Barnes Hayley, Pilcher David, Coull Julia, Sin Jesselyn, Dabscheck Eli, Siemienowicz Miranda, Pirakalathanan Janu, Khoo Jun, Sweeney Duncan, McLean Catriona, Pirakalathanan Piraveen, Eikelis Nina, Begka Christina, Westall Glen, Hoy Ryan
Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia.
Monash Centre for Occupational and Environmental Health, Monash University, Melbourne, Australia.
J Thorac Dis. 2024 Nov 30;16(11):7630-7639. doi: 10.21037/jtd-24-1050. Epub 2024 Nov 29.
The incidence of silicosis has increased due to occupational silica exposure from artificial stone, with no treatments proven to halt or reverse the disease. Whole lung lavage (WLL) involves the instillation of fluid into the lungs to wash out silica particles and disease-causing inflammatory cells. This study aimed to determine the feasibility, safety, and possible benefit of WLL in patients with artificial stone silicosis.
In this prospective observational study, people with progressive silicosis with ground glass predominant radiological changes underwent WLL. High resolution computed tomography (HRCT) chest, X-ray velocimetry (XV), lung function tests, forced oscillation technique (FOT), and cardiopulmonary exercise tests (CPET) were performed before and six months after the procedure.
Eight patients underwent WLL between June 2021 and November 2022. Five participants had an improvement in the International Classification of High Resolution Computed Tomography for Occupational and Environmental Respiratory Diseases (ICOERD) CT scores and reduction in XV regional ventilation distribution pre- and six months post-WLL. There was no difference in lung function [annualized rate of change in forced vital capacity (FVC) % predicted mean difference (MD) 1.81; 95% CI: -1.53 to 5.15, P=0.27; forced expiratory volume in 1 second (FEV1) % predicted MD -1.13, 95% CI: -5.08 to 2.83, P=0.55; diffusing capacity for carbon monoxide (DLCO) % predicted MD -2.62, 95% CI: -10.04 to 4.80, P=0.46]. There was no significant difference in CPET or FOT measurements. Following WLL, all patients experienced transient throat discomfort, one had fever and two required oral antibiotics. There were no serious adverse events.
WLL for artificial stone silicosis is safe in an expert centre who has experience in performing WLL in this population, and there may be limited benefit in selected patients. Further research is required to select those who will derive the most benefit.
由于人造石导致的职业性二氧化硅暴露，矽肺病的发病率有所上升，目前尚无经证实能阻止或逆转该病的治疗方法。全肺灌洗（WLL）是将液体注入肺部以冲洗出二氧化硅颗粒和致病炎性细胞。本研究旨在确定WLL对人造石矽肺病患者的可行性、安全性及可能的益处。
在这项前瞻性观察研究中，对具有磨玻璃影为主的放射学改变的进行性矽肺病患者实施WLL。在手术前及术后6个月进行胸部高分辨率计算机断层扫描（HRCT）、X线流速测定法（XV）、肺功能测试、强迫振荡技术（FOT）和心肺运动测试（CPET）。
2021年6月至2022年11月期间，8例患者接受了WLL。5名参与者在职业和环境呼吸系统疾病高分辨率计算机断层扫描国际分类（ICOERD）CT评分有所改善，且在WLL前和术后6个月XV区域通气分布减少。肺功能无差异[用力肺活量（FVC）预测年均变化率平均差（MD）1.81；95%可信区间：-1.53至5.15，P=0.27；第1秒用力呼气容积（FEV1）预测MD -1.13，95%可信区间：-5.08至2.83，P=0.55；一氧化碳弥散量（DLCO）预测MD -2.62, 95%可信区间：-10.04至4.80，P=0.46]。CPET或FOT测量无显著差异。WLL后，所有患者均出现短暂的咽喉不适，1例发热，2例需要口服抗生素。无严重不良事件。
在有对该人群进行WLL经验的专家中心，对人造石矽肺病进行WLL是安全的，对部分患者可能有有限的益处。需要进一步研究以筛选出能获得最大益处的患者。
