Hillerdal G
Department of Lung Medicine, Uppsala University, Akademiska Sjukhuset, Sweden.
Respir Med. 1990 Mar;84(2):129-34. doi: 10.1016/s0954-6111(08)80015-7.
From the County of Uppsala, Sweden, more than 1600 persons with pleural plaques and/or asbestos-related pleural thickening have been seen at the Uppsala University Hospital during a period of about 15 years. During the observation time, 40 patients developed lesions mainly affecting the upper lobes of the lung. They were all men, 41 to 78-years-old, and all had been occupationally exposed to asbestos. The mean latency time from the first exposure was 34 years. The mean width of the apical pleural thickening was 21 mm. In 21 patients the lesions were on the right side, in 15 they were bilateral, and in only four patients was the left side alone affected. Biopsies from the pleura were available in twelve patients and from the lung parenchyma in eight. The biopsies of the lungs all showed varying degrees of asbestosis and of the pleura nonspecific pleuritis. The lesions tended to progress and in all cases except one they were part of a diffuse pleural and parenchymal fibrosis involving the rest of the lung. Consequently, the pulmonary function was impaired, with the vital capacity reduced to an average of 62% and total lung capacity to 68% of the predicted value. In many patients there was contraction of the upper lobe and deviation of the trachea towards the same side. Upper lobe changes are a relatively rare complication of exposure to asbestos but are important to recognise. Other possible causes of upper lobe changes such as tuberculosis must always be excluded before the diagnosis is made.
在大约15年的时间里，瑞典乌普萨拉郡有1600多名患有胸膜斑和/或石棉相关胸膜增厚的患者前往乌普萨拉大学医院就诊。在观察期间，40名患者出现了主要影响肺上叶的病变。他们均为男性，年龄在41至78岁之间，且都有职业性石棉接触史。从首次接触到发病的平均潜伏期为34年。肺尖胸膜增厚的平均宽度为21毫米。21名患者的病变在右侧，15名患者双侧受累，只有4名患者仅左侧受累。12名患者获取了胸膜活检样本，8名患者获取了肺实质活检样本。肺部活检均显示出不同程度的石棉肺，胸膜活检显示为非特异性胸膜炎。病变有进展趋势，除1例之外，所有病例均是弥漫性胸膜和肺实质纤维化的一部分，累及肺的其余部分。因此，肺功能受损，肺活量平均降至预测值的62%，肺总量降至预测值的68%。许多患者出现上叶收缩，气管向同侧偏移。上叶改变是石棉接触相对少见的并发症，但很重要，需要识别。在做出诊断之前，必须始终排除其他可能导致上叶改变的原因，如肺结核。
