职业性尘肺病患者胸部CT影像表现与肺通气功能的相关性

Correlation Between Imaging Findings of Chest CT and Pulmonary Ventilation Function in Patients with Occupational Pneumoconiosis

目的探讨职业性尘肺病患者胸部CT影像表现与肺通气功能相关性。方法选取2019年1月至2021年12月焦作市疾病预防控制中心收集的86例职业性尘肺病患者纳入尘肺病组,早期煤尘肺病HRCT分期法分为Ⅰ期33例、Ⅱ期29例和Ⅲ期24例,另选取86例同期行健康体检者纳入健康对照(HC)组,均接受胸部CT检查和肺通气功能检查,采用Camiciotoli视觉评分法评估两组胸部CT影像肺间质纤维化评分,记录呼气流量峰值(PEF)、第1秒用力呼气容积(FEV_(1))、FEV_(1)/用力肺活量(FCV)、最大自主通气量(MMV)。分析职业性尘肺病患者胸部CT影像表现;比较尘肺病组和HC组胸部CT影像肺纤维化评分和肺通气功能指标水平;比较不同分期职业性尘肺病患者胸部CT影像肺纤维化评分和肺通气功能指标水平;Pearson相关性分析职业性尘肺病患者胸部CT影像肺纤维化评分与肺通气功能指标的关系。结果职业性尘肺病患者胸部CT影像主要表现为小结节影、小结节聚集、纤维斑块形和小叶间隔增厚、胸膜斑;尘肺病组胸部CT影像肺纤维化评分为(20.16±5.01)分,其FEV_(1)、PEF、FEV_(1)/FVC值、MVV低于HC组(P<0.05);Ⅲ期职业性尘肺病患者胸部CT影像肺纤维化评分高于Ⅰ期、Ⅱ期患者,FEV_(1)、PEF、FEV_(1)/FVC值、MVV低于Ⅰ期、Ⅱ期患者(P<0.05);Pearson相关性分析,职业性尘肺病患者胸部CT影像肺纤维化评分与FEV_(1)、PEF、FEV_(1)/FVC值、MVV呈负相关(r=-0.625,-0.865,-0.636,-0.673,P<0.05)。结论职业性尘肺病患者胸部CT影像肺纤维化评分与肺通气功能指标之间存在负相关性,可作为临床判断职业性尘肺病和评估病情进展的可靠的影像学指标。

Objective To explore the correlation between imaging findings of chest CT and pulmonary ventilation function in patients with occupational pneumoconiosis.Methods A total of 86 patients with occupational pneumoconiosis collected by Jiaozuo City Center for Disease Control and Prevention were enrolled as pneumoconiosis group from January 2019 and December 2021.According to HRCT staging of early pneumoconiosis,they were divided into stageⅠgroup(33 cases),stageⅡgroup(29 cases)and stageⅢgroup(24 cases).A total of 86 healthy controls during the same period were enrolled as healthy control(HC)group.All underwent chest CT and pulmonary ventilation function examinations.The score of pulmonary interstitial fibrosis was evaluated by Camiciotoli visual analogue scale.The peak expiratory flow(PEF),forced expiratory volume in one second(FEV_(1)),FEV_(1)/forced vital capacity(FVC)and maximum voluntary ventilation(MMV)were recorded.The imaging findings of chest CT in patients with occupational pneumoconiosis were analyzed.The score of pulmonary interstitial fibrosis and pulmonary ventilation function indexes were compared between pneumoconiosis group and HC group,and among patients with different stages of occupational pneumoconiosis.The relationship between score of pulmonary interstitial fibrosis and pulmonary ventilation function indexes was analyzed by Pearson correlation analysis.Results The main imaging findings of chest CT in patients with occupational pneumoconiosis included nodule shadow,nodules aggregation,fibrous plaque formation,interlobular septal thickening and pleural plaques.The score of pulmonary interstitial fibrosis in pneumoconiosis group was(20.16±5.01)points,and FEV_(1),PEF,FEV_(1)/FVC and MVV were lower than those in HC group(P<0.05).The score of pulmonary interstitial fibrosis in stageⅢgroup was higher than that in stageⅠgroup and stageⅡgroup,while FEV_(1),PEF,FEV_(1)/FVC and MVV were lower than those in stageⅠgroup and stageⅡgroup(P<0.05).Pearson correlation analysis showed that score of pulmonary interstitial fibrosis was negatively correlated with FEV_(1),PEF,FEV_(1)/FVC and MVV(r=-0.625,-0.865,-0.636,-0.673,P<0.05).Conclusion The score of pulmonary interstitial fibrosis is negatively correlated with pulmonary ventilation function indexes in patients with occupational pneumoconiosis,which can be applied as a reliable imaging index for clinical determination of occupational pneumoconiosis and evaluation of condition progression.