单中心军事飞行人员低剂量肺部CT检查结果分析

Analysis of low-dose lung CT screening results for military flying personnel in a sanatorium

目的分析军事飞行人员低剂量肺部CT检查结果,并探讨其对航空医学鉴定的影响。方法回顾性分析于空军杭州特勤疗养中心行年度体检的军事飞行人员影像学及航空医学鉴定资料。将纳入的低剂量肺部CT检查结果按影像学表现分为未见明显异常、陈旧性病灶、肺结节、肺大疱、肺部炎性病变及肺外附见疾病6类。统计分析各类检查结果的检出率,并按年龄分为20~29岁、30~39岁、40~49岁、50~59岁组,按职别分为歼教机飞行员、轰运直飞行员、轰运直机组成员组,比较不同年龄组及职别组飞行人员检查结果的差异。按照不影响航空医学鉴定结论、导致健康等级下降、导致暂时飞行不合格3种程度,分析检查结果对航空医学鉴定的影响。总体显著性水平α=0.05,两两比较以P<α/统计次数为差异有统计学意义。结果共纳入2274名飞行人员。各类检查结果按检出率从高到低依次为未见明显异常(45.82%)、陈旧性病灶(37.55%)、肺结节(14.86%)、肺大疱(6.73%)、肺部炎性病变(2.59%)及肺外附见疾病(1.85%)。不同年龄组的检查结果差异有统计学意义(χ2=183.43,P<0.001)。20~29岁和30~39岁组未见明显异常检出率最高;40~49岁和50~59岁组陈旧病灶检出率最高。未见明显异常检出率随年龄增大而递减,陈旧性病灶检出率随年龄增大而递增(P均<α/6=0.008);40~49岁组肺结节检出率高于30~39岁组;50~59岁组肺大疱检出率高于其他年龄组;40~49岁和50~59岁组肺部炎性病变检出率高于其他年龄组;50~59岁组肺外附见疾病高于20~29岁组,差异均有统计学意义(P均<0.008)。不同职别飞行人员检查结果差异有统计学意义(χ2=33.78,P=0.001)。轰运直机组成员未见明显异常的检出率低于轰运直及歼教机飞行员组,而陈旧性病灶和肺结节的检出率高于其他组,差异均有统计学意义(P均<α/3=0.017);歼教机飞行员组肺大疱检出率低于轰运直机组成员,差异有统计学意义(P<0.017)。虽然检出结果中绝大多数对航空医学鉴定结果无影响,但不同检出疾病导致健康等级下降及暂时飞行不合格比例差异有统计学意义(Fisher精确检验值=82.81,P<0.001)。结论低剂量肺部CT检查在军事飞行人员健康体检及航空医学鉴定中发挥了重要作用,可作为飞行人员年度体检必查项目。肺部相关疾病的航空医学鉴定标准与策略也应同步更新匹配。

Objective To analyze the results of low-dose lung CT screening for military flying personnel,and to explore its influence on aeromedical identification.Methods The imaging and aeromedical identification data of military flying personnel who underwent annual physical examination in Air Force Healthcare Center for Special Services Hangzhou were analyzed retrospectively.According to the imaging manifestations,the enrolled low-dose lung CT results were divided into the following 6 categories:no obvious abnormality,old lesions,pulmonary nodules,pulmonary bullae,pulmonary inflammatory lesions and extrapulmonary diseases.The detection rates of various examination results were statistically analyzed.The military flying personnel were divided into 20-29 years group,30-39 years group,40-49 years group and 50-59 years group,and they were divided into fighter pilots,bomb-trans-helicopter pilots,and bomb-trans-helicopter crew members according to the post.The differences in various examination results of flying personnel were compared among different age groups and post groups.The influence of examination results on the aeromedical identification results was analyzed in accordance with the 3-level conclusions as not affecting the conclusion of aeromedical identification,leading to the decline of health grade and leading to temporary grounding.The overall significance levelα=0.05,and the pairwise comparison with P<α/statistical times was statistically significant.Results A total of 2274 flying personnel was enrolled.The detection rates of various examination results from high to low was no obvious abnormality(45.82%),old lesions(37.55%),pulmonary nodules(14.86%),pulmonary bullae(6.73%),pulmonary inflammatory lesions(2.59%)and extrapulmonary diseases(1.85%).There was significant difference among examination results of different age groups(χ2=183.43,P<0.001).The detection rate of no obvious abnormality was the highest in 20-29 years group and 30-39 years group;the detection rate of old lesions was the highest in 40-49 years group and 50-59 years group.The detection rate of no obvious abnormality decreased with age,and the detection rate of old lesions increased with age(bothP<α/6=0.008).The detection rate of pulmonary nodules in 40-49 years group was higher than that in 30-39 years group;the detection rate of pulmonary bullae in 50-59 years group was higher than that in the other age groups;the detection rates of pulmonary inflammatory lesions in 40-49 years group and 50-59 years groups were higher than those in the other age groups;the detection rate of extrapulmonary diseases in 50-59 years group was higher than that in 20-29 years group,and the differences were statistically significant(all P<0.008).There was significant difference in the results of flying personnel among different post groups(χ2=33.78,P=0.001).The detection rate of no obvious abnormality in bomb-trans-helicopter crew members group was lower than that in bomb-trans-helicopter pilots group and fighter-trainer pilots group,but the detection rates of old lesions and pulmonary nodules were higher than those in the other groups,the differences were statistically significant(all P<α/3=0.017).The detection rate of pulmonary bullae in fighter-trainer pilots group was lower than that in bomb-trans-helicopter crew members group,and the difference was statistically significant(P<0.017).Although majority of the detected results had no effect on the results of aeromedical identification,there was a significant difference in the proportion of health grade decline and temporary grounding caused by different detected diseases(Fisher exact test value was 82.81,P<0.001).Conclusions Low-dose lung CT screening plays an important role in the physical examination and aeromedical identification for military flying personnel.It can be routinely used during the annual physical examination for flying personnel,and the aeromedical identification standards and strategies for lung related diseases should be updated synchronously.