职业性尘肺病肺部影像表现与肺功能改变关系的研究

Correlation between pulmonary imaging manifestations and lung function changes in patients with occupational pneumoconiosis

目的探讨职业性尘肺病患者胸部影像表现与肺功能改变之间的关系。方法选取职业性尘肺病患者130例,每例患者在1 d内接受胸部高千伏摄影(HKV)、胸部螺旋CT和肺功能检查。依据GBZ 70—2015《职业性尘肺病的诊断》,对每位患者的HKV和CT胸部影像表现进行综合集体评判,将不同影像表现与肺功能分级分析比较。结果HKV联合CT对q型小阴影、小阴影聚集、胸膜增厚、淋巴结肿大的检出率高于单独使用HKV(P<0.05);影像分级与肺功能分级、肺功能异常率之间呈正相关(G=0.726、rs=0.640,P<0.01),尘肺小阴影总体密集度越高,分布肺区越多,患者肺功能障碍情况越严重;尘肺阴影直径(或宽度)越大,肺功能异常率越高(rs=0.410,P<0.01),存在小阴影聚集和/或大阴影表现的患者,肺功能分级要高于仅有小阴影的患者(P<0.05);不同小阴影形态患者的肺功能差异有统计学意义(P<0.01),有不规则小阴影的尘肺病患者肺功能受影响更大。结论不同影像表现的职业性尘肺病患者具有不同程度的肺功能障碍,且影像改变越显著,肺功能障碍情况越严重。

Objective To investigate the correlation between chest imaging manifestations and lung function changes in patients with occupational pneumoconiosis.Methods A total of 130 patients with occupational pneumoconiosis were studied and each patient underwent chest-high kilovoltage(HKV),chest spiral CT and lung function examination at the same day.According to GBZ 70-2015"Diagnosis of Occupational Pneumoconiosis",the chest imaging manifestations of each patient were comprehensively evaluated together with HKV and CT,and then the different imaging characteristics were analyzed and compared with the classification of pulmonary function.Results HKV combined with CT identified more clearly of the q-typed small shadow,small shadow aggregation,pleural thickening,and lymph node enlargement,compared with HKV alone(P<0.05).There was a positive correlation between imaging grading and pulmonary function grading and the abnormal rate of pulmonary function in pneumoconiosis patients(G=0.726,P<0.01;rs=0.640,P<0.01).The patients with higher overall density and/or more distribution of lung tissue of small shadows had more severely damage of lung function(P<0.05).The larger the diameter(or width)of the shadow,the worse the lung function(rs=0.410,P<0.01).The patients with small shadow aggregates and/or large shadow manifestations had higher lung function grade than patients with only small shadows(P<0.05).There was a difference of lung function among patients with different small shadow patterns(P<0.01),and pneumoconiosis patients with small irregular shadows had worse lung function.Conclusions Patients with occupational pneumoconiosis had different degrees of lung function impairment with different imaging characteristics,and the more significant the imaging changes,the more severe the lung function impairment.