Background It is a research hotspot to study the changes of metabolites and metabolic pathways in the process of coal worker's pneumoconiosis (CWP) by metabonomics and to explore its pathogenesis. ObjectiveTo study the change of metabolites in bronchoalveolar lavage fluid (BALF) of patients with CWP and explore the metabolic regulation mechanism of the disease. MethodsPatients with CWP who met the national diagnostic criteria according to Diagnosis of occupational pneumoconiosis (GBZ 70-2015) and underwent massive whole lung lavage were selected as the case group, and patients with tracheostenosis who underwent bronchoscopy were selected as the control group. BALF samples were collected from the cases and the controls. After filtering out large particles and mucus, the supernatant was stored in a −80 ℃ refrigerator. The samples were detected and analyzed by liquid chromatography-mass spectrometry after adding extraction solution, cold bath ultrasonication, and high-speed centrifugation, and the metabolic profiles and related data of CWP patients were obtained. The differential metabolites related to the occurrence and development of CWP were screened by multiple statistical analysis; furthermore, we searched the Kyoto Encyclopedia of Genes and Genomes (KEGG) database for potential metabolic pathways involved in the progression. ResultsThere was no significant difference in the general conditions of the subjects, such as weight, height, age, and length of service among the stage I group, the stage II group, the stage III group, and the control group (P˃0.05). When comparing the CWP stage I group with the control group, 48 differential metabolites were screened out, among which 14 were up-regulated and 34 were down-regulated. A total of 66 differential metabolites were screened out between the patients with CWP stage II and the controls, 14 up-regulated and 52 down-regulated differential metabolites. Compared with the control group, 63 differential metabolites were screened out in the patients with CWP stage III, including 11 up-regulated and 52 down-regulated differential metabolites. There were 36 differential metabolites that may be related to the occurrence of CWP, among which 11 differential metabolites were up-regulated, and 25 were down-regulated. Four significant differential metabolic pathways were identified through KEGG database query: linoleic acid metabolic pathway, alanine metabolic pathway, sphingolipid metabolic pathway, and glycerophospholipid metabolic pathway. ConclusionThe metabolomic study of BALF show that there are 36 different metabolites in the occurrence and development of CWP, mainly associating with linoleic acid metabolism, alanine metabolism, sphingolipid metabolism, and glycerophospholipid metabolism pathways.

分析11例人造石英石性矽肺患者临床资料及随访情况,患者具有发病年龄轻[(40.7±10.6)岁]、接尘时间短[(5.4±2.9)年]、病程短[中位病程6(9.0±8.7)个月]、病变进展快、并发症严重、短期内丧失劳动能力甚至死亡等特点,预后不良.企业应加强人造石英石板材加工人员的职业健康监护,保护劳动者健康.

人造石材加工致矽肺具有发病时间短、病情恶化迅速等特点.本文通过分析2例人造石英石矽肺患者的临床资料并文献复习,提示该病与传统矽肺影像学表现明显不同,应高度重视其防治工作.

目的 了解我国尘肺病治疗研究现状.方法 在中国学术文献网络出版总库、万方中文期刊数据库和维普数据库检索国内发表于2011—2021年关于尘肺病治疗的文献,分别采用NoteExpress文献管理软件及VOSviewer 1.6.10软件、CiteSpace 5.2软件对检索到的文献进行整理和可视化分析.结果 ①我国尘肺病治疗研究的文献在2011—2021年年发表数量总体稳定,本次研究共纳入文献453篇;其中,期刊论文430篇,学位论文16篇,会议论文7篇.②本次纳入文献主要刊载于171种期刊上,《中华劳动卫生职业病杂志》刊发的文献数最多,前五位期刊依次为《中华劳动卫生职业病杂志》22篇、《职业与健康》18篇、《临床医药文献电子杂志》12篇、《工业卫生与职业病》10篇、《中国工业医学杂志》10篇.刊载文章篇数10篇及以上的期刊有6种,该6种期刊发表论文量占比18.02％(82/453),核心期刊4种,其中有双核心期刊3种,单核心期刊1种,其中双核心期刊为《中华劳动卫生职业病杂志》《工业卫生与职业病》《中国工业医学杂志》,单核心期刊为《职业与健康》.③453篇论文作者单位主要有综合医院、企业防治机构、职业病防治机构、高校附属医疗机构、科研院所等,其中综合医院167人次(36.86％)、企业防治机构90人次(19.86％)、职业病防治机构81人次(17.88％)、高校附属医疗机构68人次(15.01％)、科研院所16人次(3.53％).④本次研究,学位论文16篇分布于11所大学,主要分布的高校有:山东大学3篇,山东中医药大学3篇,华北理工大学2篇,新疆医科大学1篇,郑州大学1篇,成都中医药大学1篇,右江民族医学院1篇,浙江中医药大学1篇,济南大学1篇,甘肃中医药大学、华南理工大学论文各1篇.含有中国传统医学专业学校4所,中医药类论文6篇.⑤尘肺节点最大,为高频关键词.⑥近10年突现词为尘肺病、煤工尘肺、慢性阻塞性肺疾病、肺心病、肺结核、心力衰竭、呼吸衰竭、并发症、大容量肺灌洗、中西医结合疗法、护理干预、生存质量、影响因素、效果观察、汉防己甲素片、无创通气、岩盐气溶胶等.结论 2011—2021年年文献发表数量稳定,当前及未来我国尘肺病治疗相关研究主要集中在治疗群体、治疗方法、临床合并症以及治疗结局等方面,提示上述关键词最受我国尘肺病治疗研究领域科研人员的关注.

