Objective To highlight the characteristics of giant cell interstitial pneumonia ( GIP) . Methods The clinical, radiological, and pathological data of two patients with GIP pathologically proven by open lung and TBLB biopsy were presented respectively, and relevant literatures were reviewed. Results Patients with GIP usually had a history of exposure to metal dust. Clinical presentations included cough and dyspnea on exertion, and pulmonary function testing showed a restrictive abnormality. On chest radiography and high-resolution CT scans, it presented as bilateral areas of ground-glass attenuation, areas of consolidation, diffuse small nodules, extensive reticular opacities, and traction bronchiectasis. The main pathological findings included a desquamative interstitial pneumonia ( DIP) -like reaction with intra alveolar macrophages and numerous large multinucleated histiocytes that ingested inflammatory cells were admixed with macrophages. The finding of GIP was almost pathognomonic for hard metal pneumoconiosis. Conclusions GIP is a very rare chronic interstitial pneumonia, and has no characteristic clinical manifestations. Radiographic findings are similar to other idiopathic interstitial pneumonias. Careful collection of the occupational history can help to minimize misdiagnosis.
目的:探讨粟粒性肺结核、尘肺和粟粒性肺转移瘤的HRCT表现及鉴别特征。方法:回顾性分析经本院临床证实的38例粟粒性肺结核,33例尘肺和41例粟粒性肺转移瘤的常规CT及HRCT资料,观察结节的大小、分布特点,统计分析三者的差异。结果:38例粟粒性肺结核中,结节全肺野和内、中、外带分布均匀者分别为32例(84.2%)和29例(76.3%),33例(86.8%)以全小叶分布为主。33例尘肺中,结节以中、上肺野和内中带分布为主者分别为30例(90.9%)和31例(93.9%),28例(84.8%)以小叶中心分布为主。41例粟粒性肺转移瘤中,结节以中下肺野和中、外带分布为主者分别为37例(90.2%)、34例(82.9%),36例(87.8%)以小叶实质分布为主。结核、尘肺及肿瘤结节大小均匀分别为31例(81.5%)、9例(27.3%)、6例(14.6%);边界清晰者分别为36例(94.7%)、31例(93.9%)、39例(95.1%);合并有磨玻璃征者分别为34例(89.4%)、7例(21.2%)、21例(51.2%)。结论:HRCT能够很好地显示粟粒性肺结核、尘肺及粟粒性肺转移瘤结节的分布特点,在诊断和鉴别诊断这三种粟粒性疾病中具有重要价值。
ObjectiveTo explore the influence of respiratory function training on pulmonary function of patients with pneumoconiosis. MethodsOne hundred patients with pneumoconiosis hospitalized in our department between June 2011 and September 2012 were chosen as the research subjects. According to the method of random digits table, they were equally and randomly divided into contrast group and observation group. Patients in both the two groups were given routine treatment and nursing and health education, while patients in the observation group adopted respiratory training with lung functional exerciser in addition. Then we observed the forced expiratory volume in one second (FEV1), vital capacity, maximal voluntary ventilation, forced vital capacity, classification of conscious shortness of breath and shortness of breath as well as classification of activities of daily living in the patients before and after training in both the two groups. ResultsAfter 6 months, lung function index, classification of conscious shortness of breath and shortness of breath as well as classification of activities of daily living of patients in the observation group improved a lot, which was significantly better than that in the contrast group (P<0.05). Compared with the contrast group, the FEV1 [(2.75±0.43) L], vital capacity [(3.29± 0.45)L] of patients in the observation group were significantly higher (P<0.05). Compared with the contrast group, classification of conscious shortness of breath and shortness of breath (2.10±0.67), classification of activities of daily living (2.19±0.66) were also significantly different (P<0.05). ConclusionRespiratory function training with lung functional exerciser can improve lung function of patients with pneumoconiosis, alleviate the degree of dyspnea, and enhance the quality of life.
ObjectiveTo understand the prevalence,risk factors,clinical features and the medication of coal worker's pneumoconiosis(CWP) complicated with chronic obstructive pulmonary disease (COPD). MethodsPulmonary function testing results,clinical symptoms,medication of 451 patients with CWP were collected. Then, the risk factors relevant to the incidence of COPD in CWP were analyzed with Cox multivariate regression. ResultsThe prevalence of COPD in CWP was 44.6%,and the incidence was rising with the increasing of CWP phases, exposure duration,smoking index,with the odds ratio of 3.20,1.09,and 1.01,respectively.The patients with CWP and COPD were suffered more symtoms with a CAT score of 25.5 but received less regular medications. ConclusionsThe incidence of COPD in CWP is obviously higher than that in common populaton.Exposure duration, smoking index and phases of CWP are the high risk factors for COPD in the population of CWP. The patients with CWP and COPD are suffered more symtoms but receive irregular medications.
