脾氨肽口服冻干粉辅助治疗肺炎支原体肺炎患儿的疗效及对血清sB7-H3及GM-CSF表达的影响

目的：探讨长期小剂量吸入布地奈德雾化液对闭塞性细支气管炎（BO）患儿临床症状及肺功能改善情况。方法：收集2015-2019年成都市妇女儿童医院儿童呼吸科住院部及呼吸专科门诊确诊的25例BO患儿病例资料,对BO患儿肺功能指标进行随访观察。结果：（1）BO患儿的潮气肺功能主要指标达峰时间比、达峰容积比、小气道功能指标低于健康儿童（P<0.05）。（2）雾化吸入布地奈德治疗3个月,患儿咳嗽喘息次数、用药次数及入院次数无明显改善;6个月后患儿入院次数下降,差异有统计学意义（P<0.05）;12个月后咳嗽喘息次数、用药次数、入院次数均下降（P<0.05）。（3）潮气肺功能主要指标在雾化吸入布地奈德治疗3、6、12个月预后达峰时间比、达峰容积比、TEF25均改善不明显,雾化吸入布地奈德治疗12个月,TEF75、TEF50有改善（P<0.05）。结论：雾化吸入布地奈德雾化溶液长期治疗儿童闭塞性细支气管炎对改善临床症状、潮气肺功能部分指标有一定疗效。     

新鱼腥草素钠雾化吸入辅助治疗毛细支气管炎50例

目的:观察新鱼腥草素钠雾化吸入辅助治疗毛细支气管炎的临床疗效。方法:将100例毛细支气管炎的患儿随机分为两组,在综合治疗的基础上,治疗组50例加用新鱼腥草素钠雾化吸入,对照组50例加用生理盐水雾化吸入,5d为1个疗程。结果:治疗组咳嗽、气喘、三凹征和肺部罗音消失时间,均较对照组明显缩短(P<0.05),但两组住院天数无明显差别(P>0.05)。结论:新鱼腥草素钠雾化吸入辅助治疗毛细支气管炎疗效确切,方法简便,值得推广。     

蓝桉油对脂多糖引起的大鼠慢性支气管炎及黏蛋白高分泌的影响

目的 :观察蓝桉油对脂多糖引起的大鼠慢性支气管炎及黏蛋白高分泌的影响。方法 :采用一次性气管内注入 0 .2mg脂多糖复制大鼠慢性支气管炎模型 ,观察 3周后的病理学改变、支气管肺泡灌洗液变化、免疫组化特点以及蓝桉油对其的影响。结果 :注入脂多糖后的病理学表现符合慢支的特征。各给药组经不同浓度蓝桉油灌胃后能减少中性粒细胞及淋巴细胞的浸润 ,降低炎症程度 ;尤其是蓝桉油高剂量组 (300 mg·kg^-1) ,能明显减少灌洗液中黏蛋白含量 ,使气管和细支气管上皮内黏蛋白MUC5ac表达的阳性染色区域和程度明显减轻 ,通过图像分析系统测得的吸光度值和黏蛋白面积 %均明显低于模型组。结论 :蓝桉油对脂多糖引起的大鼠慢性支气管炎具有一定的抗炎作用 ,并能抑制其气道黏蛋白高分泌现象。     

Cyclooxygenase-2 expression in experimental post-transplant obliterative bronchiolitis

Epithelial cell injury, inflammation, progressive fibrosis, and airway obliteration are histological features of post-transplant obliterative bronchiolitis (OB). Cyclooxygenase (COX)-2 is expressed in acute and chronic inflammatory responses. Our aim was to elucidate the possible role of COX-2 in post-transplant OB by using a heterotopic bronchial porcine model. Bronchial allografts from non-related donors were transplanted subcutaneously into 24 random-bred domestic pigs, each weighing about 20 kg. Groups studied had grafts, non-treated allografts, allografts given cyclosporine A (CsA), methylprednisolone (MP), and azathioprine (Aza), and allografts given CsA, MP, and everolimus. Grafts were serially harvested during a follow-up period of 21 days for histology (H&E) and immunohistochemistry. Immunostaining was performed with monoclonal IgG against human COX-2 peptide, and histological alterations and immunohistochemical positivity were graded on a scale from 0 to 5. Epithelial COX-2 index was calculated by multiplying the percentage of positive cells by grade of epithelial COX-2 intensity. Ischaemic epithelial loss, evident in all implants, recovered rapidly in autografts, and bronchi remained patent. Epithelial loss in non-treated allografts preceded fibroblast proliferation, resulting in total luminal obliteration. In CsA-, MP-, and Aza-treated allografts epithelial destruction and luminal obliteration were delayed, and these were prevented in CsA-, MP-, and everolimus-treated allografts. COX-2 expression due to operative ischaemia was evident in all implants on day 2. Thereafter, the epithelial COX-2 index preceded epithelial injury and obliteration. During the inflammatory response and fibroblast proliferation, COX-2 expression occurred in macrophages and fibroblasts. In conclusion, in the early stage of OB development, COX-2 induction occurred in airway epithelial cells prior to luminal obliteration. In addition, the observation that COX-2 expression in macrophages and fibroblasts paralleled the onset of inflammation and fibroblast proliferation indicates a role in OB development, but the causal relationships need further study.     

