肺泡灌洗液中sTREM-1在VAP诊断中的意义

目的研究可溶性髓样细胞触发受体-1(sTREM-1)对呼吸机相关性肺炎(VAP)诊断中的临床价值。方法患者共分4组:25例入住ICU临床疑诊VAP患者,根据肺泡灌洗液(BALF)细菌定量培养结果分为VAP确诊组(A组)14例,机械通气对照组(B组)11例,另有肺纤维化患者对照组(C组)10例,正常对照组(D组)18例。各组入选后在纤维支气管镜引导下行支气管肺泡灌洗术,收集肺泡灌洗液(BALF)标本、血清标本,分别测定各组肺泡灌洗液和血清中sTREM-1因子含量,并测定A、B组外周血白细胞(WBC)、C反应蛋白(CRP)、红细胞沉降率(ESR),记录A、B组临床肺部感染评分(CPIS)。结果①A组患者BALF中sTREM-1水平显著高于B组、C组及D组(P均<0.05);但A组血清中sTREM-1浓度与B组、D组相比差异无统计学意义(P均>0.05)。②A组患者BALF中sTREM-1和其他指标的诊断效率由曲线下面积(ROC)测定,结果示当取阈值为143.83 ng/L时,BALF中sTREM-1产生诊断敏感性为92.9%,特异性为81.8%。结论机械通气患者肺泡灌洗液(BALF)中sTREM-1的高表达,可作为临床VAP的早期诊断的生物标记物,同时有助于VAP与肺部非感染性疾病的鉴别诊断。     

ICU内老年人医院内获得性肺炎24例临床分析

分析24例ICU内老年人院内肺炎的临床资料,探讨其临床和病原学特点、易患因素以及防治对策,发现真菌感染与革兰氏阴性杆菌感染同样常见,提出了意识障碍、气管造口或插管、持续机械通气、留置胃管等可能是重要的易患因素。     

原发性间质性肺炎的HRCT特征及诊断分析

目的总结原发性间质性肺炎HRCT特征并探析其临床诊断应用价值。方法以我院2011年1月-2015年8月收治96例原发性间质性肺炎疑似患者为例,均行HRCT检查,对原发性间质性肺炎HRCT影像表现特征进行总结。结果 96例患者HRCT共获得576个层面图像,以磨玻璃影、小叶间隔增厚、支气管血管束增粗、小叶内间质增厚、细支气管扩张、蜂窝影等较为常见,分别为81.1%、79.2%、71.0%、58.0%、44.4%、42.9%;此外还包括小叶内结节影、肺气肿、气腔性实变影、网格影、胸膜下线影、囊性变、间质结节、马赛克征,分别为16.3%、15.1%、15.8%、10.6%、7.3%(42/576)、6.6%、3.6%、2.2%。结论原发性间质性肺炎的HRCT表现具有一定特征,可为临床诊断提供较大参考。     

婴幼儿重症肺炎支原体肺炎的临床和免疫功能研究

目的 探讨婴幼儿重症肺炎支原体肺炎（MPP）临床和免疫功能变化。方法 采用酶联免疫法（ELISA）检测35例MPP患儿肺炎支原体（MP）特异IgM、IgA，速率散射比浊法测定免疫球蛋白IgG及其亚类，荧光法检测T细胞亚群，并对临床表现和实验室结果进行分析，选取同期健康婴幼儿42例作为对照组。结果 重症MPP组患儿的CD3^＋、CD4^＋细胞数，CD4^＋／CD8^＋和C3含量小于对照儿，而IgA、IgM、循环免疫复合物（CIC）、CD8^＋细胞数高于对照儿，差别有非常显著性意义（P〈0．01）．IgG及亚类间差别无显著性意义（P〉0．05）。结论 重症MP感染患儿免疫功能的变化主要表现为CD3^＋、CD4^＋受抑，免疫功能低下可能是导致其发病的原因之一。     

广州地区2003年春季传染性非典型肺炎190例临床分析

目的 探讨广州地区暴发流行的传染性非典型肺炎的诊断和治疗方法。方法 对2003年1～3月广州地区发病的190例典型的非典型肺炎病人的临床特点、治疗效果进行了分析。结果 190例病人均以高热起病,近距离接触过传染源,潜伏期2～15d,175例病人伴有呼吸困难、咳嗽、心悸、乏力、头痛头晕,伴腹泻46例(24．2％)。133例病人肺部无明显体征,胸部X线片浸润性阴影在病程初期较轻,1周内逐渐或突然加重,其中波及两个肺野93例,两肺弥漫性渗出阴影36例。36例发展为急性呼吸窘迫综合征(ARDS),死亡11例。常规抗感染治疗无效,中毒症状明显和肺部阴影扩散时,及时应用持续气道正压通气(CPAP)和皮质激素可有效控制病情发展。结论 本病传染性强,主要经呼吸道传播,常规抗感染治疗无效。肺部阴影增多和呼吸困难加重时,及时应用CPAP和皮质激素是有效的治疗方法。     

