Clinical analysis on hard metal lung disease / 中国职业医学

ABSTRACT

OBJECTIVE: To analyze the clinical features,and diagnostic and therapeutic method of hard metal lung disease( HMLD). METHODS: By using literature metrology method,the open published case reports associated with HMLD from January 1980 to October 2015 were searched using the China Hospital Knowledge Database,Wanfang Database and Pub Med Database. The data of patients with hard metal dust exposure history were collected and analyzed based on the inclusive and exclusive criteria. RESULTS: Thirty-six cases of HMLD were collected. The onset age of patients was 21. 0-63. 0( 37. 2 ± 11. 7) years old. The median exposure time was 6. 0( 0. 6-43. 0) years,and the major working type was hard metal grinder. The main clinical type of HMLD maily was giant cell interstitial pneumonia( GIP),hypersensitivity pneumonitis and occupational asthma were also seen. HMLD was lack of characteristic clinical manifestation. The clinical symptoms of HMLD mainly included dry cough,dyspnea on exertion,restrictive pulmonary ventilation,and diffuse pulmonary dysfunction. The imaging study showed ground-glass opacity,diffuse small nodule shadow and reticular opacity shadow,which were mainly seen in the lower lobes of both lungs. There were 24 cases( 66. 7%) showed GIP in the lung tissue in pathological examination. The tungsten and cobalt elements were detected in lung tissue and bronchoalveolar lavage fluid in some cases. Among 22 patients treated with glucocorticoid after keeping away from hard metal dust exposure,the treatment was effective in 19 patients. The clinical symptoms of 6 patients were improved by avoiding hard metal dust exposure. CONCLUSION: HMLD belongs to the interstitial lung disease and there is no specific clinical manifestation. Glucocorticoid therapy is effective in most of the patients. The history of exposure to hard metal dust has important significance in making the diagnosis.