儿童咳嗽变异性哮喘的诊断与鉴别诊断

小儿呼吸系统疾病是一种常见病、多发病,主要病变在气管、支气管、肺部及胸腔,小儿呼吸系统尚未发育健全,从出生到成年期间都有比成人更大的患病几率,且由于呼吸系统解剖结构和体质原因,使小儿出现更为严重的咳嗽、呼吸困难、缺氧,甚至呼吸衰竭而致死。本专题针对小儿常见的呼吸系统疾病包括变异性哮喘的诊断和鉴别诊断,支气管哮喘的Meta分析,肺炎、支气管肺炎和支气管炎的治疗研究,及呼吸窘迫综合征的药物治疗进行研究,以期为临床医生提供借鉴。     

幽门螺杆菌与胃肠外疾病

众多研究表明,幽门螺杆菌(H.pylori)感染与许多胃肠外疾病,包括呼吸系统、肝胆疾病、心血管疾病、皮肤和免疫系统等疾病有关。其机制可能是由H.pylori诱导产生的炎症和/或免疫反应所致。此文对H.pylori相关的胃肠外疾病及可能机制作一综述,为今后研究和治疗H.pylori相关性胃肠外疾病提供理论依据。     

支气管哮喘患者诱导痰中Clara细胞分泌蛋白的表达

支气管哮喘(简称哮喘)是一种慢性气道炎症，同时也有抗炎机制起作用。其中支气管无纤毛上皮Clara细胞分泌蛋白CC16即具较强的抗炎及免疫调节作用，与多种呼吸系统疾病有关。我们通过测定哮喘诱导痰中CC16 mRNA表达，探讨其在哮喘中的作用。     

支气管封堵法治疗呼吸系统疾病的研究现状

重度肺气肿、支气管胸膜瘘、难治性气胸、顽固性大咯血、耐药性空洞型肺结核等呼吸系统疾病的治疗，往往因为内科保守治疗不理想，而患者体质差又不能或不愿接受手术，可用支气管封堵法治疗。现将支气管封堵治疗呼吸系统疾病的研究现状作一简要综述。     

三氧化二砷对支气管哮喘免疫及气道炎症的调控

支气管哮喘（简称哮喘）是一种由多种细胞（嗜酸粒细胞、T细胞、中性粒细胞、肥大细胞及肺泡上皮细胞等）及细胞组分参与的气道慢性炎症性疾病。三氧化二砷在动物实验中能改善哮喘小鼠的肺功能,在临床治疗中能使患者的哮喘症状得到长期控制。新近研究表明：三氧化二砷能明显抑制小鼠的体液免疫反应,抑制小鼠的肺、皮肤等组织的T细胞增殖,能下调IL-17、IL-18和IL-23等多种炎症因子的分泌,并且通过内质网应激途径诱导中性粒细胞凋亡,从而调节免疫,抑制炎症。文章综述了三氧化二砷调控哮喘免疫及气道炎症的最新研究进展,并进行了展望。     

甘草酸及其衍生物对呼吸系统疾病的研究进展

甘草的主要成分甘草酸(glycyrrhizic acid,GCA)及其衍生物--甘草甜素、甘草次酸具有诸多治疗呼吸系统疾病的药理活性,包括治疗严重急性呼吸综合征,抗上呼吸道病毒感染、急性肺损伤、肺纤维化,调节支气管哮喘及炎症等作用.笔者认为GCA类药物在呼吸方面有巨大的发展空间,就近年来对GCA类药物治疗呼吸系统疾病的国内外药理学研究进展作一综述.     

肥胖与呼吸系统疾病的关系

自21世纪初,肥胖已成为一种重要的慢性、代谢性疾病,其发病率呈上升趋势.肥胖不仅是一种损害健康的疾病,且是多种疾病的危险因素,其可导致代谢性疾病和心血管疾病；在呼吸系统,肥胖(体质量指数)与慢性阻塞性肺疾病、支气管哮喘、肺血栓栓塞症、吸人性肺炎、阻塞性睡眠呼吸暂停低通气综合征等有关.美国哥伦比亚大学研究发现,肥胖对美国人健康的威胁已达到与吸烟并驾齐驱的程度,所以在重视吸烟对呼系统影响的同时,肥胖与呼吸系统疾病的关系也不容忽视.     