IL-16 in the airways of lung allograft recipients with acute rejection or obliterative bronchiolitis

Acute rejection (AR) is the principal risk factor for obliterative bronchiolitis (OB), the major complication of lung transplantation. It is known that activated CD4+ T lymphocytes are involved in the development of AR and that interleukin (IL)-16 can inhibit the activity of CD4+ T lymphocytes. In this study, we evaluated whether the concentration of IL-16 in the airways is altered in AR or OB and, if so, how this IL-16 concentration relates to the number or activity of airway lymphocytes. The concentration of IL-16 protein was measured in bronchoalveolar lavage (BAL) fluid at three time-points in lung allograft recipients with either AR or OB and in matched controls using ELISA. The concentration of soluble IL-2 receptor (R) protein was measured in BAL fluid using ELISA as well, as an indicator of lymphocyte activity. The percentage of airway lymphocytes was evaluated by performing BAL differential cell counts. Lung allograft recipients with AR displayed lower IL-16 concentrations compared with matched control patients and this IL-16 concentration correlated negatively with the sIL-2R concentration, but it did not correlate with the percentage of lymphocytes in BAL fluid. In contrast, in BAL fluid from lung allograft recipients with OB, the IL-16 concentration was not altered compared with matched control patients and it did not correlate with the percentage of lymphocytes or with the sIL-2R concentration. These data are compatible with an increase in IL-16 playing a protective role against AR but not against OB and, hypothetically, this type of protective effect could be exerted via a down-regulation of the activity of T lymphocytes.     

Reactive pulmonary lymphoid disorders

The two main reactive pulmonary lymphoid disorders are lymphoid interstitial pneumonia and follicular bronchitis/bronchiolitis, both pathological entities with a variety of aetiologies. We reviewed the morphological and immunohistochemical features of 26 cases with one or other of these two diagnoses, to explore the possibility that they represented overlapping patterns of hyperpiasia of the bronchopulmonary immune system. The polymerase chain reaction was used to determine the clonality of the infiltrates. Histologically, there was a spectrum of changes with two main components. An interstitial infiltrate of mainly T lymphocytes, plasma cells and histiocytes predominated in lymphoid interstitial pneumonia, whilst lymphoid follicles predominated around airways in follicular bronchitis/bronchiolitis. Classification of the disorder rested on which component the pathologists believed to be dominant. In two cases, histology and immunohistochemistry suggested lymphoma, and in one of these cases this diagnosis was confirmed by the polymerase chain reaction. One case of lymphoid interstitial pneumonia produced three bands. The remainder produced polyclonal patterns when samples were adequate. Clinically, there was no clear difference between patients with the two disorders, or patients with pathological features of both.     

喘乐宁、爱喘乐和普米克令舒联合雾化吸入治疗毛细支气管炎的疗效观察

【目的】探讨联合吸入喘乐宁,爱喘乐和普米克令舒对毛细支气管炎的疗效。【方法】将毛细支气管炎患儿93例随机分为两组,观察组48例,对照组45例,两组常规治疗方法相同,观察组联合雾化吸入喘乐宁,爱喘乐和普米克令舒,对照组仅予常规治疗。观察两组治疗效果及解除主要症状和体征的时间。【结果】观察组有效率93.75%,对照组有效率77.78%。两组比较差异有显著性(P<0.01)。【结论】联合吸入喘乐宁,爱喘乐和普米克令舒治疗毛细支气管炎显效迅速,疗效确切,值得临床推广应用。     

Nodular pulmonary lesions in children after autologous stem cell transplantation: a source of misinterpretation

In children with malignant disorders, autologous haematopoietic stem cell transplantation (HSCT) represents a therapeutic option, but several possible complications, such as life-threatening pulmonary disease, make appropriate diagnostic procedures essential. We describe two cases with bronchiolitis obliterans with organizing pneumonia after HSCT, with a brief review of important differential diagnoses.