重度吸烟者肺部振动反应成像动态图像特征初探

目的探讨肺功能正常重度吸烟者的振动反应成像（vibration vesponse vmaging,VRI）动态图像特征。方法观察60例健康非吸烟者（对照组）和67例肺功能正常的重度吸烟者（重度吸烟组）VRI图像。首先采集两组受试者的临床资料（病史、体格检查、胸部X线）,然后进行肺功能测定和VRI检查,比较两组之间VRI动态图像特征的差异。结果重度吸烟组动态图像出现无序11例（16.4%）,跳跃43例（64.2%）,不同步11例（16.4%）,延迟6例（9.0%）,对照组动态图像无序4例（6.7%）,跳跃2例（3.3%）,不同步0例（0.0%）,延迟0例（0.0%）,这些征象在两组间的分布差异均有统计学意义。重度吸烟组的动态图像积分为1.22±0.42,明显高于健康非吸烟组0.13±0.01（P〈0.05）。结论肺功能正常的重度吸烟组的动态图像较对照组紊乱。     

振动反应成像技术在吸烟所致肺损害中的应用

目的 通过研究吸烟者和被动吸烟者肺部振动反应成像(vibration response imaging,VRI)图像特征,探讨VRI技术在吸烟所致肺损害中的应用价值.方法 纳入165名肺功能正常的研究对象,其中健康不吸烟者63名,吸烟者56名,被动吸烟者46名.分别进行临床资料的收集及VRI检测,比较3组受试者VRI图像差异.结果 吸烟组VRI振动能量曲线呼气相低平41.07％,平台28.57％,最大振动能量值1.57±0.29,呼气末有残留气体80.36％,图像评分6.21±2.03;被动吸烟组VRI振动能量曲线呼气相低平39.13％,平台30.43％,最大振动能量值1.66±0.33,呼气未有残留气体63.04％,图像评分5.43±1.87;不吸烟组VRI振动能量曲线呼气相低平6.35％,平台3.17％,最大振动能量值1.77±0.27,呼气未有残留气体25.40％,图像评分3.16±1.81.三组间比较差异有统计学意义.吸烟组VRI图像评分与吸烟指数有相关性.结论 吸烟者和被动吸烟者在肺功能出现异常之前其VRI图像即出现明显异常,提示VRI检测对于判断吸烟所致早期肺损害有重要意义.     

振动反应成像诊断系统在肺切除术后近期预后中的临床应用价值

目的 探讨应用肺部振动反应成像诊断系统(VRI)预测肺部手术残余肺功能与术后近期预后的相关性.方法 将2009～2010年在我院行肺叶切除、两叶切除、全肺切除的138例患者,根据VRI预测的术后肺功能数值分为3组,A组预测术后肺功能FEV1>1.0 L,B组预测术后肺功能0.8 L0.05).C组患者术后并发症明显增高,与A、B两组有明显差别(P<0.05),尤其全肺切除术后并发症发生率升高明显(P<0.05).结论 VRI预测肺切除术后肺功能>0.8 L时,肺切除术(包括全肺切除)是安全的;预测术后肺功能<0.8 L时,并发症发生率明显增高,手术要慎重,术前准备要充分.     

慢性阻塞性肺疾病患者振动反应成像与肺功能的相关性

目的 探讨振动反应成像技术(VRI)与慢性阻塞性肺疾病(COPD)患者肺功能的相关性.方法 对210例COPD患者行肺功能和VRI检查,分析VRI结果与肺功能的相关性.结果 COPD患者的VRI图像评分(10.81±3.61)分,振动值(1.56±0.47)分,右肺QLD值(49.63±12.03)%,啰音数(5.00...     

