Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
BMC Pulm Med. 2022 Jun 20;22(1):236. doi: 10.1186/s12890-022-02022-x.
Even almost 30 years after the ban on the use of asbestos in Germany, the effects of asbestos are still highly relevant in everyday clinical practice in occupational medicine. The aim of this study was to further investigate the significance of essential parameters of both pulmonary function diagnostics and imaging techniques (low-dose HR-TCT) for the prevention and early detection of asbestos-related morphological and functional lung changes.
Data from spirometry, body plethysmography and diffusion capacity, as well as CT images of the thorax, were retrospectively studied from 72 patients examined between 2017 and 2019 at the Institute for Occupational and Maritime Medicine (ZfAM), Hamburg, Germany. The subjects were divided into four subgroups according to the presence of comorbidities (concomitant cardiac diseases, obstructive ventilatory disorder, pulmonary function pattern consistent with emphysema, and no other pulmonary or cardiac diseases). These subgroups were analysed in addition to the overall collective. The CT images were evaluated according to the International Classification of Occupational and Environmental Respiratory Diseases (ICOERD) with radiological expertise. In addition, some asbestos-related parameters were newly quantified, and corresponding scores were defined based on ICOERD. Statistical analysis included the use of correlations and fourfold tables with calculation of Spearman's rho (ρ), Cohen's κ, and accuracy.
Vital capacity (VC) is slightly reduced in the total collective compared to the normal population (mean 92% of predicted value), while diffusion capacity for CO (D) shows predominantly pathological values, mean 70% of the respective predicted value. The CO transfer coefficient (D/VA), which refers to alveolar volume (VA), also shows slightly decreased values (mean 87% pred.). Seventy-nine percent of patients (n = 57) had signs of pulmonary fibrosis on CT scans, and pleural plaques appeared in 58 of 72 patients (81%). Of the newly quantified additional parameters, particularly frequently described findings are subpleural curvilinear lines (SC, n = 39) and parenchymal bands (PB, n = 29). VC correlates well with the expression of pleural plaques (ρ = - 0.273, P < 0.05), and D measures show a better correlation with fibrosis score (ρ = - 0.315, P < 0.01). A third, newly developed score, which includes the extent of pleural plaques and additional subpleural parameters instead of fibrosis parameters, shows significant correlations for both VC and D (ρ = - 0.283, - 0.274, resp.; both P < 0.05).
The importance of spirometry (VC) and diffusion capacity measurement (D) as essential diagnostic procedures for the early detection of asbestos-related changes ‒ also including patients with relevant concomitant cardiac or pulmonary diseases ‒ was confirmed. Significant and better correlations between lung function changes (VC and D) and abnormal CT findings are seen when parenchymal bands (PB), subpleural curvilinear lines (SC), and rounded atelectasis (RA) are quantitatively included into the evaluation, in addition to assessing the extent of pleural plaques alone. Therefore, when assessing CT images according to ICOERD, these parameters should also be quantified.
即使在德国禁止使用石棉近 30 年后，石棉的影响在职业医学的日常临床实践中仍然非常重要。本研究的目的是进一步研究肺功能诊断和影像学技术（低剂量 HR-TCT）的基本参数对预防和早期发现与石棉相关的形态和功能肺部变化的重要性。
从德国汉堡职业与航海医学研究所（ZfAM）于 2017 年至 2019 年间检查的 72 名患者的肺活量计、体描法和扩散能力以及胸部 CT 图像中回顾性研究数据。根据并存疾病（并存心脏病、阻塞性通气障碍、与肺气肿一致的肺功能模式和无其他肺部或心脏疾病）将受试者分为四个亚组。除了总体群体外，还分析了这些亚组。根据国际职业和环境呼吸疾病分类（ICOERD）对 CT 图像进行评估，并由放射学专业知识进行评估。此外，还对一些与石棉相关的参数进行了新的量化，并根据 ICOERD 定义了相应的评分。统计分析包括使用相关性和四格表，计算 Spearman's rho（ρ）、Cohen's κ 和准确性。
与正常人群相比，总人群的肺活量（VC）略有降低（平均为预测值的 92%），而一氧化碳扩散量（D）主要表现为病理性值，平均为预测值的 70%。CO 转移系数（D/VA），指的是肺泡体积（VA），也显示出略微降低的值（平均为预测值的 87%）。79%的患者（n=57）在 CT 扫描中出现肺纤维化迹象，72 名患者中有 58 名（81%）出现胸膜斑。在新量化的附加参数中，经常描述的发现是胸膜下线（SC，n=39）和实质带（PB，n=29）。VC 与胸膜斑的表达相关性良好（ρ=-0.273，P<0.05），D 测量与纤维化评分的相关性更好（ρ=-0.315，P<0.01）。第三个新开发的评分，包括胸膜斑的程度和附加的胸膜下参数，而不是纤维化参数，与 VC 和 D 均显示出显著相关性（ρ=-0.283，-0.274，分别为；均 P<0.05）。
证实了肺活量计（VC）和扩散能力测量（D）作为检测与石棉相关变化的基本诊断程序的重要性，包括有相关并存心脏或肺部疾病的患者。当将实质带（PB）、胸膜下线（SC）和圆形肺不张（RA）等参数定量纳入评估中时，与单独评估胸膜斑相比，肺功能变化（VC 和 D）与异常 CT 发现之间存在更显著和更好的相关性。因此，在根据 ICOERD 评估 CT 图像时，还应量化这些参数。