目的 分析并探讨尘肺病患者合并慢性阻塞性肺疾病(COPD)的相关危险因素及其预防措施.方法 选择2019年8月-2020年1月在中国煤矿工人北戴河疗养院尘肺科入院治疗的193例尘肺病患者进行病例对照研究,根据尘肺患者是否合并COPD分为病例组和对照组,采用调查问卷与临床病历资料收集相结合的方式进行调查,并对病例组与对照组的统计资料进行统计学分析.结果 本次研究对象均为男性,其中病例组83人,对照组110人,尘肺患者合并COPD的合并率为43.01％.单因素分析结果显示,病例组与对照组患者在体质指数(BMI)、接尘时间、外周血中性粒细胞-淋巴细胞比值(NLR)、血小板-淋巴细胞比值(PLR)、C反应蛋白(CRP)浓度、民族、户籍、是否吸烟、住房类型、尘肺期别及体力活动水平因素上差异均有统计学意义(均P＜0.05).多因素logistic回归分析显示,中高强度体力活动是尘肺患者合并COPD的保护因素(P＜0.01),尘肺期别、CRP均是尘肺患者合并COPD的危险因素(均P＜0.01).结论 体力活动水平是影响尘肺患者合并COPD的独立保护因素,尘肺期别及CRP是影响尘肺患者合并COPD的独立危险因素,应加强安全培训和采取防护措施,定期进行职业健康检查,改变生活方式,提升患者的健康生活质量.

目的 探讨脉冲震荡肺功能检测在尘肺合并慢性阻塞性肺疾病(COPD)肺功能测定价值.方法 选择2018年4月 ～2019年10月在中国煤矿工人北戴河疗养院接受治疗的110例尘肺合并COPD患者,其中Ⅰ期15例,10例有吸烟史;Ⅱ期20例,16例有吸烟史;Ⅲ期75例,58例有吸烟史;均为男性;年龄36～72岁,平均(49.13±9.29)岁.检测并比较分析各期别尘肺合并慢性阻塞性肺疾病常规肺功能、脉冲震荡肺功能(IOS).结果 Ⅰ期、Ⅱ期、Ⅲ期患者常规肺功能指标FEV1Dre％,Ⅰ期、Ⅱ期、Ⅲ期患者分别为(67.21±7.82)％、(51.26±8.28)％、(46.27±16.21)％,不同期别差异有统计学意义(F=13.66,P=0.00);FEF75分别为(30.60±12.21)％、(25.17±9.27)％、(24.19±16.11)％,不同期别差异无统计学意义(F=0.16,P=0.31);MMEF75-25分别为(31.21±8.91)％、(28.32±8.32)％、(24.36±14.26)％,不同期别差异无统计学意义(F=2.19,P=0.11);Ⅰ期、Ⅱ期、Ⅲ期患者脉冲震荡肺功能检查指标R5-R20分别为(15.94±9.27)、(21.52±29.64)、(31.48±29.51),不同期别差异有统计学意义(F=5.26,P=0.00);X5分别为(-1.13±0.63)、(-1.97±0.91)、(-2.67±1.02),不同期别差异有统计学意义(F=17.88,P=0.00);Fres分别为(13.47±4.61)、(19.24±4.53)、(19.52±5.37),不同期别差异有统计学意义(F=8.84,P=0.00).结论 脉冲震荡肺功能IOS技术可用于尘肺合并慢性阻塞性肺疾病患者肺功能的变化,能够较为敏感的反映患者外周气道阻力、周边弹性阻力的增高程度,在尘肺的早期发现中具有一定价值.

