不同脏腑虚损慢性阻塞性肺疾病稳定期患者骨骼肌含量的研究

目的：观察不同脏腑虚损慢性阻塞性肺疾病稳定期患者骨骼肌含量及骨骼肌障碍的发生,探讨合适的中医治法以改善患者骨骼肌情况。方法：选择符合纳入条件的慢性阻塞性肺疾病稳定期患者140例,根据脏腑虚损情况分为肺气虚、肺脾气虚、肺肾气虚3种证型,通过人体成分分析测量其骨骼肌含量及体脂百分比,计算去脂肪指数,分析不同脏腑虚损类型与骨骼肌含量及发生骨骼肌功能障碍的关系。结果：3组慢阻肺稳定期患者均有不同程度的骨骼肌功能障碍,其中肺脾气虚组骨骼肌含量、双下肢肌肉量最低,更易合并骨骼肌功能障碍（P<0.05）。肺气虚组与肺肾气虚组之间上述指标无明显差异（P>0.05）。结论：肺脾气虚证的COPD患者可能更易发生骨骼肌含量减少,有易合并骨骼肌功能障碍趋势,运用补脾益气法可改善患者骨骼肌含量。     

泡球蚴感染小鼠Tregs与Th17细胞相关细胞因子的平衡变化

目的通过检测泡球蚴感染小鼠血清中Tregs相关细胞因子IL-10与Th17细胞相关细胞因子IL-17的浓度变化,探讨其在泡球蚴感染过程中的平衡变化关系。方法 60只雌性BALB/c小鼠随机分为实验组和对照组,实验组小鼠腹腔接种泡球蚴,对照组小鼠腹腔接种等量生理盐水,分别在接种后2、8、30、90、180和360d实验组与对照组各取5只小鼠,采血,收集血清,采用酶联免疫吸附试验(ELISA)检测IL-10和IL-17的表达水平。结果与对照组相比,小鼠血清IL-10水平在感染中晚期显著升高(P<0.01);IL-17水平在整个感染期均显著性升高(P<0.05),且晚期高于早期(P<0.01);IL-10与IL-17水平成正相关(r=0.655,P<0.01)。结论通过相关细胞因子的作用,Tregs与Th17细胞可能共同促进泡球蚴慢性感染的形成。     

Differences in key genes in human alveolar macrophages between phenotypically normal smokers and nonsmokers: diagnostic and prognostic value in lung cancer

Objective: To explore the effect of smoking on gene expression in human alveolar macrophages and the value of identified key genes in the early diagnosis and prognosis of lung cancers. Methods: We downloaded three data sets ({"type":"entrez-geo","attrs":{"text":"GSE8823","term_id":"8823"}}GSE8823, {"type":"entrez-geo","attrs":{"text":"GSE2125","term_id":"2125"}}GSE2125, and {"type":"entrez-geo","attrs":{"text":"GSE3212","term_id":"3212"}}GSE3212) from the Gene Expression Omnibus (GEO) database, including 31 non-smoking and 33 smoking human alveolar macrophage samples. We identified common differentially expressed genes (DEGs), from which we obtained module genes and hub genes by using STRING and Cytoscape. Then we analyzed the protein-protein interaction (PPI) network of DEGs, hub genes, and module genes and used David online analysis tool to carry out functional enrichment analysis of DEGs and module genes. Results: A total of 85 differentially expressed genes was obtained, including 42 up-regulated genes and 43 down-regulated genes. The Human Protein Atlas and Survival analysis showed that GBP1, ITGAM, CSF1, SPP1, COL1A1, LAMB1 and THBS1 may be closely associated with the carcinogenesis and prognosis of lung cancer. Conclusion: DEGs, module, and hub genes identified in the present study help explain the effects of smoking on human alveolar macrophages and provide candidate targets for diagnosis and treatment of smoking-related lung cancer.     

Effect of point application on chronic obstructive pulmonary disease in stationary phase and effects on pulmonary function: A systematic evaluation of randomized controlled trials

Objective

To evaluate clinical efficacy of point application or adjuvant therapy on chronic obstructive pulmonary disease in stationary phase and effects on pulmonary functions.

Methods

Computer retrieved CNKI, VIP, CBM and other databanks and manual operations retrieved correlative literatures to find randomized controlled trials (RCTs) about comparison between point application or adjuvant therapy and no-point-applications for treatment of chronic obstructive pulmonary disease in stationary phase in China. RevMan 5.0 software was used for Meta analysis.

