Pneumoconiosis and emphysema in construction workers: results of HRCT and lung function findings
Pneumoconiosis and emphysema in construction workers: results of HRCT and lung function findings
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DOI：
10.1136/oem.2010.055616
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发表时间：
2011-07-01
影响因子：
4.9
通讯作者：
Heederik, D.
中科院分区：
文献类型：
--
作者：
Meijer, E.;Nij, E. Tjoe;Heederik, D.
目的评价既往按国际劳工组织指南进行胸片检查的建筑工人HRCT征象的发生率。目的探讨接尘工人HRCT表现与肺功能的关系。方法对79名健康体检者进行问卷调查、动态肺功能测定、静态肺功能测定、单次呼气CO弥散量测定、胸部X线片及HRCT检查。经认证的B级读卡器根据国际劳工组织的分类对射线照片进行编码。根据国际分类系统读取HRCT扫描结果。结果HRCT读数之间的一致性良好(kappa>；0.60)，但有不规则的浑浊(kappa=0.23)。在0/0级中，8%的HRCT表现为圆形，22%的表现为不规则和/或线状阴影，41%的表现为肺气肿。HRCT圆形阴影与高累积石英暴露相关(OR 7.1；95%CI 1.3~37.8)。肺气肿与吸烟有关(OR10.1；95%CI 1.2~84.2)，且T-L、T-CO、T-SB降低。HRCT圆形阴影与肺功能无关。目前吸烟与FEV1/FVC比值呈负相关，与RV/TLC比值呈正相关，经不同HRCT检查调整后，T-L、T-CO、T-SB降低13.4%。在暴露程度相对较高的建筑工人中，发现患单纯性(结节)矽肺的风险增加了七倍。HRCT上的肺气肿与现在或以前吸烟者有关，但与暴露无关，并导致扩散能力降低。气流受限主要由当前吸烟决定，与单纯性(结节性)矽肺无关。
Objectives To evaluate the prevalence of HRCT findings in construction workers previously surveyed by chest radiographs classified according to ILO guidelines. To examine the association between HRCT findings and exposure to quartz containing dust, and lung function.Methods The study comprised a questionnaire, dynamic and static lung function measurements, single-breath CO diffusion capacity, chest radiographs and HRCT in 79 individuals. Certified 'B' readers coded radiographs according to the ILO classification. HRCT scans were read according to an international classification system. A qualitative exposure index for cumulative respiratory quartz on a 10-point scale was used.Results Agreement between HRCT readers was good (kappa > 0.60), except for irregular opacities (kappa=0.23). In ILO category 0/0, 8% HRCT round, 22% irregular and/or linear opacities and 41% HRCT emphysema was found. HRCT round opacities was associated with high cumulative quartz exposure (OR 7.1; 95% CI 1.3 to 37.8). Emphysema was associated with smoking (OR 10.1; 95% CI 1.2 to 84.2) and showed a reduction in T-L,T-CO,T-sb. HRCT round opacities was not associated with lung function. Current smoking was negatively associated with FEV1/FVC ratio and positively with RV/TLC ratio, and showed a reduction in T-L,T-CO,T-sb (13.4%), adjusted for different HRCT findings.Conclusions Low grade silicosis cannot be excluded in workers with normal chest radiographs (ILO 0/0). In relatively highly exposed construction workers, a sevenfold increased risk of simple (nodular) silicosis was found. Emphysema on HRCT was associated with current or former smokers, but not with exposure, and contributed to reduced diffusion capacity. Airflow limitation was mainly determined by current smoking and was not associated with simple (nodular) silicosis.