不同工种石棉肺患者CT肺功能成像指标的差异性研究

Differences of CT pulmonary function indexes in asbestosis patients engaged in different types of work

目的采用多层螺旋CT 肺功能成像技术评价不同工种石棉肺患者的肺功能指标改变及特点。方法将30 例石棉肺患者按工种分为压型组、梳纺组和原棉组，每组10 例。分别于受试者深吸气末和深呼气末屏气行全肺扫描，测定肺容积指标（最大吸气与呼气末肺容积、肺容积差、肺容积比）、平均肺密度指标（吸气与呼气末平均肺密度、肺密度差、肺密度比）和小气道指标（吸气与呼气末壁厚直径比率、吸气末支气管壁面积百分比）。结果压型组、梳纺组和原棉组在性别、年龄、接触史、分期（Ⅰ期）方面差异均无统计学意义（均P＞0.05）。肺容积、平均肺密度和小气道指标中，3 组间呼气末平均肺密度、呼气末左肺平均肺密度、呼气末右肺平均肺密度、呼气末与吸气末平均肺密度比、吸气末壁厚直径比率、吸气末支气管壁面积百分比和呼气末壁厚直径比率差异均具有统计学意义（均P＜0.05）；进一步两两比较发现，梳纺组的上述指标分别与原棉组和压型组比较，差异亦均具有统计学意义（均P＜0.05），而原棉组和压型组间差异均无统计学意义（均P〉0.05）；3 组间其余指标差异均无统计学意义（均P＞0.05）。结论与压型组和原棉组比较，梳纺组石棉肺患者的肺气肿及小气道壁和肺泡隔纤维性增厚更为明显，应加强对这部分人的保护。

Objective To evaluate the changes and characteristics of pulmonary function in asbestosis patients engaged in different types of work by multi-slice spiral CT imaging. Methods Total 30 asbestosis patients were equally divided into three groups, who engaged in the work of raw asbestos processing, fiber combing and pressure molding, respectively. The pulmonary volume, pulmonary density and pulmonary small airway indexes were measured by a whole lung scanning at maximum inspiratory and maximum expiratory efforts. The pulmonary volume indexes include maximum inspiratory volume, maximum expiratory volume, pulmonary volume difference and pulmonary volume ratio. The mean pulmonary density indexes include the mean pulmonary densities after inspiratory and expiratory activities, pulmonary density difference and pulmonary density ratio. The small airway indexes include the diameter ratios of the wall after inspiratory and expiratory activities and the percentage of bronchial wall area after inspiratory activity. Results The differences of the gender, age, stage, and contact history of the patients are not statistically significant for all the groups （all P〉0.05）. The differences of the mean pulmonary densities after expiratory activity, the left and right pulmonary densities after expiratory activities, pulmonary density ratio, diameter ratios of the wall after inspiratory and expiratory activities, and the percentage of bronchial wall area after inspiratory activity are statistically significant among the three groups （all P〈0.05）. Further pairwise comparison showed that the differences of between the combing group and the raw material processing group in the above indexes are statistically significant （all P〈0.05）, while not statistically significant between the molding group and the raw material processing group （all P〉0.05）. The differences among the three groups in other indexes are not statistically significant （all P〉0.05）.Conclusions The emphysema with fibrous thickening in the alveolar septum and small airway wall is more severe in the workers who engaged in asbestos fiber combing comparing with in raw asbestos processing and asbestos pressure molding. Therefore, the medical protection of these groups of patients should be strengthened.