Collins L C, Willing S, Bretz R, Harty M, Lane E, Anderson W H
Division of Respiratory and Environmental Medicine, University of Louisville, Ky.
Chest. 1993 Oct;104(4):1156-62. doi: 10.1378/chest.104.4.1156.
We examined 21 miners by means of standard chest radiography, high-resolution computerized tomography (HRCT), pulmonary function tests, and resting arterial blood gas levels. Using the ILO/UC classification of pneumoconiosis, 7 miners had category 1/0 or 2/1 simple coal workers' pneumoconiosis (CWP). By HRCT, nodules were identified in 12 miners; 4 of 9 were classified as category 0/0 CWP; 2 of 5, 0/1 CWP; 5 of 6, 1/0 CWP; and 1 of 1, 2/1 CWP by chest radiograph. Focal emphysema was identified by HRCT in 7 miners; 4 of 9 were classified as 0/0 CWP; 2 of 5, 0/1 CWP; and 1 of 6, 1/0 CWP by standard chest radiography. Four miners with definite nodules confirmed by HRCT had focal emphysema, while three without nodules had focal emphysema. Pulmonary function testing was not different between miners with or without CWP by standard chest radiography, nor was it different between miners with or without definite nodules evidenced by HRCT. No difference in resting oxygenation was found between any group of miners. The presence of focal emphysema confirmed by HRCT did not significantly affect pulmonary function tests on resting arterial blood gas values. There was, however, a significantly lower FEV1 and mean forced expiratory flow during the middle half of forced vital capacity with lifetime nonsmoking miners. The presence of CWP on chest radiography was significantly correlated with smoking cigarettes but not the years of mining. The presence of nodules on HRCT approached a significant correlation with cigarette smoking, but focal emphysema did not. For detecting evidence of coal dust accumulation in lung parenchyma and identifying focal emphysema, HRCT was more sensitive than standard chest radiography. However, despite earlier detection of parenchymal abnormalities, abnormal pulmonary function attributable to coal dust could not be identified.
我们通过标准胸部X线摄影、高分辨率计算机断层扫描（HRCT）、肺功能测试和静息动脉血气水平对21名矿工进行了检查。根据国际劳工组织/美国国家职业安全与健康研究所（ILO/UC）的尘肺病分类，7名矿工患有1/0或2/1期单纯性煤工尘肺（CWP）。通过HRCT检查，12名矿工发现有结节；根据胸部X线片，9名矿工中有4名被分类为0/0期CWP；5名中有2名，0/1期CWP；6名中有5名，1/0期CWP；1名中有1名，2/1期CWP。HRCT检查发现7名矿工有局灶性肺气肿；根据标准胸部X线片，9名矿工中有4名被分类为0/0期CWP；5名中有2名，0/1期CWP；6名中有1名，1/0期CWP。4名经HRCT证实有明确结节的矿工有局灶性肺气肿，而3名无结节的矿工有局灶性肺气肿。通过标准胸部X线片检查，有或无CWP的矿工之间肺功能测试无差异，通过HRCT检查有或无明确结节的矿工之间肺功能测试也无差异。任何一组矿工的静息氧合均无差异。HRCT证实的局灶性肺气肿的存在对静息动脉血气值的肺功能测试无显著影响。然而，终生不吸烟的矿工的第一秒用力呼气容积（FEV1）和用力肺活量中间一半的平均用力呼气流量明显较低。胸部X线片上CWP的存在与吸烟显著相关，但与采矿年限无关。HRCT上结节的存在与吸烟接近显著相关，但局灶性肺气肿与吸烟无关。对于检测肺实质中煤尘积聚的证据和识别局灶性肺气肿，HRCT比标准胸部X线摄影更敏感。然而，尽管更早地检测到实质异常，但无法识别出由煤尘引起的异常肺功能。
