电焊工尘肺X线胸片圆形小阴影的随访研究

Welders＇ siderosis： a retrospective cohort study on welder＇s pneumoconiosis patients with small round opacities on chest radiograph

目的 了解近年诊断的电焊工尘肺X线胸片变化及其转归.方法 回顾整理136例电焊工尘肺患者职业病诊断时职业卫生学调查资料（包括电焊工龄、所用焊接材料以及作业环境）、临床症状、肺功能、胸片,以及随访胸片、症状和肺功能,随访间隔时间为1年,随访至2014年6月30日.由3名资深尘肺病诊断专家共同阅读X线胸片（初诊及随访胸片）并记录小阴影形态、总体密集度、小阴影分布肺区以及尘肺期别.结果 136例初诊电焊工尘肺中Ⅱ期5例,Ⅰ期131例.平均工龄（9.2±6.34）年.症状表现为轻微咳嗽、胸闷、气促.肺功能基本正常.88.9％电焊工尘肺初诊X线胸片表现为圆形小阴影.对131例Ⅰ期电焊工尘肺病例多年随访,不规则小阴影基本保持不变,圆形小阴影没有发生聚集,而是呈逐渐减少的趋势.初诊2年后开始出现小阴影分布肺区减少,随访48例电焊工尘肺,平均每例随访对象分布肺区数减少0.02.初诊6年后随访48例,平均每例分布肺区数减少0.54,4例不够诊断为Ⅰ期,占随访总数8％.对36例电焊工尘肺初诊10年后随访,平均每例减少1.14分布肺区,不够Ⅰ期尘肺诊断的8例,为总随访例数22％.结论 X线胸片以圆形小阴影为主要表现的”电焊工尘肺”有减轻好转倾向,是金属肺沉着病的表现.

Objective To study the radiographycal changes and prognosis of welders＇ pneumoconiosis patients diagnosed within the last few years.Methods Occupational hygienics data （including years on welding work,welding materials exposed to and work environment）,symptoms,lung function test results and follow-up data of 136 welders＇ pneumoconiosis patients were collected retrospectively.The follow-up lasted up till June 30,2014,with follow-up interval being one year.Chest radiographs were read/reviewed together by 3 senior experts experienced in pneumoconiosis diagnosing and shape and size of small opacity,overall profusion,affected lung zones and pneumoconiosis stages were all logged.Results Of all 136 pneumoconiosis cases,five were of stage Ⅱ and 131 were stage Ⅰ,and they had been engaged in welding work for 9.2±6.34 years.All patients were present with slight symptoms including coughing,chest distress and dyspnea,while their lung function remained normal.Small round opacities were found on chest radiographs of 88.9％ of the 136 cases.Years of follow-up on 131 cases of stage Ⅰ Welder＇s pneumoconiosis showed that irregular small opacities remained fundamentally unchanged,while small round opacities tended to gradually lessen instead of coalescence.Two years after primary diagnosing,the total affected lung zones of follow-up objects were noticed to start lessening,and reduced by 0.02 per patient among the 48 follow-up subjects.Of the 48 cases followed up up to six years after primary diagnosing,the affected lung zone number was reduced by 0.54 per patient while 4 cases （8％） went down to below stage Ⅰ.As of the 36 patients followed up 10 years after after primary diagnosis,the number of affected lung areas decreased by 1.14,and 22％ （8 cases） appeared less than stage Ⅰ on chest radiograph.Conclusion It seemed that the so-called welders＇ pneumoconiosis featuring small round opacities tended to get improved over time,which suggested the diagnosis of siderosis.