Wright P H, Hanson A, Kreel L, Capel L H
Thorax. 1980 Jan;35(1):31-6. doi: 10.1136/thx.35.1.31.
Six patients with radiographic evidence of diffuse pleural thickening after industrial asbestos exposure are described. Five had computed tomography of the thorax. All the scans showed marked circumferential pleural thickening often with calcification, and four showed no significant evidence of intrapulmonary fibrosis (asbestosis). Lung function testing showed reduction of the inspiratory capacity and the single-breath carbon monoxide transfer factor (TLCO). The transfer coefficient, calculated as the TLCO divided by the alveolar volume determined by helium dilution during the measurement of TLCO, was increased. Pseudo-static compliance curves showed markedly more negative intrapleural pressures at all lung volumes than found in normal people. These results suggest that the circumferential pleural thickening was preventing normal lung expansion despite abnormally great distending pressures. The pattern of lung function tests is sufficiently distinctive for it to be recognised in clinical practice, and suggests that the lungs are held rigidly within an abnormal pleura. The pleural thickening in our patients may have been related to the condition described as "benign asbestos pleurisy" rather than the interstitial fibrosis of asbestosis.
本文描述了6例因职业性接触石棉后出现弥漫性胸膜增厚影像学证据的患者。其中5例进行了胸部计算机断层扫描。所有扫描均显示明显的环形胸膜增厚，常伴有钙化，4例未显示明显的肺内纤维化（石棉肺）证据。肺功能测试显示吸气容量和单次呼吸一氧化碳转运因子（TLCO）降低。以TLCO除以测量TLCO期间通过氦稀释法测定的肺泡容积计算得出的转运系数升高。准静态顺应性曲线显示，在所有肺容积下，胸膜腔内压力均比正常人明显更负。这些结果表明，尽管存在异常高的扩张压力，但环形胸膜增厚仍阻碍了肺的正常扩张。肺功能测试模式具有足够的特异性，可在临床实践中得到识别，提示肺被异常坚硬地固定在胸膜内。我们患者的胸膜增厚可能与被称为“良性石棉性胸膜炎”的疾病有关，而非石棉肺的间质纤维化。
