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나종양 나 환자의 세균학적 재발에 관한 연구

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 Studies on Bacteriological Relapse of Lepromatous Leprosy Patients 
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[영문] [한글] 선명희 특수 피부 진료소 및 나병 연구소에서 1955년 7월부터 1978년 8월 31일까지 등 록된 나환자 중 나종양나로 확진을 받고 1년 이상 치료받은 나환자 897명을 대상으로 재 발에 관한 수종의 조사를 하여 아래와 같은 결론을 얻었다. 1) 총 조사 대상 897명 중 485명이 균 음전하였으며 5년간 계속하여 follow-up이 가능 한 경우 균 음전율이 70.75%였으며, 9년간 계속하여 follow-up이 가능한 경우엔 94.54%였 다. 또한 균 음전율에 남녀간의 차이를 관찰할 수 없었다. 2) 세균 지수가 일정할 때 치료의 규칙도가 높을수록 짧은 기간내에 균 음전화하였고, 한편 동일한 치료 규칙도 하에서는 세균 지수가 낮을수록 짧은 기간내에 균 음전화하였다 . 이는 나병을 조기 발견하여 규칙적인 치료를 하는 것이 나병 치료 및 관리에 핵심이라 는 것을 암시해 주는 자료이다. 3) 초진시 세균 지수별 재발율은 세균 지수가 높고 낮음에 따라 재발율의 차이를 관찰 할 수 없었다. 이는 균 음전화 되기 전에 병의 진행 정도에 관계없이 재발율이 일정한 것 을 의미한다. 4) 균 음전화 되기 전에 규칙적인 치료를 하여 균 음전된 환자의 과반수 이상이 균 음 전후 투약을 소홀히 하여 이중 상당수가 재발하였다. 따라서 나사업 종사자 및 환자들에 게 재발에 대한 철저한 교육을 시켜 균 음전후에도 계속 규칙적인 약 복용의 필요성을 인 식시켜야 될 것으로 사료된다. 5) 균 음전후 치료의 규칙도가 A인 환자에서 1.28%의 재발율을 보였는데 이 경우는 상 당수가 항나제에 내성이 있는 나균에 의한 재발로 사료되며, 균 음전후 치료의 규칙도가 B 또는 c인 환자에서 각각 19.27%, 30.56 %의 재발율을 보였는데 이는 대다수가 휴민균의 재활성화에 의한 재발일 것으로 사료되나 이들 재발 환자들의 치료 기간이 얼마되지 않 은 예도 있어 계속 관찰중에 있다. 6)세균 음전후 투약기간이 길면 길수록 재발율이 낮다. 이는 균 음전후 장기간 동안 투 약하는 것이 재발 예방을 위해 중요하다는 것을 말해 주고 있다. 7) 재발시 세균 지수가 초진시 보다 낮아졌다. 이것은 환자 자신이 나병에 대한 지식이 늘어 재발을 쉽게 감지할 수 있었던 것으로 사료된다. 8) 재발시 세균 지수가 높을수록 균 음전율이 낮다. 이는 아직 재발 후 치료 기간이 얼 마 안된 예도 있어 앞으로 더 세밀한 관찰, 특허 약제내성균에 대한 관찰이 요구된다. 9) 재발 후에도 치료의 규칙도가 높은 군에서 균 음전율이 높다. 이는 재발 환자 치료 시에도 역시 규칙적 약 복용이 중요한 것으로 사료된다. Studies on Bacteriological Relapse of Lepromatous Leprosy Patients Choong San OH, M.D. Department of Medical Science The Graduate School Yonsei University (Directed by Prof. Joon LEW, M.D., Ph.D.) In 19431, Faget introduced promin for the treatment of leprosy. However, it was net until 1953 that DDS was made available throughout Korea. Thus the following changes in leprosy control and the concept involved with this disease resulted. When chemotherapy was not available, forced physical segregation was the best and only one method how to combat leprosy. But after the development of effective chemotherapy, it became possible to concert the bacilli of this disease to a noninfectious state. Therefore it became possible to treat patient at home instead of forced physical segregation. Accordingly, in Korea, outpatient clinic for leprosy patients was initiated in July of 1955. Moreover, later with the introduction of clofazimine and rifampicin, even more effective chemotherapeutic means of leprosy control came into existence. Thanks to these advances in leprology, many patients were converted to bacteriologically negative and clinically were considered to be arrested case. These arrested cases who were recovered from leprosy are now active in normal society as inhabitants of resettlement villages or at their own homes. However, among these rehabilitated bacteriologically negative cases, clinically and bacteriologically relapse cased are found following observations for a period of time. In order to eliminate this dreaded disease, some effective measures must be made to overcome this problem of relapse among these rehabilitated individuals. In Korea the World vision Special skin Clinic & Leprogy Research Institute has maintained records over a considerable period of time on its registered patients and an epidemiological survey as regards relapse in lepromatous cases was conducted to obtain data for the control of this disease. The following results were obtained in a survey of 897 leprosy cases registered at the World Vision Special Skin Clinic & Leprosy research Institute from July, 1955 to August 31, 1978. These patients were initially diagnosed as lepromatous type leprosy and received treatment for at least one year. 1. From the total survey of 897 patients, 483 patients were converted bacteriologically negative. A negative conversion rate of 70.75% was found with a five year follow-up period and a rate of 94.54% was found within a nine year follow-up period under antileprosy chemotherapy. While no difference between male and female patients could be seen tn the negative conversion rate. 2. Classifying patients according to bacteriological index, a shorter negative conversion period wag observed with increasing regularity of chemotherapy also in patients with the same regularity of chemotherapy the lower the bacterial index, the shorter the conversion period. These facts indicate that for the treatment and control of leprosy, early diagnosis and regularity of chemotherpy are very important. 3. According to B.I. at initial diagnosis, no difference was observed in rate of relapse among patients with different bacterial indices. 4. More than half of the patients, who received the chemotherapy regularly before negative conversion, had an indifferent attitude towards treatment after negative conversion and a high rate of relapse was found among these patients. 5. A relapse rate of 1.28 % was seen in patients with regularity of treatment A after negative conversion, in these relapse cases the presence of resistant bacilli is thought to be the cause of the ineffectiveness of antileprosy drugs. Whereas relapse rates of 19.27% and 30.56% were found in patients with regularity of treatment B and C respectively, the presence of persister bacilli is thought to be the cause of these relapse cases. 6. After negative conversion, the lodger the ported of regular treatment, the lower the rate of relapse. 7. B.I. of relapse case after negative conversion was lower than B.I. at initial diagnosis. The rate of negative conversion was lower with increasing B.I. at the time of relapse. Even after relapse, the negative conversion rate was higher with increasing regularity of chemotherapy.
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