振动反应成像在轻中度慢性阻塞性肺疾病综合评估中的意义

目的探讨振动反应成像(VRI)动态图像特征在慢性阻塞性肺疾病(COPD)综合评估中的作用。方法观察42例肺功能轻-中度损伤的COPD患者,依据CAT评分将其分为轻度、重度症状组,对照组为16例健康志愿者,比较组间VRI动态图像特征的差异。结果重度症状组动态图像评分2.00±0.71,高于轻度症状组0.95±0.53及对照组0.06±0.25;振动曲线异常评分重度症状组为2.82±1.13高于轻度症状组2.00±0.71与对照组0.68±0.79。MEF形态评分重度症状组最为3.47±1.42,高于轻度症状组0.88±0.81与对照组0.18±0.40;CAT评分与曲线异常评分、图像异常评分、共振频率呈线性关系,R20.767,P0.05。结论在轻中度COPD综合评估中,VRI能较好反映COPD症状程度,具有一定的临床应用价值。     

慢性阻塞性肺疾病患者中央气道P物质、血管活性肠肽的分布及其意义

用免疫组织化学方法测定20例慢性阻塞性肺疾病(COPD)患者、30例肺功能正常的非COPD患者中央气道P物质(SP)、血管活性肠肽(VIP)的分布与含量,同时分析吸烟对其含量的影响以及含量与肺功能的关系.结果显示COPD组SP含量明显高于对照组(t=2.28,P＜0.05),且SP含量与肺功能(FEV1/FVC%)呈明显负相关(r=-0.795,P＜0.05);两组间VIP含量无显著差异(t=1.609,P＞0.05);对照组吸烟者SP含量显著高于非吸烟者(t=2.119,P＜0.05),而COPD组吸烟者与非吸烟者SP含量无显著差异(t=0.93,P＞0.05).提示SP可能参与COPD的发病过程.     

探讨VRI在支气管哮喘诊断过程中的临床应用价值

目的 使用振动反应成像(vibration response imaging,VRI)对支气管舒张试验患者的呼吸音动态图像进行分析,并与肺功能相关指标比较,初步探讨VRI在支气管哮喘(简称哮喘)患者诊断过程中的应用价值.方法 选择中国医科大学附属第一院就诊的141例进行气支管舒张试验患者,舒张试验前后分别进行VRI检查和肺功能测定,比较舒张试验阳性组以及阴性组前后VRI各项指标的差别；将各项差值与FEV1改善率和改善容积进行线型回归分析,以及ROC分析；统计舒张试验阳性组VRI各指标改善与恶化的比例.结果 ①支气管舒张试验结果:舒张试验阳性77例(FEV1％平均改善率14.18％),阴性64例.②VRI结果:阳性组舒张试验后,振动能量曲线评分、动态图像跳跃感、干啰音、EVP同步性较舒张试验前明显好转(P＜0.01),阴性组舒张试验后各指标无明显变化.③舒张试验阳性组VRI结果,包括振动能量曲线评分、图像总分、EVP同步性、干啰音与FEV1改善率相关.④ROC曲线提示振动能量曲线分析在哮喘诊断中的灵敏度为63％,特异度为81％；EVP同步性的灵敏度为55％,特异度为78％.结论 VRI在哮喘诊断过程中有一定的应用价值.     

吸烟者与非吸烟者的肺功能对比观察

目的探讨运用多排螺旋CT肺功能技术对吸烟者与非吸烟者的肺功能状态。方法选取100例吸烟者,作为研究组,并选取100例一般资料无显著差异的非吸烟者作为对照组。对两组的肺功能指标进行检测,并通过多排螺旋CT,检测两组主动脉弓、支气管分叉处吸气相和呼气相的PL-(900-950)、MLD的扫描值。结果与对照组对比,研究组用力呼气量占预计值百分比(FVC)、第一秒呼气容积占预计值百分比(FEV1)、第一秒呼气容积占用力呼气量百分比(FEV1/FVC)等肺功能指标明显低于对照组,差异有统计学意义(P0.05)。在吸气相下,两组主动脉弓、支气管分叉处PL-(900-950)、MLD的扫描值相似,差异没有统计学意义(P0.05)。在呼气相下,两组主动脉弓、支气管分叉处PL-(900-950)、MLD的扫描值具有明显差异,具有统计学意义(P0.05)。结论非吸烟者的肺功能明显优于吸烟者,在呼气相下借助CT诊断,可为临床诊断治疗提供依据。     

