多排螺旋CT诊断职业性尘肺病的价值评价
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摘要
[目的]研究探讨多排螺旋计算机断层扫描(computed tomography,CT)在职业性尘肺病患者诊断中的临床应用价值。[方法]对99例疑似职业性尘肺病患者实施胸部DR检查、多排螺旋CT(简称CT)检查,以临床确诊结果为参照,对其诊断结果进行比较分析。[结果] 99例疑似职业性尘肺病患者中,有65例患者经临床确诊为职业性尘肺病,其中DR检查出63例,CT检查出62例。确诊为非尘肺病患者中,有1例被DR检查为尘肺病,2例被CT检查为尘肺病。以临床确诊结果为参照,DR、CT对尘肺病诊断的灵敏度、特异度、符合率差异均无统计学意义(P> 0.05)。CT对职业性尘肺病壹期的阳性检出率高于DR(P <0.05),而DR、CT对尘肺病贰期、叁期的阳性检出率差异均无统计学意义(P> 0.05)。在职业性尘肺病患者的肺大疱、肺气肿、肺部感染、胸膜肥厚粘连等并发症诊断中,DR、CT的阳性检出率差异均无统计学意义(P> 0.05)。经一致性分析,DR、CT诊断结果与临床确诊结果间的一致性分别为0.933、0.956,均达到良好。[结论]多排螺旋CT在职业性尘肺病诊断中具有良好的临床价值,可对职业性尘肺病及其并发症予以灵敏检出,还可对职业性尘肺病分期予以准确鉴别。
[Objective] To investigate the clinical value of multi-row spiral computed tomography(CT) in the diagnosis of occupational pneumoconiosis. [Methods] From January 2016 to July 2018,the digit X-ray(DR)and multi-row spiral CT(abbr.CT)examination of 99 patients suspected with occupational pneumoconiosis were performed and the results were compared with the definite diagnosis made by the certificated doctors. [Results] Of 99 patients suspected with occupational pneumoconiosis,65 were clinically diagnosed as occupational pneumoconiosis,among whom 63 and 62 cases were diagnosed by DR examination and CT,respectively. Among 34 negatively diagnosed cases,1 and 2 cases were diagnosed as occupational pneumoconiosis by DR and CT examination,respectively. There was no significant difference in the sensitivity,specificity and accuracy of DR and CT examination in the diagnosis of pneumoconiosis(P > 0.05). However, CT examination detected more cases with occupational pneumoconiosis in the stage I than DR examination(P < 0.05),while there was no statistical difference of detection of cases with occupational pneumoconiosis in the stage Ⅱ and Ⅲ(P > 0.05). There was no significant difference of the diagnosis of pulmonary bullae, emphysema, pulmonary infection, pleural hypertrophy and adhesion among the patients with occupational pneumoconiosis between DR and CT examination(P > 0.05). The consistency of DR and CT examination with definite diagnosis was 0.933 and 0.956,respectively. [Conclusion] Multi-row spiral CT has a good clinical value in the diagnosis of occupational pneumoconiosis. It can be used for sensitive detection of occupational pneumoconiosis and its complications. It can also be used for accurate differentiation of occupational pneumoconiosis stages.
[Objective] To investigate the clinical value of multi-row spiral computed tomography(CT) in the diagnosis of occupational pneumoconiosis. [Methods] From January 2016 to July 2018,the digit X-ray(DR)and multi-row spiral CT(abbr.CT)examination of 99 patients suspected with occupational pneumoconiosis were performed and the results were compared with the definite diagnosis made by the certificated doctors. [Results] Of 99 patients suspected with occupational pneumoconiosis,65 were clinically diagnosed as occupational pneumoconiosis,among whom 63 and 62 cases were diagnosed by DR examination and CT,respectively. Among 34 negatively diagnosed cases,1 and 2 cases were diagnosed as occupational pneumoconiosis by DR and CT examination,respectively. There was no significant difference in the sensitivity,specificity and accuracy of DR and CT examination in the diagnosis of pneumoconiosis(P > 0.05). However, CT examination detected more cases with occupational pneumoconiosis in the stage I than DR examination(P < 0.05),while there was no statistical difference of detection of cases with occupational pneumoconiosis in the stage Ⅱ and Ⅲ(P > 0.05). There was no significant difference of the diagnosis of pulmonary bullae, emphysema, pulmonary infection, pleural hypertrophy and adhesion among the patients with occupational pneumoconiosis between DR and CT examination(P > 0.05). The consistency of DR and CT examination with definite diagnosis was 0.933 and 0.956,respectively. [Conclusion] Multi-row spiral CT has a good clinical value in the diagnosis of occupational pneumoconiosis. It can be used for sensitive detection of occupational pneumoconiosis and its complications. It can also be used for accurate differentiation of occupational pneumoconiosis stages.
引文
[1]刘贵喜,熊刘珊,陈丽琨,等.多层螺旋CT低剂量胸部扫描在尘肺病检查中的应用[J].中华劳动卫生职业病杂志,2014,32(1):64-67.
[2]XING J,HUANG X,YANG L,et al. Comparison of high-resolution computerized tomography with film-screen radiography for the evaluation of opacity and the recognition of coal workers’pneumoconiosis[J]. J Occup Health,2014,56(4):301-308.
