高分辨率CT检查粉尘作业人员早期肺气肿

Detection of Early Emphysema in Workers Exposed to Dust by High-Resolution X-Ray Computed Tomography

[目的]分析应用高分辨率电子计算机断层扫描(HRCT)对粉尘作业人员早期肺气肿的检出情况,为实施职业健康监护干预提供依据。[方法]对312例粉尘作业职业健康监护观察对象进行分析,其中136例接触电焊粉尘,119例接触其他致尘肺粉尘,57例接触不引起法定尘肺的其他粉尘。全部人员经内科胸部检查、高千伏胸片、HRCT及肺功能检查。[结果]高千伏胸片检查均未见肺气肿表现。HRCT检查发现早期肺气肿51例,其中电焊作业人员29例,其他致尘肺粉尘作业人员18例,不致法定尘肺的其他粉尘作业人员4例,检出率分别为21.3%、15.1%和7.0%(χ2=6.30,P<0.05);且接尘工龄越长,检出率越高(χ2=14.59,P<0.001);年龄≥50岁组早期肺气肿检出率高于<50岁组。[结论]粉尘作业人员早期肺气肿的检出率与年龄、接尘时间、接尘种类有关,电焊工早期肺气肿检出率高。建议对年龄≥50岁的接触电焊粉尘工人优先开展HRCT检查。

To apply high-resolution x-ray computed tomography （HRCT） to early emphysema detection in dust exposed workers with suspected pneumoconiosis, and to provide evidence for oecupational health surveillance and intervention. [ Methods ] A total of 312 workers with dust exposure and meeting the criteria of suspected pneumoconiosis were recruited, among which 136 workers were exposed to welding dust, 119 to other pneumoconiosis-related dust （OPRD）, and 57 to particles not otherwise regulated. All workers received regular medical chest examination, high-KV chest radiography, HRCT and pulmonary function examination. [Results ] No emphysema was identified by high-KV radiography examination. Fifty-one cases of early emphysema were detected by HRCT, including 29 welders, 18 workers exposed to OPRD, and 4 workers exposed to particles not otherwise regulated. The corresponding detection rates were 21.3%, 15.1% and 7.0% respectively 0（2= 6.3, P〈0.05）. The longer length of service was＇ the higher detection rate presented （Z2=14.59, P〈 0.05）. The detection rate of early emphysema in the group older than 50 years was higher than that in the group younger than 50 years. [ Conclusion ] Detection rates of early emphysema in suspected pneumoconiosis workers exposed to dust .are associated with age, length of dust exposure, and dust type. More emphysema cases are found in welders having suspected pneumoconiosis. HRCT is suggested to perform in higher priority to suspected pneumoconiosis workers especially those older than 50 years old.