目的 通过比较双肺同期大容量肺灌洗尘肺患者灌洗前与灌洗后1周肺功能指标的变化,分析双肺同期大容量肺灌洗术对尘肺病患者肺功能的影响.方法 选取2017年10月-2018年5月在中国煤矿工人北戴河疗养院收治的尘肺病患者进行双肺同期大容量肺灌洗100例.按照《大容量全肺灌洗术医疗护理常规及操作规程》对100名患者进行双肺同期大容量肺灌洗,在灌洗术前和灌洗术后1周检测患者肺功能各项指标,比较肺功能指标肺活量(VC)、用力肺活量(FVC)、肺总量(TLC)、1秒率(FEV1％/VC)、最高呼气流量(PEF)、呼吸后期瞬间流速(MEF 75％)、呼吸中期瞬间流速(MEF 50％)、呼吸中断流速(MEF 25％)、最大通气量(MVV)、残总比(RV/TLC)和弥散功能(DLCO)的变化.结果 共纳入尘肺病患者100名,均为男性,尘肺Ⅰ期41例,尘肺Ⅱ期29例,尘肺Ⅲ期30例.平均年龄(49.07±6.65)岁,平均身高(170.62±4.94) cm,平均体重(70.23±10.05) kg,平均接尘年限(23.33±4.26)年,年龄、身高、体重及接尘工龄在不同组之间比较,差异均无统计学意义(均P＞0.05);治疗前和治疗后7周肺功能VC、FVC、TCL、FEV1.0％、PEF呼气流速峰值、MEF25％、MEF50％、MEF75％、MVV、RV/TLC和DLCO指标,除MVV外,其余治疗前后比较差异均无统计学意义(均P＞0.05);大容量双肺灌洗后1周,VC、TLC、RV/TLC各期别变化比较差异均无统计学意义(均P＞0.05);大容量双肺灌洗后1周和DLCO各期别变化比较差异无统计学意义(P＞0.05);大容量双肺灌洗后1周,PEF、MEF25％和MEF75％各期别变化比较差异均无统计学意义(均P＞0.05);MEF50％各期别变化比较差异有统计学意义(P＜0.05).结论 经过规范的双肺同期大容量肺灌洗及术后护理,尘肺病患者术后1周肺功能恢复较好,安全有效.

目的 探讨肺灌洗双肺通气期间精确调节灌洗侧肺通气量的有效性.方法 选取120例双肺灌洗患者为研究对象,于第一侧肺灌洗结束双肺通气期间使用容量控制通气模式呼吸管理,潮气量为8～12 ml/kg,随机分成3组,每组40例.第1组不改变左右肺的通气量为不调节组;第2组使用止血钳减少一部分非灌洗侧肺通气的横截面积为粗略调节组;第3组在灌洗侧肺安装监护仪(Philips MP50)呼吸力学监测管,使用阀门(氧气袋流量阀门)逐渐减小非灌洗侧肺的横截面积,通过监护仪监测灌洗侧肺通气量达到预设潮气量的50％,即左右肺通气量相等,每隔5 min重新调节阀门为精确调节组.结果 ①精确调节组与粗略调节组和不调节组比较,灌洗侧肺的顺应性、血氧饱和度(SPO2)、氧合指数均有提高;心率、平均动脉压等指标在灌洗后20、40、60 min 3个时间点均有下降,差异有统计学意义(P＜0.05).粗略调节组与不调节组比较灌洗侧肺的顺应性提高,平均动脉压指标在灌洗后60 min有下降,差异有统计学意义(P＜0.05).②达到第二侧肺灌洗条件时两侧肺灌洗间隔时间,精确调节组与粗略调节组及不调节组比较,粗略调节组与不调节组比较均有缩短,差异有统计学意义(P＜0.05).③术后肺不张发生率,不调节组为20.0％,粗略调节组为15.0％,而精确调节组为0;术后肺感染发生率,不调节组为22.5％,粗略调节组为15.0％,而精确调节组为0;差异均有统计学意义(P＜0.05).结论 双肺通气期间使用阀门精确调节肺通气量加快了灌洗侧肺顺应性的恢复,缩短了手术时间,减少了术后并发症,是一种行之有效的方法.