[3]SHI D,ZHANG J,LIU X,et al. Evaluation of the right ventricular function in pneumoconiosis patients using volume-time curves obtained by realtime three-dimensional echocardiography[J]. Cell Biochem Biophys,2014,70(3):1553-1557.
[4]洪亮,伊旭,易红兵,等.多层螺旋CT对尘肺患者不同分期中主肺动脉血流动力学变化的评估价值[J]. CT理论与应用研究,2015,24(2):313-318.
[5]黄登花.尘肺大阴影高千伏摄影与高分辨率CT的影像学对照分析[J].中国CT和MRI杂志,2014,12(5):53-54.
[6]杜鹏,曹爱红,郭子威,等.多层螺旋CT胸部低剂量扫描在煤工尘肺诊断中的应用[J].中华劳动卫生职业病杂志,2016,34(9):674-677.
[7]CHO Y,CHOI M,MYONG J P,et al. The association between bronchial anthracofibrosis and pneumoconiosis:a retrospective cross-sectional study[J]. J Occup Health,2015,57(2):110-117.
[8]高玉娟,李慧,代静泓,等.焊工尘肺病临床及高分辨率CT特征分析[J].中华医学杂志,2015,95(44):3611-3613.
[9]蔡志春,王思红,陈艳霞,等.尘肺病大阴影的影像学特点及其临床意义[J].中华劳动卫生职业病杂志,2016,34(3):214-217.
[10]穆迎民,孟育茹,马永飞,等.Ⅲ期尘肺行CT多平面重建图像与X线摄影对照分析[J].宁夏医科大学学报,2015,37(3):336-337.
[11]梁崟.高千伏X线与高分辨率CT在早期尘肺诊断中的应用价值[J].医学理论与实践,2017,30(8):1098-1099,1112.
[12]冯辛格.螺旋CT在尘肺鉴别诊断的应用价值分析[J].现代医用影像学,2016,25(5):914-916.
[13]刘云峰,荣光生,王宝春,等.多层螺旋CT对焊工尘肺的诊断价值[J].临床肺科杂志,2016,21(9):1586-1588.
[14]王旭,李宝平,曾庆玉,等.煤工尘肺肺内结节的病理与64排螺旋CT影像表现[J].中华劳动卫生职业病杂志,2014,32(9):668-673.
[15]李年春,翟荣存,刘晓东,等. MSCT在尘肺病分期诊断的应用探讨[J].临床放射学杂志,2016,35(12):1827-1831.
[2]XING J,HUANG X,YANG L,et al. Comparison of high-resolution computerized tomography with film-screen radiography for the evaluation of opacity and the recognition of coal workers’pneumoconiosis[J]. J Occup Health,2014,56(4):301-308.
[3]SHI D,ZHANG J,LIU X,et al. Evaluation of the right ventricular function in pneumoconiosis patients using volume-time curves obtained by realtime three-dimensional echocardiography[J]. Cell Biochem Biophys,2014,70(3):1553-1557.
[4]洪亮,伊旭,易红兵,等.多层螺旋CT对尘肺患者不同分期中主肺动脉血流动力学变化的评估价值[J]. CT理论与应用研究,2015,24(2):313-318.
[5]黄登花.尘肺大阴影高千伏摄影与高分辨率CT的影像学对照分析[J].中国CT和MRI杂志,2014,12(5):53-54.
[6]杜鹏,曹爱红,郭子威,等.多层螺旋CT胸部低剂量扫描在煤工尘肺诊断中的应用[J].中华劳动卫生职业病杂志,2016,34(9):674-677.
[7]CHO Y,CHOI M,MYONG J P,et al. The association between bronchial anthracofibrosis and pneumoconiosis:a retrospective cross-sectional study[J]. J Occup Health,2015,57(2):110-117.
[8]高玉娟,李慧,代静泓,等.焊工尘肺病临床及高分辨率CT特征分析[J].中华医学杂志,2015,95(44):3611-3613.
[9]蔡志春,王思红,陈艳霞,等.尘肺病大阴影的影像学特点及其临床意义[J].中华劳动卫生职业病杂志,2016,34(3):214-217.
[10]穆迎民,孟育茹,马永飞,等.Ⅲ期尘肺行CT多平面重建图像与X线摄影对照分析[J].宁夏医科大学学报,2015,37(3):336-337.
[11]梁崟.高千伏X线与高分辨率CT在早期尘肺诊断中的应用价值[J].医学理论与实践,2017,30(8):1098-1099,1112.
[12]冯辛格.螺旋CT在尘肺鉴别诊断的应用价值分析[J].现代医用影像学,2016,25(5):914-916.
[13]刘云峰,荣光生,王宝春,等.多层螺旋CT对焊工尘肺的诊断价值[J].临床肺科杂志,2016,21(9):1586-1588.
[14]王旭,李宝平,曾庆玉,等.煤工尘肺肺内结节的病理与64排螺旋CT影像表现[J].中华劳动卫生职业病杂志,2014,32(9):668-673.
[15]李年春,翟荣存,刘晓东,等. MSCT在尘肺病分期诊断的应用探讨[J].临床放射学杂志,2016,35(12):1827-1831.
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