不同期别煤工尘肺小叶间隔线的高分辨率CT 表现与病理对照研究

不同期别煤工尘肺小叶间隔线的高分辨率
CT 表现与病理对照研究
王振光 马大庆 陈步东 张岩松 关砚生 贺文
【摘要】 目的 研究煤工尘肺小叶间隔线在高分辨率CT( HRCT) 上的基本形态和病理基础。
方法 28 例有煤尘接触史的尸解全肺标本, 固定、干燥, 进行冠状面HRCT 扫描。选取HRCT 上线样
影丰富的肺标本薄片进行冠状面大切片( 50 ～150 μm) 和组织学切片( 5 ～8 μm) 制作。分析比较小
叶间隔线在HRCT 上的形态。结果 28 例肺标本中HRCT 扫描发现23 例有不同类型的小叶间隔
线。以规则型小叶间隔线为主10 例, 无尘肺9 例、Ⅰ期1 例; 以不规则型小叶间隔线为主10 例, 无尘
肺2 例、Ⅰ期2 例、Ⅱ期6 例; 破坏型小叶间隔3 例, Ⅱ 期2 例、Ⅲ期1 例。规则型与不规则型( q =
4. 3831, P = 0. 0024) 、规则型与破坏型小叶间隔线( q = 5. 4715, P = 0. 0006) 在不同期别煤工尘肺中的
差异有统计学意义。组织病理学上规则型小叶间隔线主要表现为小叶间隔水肿( 10 /10 ) 、小叶间隔
内炎性渗出( 8 /10) 和局限于小叶间隔内的纤维化( 9 /10) ; 不规则型小叶间隔线主要表现为小叶间隔
内及邻近小叶实质煤尘沉积( 13 /16) 和纤维化突破小叶间隔( 15 /16) ; 差异有统计学意义( Fisher 精确
概率法, P 值均< 0. 05) 。破坏型小叶间隔线是由于纤维融合块、肺气肿等造成小叶间隔线移位和破
坏。结论 规则型、不规则型和破坏型小叶间隔线并存于各期煤工尘肺和煤尘接触者中, 其代表的是
不同程度的纤维化和不同量的煤尘沉积。
【关键词】 尘肺; 体层摄影术, X 线计算机; 病理学; 对比研究
Morphologic manifest ation of inter lobular septa and pa thologic ba sis in different stage coal wor ker ′s
pneumoconiosis on high-r esolution CT WANG Zhen-gua ng* , MA Da -qing, CHEN Bu-dong, ZHANG
Ya n-song, GUAN Yan-sheng, HE Wen. * Department of Ra diology, Beijing Friendship Hospitia l, Capita l
University of Medica l Science, Beijing 100050, China
【Abstra ct 】 Objective To investigate HRCT appearances of interlobular septa and pathologic basis
in coal worker′s pneumoconiosis ( CWP ) . Met hods Twenty-eight lung specimens were available from
autopsy examination of the patients with coal worker′s pneumoconiosis and occupational exposure to coal
dusts. All lung specimens were inflated and fixed by Heitzman′s method. HRCT scans, gross specimen
section( 50 ～150 μm thickness) and histologic section ( 5 ～8 μm thickness ) were performed on dry lung
specimens and HRCT-pathologic correlation of thickened interlobular septa were analyzed. Results
Thickened interlobular septa were seen in 23 of 28 lung specimens. The morphologic manifestation of
thickened interlobular septa on HRCT could be classified into three types: regular type, irregular type and
distorted type of thickened interlobular septa. ( 1) Predominant regular type of thickened interlobular septa
were seen in 10 of 28 lung specimens, including no CWP 9 cases and stageⅠCWP 1 case. ( 2) Predominant
irregular type of thickened interlobular septa were seen in 10 of 28 lung specimens, including no CWP
2 cases , stageⅠ2 cases, and stageⅡ6 cases. ( 3) Distorted type of thickened interlobular septa were seen in
3 of 28 lung specimens, including stage Ⅱ 2 cases and stage Ⅲ 1 case. In different stage coal worker′s
pneumoconiosis, morphologic manifestation of interlobular septa had significant different between regular and
irregular type( q = 4. 3831, P = 0. 0024) , regular and distorted type ( q = 5. 4715, P = 0. 0006) of thickened
interlobular septa. On the basis of gross pathology and histologic section, regular type of thickened
interlobular septa was composed of edema( 10 /10) , inflammation( 8 /10) , slight fibrosis ( 9 /10 ) . Irregular
type of thickened interlobular septa was composed of serious clusters of coal dusts ( 13 / 16 ) and fibrosis
( 15 /16) . By way of statistical analysis, there was significant different pathologically between regular and
irregular type of thickened interlobular septa( Fisher′s exact test, P < 0. 05 ) . Distorted type of thickened
interlobular septa correlated pathologically with conglomerate fibrosis masses and emphysema. Conclusion
Regular, irregular and distorted type of thickened interlobular septa can coexist in different stage CWP and
occupational exposure to coal dusts, and due to different extent, degree fibrosis and deposits of coal dusts.
【Key wor ds】 Pneumoconiosis; Tomography, X-ray computed; Pathology; Comparative study

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