目的 观察手术结束苏醒期持续泵注小剂量瑞芬太尼对大容量肺灌洗手术全身麻醉拔管时应激反应的影响.方法 选择在某院2017年5月至6月需行择期大容量肺灌洗术患者共30例,按随机数表法分为两组,A组:全麻苏醒期间维持瑞芬太尼小剂量输注;B组:苏醒拔管期间停用所有麻醉药物,记录AB两组患者在手术开始前、拔管时和拔管后5 min的循环血流动力学变化,记录患者拔管时间、苏醒时间,并观察记录苏醒拔管质量评分.结果 ①A组麻醉苏醒期发生不耐管及躁动程度明显较B组低,A组躁动评分在拔管以后5 min、15 min均显著低于B组,Ramsay评分A组拔管之后5、15 min明显高于B组.②两组比较,A组拔管时及拔管后5 min的MAP显著降低,HR显著减慢;与手术开始前比较,B组拔管时及拔管之后5 min的MAP显著升高,HR明显增快,而A组拔管以后5 min的MAP、HR无显著改变.结论 大容量肺灌洗手术结束后苏醒拔管期间继续给予小剂量瑞芬大尼持续泵注可以减少尘肺病患者不耐管引起的躁动,改善苏醒拔管质量.

目的 探讨大容量全肺灌洗术(whole-lung lavage,WLL)疗效及安全性.方法 对某院1991年3月至2018年8月进行的13787人15000例次WLL患者,就临床症状、肺功能、胸片、并发症等情况进行进行回顾性分析.结果 ①WLL术后10 d,胸闷、胸痛、气短的好转率分别为99％、86％、88％,对45例患者观察3年疗效持续巩固.②清除粉尘量:每侧肺平均清除粉尘3000～5000 mg,其中游离SiO270～200 mg;清除细胞总数3.2×108～1.23×1010个,吞尘巨噬细胞占87％～95％.③远期疗效观察:45例3年随访情况表明,体力明显增加32例(71.7％),治疗前后体质量平均增加2.18 kg,感冒、上呼吸道感染次数减少91.1％.肺功能在小气道阻力、弥散功能方面有明显改善.60例远期疗效观察:WLL术后6～7年疗效持续巩固,肺功能无显著性差异.胸部X线片病变进展、明显进展率,治疗组为16.4％(5/30)明显低于对照组43.3％(13/30),P<0.01;稳定率治疗组为83.3％(25/30),高于对照组56.7％(17/30),P<0.05.④生活质量:灌洗组的生存质量综合评价优于非灌洗组,差异有高度统计学意义(P<0.01).灌洗组在躯体感觉、生理功能和社会活动等维度的生存质量优于非灌洗组,差异有统计学意义(P<0.05);在心理功能和其他维度上,灌洗组与非灌洗组比较,差异无统计学意义(P>0.05),按同一年龄段、同一接尘年限、期别相同、接尘性质相同分层比较,灌洗组生存质量优于非灌洗组(P<0.05).⑤并发症:随着WLL技术的不断成熟、规范操作,不良反应逐年下降,1994年前并发症发生率为48.1％,1995—2004年为8.4％,2005年后为1.24％,差异有高度统计学意义(P<0.01).结论 临床实践证明,WLL是治疗尘肺病有效方法之一,严格掌握适应证、规范操作可降低不良反应,确保WLL安全.

目的 探讨压力控制(PC)和容量控制(VC)在肺灌洗术中双肺通气期间的合理选择.方法 对150例煤工尘肺患者在灌洗结束后双肺通气时,分别采用PC通气及VC通气进行呼吸管理,并监测气道峰压(PPEAK)、平均气道压力(PMEAN)、动态顺应性(Cdyn)、呼气阻力(ER)、呼吸功(WOBM).结果 容量控制(方波)[VC(SQUARE)]模式和容量控制(递减波)[VC(RAMP)]模式与PC模式比较PPEAK、PMEAN、ER、WOBM明显升高,差异均有高度统计学意义(P<0.01);Cdyn明显降低,差异有高度统计学意义(P<0.01).VC(RAMP)模式与VC(SQUARE)模式比较PPEAK、PMEAN、Cdyn、ER、WOBM差异均有高度统计学意义(P<0.01).结论 PC模式在双肺同期大容量全肺灌洗术双肺通气期间使用可降低气道压力,提高肺顺应性,减少呼吸机做功,有效减少机械通气造成的肺损伤,有较高应用价值.

