低剂量CT检查20年以上工龄煤矿工人肺结节的意义

Clinical significance of low-dose CT performed for three consecutive years in diagnosis of lung nodules in coal mine workers with 20 working years

目的探讨应用低剂量CT（LDCT）对较长工龄煤矿职工检查的意义。方法907例工龄超过20年煤矿职工，男863例，女44例，平均年龄49．5岁，2013年对每例行DR体检，2014至2016连续3年对每例行LDCT体检。结果2013年DR提示肺内结节32例。2014年LDCT：肺内非钙化结节269例，与前一年度DR检出例数比较，差异有统计学意义（χ2=-233．73，P〈0．01）。不同接尘工龄受检者结节检出率的差异有统计学意义（χ2=6．648，P=0．00）。男性结节检出率明显高于女性，差异有统计学意义（χ2=5．690，P=-0．017）。不同工种的结节个数的差异无统计学意义（χ2=16．985，P=0．05）。结节总数443个，实性结节占71．56％，≤4mm的结节占55．75％；基线LDCT后经手术证实恶性0．66％（6／907）。2015、2016年复查LDCT：新发结节8例，增大结节3例，≤4mm的结节均无明显变化。结论用LDCT对煤矿职工高危人群筛查十分必要。≤4mm结节随诊策略与阴性一样，〉4mm～8mm结节行年度复查，〉8mm结节转入临床处理。

Objective To investigate the clinical significance of low-dose CT（LDCT） in coal mine workers with relatively long working years. Methods A total of 907 coal mine workers with ≥20 working years were enrolled, among whom there were 863 male and 44 female workers with a mean age of 49.5 years. Digital radiography （DR） was performed for these workers in 2013, and LDCT was performed for three consecutive years from 2014 to 2016. Results A total of 32 workers were found to have lung nodules by DR in 2013, while in 2014, 269 workers were found to have non-calcified lung nodules by LDCT, and there was a significant difference in the number of workers with lung nodules （≥2=233.73, P〈0.005 ）. There was also a significant difference in the detection rate of nodules between the workers with different working years of dust exposure （χ2=6.648, P=0.00）. The male workers had a significantly higher detection rate of nodules than the female workers （χ2=5.690, P=0.017）. There was no significant difference in the number of nodules between workers with different types of work （χ2=16.985, P= 0.05）. There were 443 lung nodules in total, among which 71.56% were solid nodules and 55.75% had a size of ≤ 4 mm; malignant nodules were confirmed by surgery in 6 （0.66%） of the 907 workers after baseline LDCT. LDCT reexamination in 2015 and 2016 found new nodules in 8 workers and enlarged nodules in 3 workers, and there was no significant change in the number of nodules with a size of ≤4 mm. Conclusions It is necessary to perform high-risk population screening for coal mine workers by LDCT. The follow-up strategies for nodules with a size of ≤4 mm are the same as those for negative results ; annual reexamination is recommended for nodules with a size of 〉 4-8 mm, and clinical treatment should be considered for nodules with a size of〉8 mm.