CAJ | 학술논문

目的　研究矽肺抗纤维化治疗的远期疗效。方法　对“八五”攻关课题“矽肺治疗措施及效果评价研究”(简称“八五”)中的100例矽肺治疗病例,停药2年后，根据病情分别采用汉防己甲素 (汉甲素)+羟基磷酸哌喹(羟哌)、汉甲素+克矽平、柠檬酸铝(柠铝)+羟哌进行全量复治、小剂量治疗和继续停药3种临床方案观察2年。对照组仍为“八五”对照组的50例矽肺病例。结果　咳嗽、咯痰的治疗有效率各治疗组均高于对照组;胸痛及呼吸困难的治疗有效率“汉甲素+克矽平”的全量组也高于对照组。临床症状综合评价显示,无论经“八五”治疗后停药观察或“九五”攻关课题“联合用药治疗矽肺效果及综合评价方法研究”(简称“九五”)进行复治的病例，绝大部分均病情稳定，各治疗方案均没有出现病情加重病例。“八五”治疗病例停药2年后,X线胸片病变形态都有进展，好转率降为0;再经2年治疗，X线胸片疗效观察结果 :(1)“汉甲素+羟哌”全量组的好转率升至23.8%，进展率由停药后的71. 4%降至42.9%；维持量组好转率为4.8%，进展率由14.3%降至9.5%；观察组的好转率稳定为4.6%。(2)“汉甲素+克矽平”全量组的好转率升至33.3%，进展率由66.7%降至33.3%；维持量组稳定率由83.3%降至50.0%，进展率由16.7%升到50.0%；观察组停药4年后仍有71.4%的稳定率。(3)“柠铝+羟哌”组好转率回升至5.9%，进展率由11.8%降为0。结论　矽肺抗纤维化治疗对稳定病情、延缓纤维化进展具有一定的远期疗效，但多数病例应根据病情进行阶段性重复治疗或小剂量维持治疗。
목적　연구석폐항섬유화치료적원기료효 。방법　대“팔오”공관과제“석폐치료조시급효과평개연구”(간 칭“팔오”)중적100례석폐치료병례,정약2년후，근거병정분별채용한방기갑소 (한갑소)+간기린산고규(간고)、한갑소+극석평、저몽산려(저려)+간고진행전량복치、소 제량치료화계속정약3충림상방안관찰2년。대조조잉위“팔오”대조조적50례석 폐병례。결과　 해수、각담적치료유효솔각치료조균고우대조조;흉통급호흡곤난적치료유효솔“한갑 소+극석평”적전량조야고우대조조。림상증상종합평개현시,무론경“팔오”치료후정약관 찰혹“구오”공관과제“연합용약치료석폐효과급종합평개방법연구”(간칭“구오”)진행 복치적병례，절대부분균병정은정，각치료방안균몰유출현병정가중병례。“팔오”치 료병례정약2년후,X선흉편병변형태도유진전，호전솔강위0;재경2년치료，X선흉편료효관 찰결과 :(1)“한갑소+간고”전량조적호전솔승지23.8%，진전솔유정약후적71. 4%강지42.9%； 유지량조호전솔위4.8%，진전솔유14.3%강지9.5%；관찰조적호전솔은 정위4.6%。(2)“한갑소+극석평”전량조적호전솔승지33.3%，진전솔 유66.7%강지33.3%；유지량 조은정솔유83.3%강지50.0%，진전솔유16.7%승도50.0%；관찰조정약4년후 잉유71.4%적은정솔。(3)“저려+간고”조호전솔회승지5.9%，진전솔 유11.8%강위0。결론　석폐항섬유화치료대은정병정、연완섬유화진전구유일정적원기료효，단다수병례응근거병 정진행계단성중복치료혹소제량유지치료。
Objective　To investigate long-term therape utic effect of combined anti-fibrosis drugs on silicosis. Methods　100 cases of silicosis,who were treated with the combined anti-fibrosis drugs:tetrandrine(TD)+quinolyl-piperazine hydroxyl phosphate(QO HP),TD+poly-2-vinyl pyridine-nitrogen oxide(PVNO),QOHP+aluminium citrate(ALC) and stopped the treatment for two years,were divided into three groups:re-treat ed group with the same dosage of drugs as before,maintained group with a lower d osage and observed(not treated)group.The control consisted of 50 silicosis patie nts in previous study. Results 　In all treated groups,cough and expectoration were getting better t han that in control group.Chest pain and dyspnea also showed improvement in TD+P VNO re-treated group.The evaluation by summing up all clinical symptoms indicat ed that the condition of patients in most of the treated and observed groups were stable and no case was getting w orse.Concerning the changes of chest X-ray films,over the two years after the p revious treatment,the images of fibrosis in X-ray films in all cases were aggra vated,the improving rate was 0.With the two years treatment again,the results of X-ray films were as follows:by using TD+QOHP,the improving rate was 23.8% and the aggravating rate went down from 71.4% to 42.9% in re-treated group,4.8% and from 14.3% to 9.5% respectively in maintained group,the improvin g rate was not changed(4.6%) in observed group;by using TD+PVNO,the improvin g rate reached 33.3% and the aggravating rate decreased from 66.7% to 33.3% in r e-treated group,the stability rate went down from 83.3% to 50.0% and the aggrav ating rate went up from 16.7% to 50.0%in maintained group,71.4% of cases sho wed no change in observed group;by using ALC+QOHP,the improving rate was 5.9% a nd aggravating rate went down from 11.8% to 0. Conclusion　 The treatment of silicosis with combined anti-fibrosis drugs showed a certain l ong-term therapeutic effect.Repeated treatment and maintained treatment with a lower dosage were suggested for most patients according to their condition.