经支气管镜介入冷冻技术在呼吸系统疾病应用中的研究进展

冷冻治疗古已有之。随着医疗器械、临床技术的不断发展,冷冻技术因其特有的优势在临床应用中占据着重要地位。冷冻不仅应用于皮肤表面疾病的治疗,而且也用于肺部肿瘤、胃部肿瘤等体内脏器疾病的治疗。此外,各种内镜腔内冷冻技术也在不断发展,扩大了冷冻在临床中的应用范围。其中经支气管镜冷冻治疗就用于多种临床疾病,包括恶性和良性中央气道阻塞的治疗,异物清除或支气管结核的治疗和支气管内活检等。有关研究证实了冷冻技术在气道疾病治疗中的有效性。作者就近年来经支气管镜介入冷冻技术在呼吸系统疾病中的应用及进展进行综述,以期相关临床工作者更加全面地了解经支气管镜介入冷冻技术的特点。     

IL-37与呼吸系统疾病的研究进展

IL-37是新发现的一种免疫抑制因子,作为IL-1家族的新成员,具有显著的抗炎作用.研究表明IL-37可能通过下调树突状细胞的活性,减轻T细胞免疫应答,从而抑制炎症级联反应来发挥抗炎作用,参与体内多种疾病的免疫过程,与支气管哮喘、肺结核、肺炎和肺癌等发生和发展密切相关.现就IL-37在呼吸系统疾病中的作用机制作一综述,旨为上述疾病的治疗提供新的科学依据.     

Toll样受体4与呼吸系统疾病的研究进展

人类Toll样受体4(Toll-like receptor 4,TLR4)是最早被认识诱导哺乳动物活化天然免疫和获得性免疫的TLR,属于天然免疫系统的重要分子,可通过识别病原相关的分子模式,引发信号传导,导致炎症介质的释放,并最终激活获得性免疫系统.近年来的众多研究表明,TLR4作为跨膜受体与呼吸系统的多种疾病有着密切的联系.对TLR4的研究使我们进一步了解呼吸系统疾病的发病机制,以寻找更好的抗感染、抗炎症的治疗方法,为防治各种呼吸系统疾病开辟广阔的前景.本文主要对TLR4的结构、功能及与一些呼吸系统疾病的联系作一简要综述.     

The evolving use of arsenic in pharmacotherapy of malignant disease

For more than 2,000 years, arsenic and its derivatives have shown medical utility. Owing to the toxicities and potential carcinogenicity of arsenicals, their popularity has fluctuated. The exact mechanism of action of therapeutic arsenic is not well characterized but likely to involve apoptosis, generation of reactive oxygen species, inhibition of intracellular transduction pathways, and cell functions. Arsenic trioxide has received approval for use in patients with relapsed acute promyelocytic leukemia for remission induction. Arsenic has additionally shown activity in a range of solid tumors, myelodysplastic syndrome, multiple myeloma, and in autoimmune diseases. The following is a review of the history of arsenic, its cellular metabolism, pharmacology, genetic basis of disposition, associated toxicities, and clinical efficacy.     

Prolongation of the QT interval and ventricular tachycardia in patients treated with arsenic trioxide for acute promyelocytic leukemia

BACKGROUND: Recently, arsenic trioxide has increasingly been used for relapsed acute promyelocytic leukemia. However, it is known to have several adverse effects, including acute cardiac toxicities. OBJECTIVE: To determine cardiac toxicities resulting from arsenic trioxide therapy in patients with relapsed or refractory acute promyelocytic leukemia. DESIGN: Phase II clinical prospective cohort study. SETTING: A university hospital in Hamamatsu, Japan. PATIENTS: 8 patients with relapsed acute promyelocytic leukemia. INTERVENTION: Arsenic trioxide, 0.15 mg/kg of body weight, administered daily by 2-hour infusion for a maximum of 60 days. MEASUREMENTS: Continuous monitoring with ambulatory electrocardiography. RESULTS: Five patients (63%) achieved complete remission. During induction therapy with arsenic trioxide, prolonged QT intervals were observed in all patients. Ventricular premature contractions were noticed during 8 of 12 courses of therapy. Four patients developed nonsustained ventricular tachycardia and required treatment with antiarrhythmic agents. CONCLUSIONS: Cardiac toxicity occurs during arsenic trioxide therapy in patients with acute promyelocytic leukemia. Such patients should be monitored for prolonged QT intervals and ventricular arrhythmia.     

下呼吸道微生态在支气管哮喘中的研究进展

随着二代测序的不断发展,过去人们认为无菌的下呼吸道现已被证实有多种不同的微生物群落定植.同时,越来越多的研究也证明,微生态在宿主免疫系统的发生发展中起着重要的作用.呼吸道微生态紊乱可能与多种呼吸道疾病密切相关,包括肺结核、COPD及支气管哮喘(简称哮喘)等.该研究主要回顾了近年来对哮喘患者及健康人群呼吸道微生态的研究,探讨在哮喘患者中呼吸道菌群定植的改变趋势,以及呼吸道微生态的改变与哮喘发病机制之间的关系,并且对呼吸道微生态在哮喘治疗中的研究进展进行讨论.     

