粉尘不同,诊断的尘肺病种类不同。我国现有尘肺病13种分别对应不同的粉尘或工种。ILO(国际劳工组织)的专家们普遍认为区分致纤维化矿物粉尘如二氧化硅和石棉和非致纤维化矿物粉尘如云母和石墨是重要的。我国的专家持不同的观念,认为吸入并贮留在肺内的任何粉尘均能引起异物反应,长期贮留在肺内的异物均可以导致非特异性的纤维性增生。从各种尘肺的病理特点以及普通型间质性肺炎的病理改变中发现,二氧化硅和石棉所致肺间质纤维化最具特点。二氧化硅可以致肺组织内形成同心圆排列的玻璃样变。石棉粉尘主要的病理改变是导致胸膜斑的形成。其他各种粉尘多是在肺内引起多发性粉尘灶,可能是这些粉尘在局部潴留而形成继发性纤维化。将矿物性粉尘区分为致纤维化和非致纤维化2个大类,并设定合理的开放性目录,为职业病诊断提供便利。国际癌症组织(IARC)将石棉和石英列为人类已知的致癌物,致纤维化粉尘的概念突出了游离二氧化硅和石棉的危害。癌症比肺间质纤维化更具有致死性;致纤维化粉尘比非致纤维化粉尘更具侵入性。 Different dust, pneumoconiosis diagnosis of different types. Thirteen species of pneumoconiosis currently available in our country correspond to different types of dust or types of work. It is generally accepted by ILO experts that it is important to distinguish between fibrotic mineral dusts such as silica and asbestos and non-fibrillating mineral dusts such as mica and graphite. Our experts hold a different view that any dust inhaled and stored in the lungs can cause foreign body reactions, foreign body long-term storage in the lungs can lead to non-specific fibrous proliferation. Pathological features from a variety of pneumoconiosis and pathological changes of common interstitial pneumonia found that silica and asbestos-induced pulmonary interstitial fibrosis most characteristic. Silicon dioxide can cause concentric arrangement of the glass-like changes in the lung tissue. The major pathological changes in asbestos dust result in the formation of pleural plaques. Many other types of dust are caused by multiple dust in the lungs stove, dust may be formed in the local retention of secondary fibrosis. The classification of mineral dust into fibrosis and non-fibrosis two categories, and set a reasonable open directory, to facilitate the diagnosis of occupational diseases. The International Agency for Research on Cancer (IARC) lists asbestos and quartz as carcinogens known to mankind, and the concept of fibrotic dust highlights the dangers of free silica and asbestos. Cancer is more lethal than pulmonary interstitial fibrosis; fibrotic dust is more invasive than non-fibrotic dust.