目的 探讨大容量全肺灌洗(whole-lung lavage,WLL)术中术后并发症发生情况.方法 选取某院1991-03—2014-03收治9284人,10118例次WLL的患者,均采用全身麻醉,插入双腔支气管导管,一侧肺通气,另侧肺灌洗.2004年前按常规WLL方法进行灌洗,2004年后按规范的WLL方法进行.结果 ①1991—1994年,共灌洗697例,并发症320例,发生率45.91%;1995—2003年灌洗1587例,并发症134例,发生率8.44%;2004—2014年灌洗7834例,并发症120例,发生率1.53%.各组间比较差异有高度统计学意义(P<0.01).②在尘肺患者病情逐年加重的情况下,并发症逐年下降,差异有高度统计学意义(P<0.01).结论 WLL并发症的发生与技术熟练程度、操作规范情况、病情等相关.

目的 探讨半导体激光治疗对大容量肺灌洗术后患者恢复的疗效.方法 选取2013-07—2014-02于某院行大容量肺灌洗术后患者400例,随机分为治疗组和对照组,对照组予常规抗炎、化痰、平喘、雾化治疗,治疗组予常规治疗基础上加用半导体激光治疗,调整功率500 mW,时间10 min,照射部位双肺背部,2次/d.观察患者术后第3天及第5天症状及肺部听诊的变化.结果 ①治疗组症状第3天好转70例(35.0%),第5天好转147例(73.5%);对照组症状第3天好转43例(21.5%),第5天好转123例(61.5%),两组差异有统计学意义(P<0.05).②治疗组听诊呼吸音第3天好转77例(38.5%),第5天好转141例(70.5%),相比对照组均有所提高,其中,第5天听诊好转两组差异有统计学意义(P<0.05).结论 大容量肺灌洗术后辅助半导体激光治疗可提高术后患者症状及体征好转率,促进肺功能恢复,是一种安全有效的辅助治疗方法.

目的 探讨中医定向透化治疗在尘肺合并慢性阻塞性肺疾病(COPD)中的疗效.方法 选取2016年尘肺合并中重度COPD患者80例,随机分为两组,对照组常规采用抗炎、祛痰、解痉、平喘治疗,治疗组在常规治疗基础上加用中医定向透化治疗.结果 治疗后3 d及7 d,咳嗽、咳痰症状治疗组较对照组均有较好表现,差异有统计学意义,P<0.05;治疗后7 d治疗组及对照组均较术前症状改善,差异有高度统计学意义,P<0.01.治疗组肺部湿性啰音、干性啰音减少或消失时间在(2.6±1.3)d,术前准备达到肺灌洗条件时间在(6.7±1.1)d;而对照组肺部啰音变化时间在(5.8±2.3)d,术前准备达到肺灌洗条件时间在(10.6±1.4)d,两组比较,差异有高度统计学意义,P<0.01.治疗组显效11例(27.5%),有效26例(65.0%),无效3例(7.5%),总有效率92.5%;对照组显效4例(10.0%),有效26例(65.0%),无效10例(25.0%),总有效率75.0%.两组显效率及总有效率差异有统计学意义,P<0.05.治疗组治疗后肺通气功能较疗前明显改善,治疗组FVC(实测/预计):治疗前(48.2±9.8)%,治疗后(54.6±8.2)%;FEV1.0(实测/预计):治疗前(40.8±7.6)%,治疗后(50.8±8.5)%,差异有高度统计学意义,P<0.01.结论 中医定向透化治疗结合西医药物治疗尘肺合并COPD具有改善症状迅速、肺部啰音消失快、改善患者肺通气功能的优点.