探讨VRI在支气管哮喘诊断过程中的临床应用价值

目的使用振动反应成像(vibration response imaging,VRI)对支气管舒张试验患者的呼吸音动态图像进行分析,并与肺功能相关指标比较,初步探讨VRI在支气管哮喘(简称哮喘)患者诊断过程中的应用价值。方法选择141例在门诊进行气支管舒张试验的患者,舒张试验前后分别进行VRI检查和肺功能测定,比较舒张试验阳性组以及阴性组前后VRI各项指标的差别;将各项差值与FEV1改善率和改善容积进行线型回归分析,以及ROC分析;统计舒张试验阳性组VRI各指标改善与恶化的比例。结果①支气管舒张试验结果:舒张试验阳性77例(FEV1%平均改善率14.18%),阴性64例。②VRI结果:阳性组舒张试验后,振动能量曲线评分、动态图像跳跃感、干啰音、EVP同步性较舒张试验前明显好转(P<0.01),阴性组舒张试验后各指标无明显变化。③舒张试验阳性组VRI结果,包括振动能量曲线评分、图像总分、EVP同步性、干啰音与FEV1改善率相关。④ROC曲线提示振动能量曲线分析在哮喘诊断中的灵敏度为63%,特异度为81%;EVP同步性的灵敏度为55%,特异度为78%。结论 VRI在哮喘诊断过程中有一定的应用价值。     

振动反应成像技术在COPD中的临床价值分析

目的探讨VRI在COPD中的临床价值。方法选择新疆医科大学一附院呼吸科行VRI及肺功能检查的100例住院慢阻肺患者与35例健康志愿者,分析VRI与肺功能的相关性。结果慢阻肺患者VRI结果与对照组相比存在显著差异(P<0.01),振动曲线异常和动态图像异常随病情严重程度而改变(P<0.05),且与FEV1%pred呈相关(复合相关系数r=0.549,P<0.01)。结论 VRI对COPD诊断及评价病情严重程度有重要临床价值。     

Vibration response imaging in healthy Japanesesubjects

BackgroundVibration response imaging (VRI) records the intensity and distribution of lung sounds during the respiration cycle. Our objective was to analyze VRI findings in healthy Japanese adults.MethodsVRI images of 106 healthy subjects (33.7±9.6 years, 52 male and 54 female), including 67 nonsmokers and 39 asymptomatic smokers, were recorded. The regional intensity of vibrations was assessed using quantitative lung data (QLD), and VRI dynamic images by rater assessment, left and right lung asynchrony (gap index), and regional lung asynchrony (asynchrony score).ResultsA dominance of total left lung QLD was observed in all subjects, and this phenomenon was more prominent in female subjects. However, there was no significant difference between the total left and total right lung QLD in smokers. Rater assessments showed that 81.1% of all subjects had a normal final assessment. Male subjects had a significantly higher percentage of good or normal assessments for all image scores, except dynamic image scoring. The asynchrony score was significantly higher in female subjects. There were no significant differences in these qualitative assessments between non-smokers and smokers.ConclusionsAlthough our QLD results were similar to those of a previous report, there were discrepancies between sexes for the qualitative assessments. A significantly higher number of female subjects had abnormal images as assessed by the raters. Furthermore, significantly higher asynchrony scores were observed in female subjects. The VRI variability in sex may be considered normal among the Japanese population. This study is registered with UMIN-CTR under registration number UMIN000002355.     

