支气管扩张症辨证模式初探

目的:探讨支气管扩张症的中医辨证分型规律及证候特点.方法:通过对563例支气管扩张症的临床流行病学调查,采集以症状、体征、舌、脉及相关理化检测为变量的基本信息,以频数分析、聚类分析、方差分析等方法,提炼支气管扩张症的证候分布规律及证候特点.结果:临床上支气管扩张症多见4种证候类型,分别为痰热壅肺证(45.65%)、肝火犯肺证(24.51%)、肺脾气虚证(22.38%)、气阴两虚证(7.46%).结论:较大样本的临床流行病学调查为研究支气管扩张症辨证分型规律提供了科学依据,并可以通过主症判别分析法建立证候识别模式,为临床实践提供依据.     

Diffuse panbronchiolitis: Case report and review of the literature

Diffuse panbronchiolitis is an uncommon disease of unknown aetiology mainly occurring in Asian races. Treatment with erythromycin acting through unclarif ied mechanisms is promising and may improve the poor prognosis currently associated with the disease. A case is presented illustrating how the imaging features of the disease, particularly on high-resolution computed tomography, may be used to support a diagnosis suggested on clinical grounds.     

支气管扩张症中神经内分泌免疫网络及肥大细胞的变化

目的：探讨支气管扩张症中神经内分泌免疫网络的异常和肥大细胞（MC）在该病发病中的作用及关系。方法：应用组织化学、免疫组化、组织化学与免疫组化结合的方法和形态计量学方法进行观测。结果：支气管扩张症中，支气管上皮蛙皮素（Bombesin）阳性细胞、固有膜S-100蛋白和神经特异性烯醇化酶（NSE）阳性神经纤维、IgE阳性细胞、MC和IgE阳性MC均显著增多，且在支气管相关淋巴组织（BALT）增生的区域上述肺内分泌细胞、神经纤维和IgE阳性细胞增多尤为显著，S-100蛋白和NSE阳性神经纤维分布于弥散淋巴组织和BALT中，MC与S-100蛋白阳性神经纤维紧密接触．MC表面有IgE阳性环状带，MC和IgE阳性细胞出现在支气管上皮间和肺泡壁。结论：支气管扩张症的发病与局部神经内分泌免疫网络异常有关；MC可能作为感受器、分泌细胞或靶细胞参与神经内分泌免疫网络，在支气管扩张症的发病中起重要作用。     

Ancillary treatment of patients with lung disease due to non-tuberculous mycobacteria: a narrative review

Background and ObjectiveNon-tuberculous mycobacterial lung disease (NTM-LD) manifests with bronchiectasis, inflammatory bronchiolitis, nodules, and/or cavitation. Bronchiectasis is characterized by permanently dilated airways wherein mucus accumulates, creating a vicious cycle of chronic injurious inflammation and recurrent infections. While antibiotics are an important part of the treatment of NTM-LD, airway clearance techniques to mitigate this pathogenic mechanism of bronchiectasis as well as other ancillary measures are also important components of NTM-LD treatment. The objective of this contemporaneous Narrative Review is to emphasize the importance of such ancillary measures.MethodsWe searched PubMed for the key words of “airway clearance”, “pulmonary rehabilitation”, “nutrition”, “swallowing dysfunction”, “gastroesophageal reflux”, “vestibular dysfunction”, or “cochlear dysfunction” with that of “non-tuberculous mycobacterial lung disease”, “bronchiectasis”, or “respiratory disease”. The bibliographies of identified articles were further searched for relevant articles not previously identified. Each relevant article was reviewed by one or more of the authors and a narrative review was composed.Key Content and FindingsHerein, we discuss five ancillary treatment measures that are pertinent to patients with bronchiectasis and NTM-LD: (I) airway clearance; (II) physical and pulmonary rehabilitation; (III) nutrition; (IV) diagnosis and mitigation of swallowing dysfunction and of gastroesophageal reflux disease (GERD); and (V) minimization of vestibular and cochlear dysfunction associated with some anti-NTM drugs.ConclusionsWhile antibiotics is often the central focus of treatment of NTM-LD, given its propensity for recurrent and recalcitrant infection, other ancillary measures to break the vicious cycle of injurious inflammation and infection should also be emphasized to optimize treatment success.     

Unilateral Autoimmune Pulmonary Alveolar Proteinosis with Polymyositis-related Interstitial Lung Disease

A 61-year-old patient with cystic bronchiectasis and bronchial artery hyperplasia in the left lung was diagnosed with polymyositis-related interstitial lung disease. After nine months of immunosuppressive therapy, he developed unilateral autoimmune pulmonary alveolar proteinosis (APAP) in the right lung with respiratory failure. After bronchial artery embolization to prevent massive hemoptysis, whole-lung lavage was performed using veno-venous extracorporeal membrane oxygenation. His respiratory condition improved, and he was discharged from the hospital with supplemental oxygen. Three reported cases of APAP with polymyositis-related interstitial lung disease, including the present case, were all positive for anti-glycyl tRNA synthetase antibody and were under immunosuppressive treatment.     

