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摘要:
《尘肺病治疗中国专家共识（2024年版）》最重要的修订是重视尘肺病抗纤维化治疗，推荐汉防己甲素和尼达尼布用于治疗矽肺、煤工尘肺，特别是快进型矽肺患者；另外，对肺移植采取了积极的态度，推荐终末期尘肺病经内科最优化的保守治疗仍然无效的患者，尽早进行肺移植。除此之外，此次修订内容还包括增加宏基因组新一代测序技术（mNGS）在尘肺合并肺部感染的应用，增加尘肺病合并非结核分枝杆菌肺病（NTM肺病）的诊治，以及增加尘肺并发呼吸衰竭治疗中经鼻高流量氧疗。本版本共识采用推荐分级的评估、制定与评价（GRADE）证据等级系统作为证据和推荐意见的评价方法。
Abstract:The most important revision of the
Consensus of Chinese experts on pneumoconiosis treatment (2024) is to attach importance to antifibrotic treatment, and recommend tetrandrine and nintedanib for the treatment of silicosis and coal worker's pneumoconiosis, especially in patients with rapidly progressing silicosis. The second most important revision is a positive attitude towards lung transplantation which is recommended for patients with end-stage pneumoconiosis who do not respond to medically optimized conservative treatment as early as possible. In addition, new updates also include the addition of the application of metagenomic next-generation sequencing (mNGS) in pneumoconiosis with pulmonary infection, the diagnosis and treatment of pneumoconiosis with nontuberculous mycobacteriosis (NTM), and high-flow nasal cannula oxygen therapy (HFNC) in pneumoconiosis with respiratory failure therapies. The evidence and recommendations of the current version are assessed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.-
Keywords:
- pneumoconiosis treatment /
- consensus /
- interpretation
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[1] 李德鸿. 不要把尘肺病防治引入歧途[J]. 环境与职业医学, 2018, 35(4): 283-285. LI D H. Don't mislead the prevention and treatment of pneumoconiosis[J]. J Environ Occup Med, 2018, 35(4): 283-285.
[2] SHI P, XING X, XI S, et al. Trends in global, regional and national incidence of pneumoconiosis caused by different aetiologies: an analysis from the Global Burden of Disease Study 2017[J]. Occup Environ Med, 2020, 77(6): 407-414. doi: 10.1136/oemed-2019-106321
[3] WU W H, FENG Y H, MIN C Y, et al. Clinical efficacy of tetrandrine in artificial stone-associated silicosis: a retrospective cohort study[J]. Front Med, 2023, 10: 1107967. doi: 10.3389/fmed.2023.1107967
[4] TANG M, TAN F, LUO Y, et al. Tetrandrine slows the radiographic progression of progressive massive fibrosis in pneumoconiosis: a retrospective cohort study[J]. BMC Pulm Med, 2023, 23(1): 290. doi: 10.1186/s12890-023-02577-3
[5] SONG M Y, WANG J X, SUN Y L, et al. Tetrandrine alleviates silicosis by inhibiting canonical and non-canonical NLRP3 inflammasome activation in lung macrophages[J]. Acta Pharmacol Sin, 2022, 43(5): 1274-1284. doi: 10.1038/s41401-021-00693-6
[6] FLAHERTY K R, WELLS A U, COTTIN V, et al. Nintedanib in progressive fibrosing interstitial lung diseases[J]. N Engl J Med, 2019, 381(18): 1718-1727. doi: 10.1056/NEJMoa1908681
[7] WELLS A U, FLAHERTY K R, BROWN K K, et al. Nintedanib in patients with progressive fibrosing interstitial lung diseases-subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: a randomised, double-blind, placebo-controlled, parallel-group trial[J]. Lancet Respir Med, 2020, 8(5): 453-460. doi: 10.1016/S2213-2600(20)30036-9
[8] 中华医学会检验医学分会临床微生物学组, 中华医学会微生物学与免疫学分会临床微生物学组, 中国医疗保健国际交流促进会临床微生物与感染分会. 宏基因组高通量测序技术应用于感染性疾病病原检测中国专家共识[J]. 中华检验医学杂志, 2021, 44(2): 107-120. Clinical Microbiology Group of Chinese Society of Laboratory Medicine, Clinical Microbiology Group of Chinese Society of Microbiology and Immunology, Society of Clinical Microbiology and Infection of China International Exchange and Promotion Association for Medical and Healthcare. Chinese expert consensus on metagenomics next‐generation sequencing application on pathogen detection of infectious diseases[J]. Chin J Lab Med, 2021, 44(2): 107-120.
