李颖, 肖雄斌, 肖云龙, 肖友立, 戴伟荣, 阎永健. 职业性硬金属肺病一例并文献复习[J]. 环境与职业医学, 2016, 33(1): 73-76. DOI: 10.13213/j.cnki.jeom.2016.15225
引用本文: 李颖, 肖雄斌, 肖云龙, 肖友立, 戴伟荣, 阎永健. 职业性硬金属肺病一例并文献复习[J]. 环境与职业医学, 2016, 33(1): 73-76. DOI: 10.13213/j.cnki.jeom.2016.15225
LI Ying, XIAO Xiong-bin, XIAO Yun-long, XIAO You-li, DAI Wei-rong, YAN Yong-jian. One Case Report and Literature Review of Occupational Hard Metal Lung Disease[J]. Journal of Environmental and Occupational Medicine, 2016, 33(1): 73-76. DOI: 10.13213/j.cnki.jeom.2016.15225
Citation: LI Ying, XIAO Xiong-bin, XIAO Yun-long, XIAO You-li, DAI Wei-rong, YAN Yong-jian. One Case Report and Literature Review of Occupational Hard Metal Lung Disease[J]. Journal of Environmental and Occupational Medicine, 2016, 33(1): 73-76. DOI: 10.13213/j.cnki.jeom.2016.15225

职业性硬金属肺病一例并文献复习

One Case Report and Literature Review of Occupational Hard Metal Lung Disease

  • 摘要: 目的

    通过对湖南省首次诊断的职业性硬金属肺病病例特点进行分析,为职业性硬金属肺病诊断标准的制定提供参考依据。

    方法

    对湖南省首例职业性硬金属肺病确诊病例的职业史、临床表现、影像学改变、病理检查以及相关文献进行回顾性分析。

    结果

    职业性硬金属肺病临床症状以干咳、胸闷气促为主,肺功能检查显示限制性肺通气功能障碍和弥散功能降低,影像学检查显示两肺弥漫性分布的磨玻璃影和条索影。肺活检病理表现为肺泡腔内可见巨噬细胞和大量的多核巨细胞聚集,即巨细胞间质性肺炎(GIP),糖皮质激素治疗有效。

    结论

    职业性硬金属肺病的临床表现无特异性,GIP是其主要特征性病理改变。根据患者GIP临床诊断,结合患者接触硬金属的职业史,诊断为职业性硬金属肺病。

     

    Abstract: Objective

    To analyze the first case of occupational hard metal lung disease (OHMLD) diagnosed in Hunan Province and to provide reference for making corresponding diagnostic criteria.

    Methods

    The occupational history, clinical manifestations, radiological changes, and pathological data of a patient with confirmed OHMLD were presented, and relevant literatures were reviewed.

    Results

    The main clinical symptoms of the OHMLD patient included dry cough, dyspnea, and gasp; the pulmonary function testing results showed a restrictive ventilatory functional disturbance and diffusion dysfunction; the CT scans demonstrated diffuse bilateral ground-glass attenuations and fibrous strips. The lung biopsy specimens showed congregations of alveolar macrophages and numerous large multinucleated histiocytes in alveolar spaces, which were the typical presentation of giant cell interstitial pneumonia (GIP). The results indicated that glucocorticoid treatment was effective for OHMLD.

    Conclusion

    OHMLD shows no specific clinical manifestations, and GIP is the major pathognomonic change. A diagnosis of OHMLD could be well achieved based on the clinical diagnosis of GIP and the occupational history of hard metal exposure.

     

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