慢性阻塞性肺疾病中MMP-9/TIMP-1与Th17/Treg作用与联系

目的 检测慢性阻塞性肺疾病（COPD）外周血中Th17、Treg细胞占CD4^＋T细胞的比例、Th 17/Treg比值和血浆中MMP-9、TIMP-1含量、MMP-9/TIMP-1比值,探讨其在发病中的作用和机制.方法 COPD急性加重组患者30例,COPD缓解组25例患者健康吸烟组20例患者,健康非吸烟组20例患者;采用流式细胞分析技术检测Th17、Treg细胞占CD4^＋T细胞的比例,ELISA法检测血浆中MMP-9、TIMP-1含量.结果 外周血Th17占CD4^＋T细胞的比例在：COPD急性期组高于缓解组、健康非吸烟组、健康吸烟组,差异有统计学意义（P＜0.05）,COPD缓解期组与健康吸烟组相比差异无统计学意义（P＞0.05）,与健康非吸烟组相比差异有统计学意义（P＜0.05）.外周血Treg占CD4＋T细胞比例在：各组间比较,差异无统计学意义（F=1.971,P＞0.05）;Th17/Treg比值的：COPD急性期组分别与COPD缓解期组、健康吸烟组、健康非吸烟组比较,差异均有统计学意义（P＜0.05）,COPD缓解期组与健康吸烟和健康非吸烟组比较,差异无统计学意义（P＞0.05）;血浆中MMP-9含量的在：COPD急性期组与COPD缓解期组、健康吸烟组、健康非吸烟组比较,差异均有统计学意义（P＜0.05）,COPD缓解期组与健康吸烟组、健康非吸烟组比较,差异有统计学意义（P＜0.05）,血浆中MMP-9/TIMP-1比值：COPD急性加重期组与其他三组相比均有统计学意义（P＜0.05）,COPD缓解期组与健康组相比,均有统计学意义（P＜0.05）.结论 Th17、Treg细胞、MMP-9、TIMP-1可能均参与了COPD的发生和发展.Th17、MMP-9增高可能促发COPD的发生和急性加重,并且两者存在一定相关性,并相互影响,加重COPD的自体免疫反应.     

Permeability changes in bronchiolo-alveolar epithelium

The pathophysiology in the bronchiolo-alveolar region in healthy smokers and patients with interstitial lung diseases was assessed in terms of changes in epithelial permeability. The pulmonary epithelial permeability was estimated by the rate constant (referred to as "kep") of inhaled 99mTc-DTPA (diethylene triamine penta acetate) clearance from the lungs. Healthy nonsmokers had a mean kep value of 0.82 +/- 0.26%/min, and their kep values were constant irrespective of age or sex. Of healthy smokers 53% showed increased permeability. Young smoking males, whose lung injury was supposed to be limited mainly to respiratory bronchioles, showed increased permeability. This increase was correlated with their cigarette consumption per day and was reversible after stopping smoking. The patients with interstitial lung diseases also showed increased permeability as compared with healthy non-smokers. We believe that the method is a sensitive test to detect inflammatory changes in the bronchiolo-alveolar epithelium.     

振动反应成像技术在慢性气流受限疾病中的价值

目的 肺部振动反应成像(vibration response imaging,VRI)是一种新型肺部成像技术.本实验初步探讨慢性气流受限疾病的图像特点.方法 选取60例住院的慢性气流受限患者常规行肺功能及VRI检查,并分析图像特点.VRI检查包括曲线振动值、动态跳跃感、右肺QLD值、MEF图像缺陷、图像总评分.结果 慢性气流受限疾病存在特异的图像特征.曲线振动异常明显者多见于阻塞性通气功能障碍,表现为曲线不光滑、呼气相增高或形成单相曲线.气流受限越重则曲线异常评分越高,表现越异常则VRI图像总评分越高.结论 VRI在慢性气流受限疾病中有特异性表现,可作为一种新的检查手段应用于临床.     

振动反应成像技术用于稳定期慢性阻塞性肺疾病严重度分级的临床价值研究

目的探讨振动反应成像(VRI)在稳定期慢性阻塞性肺疾病(COPD)患者病情严重度分级中的应用价值。方法将2010年1月至6月南京医科大学附属南京第一医院呼吸科收治的210例COPD患者按病情严重度分为4级,对照组80名为健康志愿者,同时进行肺功能和VRI检查。结果 COPD组VRI结果与对照组相比差异有统计学意义(P<0.01)。振动曲线异常评分和动态图像异常评分随着COPD病情的严重程度显著增加(P<0.05)。结论 VRI在COPD病情严重程度分级中具有一定价值。     

Disassociation in the mucociliary function of central and peripheral airways of asymptomatic smokers