Molecular remission without blood product support using all-trans retinoic acid (ATRA) induction and combined arsenic trioxide/ATRA consolidation in a Jehovah's Witness with de novo acute promyelocytic leukaemia

Arsenic trioxide has recently been used in the treatment of both relapsed and de novo acute promyelocytic leukaemia (APML). Molecular remissions have been attained using arsenic trioxide with minimal associated haematological toxicity, making protocols utilizing this drug an attractive option for Jehovah's Witnesses with APML. A 62-year-old female Jehovah's Witness with de novo APML was treated with all-trans retinoic acid induction followed by combined arsenic trioxide/ATRA consolidation, and achieved molecular remission with minimal haematological toxicity and no blood product support.     

Clara细胞分泌蛋白CC16与支气管哮喘的关系

CC16(Clara细胞分泌蛋白-16)是Clara细胞主要的分泌物,具有抗炎、抗氧化、调节免疫及抑制肿瘤的生成和转移等多种生物活性。我国近年来研究显示CC16与支气管哮喘的发病机制、诊断及治疗有密切关系,其中CC16与Th1/Th2失衡的关系成为一研究热点。现就CC16与支气管哮喘的关系作一综述,为以后进一步深入研究作铺垫。     

microRNA expression alteration after arsenic trioxide treatment in HepG-2 cells

Background and Aim: More and more microRNA (miRNA) are found to be involved in tumor genesis and progress. Arsenic trioxide has been an effective chemotherapeutic drug in cancer therapy for many years. In this study, we aimed to find the miRNA involved in the mechanisms of arsenic trioxide treatment in cancer therapy. Methods: We detected the expression profile of miRNA by miRNA microarray and quantitative real‐time polymerase chain reaction. Cell viability assay, flow cytometry analysis, prediction of miRNA targets, Western blot analysis and luciferase reporter assay were carried out to determine the role of one selected miRNA, namely mir‐29a, in affecting the biological behaviors of HepG‐2 cells. Results: Among the 677 human miRNA in the microarray, five miRNA were upregulated and four were downregulated in HepG‐2 cells treated with arsenic trioxide compared to their controls. If only changes above two folds were considered, four miRNA were identified, namely miR‐24, miR‐29a, miR‐30a and miR‐210, which were all upregulated. Among them, miR‐29a showed a positive therapeutic effect in liver cancer cells by inhibiting cell growth and inducing cell apoptosis, and PPM1D was confirmed to be the target gene of miR‐29a. Furthermore, a synergy effect was detected between miR‐29a and arsenic trioxide. Conclusions: Arsenic trioxide altered miRNA expression profile in HepG‐2 cells. Among the altered miRNA, miR‐29a seemed to take a role in the mechanism of arsenic trioxide in liver cancer therapy. The synergy effect between miR‐29a and arsenic trioxide may offer this drug a new chance in cancer therapy by decreasing its dose and toxic side‐effects.     

颗粒蛋白前体在呼吸系统疾病的研究进展

颗粒蛋白前体(PGRN)是多功能的生长因子,在正常组织的发生、增生、再生、宿主防御的动态调节中起重要作用.诸多研究表明PGRN参与传染病、伤口愈合、肿瘤发生、神经增殖和退化性疾病.目前研究发现PGRN在炎性疾病中发挥重要作用,此外,PGRN在COPD、ARDS、非小细胞肺癌、间质性肺病中也有研究,本文就PGRN在肺部疾病中的研究进展进行综述.     

Comparative frequencies of the beats of nasal and bronchial ciliary cells. Study in 10 adults without respiratory pathology

The frequencies of nasal and bronchial ciliated cell beats were compared in 10 adult subjects (mean age 56 years) with E.N.T. tumoral pathology but no recent respiratory disease. Ciliated cells were collected by simultaneous nasal curettage and bronchial brushing carried out under general anaesthesia during endoscopic evaluation of the tumors. The frequency of beats was measured by the stroboscopic method at room temperature (18 degrees-25 degrees C) at least 3 hours after cell collection. A significant (p less than 0.05) difference was found between nasal (8.89 +/- 0.84 Hz) and bronchial (9.6 +/- 1.03 Hz) beats. A study of nasal ciliated cell beats therefore provides a first assessment of ciliary function which is of interest in patients with recurrent respiratory diseases. It is a simple procedure that can easily be performed prior to more complex investigations, such as study of the bronchial ciliated cell beats or ultrastructural study of the cilia.