[9] 陈晓红, 廖小琴, 吴迪, 等. 福州地区非结核分枝杆菌肺病临床特征[J]. 中国感染控制杂志, 2021, 20(8): 688-693. CHEN X H, LIAO X Q, WU D, et al. Clinical characteristics of non-tuberculous mycobacterial pulmonary disease in Fuzhou[J]. Chin J Infect Control, 2021, 20(8): 688-693.
[10] MAURI T, TURRINI C, ERONIA N, et al. Physiologic effects of high-flow nasal cannula in acute hypoxemic respiratory failure[J]. Am J Respir Crit Care Med, 2017, 195(9): 1207-1215. doi: 10.1164/rccm.201605-0916OC
[11] DAVIDSON A C, BANHAM S, ELLIOTT M, et al. BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults[J]. Thorax, 2016, 71 Suppl 2: ii1-ii35.
[12] ROCHWERG B, BROCHARD L, ELLIOTT M W, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure[J]. Eur Respir J, 2017, 50(2): 1602426. doi: 10.1183/13993003.02426-2016
[13] 中国医师协会呼吸医师分会, 中华医学会呼吸病学分会, 中国康复医学会呼吸康复专业委员会, 等. 中国慢性呼吸道疾病呼吸康复管理指南(2021年)[J]. 中华健康管理学杂志, 2021, 15(6): 521-538. Chinese Association of Chest Physicians, Chinese Thoracic Society, Respiratory Rehabilitation Committee of Chinese Association of Rehabilitation Medicine, et al. Guidelines for respiratory rehabilitation management of chronic respiratory diseases in China[J]. Chin J Health Manage, 2021, 15(6): 521-538.
[14] 中华医学会呼吸病学分会呼吸危重症医学学组, 中国医师协会呼吸医师分会危重症医学工作委员会. 成人经鼻高流量湿化氧疗临床规范应用专家共识[J]. 中华结核和呼吸杂志, 2019, 42(2): 83-91. Respiratory & Critical Care Medicine Group of Chinese Thoracic Society, Respiratory & Critical Care Medicine Committee of Chinese Association of Chest Physician. Expert consensus of high-flow nasal cannula oxygen therapy on clinical application regularity[J]. Chin J Tuberc Respir Dis, 2019, 42(2): 83-91.
[15] 中华医学会呼吸病学分会肺栓塞与肺血管病学组, 中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会, 全国肺栓塞与肺血管病防治协作组, 等. 中国肺动脉高压诊断与治疗指南(2021版)[J]. 中华医学杂志, 2021, 101(1): 11-51. Pulmonary Embolism and Pulmonary Vascular Disease Group, Chinese Society of Respiratory Medicine, Pulmonary Embolism and Pulmonary Vascular Disease Working Committee of Respiratory Physician Branch of Chinese Medical Doctor Association, National Cooperation Group on Prevention and Treatment of Pulmonary Embolism and Pulmonary Vascular Disease, et al. Chinese guidelines for diagnosis and treatment of pulmonary hypertension (2021 edition)[J]. Natl Med J China, 2021, 101(1): 11-51.
[16] 张子萍, 袁雅冬. 《中国肺动脉高压诊断与治疗指南(2021版)》解读: 肺部疾病和/或低氧所致肺动脉高压[J]. 国际呼吸杂志, 2022, 42(5): 343-349. ZHANG Z P, YUAN Y D. Interpretation of guidelines for the diagnosis and treatment of pulmonary hypertension in China (2021 Edition): pulmonary disease and/or hypoxia-induced pulmonary hypertension[J]. In J Respir, 2022, 42(5): 343-349.
[17] HUMBERT M, KOVACS G, HOEPER M M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension[J]. Eur Respir J, 2023, 61(1): 2200879. doi: 10.1183/13993003.00879-2022
[18] GUYATT G, OXMAN A D, AKL E A, et al. GRADE guidelines: 1. Introduction‐GRADE evidence profiles and summary of findings tables[J]. J Clin Epidemiol, 2011, 64(4): 383‐394.
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