妊娠合并肺炎的临床观察与护理

目的观察妊娠合并肺炎的临床治疗、护理经过与转归。方法抽取于我院治疗的妊娠合并各型肺炎孕妇42例,经过积极的降温、消炎、抗感染、纠正电解质紊乱及生活、用药、对症、心理护理等一系列治疗护理措施后,观察孕产妇的转归及预后。结果 42例孕妇28例经积极治疗后治愈出院,继续待产。10例孕妇经积极治疗体温降至正常后自行经阴道分娩。4例因高热,胎心持续160bpm以上,给予剖宫产术结束妊娠,新生儿生后5minApgar评分8～10分2例,7～9分1例,5～6分1例,立即进行新生儿复苏抢救后生后10min评9分。结论加强妊娠合并肺炎的治疗与护理,是促使病情早日康复、降低母儿损伤的的重要环节。     

沐舒坦静脉推注联合雾化吸入治疗脑卒中伴坠积性肺炎的疗效

【目的】探讨沐舒坦静脉推注联合雾化吸入治疗脑卒中伴坠积性肺炎的临床疗效。【方法】选取2012年5月至2013年5月本院收治的脑卒中伴坠积性肺炎患者80例，按照随机数字表法分为观察组和对照组各40例。对照组给予抗生素、对症、治疗原发病等常规治疗。观察组在常规治疗的基础上给予沐舒坦静脉推注联合雾化吸入。观察并对比两组的临床疗效，肺部哆音和胸片阴影消失时间，治疗前后的动脉血二氧化碳分压（PaCO2）和氧饱和度（SaO2）的变化。【结果】观察组临床有效率明显高于对照组（85％VS62．5％），且两组相比较差异有显著性（P〈0．05）；观察组肺部哆音和胸片阴影消失时间明显短于对照组（P〈0．01）。治疗前两组的SaO2和PaCO2比较差异无显著性（P〉0．05），观察组治疗后的SaO2和PaCO2较治疗前明显改善（P〈0．05），且明显优于对照组（P〈0．05），而对照组治疗后的SaO2和PaCO2与治疗前比较差异无显著性（P〉0．05）。【结论】沐舒坦静脉推注联合雾化吸入治疗脑卒中伴坠积性肺炎的疗效显著，值得临床推广。     

Interstitial lung diseases in children

Interstitial lung disease (ILD) in children (chILD) is a heterogeneous group of rare respiratory disorders that are mostly chronic and associated with high morbidity and mortality. The pathogenesis of the various chILD is complex and the diseases share common features of inflammatory and fibrotic changes of the lung parenchyma that impair gas exchanges. The etiologies of chILD are numerous. In this review, we chose to classify them as ILD related to exposure/environment insults, ILD related to systemic and immunological diseases, ILD related to primary lung parenchyma dysfunctions and ILD specific to infancy. A growing part of the etiologic spectrum of chILD is being attributed to molecular defects. Currently, the main genetic mutations associated with chILD are identified in the surfactant genes SFTPA1, SFTPA2, SFTPB, SFTPC, ABCA3 and NKX2-1. Other genetic contributors include mutations in MARS, CSF2RA and CSF2RB in pulmonary alveolar proteinosis, and mutations in TMEM173 and COPA in specific auto-inflammatory forms of chILD. However, only few genotype-phenotype correlations could be identified so far. Herein, information is provided about the clinical presentation and the diagnosis approach of chILD. Despite improvements in patient management, the therapeutic strategies are still relying mostly on corticosteroids although specific therapies are emerging. Larger longitudinal cohorts of patients are being gathered through ongoing international collaborations to improve disease knowledge and targeted therapies. Thus, it is expected that children with ILD will be able to reach the adulthood transition in a better condition.     

Corynebacterium species as one of the major causative pathogens of bacterial pneumonia

Recent advances using molecular methods, matrix-assisted laser desorption ionization time of flightmass spectrometry, and next-generation sequencers enable rapid and precise detection of bacterial species in the clinical samples, revealing bacterial diversities in the human body. Corynebacterium species are Gram-positive bacilli, which can cause pneumonia and have been reported as causative pathogens of lower respiratory tract infections since the 1970's. However, Corynebacterium spp. may be recognized and sorted as part of normal respiratory flora on Gram staining and culture, resulting in clinical under-recognition as pathogenic bacteria.The results of the clone library method using bacterial 16S ribosomal RNA gene sequence analysis in Japanese patients with hospital-acquired pneumonia revealed that bronchoalveolar lavage fluid obtained from the lung lesions contained 11.8% Corynebacterium spp., which was the second most predominant bacterial phylotype. Additionally, among patients in whom Corynebacterium spp. were detected, C. simulans was most commonly detected followed by C. striatum. In addition, almost half of the patients in whom C. simulans was detected was monophylotypic infection and/or co-detection of C. simulansand C. striatum. Further clinical information is expected on corynebacteria as pathogens of lower respiratory tract infection.