尘肺病患者胸片纤维化评分与肺功能的相关性研究

Correlation between pulmonary function and chest radiograph fibrosis score in pneumoconiosis patients

目的探讨尘肺病患者胸片纤维化评分与肺功能特征的相关性。方法选取2020年11月—2021年4月于山东省职业卫生与职业病防治研究院就诊的100例尘肺病患者为研究对象,评判患者胸部数字化摄影影像学表现,按照胸片各肺区阴影密集度进行纤维化评分,分析胸片纤维化评分与患者肺功能的关系。结果100例尘肺病患者均为男性,壹期患者53例,贰期25例,叁期22例。出现肺功能损伤的有34例,包括轻度损伤22例,中度损伤11例,重度损伤1例。壹期患者肺功能损伤发生率为22.6%,贰期患者肺功能损伤发生率为40.0%,叁期患者肺功能损伤发生率为54.5%,差异有统计学意义(P<0.05)。随着尘肺病期别增加,患者纤维化评分升高(P<0.01),用力肺活量(forced vital capacity,FVC)、第一秒用力呼气量(forced expiratory volume in one second,FEV1)、第一秒用力呼气量与用力肺活量比值(FEV1/FVC)、75%肺活量时最大呼气流量(75%maximal expiratory flow,MEF75)、50%肺活量时最大呼气流量(MEF50)减小(P<0.05)。胸片纤维化评分与肺功能指标FVC、FEV1、MEF75、MEF50、25%肺活量时最大呼气流量(MEF25)和一氧化碳弥散量(the single breath diffusing capacity for carbon monoxide,DLco SB)均呈负相关关系(r=-0.339、-0.431、-0.334、-0.362、-0.369、-0.245,P<0.05)。肺功能损伤越严重,纤维化评分越高(P<0.05)。结论利用尘肺病患者胸片纤维化评分,有助于临床医生评估尘肺病引起的肺功能损伤情况。

Objective To explore the correlation between pulmonary function and chest radiograph fibrosis score among patients with pneumoconiosis.Methods A total of 100 patients with pneumoconiosis treated at the Shandong Academy of Occupational Health and Occupational Medicine from November 2020 to April 2021 were studied.The chest digital radiography of these patients was evaluated,and the fibrosis score was assessed based on the density of shadow in each lung area on the chest X-ray.The relationship between the score of pulmonary fibrosis and pulmonary function was analyzed.Results Among 100 male cases of pneumoconiosis,37 cases were in the first stage,41 cases in the second stage,and 22 cases in the third stage.34 cases had lung function impairment,including 22 mild,11 moderate,and 1 severe case,with an incidence of 27.02%in the first stage,29.26%in the second stage,and 54.54%in the third stage;the difference was significant(P<0.05).The fibrosis score increased with the pneumoconiosis stage(P<0.01),and the forced vital capacity(FVC),forced expiratory volume in one second(FEV1),FEV1/FVC,75%maximal expiratory flow(MEF75),and 50%maximal expiratory flow(MEF50)decreased(P<0.05).The scores of pulmonary fibrosis were negatively correlated with FVC,FEV1,MEF75,MEF50,25%vital capacity(MEF25),and the single breath diffusing capacity for carbon monoxide(DLCO SB)(r=-0.339,-0.431,-0.334,-0.362,-0.369,-0.245,P<0.05).The patients with more severe pulmonary function had a higher score of fibrosis(P<0.05).Conclusions The fibrosis score on the chest radiograph of pneumoconiosis patients is a useful indicator for the clinician to evaluate the lung function damage caused by pneumoconiosis.