Combined pulmonary fibrosis and emphysema: How does cohabitation affect respiratory functions?

PurposeCombined pulmonary fibrosis and emphysema (CPFE) has emerged as a new syndrome with characteristics of both fibrosis and emphysema. We determined the impacts of radiologic emphysema severity on pulmonary function tests (PFTs), exercise capacity and mortality.Patients and methodsIPF patients (n = 110) diagnosed at the Chest Diseases Clinic between September 2013 and January 2016 were enrolled in the study and followed up until June 2017. Visual and digital emphysema scores, PFTs, pulmonary artery pressure (sPAP), 6-minute walking test, composite physiologic index (CPI), and survival status were recorded. Patients with emphysema and those with pure IPF were compared.ResultsThe CPFE-group had a significantly greater ratio of men(p < 0.001), lower BMI (p < 0.001), lower mean PaO₂ (p = 0.005), higher mean sPAP (p = 0.014), and higher exercise desaturation (p < 0.001). The CPFE group had a significantly higher FVC(L)(p = 0.016), and lower FEV1/FVC ratio (p = 0.002), DLCO, and DLCO/VA ratio(p = 0.03 and p = 0.005, respectively). Lung volumes of the CPFE group had significantly higher VC(p = 0.017), FRC (p < 0.001), RV(p < 0.001), RV/TLC(p < 0.001), and TLC(p < 0.001). There were significant correlations between emphysema scores and FVC (L)(p = 0.01), FEV1/FVC(p = 0.001), DLCO (p = 0.003), VC(p = 0.014), FRC (L)(p < 0.001), RV(p < 0.001), TLC(p < 0.001), and RV/TLC (p < 0.001). Mortality rates were comparable between the two groups. CPI (p = 0.02) and sPAP (p = 0.01) were independent predictors of mortality in patients with CPFE.ConclusionsThe presence and severity of emphysema affects pulmonary function in IPF. Patients with CPFE have reduced diffusion capacity, more severe air trapping, worse muscle weakness, more severe exercise desaturation, and pulmonary hypertension. CPI and pulmonary hypertension are two independent risk factors for mortality in subjects with CPFE.     

甲泼尼龙琥珀酸钠对自身免疫性肺气肿模型大鼠氧化应激和抗内皮细胞抗体的影响

目的:研究甲泼尼龙琥珀酸钠对自身免疫性肺气肿模型大鼠氧化应激和抗内皮细胞抗体(AECA)的影响。方法:将雄性SD大鼠随机分为对照组、模型组和干预组,每组8只。除对照组大鼠腹腔注射等体积的完全弗氏佐剂外,模型组和干预组大鼠均腹腔注射体外培养的人脐静脉内皮细胞+完全弗氏佐剂混合物以复制自身免疫性肺气肿模型;造模给药后第2天,干预组大鼠腹腔注射甲泼尼龙琥珀酸钠10 mg/(kg·d),对照组和模型组大鼠均腹腔注射等体积的生理盐水,每日1次,连续21 d。末次给药后,取各组大鼠右肺组织制作石蜡切片并行苏木精-伊红染色,观察肺组织病理变化,测量单位面积内的肺泡数(MAN)和内衬间隔(MLI);检测左肺肺泡灌洗液(BALF)中丙二醛(MDA)、还原型谷胱甘肽(GSH)含量和超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)活性,以及BALF和血清中AECA含量。采用Pearson分析模型组大鼠BALF中AECA与MDA、GSH、SOD、GSH-Px的相关性。结果:与对照组比较,模型组大鼠肺组织可见明显的肺气肿病理变化,其MAN显著减少,MLI显著延长(P<0.01);BALF中GSH含量和SOD、GSH-Px活性均显著降低,BALF中MDA含量以及BALF、血清中AECA含量均显著升高(P<0.01)。与模型组比较,干预组大鼠肺组织的肺气肿病理变化明显改善,其MAN显著增加,MLI显著缩短(P<0.01);BALF中GSH含量和SOD、GSH-Px活性均显著升高;BALF中MDA含量以及BALF、血清中AECA含量均显著降低(P<0.01)。模型组大鼠BALF中的AECA与MDA呈正相关(r=0.710,P<0.05),与GSH、SOD、GSH-Px呈负相关(r=-0.754、-0.781、-0.736,P<0.05)。结论:甲泼尼龙琥珀酸钠可能通过减轻氧化应激反应、抑制AECA的表达,从而达到预防自身免疫性肺气肿的目的。     

干细胞疗法在肺气肿治疗中的研究进展

COPD是一种持续性不可逆气道受限的常见呼吸系统的疾病，肺气肿是 COPD晚期的病理改变，目前为止，尚没有有效的治疗方法。干细胞有分化为各种组织细胞的潜能，大量动物实验已经证实了干细胞移植治疗肺气肿起到了一定效果，所以干细胞疗法在肺气肿的治疗中的前景令人憧憬。本文将对近年来干细胞在肺气肿治疗中的研究进展进行综述。     

清开灵合头孢哌酮舒巴坦钠治疗老年肺气肿合并感染的观察

目的观察清开灵联合头孢哌酮舒巴坦钠治疗老年肺气肿合并感染的疗效,并探讨其作用机理。方法将50例甘肃省第三人民医院住院部及门诊收治的哮喘患者,按照入院的先后顺序随机分为对照组和治疗组,对照组25例给予头孢哌酮舒巴坦钠,治疗组25例在对照组的基础上合用清开灵注射液。两组患者均以1周为一个疗程,治疗2个疗程后观察其疗效。结果两组患者分别从临床疗效,主要症状体征进行评价,治疗组完全缓解12例,部分缓解11例,无效2例,有效率为92.00%,明显优于对照组的56.00%。两组对比,差异有统计学意义(P0.05)。结论清开灵联合头孢哌酮舒巴坦钠治疗老年性肺气肿合并感染的疗效确切。     

糖尿病酮症酸中毒并发纵隔气肿、横纹肌溶解1例报告

该文报道1 例糖尿病酮症酸中毒并发纵隔气肿、横纹肌溶解。此患者因糖尿病酮症酸中毒急诊入院,病程中出现纵隔气肿,肌痛伴肌酸激酶、肌酸激酶-MB、血淀粉酶升高,经过积极补液、小剂量胰岛素等处理后病情好转。糖尿病最常见的急性并发症,多出现高血糖、高血酮、脱水、代谢性酸中毒及水电解质紊乱等征候群,但在糖尿病酮症酸中毒的诊治过程中,也需要关注并警惕少见并发症的发生,对于重症糖尿病酮症酸中毒的诊治及预后判断有积极的作用。     

Other conditions of the lung (abscesses,inhaled foreign bodies,bullous lung disease,hydatid)

Lung abscess remains a common complication of pneumonia and aspiration, particularly in immunosuppressed patients, and must be differentiated from a cavitary form of lung cancer. The conservative treatment with antibiotics is still the main therapeutic approach; however, percutaneous drainage may be employed in selected cases.     

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牙拔除术是一种常见的口腔外科手术,在术中、术后均可能会引起一些并发症,感染和皮下气肿就是其中的两种。本文针对拔牙术后感染和皮下气肿的发生原因、临床表现、治疗方式和预防措施进行阐述,以期为临床上避免或减少该类并发症的发生提供参考。