Objective To clarify the thin-layer 16-slice spiral CT features of coal worker’s pneumoconiosis and the superior distribution of comorbidities in their staging and lobes and lung field anatomy. Methods Sixty-six patients with coal worker's pneumoconiosis diagnosed by the pneumoconiosis diagnosis and identification group from October 2014 to March 2015 were enrolled. All patients underwent 16-slice spiral CT and thin-layer CT reconstruction with a thickness of 1.5 mm. The thin-slice CT signs and comorbidities of coal workers’ pneumoconiosis were observed, and the superior distribution of CT signs in patients at different stage and different lobes and lung field anatomy were evaluated. Results There were 16 cases of irregular small nodules in the lungs, 22 cases of large shadow fusion, 18 cases of intraocular shadow calcification, 41 cases of emphysema, 21 cases of pulmonary bullae, 21 cases of pulmonary hypertension, and 31 cases of enlarged lymph nodes in the mediastinum and calcified. The above signs were mostly distributed in stage Ⅲ pneumoconiosis (P<0.05). There were 32 cases of regular small nodules, which were mostly distributed in stage Ⅰ pneumoconiosis. In the 16 cases of irregular small nodules, the advantage was distributed in the middle and outer lobes of the double lungs. In the 22 cases of large shadow fusion, the advantage was distributed in the upper and lower lobe of the lungs. In the 16 cases of tuberculosis, the advantage was distributed in the upper lobe of the lungs. In the 21 cases of bullous bullae, the advantage was distributed in the upper lobe of the two lungs, mostly in the right upper lung. Conclusion The thin 16-slice spiral CT signs of coal worker’s pneumoconiosis can reflect the pathological changes, and have a certain correlation with the stage of pneumoconiosis, and have obvious characteristics in the anatomical distribution of lung and lung fields.
ObjectiveTo investigate the relationship between immunity related GTPase M gene (IRGM) polymorphism and pneumoconiosis susceptibility.MethodsTwo hundred and forty-eight pneumoconiosis patients were selected as a case group, 275 non-pneumoconiosis workers with similar age, sex, nationality, type of work and working age were selected as a control group. The genotypes and alleles of three single nucleotide polymorphisms (SNP) of IRGM were detected by Sanger sequencing in case group and control group. SNPstats software was used to analyze the correlation between single SNP and pneumoconiosis, and SHEsis software was used to analyze the linkage imbalance and haplotype of each locus.ResultsThe distribution frequency of IRGM rs4958846 TT genotype in the case group was higher than that of the control group. The distribution frequency of TC and CC genotype in control group was higher than that of the case group. The distribution frequency of T allele in the case group was higher than that of the control group. The distribution frequency of C allele in the control group was higher than that of the case group. All of the differences were statistical significant (P<0.05). There was no statistical significance for the distribution difference between the two groups in terms of genotype and allele at IRGM rs4958842 and rs4958843 (P>0.05). After linkage disequilibrium analysis to three gene loci at rs4958842, rs4958843 and rs4958846 of IRGM, there was linkage disequilibrium between each other gene loci (D'>0.7, r2>0.3). Haplotype analysis was conducted on three genetic loci and established four kinds of haplotypes, the frequency distribution of ACT and ACC haplotypes had statistical significances between the two groups (P<0.05), and the other haplotype had no significant correlation with the susceptibility of pneumoconiosis (P>0.05).ConclusionT allele and ACT haplotype of IRGM rs4958846 may be associated with pneumoconiosis susceptibility.
ObjectiveTo systematically review the disease burden of pneumoconiosis in Chinese population so as to provide references for health resources allocation and health policy making.MethodsDatabases including PubMed, EBSCO, Web of Science, CNKI, WanFang Data and VIP databases were searched for studies on investigation of the disease burden of pneumoconiosis in Chinese population from inception to 31st January, 2020. Two reviewers independently screened literature, exacted data, and assessed risk of bias of included studies. Systematic review was performed on data of pneumoconiosis associated population, mortality, and disease burden.ResultsA total of 26 studies were included. Qualitative analysis showed that the decrease of DALY and YLL of pneumoconiosis in China had been lower than that in globally, and the increase of YLD had been higher than that in globally in recent 10 years. 14 factors were included in the analysis of influencing factors on the financial burden or hospitalization expenses of pneumoconiosis patients; among them, the length of hospitalization, related complications, and pneumoconiosis stage were the most important indexes which had influence or difference on patients’ financial burden (or hospitalization expenses). The burden of pneumoconiosis in the Chinese population was primarily concentrated on males. Occupational diseases caused most of them, and middle-aged and older adults were the primary population for pneumoconiosis. However, young patients due to early-onset age, long course of disease and complications, and other factors resulting in a larger YLD phenomenon should also be considered.ConclusionsThe disease burden of pneumoconiosis patients in China is still heavy. It is recommended to continue to reduce the DALY of pneumoconiosis among the Chinese population as a long-term goal, and to strengthen control strategies to curb the early onset and death of pneumoconiosis.
Pneumoconiosis is the most harmful and common occupational disease in China. The development of a pneumoconiosis rehabilitation expert consensus can improve utilization of the unique advantages of Chinese and Western medicine rehabilitation strategies, and provide effective and feasible guidance for the clinical rehabilitation of pneumoconiosis. We conducted clinical problem investigation, evidence collection and evaluation, Delphi consultation, and other technical links following the WHO guidelines to formulate manual procedures. Relevant rehabilitation guidelines, systematic reviews, clinical researches, and other current best evidence and expert opinions were extensively solicited to formulate the consensus. The reporting of consensus followed the RIGHT statement. The 14 types of rehabilitation strategies recommended by this consensus can be used by clinical rehabilitation physicians, rehabilitation therapists, respiratory therapists, nursing staff, community rehabilitation, health education, and other professionals for the rehabilitation of pneumoconiosis patients.
Pneumoconiosis is an interstitial lung disease with pulmonary fibrosis as the main pathological change. Patients with pneumoconiosis can increase immunity, delay disease progression, reduce symptoms, and improve lung function through respiratory rehabilitation. With the development of the domestic medical stratification, grading, and referral system between various specialties and the promotion of “internet +” model, remote home respiratory rehabilitation has become an inevitable trend in the full-cycle management of chronic respiratory diseases. By searching Chinese and English literatures, this article summarizes the safety, efficacy and research progress of remote home respiratory rehabilitation for pneumoconiosis. The purpose is to provide ideas for patients with pneumoconiosis to receive home-based remote rehabilitation management.