242例新发尘肺病的临床与X线影像特征分析

Clinical characterization and X-ray image features of 242 first diagnosed pneumoconiosis cases

目的探讨首次确诊的尘肺病患者的临床表现和X线影像特征。方法收集2009年1月至2013年12月在广东省职业病防治院住院的242例尘肺病患者,对其进行临床分析。结果 242例尘肺病患者全为男性,其中壹期尘肺病109例(45.04%),贰期87例(35.95%),叁期46例(19.01%)。发病以矽肺和陶工尘肺病例居多。佛山、中山和惠州三市尘肺病患者占全省总数50%。患者平均发病年龄为(43.25±7.39)岁,平均接尘工龄为(9.92±5.27)年;各期尘肺病发病年龄和接尘工龄的差异无统计学意义(F=0.719、2.570,P>0.05)。各期尘肺病的气促发生率差异有统计学意义(χ2=15.586,P<0.05)。肺通气功能损伤发生率、小气道功能损伤发生率均随尘肺病期别递增而升高(趋势χ2=4.032、5.550,P<0.05),肺通气功能损伤类型以限制性损伤为主(72.09%)。尘肺病合并结核发生率较低(1.65%)。尘肺病X线影像最突出的是存在圆形小阴影(98.76%,239/242)。小阴影形态以q影为主(78.24%,187/239)。小阴影分布以两中肺区(40.19%,461/1147)为最多。大阴影分布以右上肺区(47.95%,35/73)居多,其形态以圆形或椭圆形较为常见。结论广东省新发尘肺病例以矽肺和陶工尘肺病居多。控制尘肺病的重点是佛山、中山和惠州三市的宝石加工、石场和陶瓷制造业。企业应认真做好尘肺病防治工作,特别是设置通风防尘设施和做好职业健康监护工作。

Objective To summarize clinical characteristics and X-ray imaging features of the first diagnosed pneumoconiosis patients. Methods The data of 242 first diagnosed cases from January 2009 to December 2013 in hospital were analyzed. Results All of the cases were male, among them 109 cases at stage 1（45.04%）,87 cases at stage 2（35.95%）,46 cases at stage 3 （19.01%）. Most cases were silicosis and potter＇s pneumoconiosis. The average age of onset was （43.25± 7.39）years old and the average dust exposure time was （9.92 ± 5.27 ）years, and there was no statistical significance on age and exposure time among cases diagnosed at different stages （F = 0.719,2.570,P 〉 0.05 ）. There was statistical significance on the occurrence of shortness of breath among different stages （~ = 15.586,P 〈 0.05）. Pulmonary function injury rate and small airway function damage rate increased with the severity change varied from stage 1 to stage 3 （χ2= 4.032,5.550,P 〈 0.05）. The major type of pulmonary function damage was restrictive injury （accounting for 72.09% ）. The occurrence of complication as tuberculosis was low（ 1.65% ）. The most prominent X-ray image was the presence of small round opacities （98.76% ,239/242）and majority was ＂q＂shadow （78.24%, 187/239）. The small opacities were mostly distributed in the middle lobes （40.19%,461/1 147）. Large shadows were mostly distributed in the right upper lung zones （47.95% ,35/73）with round or oval form. Conclusion In Guangdong Province new pneumoeoniosis cases were mostly silicosis and potter＇s pneumoconiosis. The enterprises should improve working environment to prevent pneumoconiosis.