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[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。
[Objective] To analyze the characteristics of the first diagnosis of occupational hard metal lung disease in Hunan Province and provide reference for the development of the diagnostic criteria of occupational hard metal lung disease. [Methods] The occupational history, clinical manifestations, imaging changes, pathological examination and related literatures of the first case of occupational hard metal lung disease in Hunan Province were retrospectively analyzed. [Results] The clinical symptoms of occupational hard metal lung disease were mainly dry cough and chest tightness. Pulmonary function tests showed limited pulmonary ventilation dysfunction and diffusing function. The imaging examination showed diffusely distributed glass froth and cords shadow. Lung biopsy showed intraluminal alveolar macrophages and a large number of multinucleated giant cells gathered, that giant cell interstitial pneumonia (GIP), glucocorticoid treatment is effective. [Conclusion] There is no specific clinical manifestations of occupational hard metal lung disease, GIP is the main characteristic pathological changes. According to the clinical diagnosis of patients with GIP, combined with the patient’s history of exposure to hard metal, diagnosis of occupational hard metal lung disease.