远洋船员肺结节发病情况调查分析

Investigation and analysis of the incidence of pulmonary nodules in ocean-going seafarers

目的采用胸部低剂量螺旋CT(low-dose computed tomography,LDCT)筛查远洋船员肺结节发生情况,为航海医学保障提供依据。方法选取2015年12月至2017年12月入烟台市烟台山医院体检中心体检的某大型渔业公司共972例渔业船员为研究对象,按照受检船员工作中航程作业远近及船舶航行天数分为远洋作业组(479例)和近海作业组(493例);同时选取在本中心进行健康体检的1 057例作为健康对照组。应用LDCT平扫检测2组船员胸部,统计肺结节检出情况,对所检出阳性结节进一步行肺结节高分辨CT检查其恶性趋势。结果远洋作业组和近海作业组吸烟指数明显高于健康对照组,差异有统计学意义(P<0.01)。远洋作业组和近海作业组总检出率及结节>8 mm检出率明显高于健康对照组,差异有统计学意义(P<0.01),远洋作业组总检出率及结节>8 mm检出率明显高于近海作业组,差异有统计学意义(P<0.05)。远洋作业组和近海作业组人群阳性结节和恶性趋势结节发生率明显高于健康对照组,差异有统计学意义(P<0.01),远洋作业组总人群阳性结节和恶性趋势结节发生率明显高于近海作业组,差异有统计学意义(P<0.05)。结论远、近海作业船员的肺结节发病率高于正常人群,而远洋作业船员比近海作业船员肺结节发生率更高,主要与远洋船员较为恶劣的工作环境及工作状态有关,应对此特殊群体加强预防和医学保障。

Objective To screen the incidence of pulmonary nodules among ocean-going seafarers by chest low-dose computed tomography(LDCT),so as to provide solid evidence for proper medical support of seafarers.MethodsNine hundred and seventy-two fishermen from a large fishing company who underwent physical examination in the Medical Examination Center of Yantaishan Hospital from December 2015 to December 2017 were selected as research subjects.In accordance with the range of fishing operation and the number of working days at sea,they were divided into the ocean-going operation group(n=479)and offshore operation group(n=493).At the same time,1 057 examinees who underwent physical check at the Center were designated as the healthy control group.LDCT plain scanning was used to identify the detection rate of pulmonary nodules in the 2 groups.Then,high resolution CT was used to identify the incidence of malignant trend nodules in the positive pulmonary nodules.ResultsThe smoking indexes of the ocean-going operation group and the offshore working group were significantly higher than those of the healthy control group,and statistical significance could be found when comparisons were made between them(P<0.01).Total detection rates and the number of nodules larger than 8mm in the ocean-going and offshore operation groups were significantly higher than those in the healthy control group(P<0.01).Total detection rate and the number of nodules larger than 8mm in the ocean-going operation group were obviously higher than those of the offshore operation group,and statistical significance could also be noted when comparisons were made between them(P<0.05).The incidence of positive nodules and malignant trend nodules in the ocean-going and offshore operation groups was significantly higher than that in the healthy control group,also with statistical significance(P<0.01).The incidence of positive nodules and malignant trend nodules in the total population of the ocean-going operation group was significantly higher than that in the offshore operation group(P<0.05),also with statistical significance(P<0.05).ConclusionThe incidence of pulmonary nodules in ocean-going and offshore seafarers was obviously higher than that in the normal population,and the incidence of pulmonary nodules in ocean-going seafarers was higher than that in offshore seafarers.This might be related to the adverse environment and working conditions of ocean-going seafarers,for whom corresponding preventive and medical support measures should be taken for the maintenance of health.