20年工龄煤矿职工胸部低剂量CT体检结果分析

摘要

目的 探讨低剂量CT(LDCT)对不同接尘工龄煤矿工人在胸部体检的价值.方法 收集972例工龄＞20年的煤矿工人连续3年LDCT资料.其中,接尘工龄＜10年317例、10～20年299例、＞20年356例.2014～2016年连续3年,每12个月对每例行LDCT体检.结果 基线LDCT:接尘工龄＜10年、10～20年及＞20年的工人检出肺内非钙化结节、间质性病变、肺结核临床治愈或无活动性、肺内钙化及纤维索条灶等随接尘工龄延长例数均有增加趋势,但统计学比较无差别;肺大泡、主动脉及冠状动脉硬化等随接尘工龄增大检出率略有升高;支气管扩张、肺内炎性病变、淋巴结增大及钙化、胸膜病变等检出率与接尘工龄无相关性.6例恶性结节及2例活动性肺结核检出者接尘工龄均＞10年.2个年度复查LDCT:肺内、胸膜及纵隔大部分病变无明显变化;≤4 mm的肺内结节无明显变化;＞4～8 mm的肺内结节增大3例;肺内炎性病变大部分有变化.结论 LDCT对不同接尘工龄煤矿工人胸部体检具有一定价值.接尘工龄＞10年的工人为高危人群,应用基线LDCT对其行胸部体检意义重大,复查LDCT对于＞4 mm的肺内结节及肺内炎性病变很有意义.大部分的肺内、胸膜及纵隔阳性发现短期内无明显变化,其应与基线LDCT阴性一样,不需每个年度复查LDCT.%Objective To evaluate the application value of low-dose CT (LDCT) in physical examination for coal miners with different exposure time.Methods The consecutive three-year imaging data of 972 coal miners with over 20-year exposure were retrospectively reviewed.All miners were divided into 3 groups according to different exposure time,including 317 cases with less than 10 years,299 cases with 10-20 years and 356 cases with more than 20 years.All subjects underwent LDCT examination every year during three consecutive years.Results Baseline LDCT:As the exposure time was prolonged (with less than 10 years,10-20 years and more than 20 years),the number of coal miners has increased with non-calcified pulmonary nodules,interstitial pulmonary lesions,clinically cured or stable stage of pulmonary tuberculosis,pulmonary calcification and pulmonary fibrous stripes,but without statistically significant difference.The detection rates of lung bullae,aorta and coronary artery sclerosis were also increased mildly,with the prolonged exposure time.There was no significant correlation between exposure time and detection rates of bronchiectasis,pulmonary inflammatory lesions,lymph node enlargement or calcification,pleural lesions.The exposure time of 6 cases of malignant nodules and 2 cases of active tuberculosis was more than 10 years.During a two-year follow-up using LDCT scan,there were no significant changes in most of intrapulmonary,pleural and mediastinal lesions.Neither were in pulmonary nodules less than or equal to 4 mm.Three pulmonary nodules with 4-8 mm diameters were enlarged.Most of the inflammatory lesions have changed in size.Conclusion The LDCT scan has a certain value for chest physical examination of the coal miners with different exposure time.It is very necessary to screen the high-risk population of coal miners with exposure time of more than 10 years using LDCT.LDCT reexamination has significant value for pulmonary nodules and inflammatory lesions with diameter of more than 4 mm.Most of intrapulmonary,pleural and mediastinal lesions have no obvious change in the short term,and make an annual reexamination unnecessary,neither does a negative baseline LDCT.