脉冲振荡肺功能技术对矽肺病情评估价值

Value of impulse oscillometry technique in assessment of silicosis

目的探讨脉冲振荡肺功能(IOS)技术对矽肺病情评估的价值。方法采用判断抽样方法,选取90例矽肺患者为矽肺组,其中矽肺壹期、贰期、叁期亚组各30例。另选择30例无游离二氧化硅粉尘接触史的工人为对照组。所有受试者均进行常规肺功能和IOS检测。结果矽肺组人群振荡频率为5 Hz时的呼吸总阻抗(Z5)、振荡频率为5 Hz时的电抗(X5)、振荡频率为5 Hz时的气道阻力(R5)、振荡频率为20 Hz时的气道阻力(R20)、振荡频率为5和20 Hz时的气道阻力差值(R5-R20)、低频电抗面积(AX)和共振频率(Fres)均高于对照组(P<0.05);随着矽肺期别的升高,上述IOS指标均呈上升趋势(P<0.05)。矽肺组患者的X5与用力肺活量(FVC)、一秒呼气容量(FEV_1)、FEV_1/FVC均呈正相关(P<0.05),Z5、R5、R50-R20、Fres与FVC、FEV_1、FEV_1/FVC均呈负相关(P<0.05)。结论 IOS检测技术对早期矽肺的诊断敏感性较高。IOS中反映气道阻力的指标与常规肺功能检测中反映通气障碍的指标具有相关性,对矽肺病情的评估有重要价值。

Objective To investigate the value of impulse oscillometry(IOS)technique in the assessment of silicosis.Methods A judgment sampling method was used to select 90 patients with silicosis as the silicosis group,which includes 30 cases in each stage of silicosis(stage 1-3).Thirty workers with no exposure history to free silica dust were selected as the control group.All subjects underwent routine pulmonary function and IOS test.Results The total respiratory impedanceat at 5 Hz(Z5),reactance at 5 Hz(X5),airway resistance at 5 Hz(R5),airway resistance at 20 Hz(R20),difference of R5 and R20(R5-R20),low frequency reactance area(AX)and resonance frequency(Fres)were higher in silicosis group than those in control group(P<0.05).The above IOS indicators showed an upward trend with the higher stages of silicosis(P<0.05).X5 was positively correlated with forced vital capacity(FVC),one-second expiratory capacity(FEV1),FEV1/FVC(P<0.05).Z5,R5,R50-R20 and Fres were negatively correlated with FVC,FEV1 and FEV1/FVC(P<0.05).Conclusion IOS detection is highly sensitive for early diagnosis of silicosis.The parameters of airway resistance in IOS is correlated with the parameters of ventilatory dysfunction in routine pulmonary function test,which is of great value for the evaluation of silicosis.