恶性和非恶性石棉相关胸膜和肺部疾病：10年随访研究。

Malignant and non-malignant asbestos-related pleural and lung disease: 10-year follow-up study.

作者信息

Cvitanović Slavica, Znaor Ljubo, Konsa Tonći, Ivancević Zeljko, Perić Irena, Erceg Marijan, Vujović Mirjana, Vuković Jonatan, Beg-Zec Zlata

机构信息

Department for Pulmonary Diseases, Split University Hospital, Spinciceva 1, 21000 Split, Croatia.

出版信息

Croat Med J. 2003 Oct;44(5):618-25.

PMID:14515425

Abstract

AIM

To examine the presence of radiologically visible lung and pleural changes in patients who were exposed to the asbestos dust, and to correlate the progression of these changes with the duration and intensity of exposure and smoking. We also evaluated possible correlation between non-malignant asbestos-related pleural abnormalities and the occurrence of malignant pleural mesothelioma.

METHODS

Among 7,300 patients who visited our department between 1991 and 2000 due to non-specific respiratory symptoms, we selected 2,420 with chest X-rays indicating the possible existence of non-malignant asbestos-related diseases. The selected group was followed-up for progression of radiological changes and the development of malignant pleural mesothelioma, and the changes were correlated with the intensity and duration of exposure to asbestos dust and smoking.

RESULTS

Radiological changes characteristic for non-malignant asbestos-related pleural disease or lung asbestosis were identified in 340 (14%) out of 2,420 examined patients, of whom 77 (22.6%) developed malignant pleural mesothelioma, as compared with 13 patients out of 2,080 (0.6%) without radiological signs of asbestosis or pleural changes. Twenty-three (29.9%) patients who presented with a progression of pleural disease and lung asbestosis had a very significant incidence of malignant pleural mesothelioma (p<0.001). We also found that 55 (71.4%) patients with the highest asbestos exposure level (grade 3) developed malignant pleural mesothelioma more often (p=0.044). No correlation was found between malignant pleural mesothelioma development and duration of asbestos exposure (p=0.149) or smoking habit (p=0.617). Professionally exposed patients were at 3.3-times higher relative risk (95% confidence interval, 2.28-4.75) than those who were not exposed to develop malignant pleural mesothelioma.

CONCLUSIONS

The risk of developing lung asbestosis increased with the level of exposure to asbestos dust and smoking. The risk of developing pleural disease correlated with the intensity and duration of exposure, but not with smoking. The patients with progressive pleural and parenchymal changes are at particularly high risk of developing malignant pleural mesothelioma and must be under special surveillance.

摘要

目的

检查接触石棉粉尘的患者肺部和胸膜在影像学上可见的变化，并将这些变化的进展与接触时间、接触强度及吸烟情况相关联。我们还评估了非恶性石棉相关胸膜异常与恶性胸膜间皮瘤发生之间的可能关联。

方法

在1991年至2000年间因非特异性呼吸道症状前来我科就诊的7300例患者中，我们挑选出2420例胸部X光显示可能存在非恶性石棉相关疾病的患者。对选定的这组患者进行随访，观察其影像学变化的进展以及恶性胸膜间皮瘤的发生情况，并将这些变化与石棉粉尘接触强度、接触时间及吸烟情况相关联。

结果

在2420例接受检查的患者中，340例（14%）出现了非恶性石棉相关胸膜疾病或肺石棉沉着病的特征性影像学变化，其中77例（22.6%）发展为恶性胸膜间皮瘤，相比之下，在2080例无石棉沉着病或胸膜变化影像学征象的患者中有13例（0.6%）发生了恶性胸膜间皮瘤。23例（29.9%）出现胸膜疾病和肺石棉沉着病进展的患者发生恶性胸膜间皮瘤的发生率非常高（p<0.001）。我们还发现，石棉暴露水平最高（3级）的55例（71.4%）患者发生恶性胸膜间皮瘤的频率更高（p=0.044）。未发现恶性胸膜间皮瘤的发生与石棉暴露时间（p=0.149）或吸烟习惯（p=0.617）之间存在相关性。职业暴露患者发生恶性胸膜间皮瘤的相对风险比未暴露患者高3.3倍（95%置信区间，2.28 - 4.75）。