全肺灌洗治疗尘肺远期疗效评价

Long-term therapeutic effects of whole lung iavage in the management of silicosis

目的探讨全肺灌洗（WLL）治疗尘肺的远期效果。方法70例尘肺患者根据X线胸片进展情况，矽肺分期、年龄及接尘工龄等按1：1比例随机分为灌洗组与对照组，进行远期疗效对比观察；并对157例病例资料进行长期随访观察。结果治疗2年后，灌洗组咳嗽、咳痰及气喘好转率分别为62．5％、75.0％及81．8％，明显高于对照组（24．0％、23．8％及26．3％），差异有统计学意义（P〈0．05）。治疗4年后,灌洗组气喘好转率（59．1％）与对照组（21．1％）的差异有统计学意义（P〈0．05）。灌洗组治疗后用力肺活量（FVC）与第1秒用力呼气量（FEV10）比治疗前稍有下降，差异无统计学意义（P〉0．05）；对照组治疗后FVC与FEV10比治疗前明显下降，差异有统计学意义（P〈0．05或P〈0．01），治疗2、4年后，灌洗组X线胸片无变化率高于对照组，进展与明显进展率低于对照组，两组比较，差异均无统计学意义（P〉0．05）。灌洗组22例快型矽肺治疗2、4年后的X线胸片无变化率（75．0％、58．3％）明显高于对照组（30．0％、20．0％），灌洗组治疗后2年X线胸片进展率（16．7％）、治疗后4年X线胸片明显进展率（8．3％）低于对照组（50．0％和30．0％），差异均有统计学意义（P〈0．05）。随访59例WLL治疗患者，治疗后2-3年咳嗽、气喘好转率分别为74．4％、76．3％；治疗后4-5年、6～7年咳嗽、气喘好转率仍为55．0％-57．1％。随访85例WLL治疗患者的肺功能，治疗后2-3年FVC与治疗前比较，基本保持不变或轻度下降；治疗后4～5年、6～7年FVC均下降，尘肺期别越低，下降幅度越小。随访108例WLL治疗患者，治疗后2-3年、4～5年、6～7年X线胸片随访显示，尘肺期别越低，X线胸片稳定无变化率越高，Ⅱ、Ⅲ期尘肺组X线胸片无变化率与0、Ⅰ期的差异有统计学意义（P〈0．01）。结论WLL是治疗矽（尘）有效的方法，特别对早期矽肺、快型矽肺施行WLL更为有效。对晚期矽肺应慎重选择WLL。

Objective To investigate the long-term therapeutic effect of whole lung lavage （WLL） in the treatment of silicosis. Methods A total of 70 patients with silicosis were randomly and equally divided into WLL group and control group based on chest X-ray, silicosis staging, age, and working age of dust exposure. Comparative analysis was performed to evaluate the long-term therapeutic effect of WLL. Moreover, 157 patients with silicosis treated by WLL were subject to long-term follow-up. Results Two years after treatment, the cough, expectoration, and asthma improvement rates of the WLL group were 62.5%, 75.0%, and 81.8%, respectively, significantly higher than those （24.0%, 23.8%, and 26.3%） of the control group （P〈0.05）. Four years after treatment, the asthma improvement rate （59.1%） of the WLL group was significantly higher than that （21.1%） of the control group （P〈0.05）. The WLL group showed slight decrease in forced vital capacity （FVC） and forced expiratory volume in one second （FEV0 after treatment （P〉0.05）, while the control group showed significant decrease in FVC and FEV 1 after treatment （P〈0.05 or P〈0.01）. Two and four years after treatment, the WLL group had higher no change rate and lower progression rate and significant progression rate than the control group in terms of chest X-ray （P〉0.05）. 22 cases of accelerated silicosis in the WLL group had significantly higher no change rate than the control group with respect to chest X-ray （75.0% vs. 30.0%; 58.3% vs. 20.0%）. The WLL group had lower progression rate （2 years of treatment） and significant progression rate （4 years after treatment） than the control group （16.7% vs. 50.0%, P〈0.05; 8.3% vs. 30.0%, P〈0.05）. Follow- up of 59 eases treated by WLL showed that the cough and asthma improvement rates were 74.4% and 76.3% 2- 3 years after treatment and remained 55.0%-57.1% 4-5 years and 6-7 years after treatment. Follow-up of 85 cases treated by WLL showed that FVC remained unchanged or slightly decreased 2-3 years after treatment and decreased 4-5 years and 6 -7 years after treatment and that the lower silicosis stage was, the less FVC decreased. Follow-up of 108 eases treated by WLL showed that the lower silicosis stage was, the higher no change rate was, according to the chest X-ray findings 2-3, 4-5, and 6-7 years after treatment and that there were significant differences in no change rate between stages Ⅱ and Ⅲ silicosis groups and stages 0 ＋ and Ⅰ silicosis groups （P〈0.01）. Conclusion WLL is an effective therapy for silicosis, especially for early silicosis and accelerated silicosis. However, WLL should be used cautiously in the treatment of advanced silicosis.