Objective To study the mechanism of tumor necrosis factor (TNF)-α and its receptor (TNFR) signal transduction pathways in regulating cell apoptosis of alveolar macrophage (AM) in coal workers'' pneumoconiosis (CWP).Methods Twenty-four coal workers with pneumoconiosis at stageⅠwere selected as CWP group and four observation subjects exposed to coal were chosen as observation group by using simple random sampling method.The bronchoalveolar lavage fluids of whole-lung lavage of two groups were collected.AMs were separated and purified.Then they were divided into 6 groups: a control group, a superoxide dismutase (SOD) group, a TNF/TNFR group, an anti-TNF-α antibody group, a Caspase-8 suppression group and a nuclear factor-κB (NF-κB) suppression group.The AMs of 6 groups with corresponding treatment were cultivated.After 24 hours, the cells were harvested and proteins extracted.The relative expression of TNF-α, TNFR1, TNFR2, Caspase-8, Caspase-3, NF-κB P50 and NF-κB P65 protein was detected by Western blotting.Results The protein relative expression of TNF-α, TNFR2, Caspase-8, Caspase-3, NF-κB P50 and NF-κB P65 in CWP group was significantly higher than those in the observation group (P<0.05).The protein relative expression of TNF-α, TNFR1, Caspase-8, Caspase-3 and NF-κB P50 in the TNF/TNFR group and the anti-TNF-α antibody group was lower than that of the control group (P<0.05).The above indexes in the anti-TNF-α antibody group were lower than that of the NF-κB suppression group (P<0.05).The protein relative expression of TNFR1, Caspase-8 and Caspase-3 in the TNF/TNFR group was higher than that of the SOD group and the Caspase-8 suppression group (P<0.05).The protein relative expression of TNFR1, Caspase-8 and NF-κB P50 in the TNF/TNFR group was lower than that of the NF-κB suppression group (P<0.05).Among the CWP patients, the relative expression of TNFR2 and NF-κB P65 in the TNF/TNFR group was lower than that of the control group (P<0.05), and higher than that of the SOD group (P<0.05).Conclusion AM apoptosis mediated by TNF-α/TNFR/NF-κB signal transduction pathway plays an important role in the occurrence and development of CWP.The TNF-α/TNFR/NF-κB signal transduction pathways inhibited or blocked at different stages can affect the expression of proteins related to AM apoptosis.

目的 对煤工尘肺大容量肺灌洗前后影像学改变进行评价.方法 2009年1 1月～2010年5月中国煤矿工人北戴河疗养院肺灌洗煤工尘肺患者102例,其中Ⅰ期57例,Ⅱ期37例,Ⅲ期8例;均为男性,平均年龄51.74岁,平均接尘工龄24.74年.仅对第1次复查结果进行比较分析.分析102例资料齐全的尘肺病患者比较大容量全肺灌洗前、后高千伏X线或DR胸片的期别、总体密度;比较57例尘肺病患者肺灌洗前后支气管管壁的64排螺旋CT支气管内径的影像表现;比较99例尘肺病患者灌洗前后64排螺旋CT双肺平均CT值肺密度值、双肺重量.结果 灌洗前后高千伏X线胸片和DR胸片所显示病变、影像表现均未见明显变化,尘肺期别、总体密集度等方面无明显变化,差异无统计学意义(P＞0.05).57例尘肺病患者尘肺灌洗前后右主支气管内径、灌洗前后右上叶支气管后段段支气管内径、灌洗前后右中叶支气管内侧段亚段支气管内径前后差值比较,差异有统计学意义(P＜0.05).99例尘肺灌洗前双肺平均CT值:(HU)为-803.996±65.955,灌洗后双肺HU为-829.052±65.201,灌洗前后双肺HU比较,差异有统计学意义(t=6.783,P＜0.01).99例尘肺灌洗后双肺平均重量、肺密度较灌洗前降低,差异有统计学意义(P＜0.01).结论 煤工尘肺灌洗后部分支气管内径较灌洗前增宽,肺CT值、肺组织密度、自身重量减小.提示灌洗后增加了肺的含气量,提高了肺的通气功能,改善了尘肺病患者的肺功能.

