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目的:分析石棉肺患者疾病进展的胸部高分辨率CT（HRCT）影像特征，探讨预测石棉肺疾病进展的征象。方法:采用前瞻性研究方法，纳入2013至2016年规律随访的68例石棉肺患者，根据职业和环境相关性呼吸疾病HRCT国际分类描述石棉肺患者的影像特征，比较观察期内疾病进展者与非进展者的异同。经Cox比例风险模型分析预测石棉肺疾病进展的胸部HRCT影像征象。结果:纳入研究的石棉肺患者年龄为（65.5±7.8）岁，其中64.7%（44/68）为女性，29.4%（20/68）有吸烟史。疾病进展石棉肺患者（20.6%，14/68）与无进展石棉肺患者（79.4%，54/68）年龄、性别、吸烟和石棉接触等差异均无统计学意义（n P>0.05）。石棉肺患者胸部HRCT均有不规则和（或）线状影，其中5.9%（4/68）伴有蜂窝影，以下肺分布为主；可伴有磨玻璃影、马赛克征。98.5%（67/68）合并胸膜异常，其中39.7%（27/68）为弥漫性胸膜增厚伴实质带和（或）球形肺不张。多因素Cox比例风险模型分析显示，不规则和（或）线状影评分增加（n HR=1.184，95%n CI：1.012~1.384，n P=0.034）和蜂窝影（n HR=6.488，95%n CI：1.447~29.097，n P=0.015）是石棉肺疾病进展的危险因素。n 结论:基于胸部HRCT的不规则和（或）线状影评分和蜂窝影是预测石棉肺疾病进展的独立影响因素。“,”Objective:To analyze the radiological characteristics of chest high-resolution computed tomography (HRCT) of patients with asbestosis, and to investigate the signs of predicting the disease progression of asbestosis.Methods:A prospective method was used to enroll 68 patients with asbestosis who were regularly followed up from 2013 to 2016. The radiological characteristics of patients with asbestosis were described by the International Classification of HRCT for Occupational and Environmental Respiratory Diseases (ICOERD) , and the differences between patients with and without progression were compared during the observation period. The Cox proportional hazards regression model was used to analyze the chest HRCT radiological signs predicting the progression of asbestosis.Results:The study included 68 patients with asbestosis aged (65.5±7.8) years old, of which 64.7% (44/68) were female, 29.4% (20/68) had a history of smoking. There was no significant difference in age, sex, smoking and asbestos exposure between patients with progressive asbestosis (20.6%, 14/68) and patients without progressive asbestosis (79.4%, 54/68) (n P>0.05) . Chest HRCT of patients with asbestosis showed irregular and/or linear opacities, of which 5.9% (4/68) were accompanied by honeycombing. Irregular and/or linear opacities were mainly lower lung preponderant, often accompanied with ground glass opacity and mosaic perfusion. 98.5% (67/68) had pleural abnormalities, of which 39.7% (27/68) had diffuse pleural thickening with parenchymal bands and/or rounded atelectasis. The analysis of multivariable Cox proportional hazard regression showed that the risk of the progression of asbestosis was increased with higher irregular and/or linears opacities cores (n HR=1.184, 95%n CI: 1.012-1.384, n P=0.034) and the appearance of honeycombing (n HR=6.488, 95%n CI: 1.447-29.097, n P=0.015) .n Conclusion:The irregular and/or linear opacities scores and honeycombing on chest HRCT are independent influencing factors for predicting the disease progression of asbestosis.