支气管肺泡灌洗和99mTc-DTPA清除率作为患和未患石棉沉着病的石棉工人的预后因素

al Jarad N, Gellert A R, Rudd R M

London Chest Hospital, U.K.

Respir Med. 1993 Jul;87(5):365-74. doi: 10.1016/0954-6111(93)90050-a.

The aims of this study are to investigate the change-over time of lung function and chest radiographic findings in patients with asbestosis (AS) and asbestos workers without asbestosis (AW). Secondly, to correlate these changes with broncho-alveolar lavage (BAL) profiles and with lung epithelial permeability, as detected by half-time lung-to-blood (t1/2 LB) clearance of an inhaled aerosol of diethylene triamine pentacetate labelled with technetium 99 (99mTc-DTPA) obtained a mean period of 4.2 yr (range 2.3-5.8) previously. Thirty-three patients with asbestosis and 24 asbestos workers with substantial asbestos exposure were followed-up. Nineteen healthy smokers (HS) with no asbestos exposure who were followed up for a mean period of 3.9 yr were taken as a control group for spirometric changes. Compared with AW, FEV1, FVC and TLCO were lower in AS (P < 0.0001 in each case). Smoker AS and AW had lower numbers (P < 0.03) and percentages (P < 0.004) of BAL lymphocytes and higher numbers (P < 0.04) and percentages (P < 0.02) of BAL neutrophils plus eosinophils than ex- and non-smokers. Annual declines of FEV1 (dFEV1 yr-1) and FVC (dFVC yr-1) in AS and AW were significantly greater than in HS and predicted annual declines (P < 0.002 in each case). Annual declines of TLCO (dTLCO yr-1) and KCO (dKCO yr-1) in AS and AW were significantly greater than predicted annual declines (P < 0.002 in each case). No significant differences were noted between AS and AW in annual declines in any lung function measurement. dTLCO yr-1, dKCO yr-1 were significantly greater in smokers than in ex- and non-smokers, (P < 0.05 and P < 0.04 respectively). Annual decline did not relate to base line values for any lung function measurement. Numbers and proportions of BAL lymphocyte were higher (P < 0.008 and P < 0.02, respectively) and numbers and proportions of BAL neutrophils and eosinophils were lower (P < 0.02 and P < 0.03, respectively) in patients in whom dTLCO yr-1 was less than 0.3 mmol min-1 kPa-1 than in patients in whom dTLCO yr-1 was more than 0.3 mmol min-1 kPa-1. dTLCO yr-1 inversely correlated with t1/2 LB; r = 0.51; (P < 0.008). Patients in whom the radiograph remained unchanged had higher numbers (P < 0.002) and percentages (P < 0.001) of BAL lymphocytes than patients in whom the radiograph deteriorated.(ABSTRACT TRUNCATED AT 250 WORDS)

本研究的目的是调查石棉肺（AS）患者和无石棉肺的石棉工人（AW）的肺功能及胸部X光检查结果随时间的变化。其次，将这些变化与支气管肺泡灌洗（BAL）特征以及肺上皮通透性相关联，肺上皮通透性通过之前在平均4.2年（范围2.3 - 5.8年）期间获得的用99锝标记的二乙烯三胺五乙酸（99mTc - DTPA）吸入气雾剂的肺 - 血半清除时间（t1/2 LB）来检测。对33例石棉肺患者和24例有大量石棉接触史的石棉工人进行了随访。选取19名无石棉接触史的健康吸烟者（HS）作为肺活量测定变化的对照组，其平均随访时间为3.9年。与AW相比，AS患者的第一秒用力呼气容积（FEV1）、用力肺活量（FVC）和肺一氧化碳弥散量（TLCO）较低（每种情况P < 0.0001）。与既往吸烟者和非吸烟者相比，吸烟的AS和AW患者的BAL淋巴细胞数量（P < 0.03）和百分比（P < 0.004）较低，BAL中性粒细胞加嗜酸性粒细胞的数量（P < 0.04）和百分比（P < 0.02）较高。AS和AW患者的FEV1（dFEV1 yr-1）和FVC（dFVC yr-1）的年下降幅度显著大于HS患者及预测的年下降幅度（每种情况P < 0.002）。AS和AW患者的TLCO（dTLCO yr-1）和一氧化碳弥散系数（KCO，dKCO yr-1）的年下降幅度显著大于预测的年下降幅度（每种情况P < 0.002）。在任何肺功能测量的年下降幅度方面，AS和AW之间未观察到显著差异。吸烟者的dTLCO yr-1、dKCO yr-1显著大于既往吸烟者和非吸烟者（分别为P < 0.05和P < 0.04）。年下降幅度与任何肺功能测量的基线值均无关。dTLCO yr-1小于0.3 mmol min-1 kPa-1的患者，其BAL淋巴细胞数量（分别为P < 0.008和P < 0.02）和百分比更高，BAL中性粒细胞和嗜酸性粒细胞的数量（分别为P < 0.02和P < 0.03）和百分比更低，而dTLCO yr-1大于0.3 mmol min-1 kPa-1的患者则相反。dTLCO yr-1与t1/2 LB呈负相关；r = 0.51；（P < 0.008）。胸片未改变的患者，其BAL淋巴细胞数量（P < 0.002）和百分比（P < 0.001）高于胸片恶化的患者。（摘要截断于250字）