不同期別煤工塵肺小葉間隔線的高分辨率
CT 表現(xiàn)與病理對(duì)照研究
王振光 馬大慶 陳步東 張巖松 關(guān)硯生 賀文
【摘要】 目的 研究煤工塵肺小葉間隔線在高分辨率CT( HRCT) 上的基本形態(tài)和病理基礎(chǔ)。
方法 28 例有煤塵接觸史的尸解全肺標(biāo)本, 固定、干燥, 進(jìn)行冠狀面HRCT 掃描。選取HRCT 上線樣
影豐富的肺標(biāo)本薄片進(jìn)行冠狀面大切片( 50 ～150 μm) 和組織學(xué)切片( 5 ～8 μm) 制作。分析比較小
葉間隔線在HRCT 上的形態(tài)。結(jié)果 28 例肺標(biāo)本中HRCT 掃描發(fā)現(xiàn)23 例有不同類型的小葉間隔
線。以規(guī)則型小葉間隔線為主10 例, 無(wú)塵肺9 例、Ⅰ期1 例; 以不規(guī)則型小葉間隔線為主10 例, 無(wú)塵
肺2 例、Ⅰ期2 例、Ⅱ期6 例; 破壞型小葉間隔3 例, Ⅱ 期2 例、Ⅲ期1 例。規(guī)則型與不規(guī)則型( q =
4. 3831, P = 0. 0024) 、規(guī)則型與破壞型小葉間隔線( q = 5. 4715, P = 0. 0006) 在不同期別煤工塵肺中的
差異有統(tǒng)計(jì)學(xué)意義。組織病理學(xué)上規(guī)則型小葉間隔線主要表現(xiàn)為小葉間隔水腫( 10 /10 ) 、小葉間隔
內(nèi)炎性滲出( 8 /10) 和局限于小葉間隔內(nèi)的纖維化( 9 /10) ; 不規(guī)則型小葉間隔線主要表現(xiàn)為小葉間隔
內(nèi)及鄰近小葉實(shí)質(zhì)煤塵沉積( 13 /16) 和纖維化突破小葉間隔( 15 /16) ; 差異有統(tǒng)計(jì)學(xué)意義( Fisher 精確
概率法, P 值均< 0. 05) 。破壞型小葉間隔線是由于纖維融合塊、肺氣腫等造成小葉間隔線移位和破
壞。結(jié)論 規(guī)則型、不規(guī)則型和破壞型小葉間隔線并存于各期煤工塵肺和煤塵接觸者中, 其代表的是
不同程度的纖維化和不同量的煤塵沉積。
【關(guān)鍵詞】 塵肺; 體層攝影術(shù), X 線計(jì)算機(jī); 病理學(xué); 對(duì)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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