铁及其化合物粉尘肺沉着病2种影像诊断比较研究

Comparison of two imaging diagnosis methods in the diagnosis of pulmonary thesaurosis induced by dust of iron and its compounds

目的比较高千伏X射线胸片和胸部高分辨率计算机断层扫描(HRCT)对铁及其化合物粉尘肺沉着病(以下简称"铁肺沉着病")的诊断价值。方法采用偶遇抽样方法,选择某磁材厂80名接触铁氧体粉尘的工人进行高千伏X射线胸片和胸部HRCT检查。比较2种方法对铁肺沉着病诊断结论的差异。结果 80名工人中,仅5人(占6.2%)胸部HRCT未见异常改变,其余均呈现不同程度弥漫性分布的气腔结节、磨玻璃影病变。高千伏X射线胸片、胸部HRCT诊断铁肺沉着病,极轻度分别占8.8%(7/80)和37.5%(30/80),轻度者分别占21.3%(17/80)和26.3%(21/80);对铁肺沉着病患者的诊断率分别为30.0%(24/80)和63.8%(51/80)。采用2种方法诊断铁肺沉着病的结果存在一致性(Kappa值=0.411,P<0.01);与高千伏X射线胸片比较,胸部HRCT对铁肺沉着病的诊断分度和诊断率均较高(P<0.01)。结论胸部HRCT对铁肺沉着病的诊断分级和诊断率均高于高千伏X射线胸片;胸部HRCT有助于该疾病的早期诊断。

Objective To compare the diagnostic value of high-kV X-ray chest photography and chest high-resolution computed tomography （ HRCT ） in the diagnosis of pulmonary thesaurosis induced by dust of iron and its compounds （hereinafter called the iron pulmonary thesaurosis）. Methods A total of 80 workers exposed to iron oxide dust in a magnetic material factory were collected as the study subjects by convenience sampling method, and they were examined with high-kV X-ray chest photography and HRCT. Differences between the two methods in the diagnosis of iron pulmonary thesaurosis were compared. Results Of the 80 workers, only 5 of them （6. 2% ） showed no abnormal changes in chest HRCT, others showed varying degrees of diffuse distribution of air-cavity nodules and ground-glass lesions. High-kV X-ray chest photography and chest HRCT diagnosis of iron pulmonary thesaurosis accounted for 8.8% （ 7/80 ） and 37.5% （30/80） with extreme mild degree, and 21.3% （17/80） and 26.3% （21/80） with mild degree respectively. The diagnostic rates for iron pulmonary thesaurosis were 30.0% （24/80） and 63.8% （51/80） , respectively. There was consistency between the two methods for the diagnosis of iron pneumoconiosis （Kappa = 0. 411, P 〈 0. 01 ）. The chest HRCT has a higher diagnostic classification and diagnosis rate compared with the high-kV X-ray chest photography （ P 〈 0. 01 ）. Conclusions The chest HRCT has a higher diagnostic grade and higher diagnostic rate for lung siderosis compared with the high-kV X-ray chest photography, which is helpful for the early diagnosis of the disease.