老年支气管扩张合并急性感染的病原菌及其耐药性研究

目的:了解老年支气管扩张患者急性感染的病原学分布及药敏情况,指导临床抗菌药物的使用。方法:对2000—2012年本院呼吸科104份老年支气管扩张急性感染患者的痰标本进行细菌培养及药敏试验。结果:150例痰标本分离出致病菌107株,其中革兰氏阴性菌87株,占81%,排在前3位的致病菌分别是铜绿假单胞菌(35%),肺炎克雷伯菌(14%),鲍曼不动杆菌(11%)。革兰氏阳性球菌8株(7%),真菌12株(11%)。药敏实验显示所分离出的革兰氏阴性杆菌对哌拉西林-他唑巴坦,第3、4代头孢菌素及碳青霉烯类、多粘菌素等抗菌药物敏感性较高。结论:老年支气管扩张急性感染的病原菌分布以革兰氏阴性杆菌为主,铜绿假单胞菌排在首位,经验治疗时建议选用哌拉西林/他唑巴坦、头孢三代、四代或碳青霉烯类药物。     

Impacts of Asthma in Patients With Bronchiectasis: Findings From the KMBARC Registry

PurposeAlthough the coexistence of asthma and bronchiectasis is common, the impacts of asthma on bronchiectastic patients (BE) have not been well evaluated because this issue using bronchiectasis cohorts has been investigated in only a few studies.MethodsIn the present study, 598 patients who were prospectively enrolled in the Korean bronchiectasis registry were evaluated. The clinical characteristics between BE with asthma and those without asthma were compared.ResultsAsthma was found in 22.4% of BE. BE with asthma had a higher body mass index (BMI) (P = 0.020), more dyspnea (P < 0.001), larger sputum volume (P = 0.015), and lower forced expiratory volume in 1 second (FEV1) (P < 0.001) than those without asthma. BE with asthma had a higher rate of previous pneumonia (P = 0.017) or measles (P = 0.037) than those without asthma. Regarding treatment, BE with asthma used inhaled corticosteroids, long-acting muscarinic antagonists, and leukotriene receptor antagonists more frequently than those without asthma. Although intergroup differences were not observed in disease severity of bronchiectasis (P = 0.230 for Bronchiectasis Severity Index and P = 0.089 for FACED), the Bronchiectasis Health Questionnaire (BHQ) scores indicating the quality of life, were significantly lower in BE with asthma than in those without asthma (61.6 vs. 64.8, P < 0.001). In a multivariable model adjusting for age, sex, body mass index, forced expiratory volume in 1 second %predicted, sputum volume, modified Medical Research Council dyspnea scale ≥ 2, and the number of involved lobes, asthma was associated with lower BHQ scores (β-coefficient = −2.579, P = 0.014).ConclusionsBE with asthma have more respiratory symptoms, worse lung function, and poorer quality of life than those without asthma. A better understanding of the impacts of asthma in BE will guide appropriate management in this population.     

经纤维支气管镜局部冲洗治疗支气管扩张症53例报告

目的探讨经纤维支气管镜（以下简称纤支镜）局部灌洗注药治疗支气管扩张症的疗效。方法53例支气管扩张病人除常规治疗外,还采用纤维支气管镜反复气道灌洗和注药,在纤维支气管镜治疗前后常规监测患者临床情况、通气换气功能及血气指标。结果灌洗注药后患者体温迅速下降,外周血白细胞、痰液量明显减少,X线胸片明显改善。灌洗后血气指标（PaO2,SaO2及PaO2／FiO2）改善;肺通气功能检测（VC、FEVI、FEVI％、VS0、V25及MVV）明显改善（P〈0．05）。结论经纤维支气管镜肺泡灌洗和注药能有效清除痰痂和气道分泌物,解除支气管的阻塞,改善患者通气换气功能,是一种安全、简便实用的治疗支气管扩张的有效手段。     

强力稀化粘素治疗稳定期支气管扩张症的疗效观察

目的 观察强力稀化粘素对稳定期支气管扩张症的疗效.方法 对35例稳定期支气管扩张患者,强力稀化粘素300 mg每日3次口服治疗,疗程6个月.观察并记录支扩急性加重的频率、临床表现并与治疗前6个月进行比较.结果 35例患者完成了6个月的治疗和随访.6个月来患者的平均恶化次数从治疗前4.2次减少到1.3次；痰量从治疗前的平均0.066 L/d减少至0.034 L/d.结论 长期强力稀化粘素治疗能减少支扩恶化次数,改善临床症状.