Mucociliary function of peripheral airways in asymptomatic smokers may be impaired and contribute to the abnormal airway changes described in these subjects. Techniques using the inhalation and deposition of radioactive particles followed by gamma camera imaging were applied to healthy subjects discordant for smoking habit to determine if mucus transport of peripheral and central airways was altered by smoking. Smokers (n = 8) averaged 26 +/- 2 yr (mean +/- SEM) and less than 7.5 pack-years of smoking, with pulmonary function within normal limits; when compared with the nonsmokers (n = 8) of similar age, their expiratory volumes were similar, i.e., FEV1 as a percent of predicted averaged 94.5 +/- 4% (mean +/- SEM) in the smokers and 98.8 +/- 4% in the nonsmokers. Using 24-h particle retention and planar distribution of particles in the chest as indexes of peripheral and central deposition, the 2 groups had similar deposition patterns. Mucus clearance of particles deposited onto tracheobronchial airways was quantitated as the interval between initial deposition and the time required to attain 75, 50, and 25% retention levels. Six of the 8 smokers had 75% retention times comparable to those of the nonsmokers, but the 50 and 25% retention times differed significantly between the 2 groups (p less than 0.025). Smokers cleared lung mucus at slower rates, i.e., the intervals to attain 25 and 50% retention levels were 60 to 90% greater than the mean values observed for nonsmokers. Velocity of mucus streaming within stem bronchi was comparable for the 2 groups; beta 2-adrenergic stimulation increased mucus transport in the smokers to the baseline control rates of the nonsmokers.(ABSTRACT TRUNCATED AT 250 WORDS)     

Sputum substance P and neurokinin A are reduced during exacerbations of chronic obstructive pulmonary disease

Involvement of tachykinins in airway inflammation has been demonstrated in animal models, but evidence in humans is sparse. The aim of this study was to quantify the levels of substance P and neurokinin A in induced sputum of patients with chronic obstructive pulmonary disease (COPD) and to compare them with the levels in smokers with normal lung function and healthy nonsmokers. Content of tackykinins was measured in 12 sputum samples collected during stable condition and nine sputum samples collected during exacerbations from 13 COPD patients, in eight sputum samples from smokers with normal lung function and in nine from healthy nonsmokers. Patients with COPD exacerbations had a lower sputum content of substance P compared with the other 3 groups (p<0.05). No differences were found between patients with stable COPD, smokers with normal lung function, and nonsmokers. Sputum levels of neurokinin A were trending in the same direction of substance P, but the significant difference was reached for the paired sputum samples collected from the same COPD patients (n=8) during exacerbation and in stable condition. COPD exacerbations are associated with a reduced sputum content of substance P and neurokinin A. These tackykinins might be involved in COPD exacerbations.     

CD8+ve cells in the lungs of smokers with chronic obstructive pulmonary disease.

Previous studies have shown an increased number of inflammatory cells and, in particular, CD8+ve cells in the airways of smokers with chronic obstructive pulmonary disease (COPD). In this study we investigated whether a similar inflammatory process is also present in the lungs, and particularly in lung parenchyma and pulmonary arteries. We examined surgical specimens from three groups of subjects undergoing lung resection for localized pulmonary lesions: nonsmokers (n = 8), asymptomatic smokers with normal lung function (n = 6), and smokers with COPD (n = 10). Alveolar walls and pulmonary arteries were examined with immunohistochemical methods to identify neutrophils, eosinophils, mast cells, macrophages, and CD4+ve and CD8+ve cells. Smokers with COPD had an increased number of CD8+ve cells in both lung parenchyma (p < 0.05) and pulmonary arteries (p < 0.001) as compared with nonsmokers. CD8+ve cells were also increased in pulmonary arteries of smokers with COPD as compared with smokers with normal lung function (p < 0.01). Other inflammatory cells were no different among the three groups. The number of CD8+ve cells in both lung parenchyma and pulmonary arteries was significantly correlated with the degree of airflow limitation in smokers. These results show that an inflammatory process similar to that present in the conducting airways is also present in lung parenchyma and pulmonary arteries of smokers with COPD.