[Objective]To explore the reason of the difference in diagnosis of pneumoconiosis between different areas,and provide evidence for improving accuracy and consistency in diagnosis of pneumoconiosis by X-ray chest film.[Methods]A total of 163 pneumoconiosis patients received lung lavage and diagnosed by high kV X-ray in original units(local diagnostic group) of different areas were selected in this study.Their chest x-ray films were read by 5 experienced pneumoconiosis diagnosticians(expert diagnostic group).The stage classification results identified twice by expert diagnostic group were analyzed statistically.And the difference of stage classification results between local diagnostic group and expert diagnostic group was compared.[Results] The 2 diagnostic results by expert diagnostic group were analyzed via kappa consistency,the Kappa value = 0.807 0.75 which indicated the satisfied onsistency of the 2 results(85.89%).The Kappa value of results by local diagnostic group and expert diagnostic group was 0.177 0.4 which indicated unsatisfied consistency of the 2 results(49.69%).The differences of CV %,high diagnostic rate,low diagnosis rate,coincidence ratio were 7.19%-75.22%,7.14%-83.33%,0.00-66.67%,14.29%-87.50% between local diagnostic group and expert diagnostic group.[Conclusion]The difference exists in diagnosis of pneumoconiosis by X-ray chest film between local diagnostic group and expert diagnostic group.It is necessary to improve the quality of chest X-ray film via condition control,to accurately grasp the diagnostic criteria,to perform regular training,to identify the film together based on the control,to persist in seeking truth from facts,to improve professional ethics,to carry out CT differential diagnosis to reduce the diagnostic error and improve diagnostic accuracy if necessary.

目的 对煤工尘肺大容量肺灌洗前后影像学改变进行评价.方法 2009年1 1月～2010年5月中国煤矿工人北戴河疗养院肺灌洗煤工尘肺患者102例,其中Ⅰ期57例,Ⅱ期37例,Ⅲ期8例;均为男性,平均年龄51.74岁,平均接尘工龄24.74年.仅对第1次复查结果进行比较分析.分析102例资料齐全的尘肺病患者比较大容量全肺灌洗前、后高千伏X线或DR胸片的期别、总体密度;比较57例尘肺病患者肺灌洗前后支气管管壁的64排螺旋CT支气管内径的影像表现;比较99例尘肺病患者灌洗前后64排螺旋CT双肺平均CT值肺密度值、双肺重量.结果 灌洗前后高千伏X线胸片和DR胸片所显示病变、影像表现均未见明显变化,尘肺期别、总体密集度等方面无明显变化,差异无统计学意义(P＞0.05).57例尘肺病患者尘肺灌洗前后右主支气管内径、灌洗前后右上叶支气管后段段支气管内径、灌洗前后右中叶支气管内侧段亚段支气管内径前后差值比较,差异有统计学意义(P＜0.05).99例尘肺灌洗前双肺平均CT值:(HU)为-803.996±65.955,灌洗后双肺HU为-829.052±65.201,灌洗前后双肺HU比较,差异有统计学意义(t=6.783,P＜0.01).99例尘肺灌洗后双肺平均重量、肺密度较灌洗前降低,差异有统计学意义(P＜0.01).结论 煤工尘肺灌洗后部分支气管内径较灌洗前增宽,肺CT值、肺组织密度、自身重量减小.提示灌洗后增加了肺的含气量,提高了肺的通气功能,改善了尘肺病患者的肺功能。

Objective To explore the correlation between 6 kinds of lung fibrosis-related cytokines released from alveolar macrophage(AM) and the development of silicosis.Methods Twenty-nine male silicosis patients,three male patients with foreign body inhaled and three male workers exposed to silica no longer than three months were taken as subjects.The lung lavage fluids were collected and AMs were separated and purified.After that,AMs were incubated at 37℃ for 24hours.The supernatants of cultured AMs from all subjects were collected.Cytokines of tumor necrosis factor(TNF-α),interlukin1beta(IL-1β ) and IL-8,transforming growth factor beta 1(TGF-β1),macrophage inflammatory protein 1α(MIP-1α) and monocyte chemotactic protein-1(MCP-1 )were detected by ELISA.The relationship between cytokine level and silicosis was analyzed.Results The levels of IL-1β ,TNF-α,TGF-β1,IL-8 and MCP-1 in the cultured supernatants of AM from silicosis patients were higher than those of controls,the levels of TNF-α and MCP-1 in patients of stageⅡ were higher than those of stageⅠ,but TGF-β1 was lower than that of stageⅠ.The levels of IL-1β ,TGF-β1 and MIP-1αin those keeping exposed to silica were higher than those of ceased to silica exposure,but TNF-αshowed the reversed trend.The IL-1β in those with duration from silica exposure to silicosis onset less than 15 years was lower than those of≧15 years,but MCP-1 showed the reversed trend.The levels of IL-1β ,TNF-α and MCP-1 were negatively related to duration of cessation of silica exposure.Conclusions Differential expressions of silica induced inflammatory and fibrotic cytokines play an important role in the development of silicosis.