【摘要】 目的探讨壹期电焊工尘肺肺部不同HRCT表现的病理学基础。方法对比分析15例确诊为壹期电焊工尘肺的肺部HRCT资料和经支气管肺活检的病理资料。HRCT检查和经支气管肺活检的间隔时间在3～50天。15例中男性13例,女性2例,平均年龄(35±6.8)岁,电焊工工龄(8.8±3.5)年。将标本粉尘的量分为无、少量、中量和大量,将纤维化的程度分为无、轻度、中度和重度。结果 HRCT上7例主要表现为小叶中心小叶核影的增大、增多,呈分支状线影;3例表现为小叶中心的磨玻璃密度的结节影,约4～8mm大小;5例表现为磨玻璃结节与分支状线影混合存在。其中5例有轻度小叶间隔增厚,6例可见小叶中央型肺气肿。病理学表现为呼吸性细支气管及其肺泡群内大量尘斑,并可见肉芽组织和少量的胶原纤维,支气管粘膜下肺组织和肺泡间隔纤维组织弥漫增生,胶原纤维沉积。偏光镜和普鲁士蓝铁染色证明尘斑中铁颗粒存在。弥漫性以分支状线影为主要表现的纤维化程度重于弥漫性磨玻璃密度结节为主的病例(t=9.00,P=0.00),但粉尘量以磨玻璃密度结节为主的病例较重(t=-4.71,P=0.001)。结论 HRCT可以显示电焊烟尘所致的肺内尘斑及其纤维化的程度。更多还原

【Abstract】 Objective To explore the pathological foundation of different HRCT findings of stage I welder`s lung.Methods To compare the HRCT findings with pathological manifestations for the 15 cases diagnosed of stage I are-welder’s lung.The biopsy by transbronchial lung was obtained in 3~50 days of HRCT scan.The patients included 13 men and 2 women.The average age of the workers was(35±6.8) years.All had been exposed to fume dust for an average of(8.8±3.5) years.Results Predominant HRCT findings were centrilobular branching linear structure(7 cases),4~8 mm poorly-defined micro nodules with ground-glass attenuation(3 cases),and mixed lesions with two kinds of abnormalities(5 cases).Slightly interlobular septal thickening was found in 5 cases and centrilobular emphysema was revealed in 6 cases.Abundant deposition of dust spots with mild fibrotic stroma was found in the centroacinar location.The tnansbronchial biopsy specimens showed marked interstitial accumulation of opaque particles in perivascular and peribronchiolar regions.Emphysema and mild interstitial fibrosis were found,with marked interstitial and alveolar accumulation of pigment in predominantly perivascular and peribronchiolar areas.Small branching opacities could be detected to some degree in the upper lung zones and reflected peribronchiolar fibrosis with dust accumulation histologically.The polarizing prism examination and the Prussian blue iron stain revealed the presence of iron element.The degree of fibrosis was more severe(t=9.00,P=0.00) and quality of accumulation of pigment was less(t=-4.71,P=0.001) in the group with small branching opacities.Conclusion The pigment of dust may be found and the degree of fibrosis should be made with HRCT.更多还原