学特点。结果 (1)308例大棚肺患者临床症状按出现的频率高低分别为咳嗽和(或)咳痰192例(62.34%)、发热和寒战180例(58.44%)、胸闷和(或)气急160例(51.95%)、乏力和体重减轻116例(37.66%)、头晕头痛40例(12.99%);(2)两下肺闻及捻发音为大棚肺患者中的主要体征;(3)153例(49.67%)出现X线胸片改变,高分辨CT显示弥漫微小结节影63例(41.18%)、斑片状磨玻璃样阴影48例(31.37%)、结节状磨玻璃样影36例(23.53%)、局限性空气残留并形成"马赛克"样灌注12例(9.15%)、纤维索条影10例(6.54%)、纤维化2例(1.31%);(4)肺外疾病:出现颈项痛及腰腿酸痛169例、关节炎及关节畸形者116例、过敏性皮肤病96例、静脉曲张37例、消化道疾病32例、眼病(包括急性结膜炎、眼缘炎、过敏性结膜炎等)24例。结论大棚肺的早期临床表现变化迅速、非特异性;大棚肺常合并肺外多系统疾病;根据病程的长短,其肺部影像学特点不同。

Objective To investigate the clinical and image features of greenhouse farmer's lung so as to reduce the misdiagnosis rate.Methods A survey and lung function test for more than 800 plastic greenhouses with their farmers was performed in Shenyang,Xinmin,Chaoyang and Jinzhou.After screening 308 patients with greenhouse's lung in 5880 famers,we analyzed the clinical features,physical sign and image features.Results(1)By the frequency,the clinical symptoms of 308 greenhouse's lung are cough and/or expectoration 62.34%(192/308),fever and chill 58.44%(180/308),chest tightness and/or shortness of breath 51.95 %(160/308),fatigue and weight loss 37.66 %(116/308),diziness and headache 12.99%(40/308)in order;(2)Crepitus in lower lung field is the main sign of 308 patients with greenhouse's lung;(3)153 patients(49.67%)had lung X-ray changes.In HRCT,there are 63 diffuse micro nodules(41.18%),48 patchy ground-glass changes(31.37%),36 ground-glass opacity(23.53%),12 residues and the formation of the limitations of the air'mosaic'-like perfusion(9.15%),10 article fibrous(6.54%)and 2 fibrosis(1.31%);(4)Other diseases:169 cases present waist,leg and neck pain,116 cases present arthritis and joint deformities,96 cases present allergic skin diseases,37 cases present varicose veins,32 cases present gastrointestinal disease and 24 cases present eye diseases including acute conjunctivitis,margin of eye inflammation,allergic conjunctivitis etc.Conclusion Early clinical manifestations of greenhouse's lung changes rapidly and are nonspecific;Greenhouse's lung often combines multi-system extra pulmonary diseases;According to the length of the course,image characteristic is different.