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目的观察职业性铁及其化合物粉尘肺沉着病患者脱离粉尘接触约10年后铁代谢指标的改变情况。方法以22例于2004—2006年误诊为电焊工尘肺的职业性铁及其化合物粉尘肺沉着病患者为研究对象,在其脱离粉尘接触约10年后,对其进行胸部高千伏X射线摄影和计算机断层扫描,检测血清铁代谢指标、血常规和血生化指标。随机抽取6例患者进行遗传性血色病基因检测。根据肺部是否有小阴影分为观察组(13例)和对照组(9例)。结果 22例患者血清铁蛋白(SF)水平中位数为858.2μg/L,超标率为77.3%(17/22),其中铁过载占40.9%(9/22)。血清总铁结合力(TIBC)超标率为22.7%(5/22);血清铁超标率为4.5%(1/22)。观察组SF水平高于对照组(P<0.05)。SF与丙氨酸氨基转移酶(ALT)呈正相关(P<0.05),TIBC与前白蛋白呈正相关(P<0.05),血清铁分别与ALT、天冬氨酸氨基转移酶呈正相关(P<0.05);上述3个铁代谢指标均与血常规指标、血糖、C反应蛋白不相关(P>0.05)。6例患者经遗传性血色病基因检测均可排除遗传性血色病。结论职业性铁及其化合物粉尘肺沉着病患者体内存在铁代谢异常,与铁在肺内沉积有关。
Objective To observe the change of iron metabolism index of occupational iron and its compounds in patients with pneumoconiosis after being exposed to dust for about 10 years. Methods Twenty-two patients with occupational iron and its compounds pneumoconiosis who were misdiagnosed as electricians’ pneumoconiosis from 2004 to 2006 were studied. About 10 years after their exposure to dust, they were subjected to high kV chest radiography And computed tomography, detection of serum iron metabolism, blood and blood biochemical indicators. Six patients were randomly selected for hereditary hemochromatosis gene testing. According to whether the small shadow of the lungs were divided into observation group (13 cases) and control group (9 cases). Results The median SF level of 22 patients was 858.2 μg / L, the rate of over standard rate was 77.3% (17/22), and the overload of iron was 40.9% (9/22). Serum total iron binding capacity (TIBC) exceeded the rate of 22.7% (5/22); serum iron exceeded the standard rate of 4.5% (1/22). SF level in observation group was higher than that in control group (P <0.05). SF was positively correlated with alanine aminotransferase (ALT) (P <0.05), TIBC was positively correlated with prealbumin (P <0.05), serum iron was positively correlated with ALT and aspartate aminotransferase (P < 0.05). The above three indexes of iron metabolism were unrelated to blood indexes, blood glucose and C-reactive protein (P> 0.05). Hereditary hemochromatosis can be ruled out in 6 patients by hereditary hemochromatosis gene testing. Conclusion There is iron metabolism abnormality in occupational iron and its compound pneumoconiosis patients, which is related to the deposition of iron in the lung.