焊工尘肺病临床及高分辨率CT特征分析

Clinical and high-resolution computed tomography characteristics of the welder＇s pneumoconiosis

目的分析焊工尘肺病临床及高分辨率CT（HRCT）特征。方法对南京鼓楼医院2010年1月至2015年1月收治的10例经病理学诊断的焊工尘肺病患者的相关职业史、临床表现及肺功能、病理学、HRCT检查结果进行回顾性分析。结果10例患者相关从业时间5—30年，临床表现主要为咳嗽、咳痰、胸闷等。4例患者第1秒用力呼气量与用力肺活量的比值（FEV．／FVC）〈75．0％。气管镜肺活检病理表现为肺泡腔内见多量吞噬棕褐色颗粒的肺泡巨噬细胞，铁染色阳性。10例患者HRCT均表现为两肺弥漫性分布边缘模糊的小叶中央型结节影，伴线状影或树芽状影7例，伴磨玻璃影3例。1例被误诊为肺结核，3例为问质性肺炎，1例为过敏性肺泡炎，2例为双肺弥漫性病变，1例为血管炎。结论焊工尘肺病患者临床表现无特异性；HRCT表现为弥漫性边缘模糊的小叶中央型小结节影，伴线状影或树芽状影。

Objective To investigate the clinical and high-resolution computed tomography （HRCT） features of the welder＇s pneumoconiosis. Methods A total of 10 patients diagnosed by bronchoscopy and pathology from January 2010 to January 2015 in Nanjing Drum Tower Hospital were recruited in this study, and the clinical manifestations, pulmonary function tests, pathology and HRCT data were collected and analyzed retrospectively. Results Ten patients all had welder＇s occupational history for 5 - 30 years, with the main clinical manifestations of cough, sputum production, chest tightness and other symptoms. And the ratio of forced expiratory volume in one second and forced vital capacity （FEVt/FVC） of 4 patients was lower than 75.0% in the pulmonary function tests. Transbronchial lung biopsy specimen showed numerous hemosiderin-laden macrophages within the alveolar space, associated with positive iron staining. In welder＇s pneumoconiosis, small centrilobular nodules （10 cases） were frequently seen on HRCT in bilateral lung fields, with branching linear structures or the tree buds hke shadows in 7 eases; 3 patients also showed areas of ground-glass attenuation. And the patients were misdiagnosed as tuberculosis （1/10）, interstitial pneumonia （3/10）, allergic alveolitis （ 1/10 ）, diffuse lung disease （2/10）, and vasculitis （1/10）. Conclusions Clinical manifestations of welder＇s pneumoconiosis are not specific; small centrilobular nodules are frequently seen on HRCT, with linear opacities or tree bud-like shadows.