Krabbe Julia, Reimers Damian J, Otte Nelly, Doukas Panagiotis, Dirrichs Timm, Radtke Thomas, Dressel Holger, Kraus Thomas
Institute of Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
Department of Vascular Surgery, Medical Faculty, European Vascular Centre Aachen-Maastricht, RWTH Aachen University, Aachen, Germany.
Sci Rep. 2025 May 2;15(1):15380. doi: 10.1038/s41598-025-99824-w.
Asbestos exposure can induce pulmonary fibrosis known as asbestosis, and pleural thickening, as well as various cancers. Although lung diffusion capacity (DL) including nitric oxide (NO) is assumed to be more sensitive than carbon monoxide (CO), its added value in assessment of pneumoconiosis has not been investigated yet. 371 formerly exposed workers visiting the outpatient clinic for assessment including pulmonary function testing with DL and low-dose high resolution computed tomography between 2018 and 2021 were included. Subgroups were formed depending on findings in low-dose high resolution computed tomography classified according to ICOERD. Receiver operating characteristic curve (ROC) analysis revealed some diagnostic accuracy for DLNO (AUC = 0.73; 95% confidence interval 0.64-0.82) and DLCO (AUC = 0.70; 95% confidence interval 0.60-0.79) regarding asbestosis, but not per unit alveolar volume. DLCO and DLNO correlated strongly with a decreasing score of irregular opacities according to ICOERD (ρ = - 0.87, ρ = - 0.85) but DLNO was also susceptible to emphysema. Although tendencies of a more sensitive detection of diffusion capacity impairment were observed, DLNO was not clearly superior to DLCO in assessment of asbestosis. Based on our findings and considering the lack of availability of DLNO in clinical routine, DLNO does not seem to have added value for clinical assessment of formerly asbestos exposed workers. Future studies should further investigate DLNO including healthy controls and confounders such as emphysema and smoking.
接触石棉可诱发称为石棉肺的肺纤维化、胸膜增厚以及各种癌症。尽管包括一氧化氮（NO）在内的肺弥散能力（DL）被认为比一氧化碳（CO）更敏感，但其在尘肺病评估中的附加价值尚未得到研究。纳入了2018年至2021年间到门诊进行评估的371名曾接触石棉的工人，评估内容包括使用DL进行肺功能测试以及低剂量高分辨率计算机断层扫描。根据国际尘肺病研究和诊断委员会（ICOERD）分类的低剂量高分辨率计算机断层扫描结果形成亚组。受试者工作特征曲线（ROC）分析显示，DLNO（曲线下面积[AUC]=0.73；95%置信区间0.64 - 0.82）和DLCO（AUC = 0.70；95%置信区间0.60 - 0.79）对于石棉肺有一定诊断准确性，但对于单位肺泡容积则不然。根据ICOERD，DLCO和DLNO与不规则阴影评分降低密切相关（ρ = - 0.87，ρ = - 0.85），但DLNO也易受肺气肿影响。尽管观察到弥散能力损害检测更敏感的趋势，但在石棉肺评估中DLNO并不明显优于DLCO。基于我们的研究结果并考虑到临床常规中DLNO难以获得，DLNO似乎对曾接触石棉工人的临床评估没有附加价值。未来的研究应进一步调查DLNO，包括健康对照以及肺气肿和吸烟等混杂因素。