Results

Among 3481 cases in the inclusive 32 RCTS, 1780 cases were in the test group and 1701 cases in the control group. Meta analysis indicated: 1) clinical efficacy: the groups containing point application therapy all were better than the groups of no-point-application; 2) force vital capacity (FVC): There was no statistically significant difference between the group of point application plus Western Medicine and the Western Medicine group; 3) force expiratory volume 1 (FEV1): The groups containing point application therapy were better than the no-point-application; 4) FEV1%: the groups of point application plus Western Medicine were better than the Western Medicine groups; 5) FEV1/FVC: there was a significant difference between the group of point application plus Chinese drugs and the group of Chinese drug.

Conclusion

Point application can increase clinical efficacy of chronic obstructive pulmonary disease in stationary phase in varying degrees, and different combinations of point application with Chinese drugs or Western Medicines have incomplete same actions in improvement of pulmonary function and therapeutic effect.     

Cryptococcosis in patients with liver cirrhosis: Death risk factors and predictive value of prognostic models

BackgroundLiver cirrhosis is associated with immune deficiency, which causes these patients to be susceptible to various infections, including cryptococcus infection. Mortality in cirrhotic patients with cryptococcosis has increased. The present study was to explore the risk factors of mortality and the predictive ability of different prognostic models.MethodsForty-seven cirrhotic patients with cryptococcosis at a tertiary care hospital were included in this retrospective study. Data on demographics, clinical parameters, laboratory exams, diagnostic methods, medication during hospitalization, severity scores and prognosis were collected and analyzed. Student's t test and Mann-Whitney test were used to compare characteristics of survivors and non-survivors at a 90-day follow-up and cerebrospinal fluid (CSF) manifestations of cryptococcal meningitis. Multivariate Cox regression analysis was used to identify the independent risk factors for mortality. Kaplan-Meier curves were used to analyze patient survival. Receiver operating characteristic (ROC) curves were used to evaluate the different prognostic factors.ResultsThe 30- and 90-day survival rates were 93.6% and 80.9%, respectively, in cirrhotic patients with cryptococcosis. Cryptogenic liver diseases [hazard ratio (HR) = 7.567, 95% confidence interval (CI): 1.616-35.428, P = 0.010], activated partial thromboplastin time (APTT) (HR = 1.117, 95% CI: 1.016-1.229, P = 0.022) and Child-Pugh score (HR = 2.146, 95% CI: 1.314-3.504, P = 0.002) were risk factors for 90-day mortality in cirrhotic patients with cryptococcosis. Platelet count (HR = 0.965, 95% CI: 0.940-0.991, P = 0.008) was a protective factor. APTT (HR = 1.120, 95% CI: 1.044-1.202, P = 0.002) and Child-Pugh score (HR = 1.637, 95% CI: 1.086-2.469, P = 0.019) were risk factors for 90-day mortality in cirrhotic patients with cryptococcal meningitis. There was significant difference in the percentage of lymphocytes in CSF between survivors and non-survivors [60.0 (35.0-75.0) vs. 95.0 (83.8-97.2), P < 0.001]. The model of end-stage liver disease-sodium (MELD-Na) score was more accurate for predicting 30-day mortality both in patients with cryptococcosis [area under curve (AUC): 0.826, 95% CI: 0.618-1.000] and those with cryptococcal meningitis (AUC: 0.742, 95% CI: 0.560-0.924); Child-Pugh score was more useful for predicting 90-day mortality in patients with cryptococcosis (AUC: 0.823, 95% CI: 0.646-1.000) and those with cryptococcal meningitis (AUC: 0.815, 95% CI: 0.670-0.960).ConclusionsThese results showed that cryptogenic liver diseases, APTT and Child-Pugh score were associated with mortality in cirrhotic patients with cryptococcosis and cryptococcal meningitis. MELD-Na score was important for predicting 30-day mortality, and Child-Pugh score was critical for predicting 90-day mortality.     

慢性阻塞性肺疾病动物模型研究概况

慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)由基因-环境交互作用而致病,目前COPD拟临床研究大多是采用诱发性动物模型。动物选择根据实际需要以鼠、猪和灵长类动物为主。造模方法主要是将可诱发COPD的危险因素,强加于动物以诱导COPD的发生。造模时间的长短则与诱因的性质和暴露量密切相关。模型建成后主要从肺功能、肺部病理改变等方面,并采用血清炎症因子、细胞因子检测等手段对模型进行评价,但在实际操作中尚有待进一步的评估。