支气管扩张症高分辨率CT与肺通气功能的相关性

目的 探讨支气管扩张症(简称支扩)高分辨率CT(HRCT)与肺通气功能的相关性.方法 纳入经胸部HRCT诊断的支扩稳定期患者40例.根据CT评分系统对其胸部CT进行评分,并进行肺通气功能检查.结果 CT评分显示,支扩分布范围、扩张程度、管壁厚度分别为:(7.098±4.918)分、(6.540±4.113)分、(4.405±2.477)分.肺通气功能指标:FEV1占预计值%(FEVl%pred)为(56.122±26.335)%,FVC占预计值%(FVC%pred)为(66.857±21.951)%,FEV1/FVC为(64.612±14.890)%.支扩分布范围与FEV1 oApred、FVC%pred、FEV1/FVC均呈明显负相关(r=-0.451～-O.571,P值均<0.01).扩张程度、管壁厚度与FEV1%pred、FVC%pred、FEV1/FVC均无相关性.结论 支扩的分布范围与肺通气功能密切相关.     

支气管扩张症43例CT诊断

支气管扩张症 (支扩 )是临床常见的咯血原因之一。以往主要靠支气管碘油造影确诊 ,但由于碘油造影病人较痛苦 ,副作用大 ,近年来已逐渐被ＣＴ及高分辨率ＣＴ(ＨＲＣＴ)检查所取代。现对 1999年3月～ 2 0 0 1年 3月在外院进修期间经ＣＴ、Ｘ线平片及临床确诊 (其中 2 8例经手术病理证实 ,15例为支气管碘油造影证实 )的 43例支气管扩张病例进行总结 ,分析 ,并就有关问题进行讨论。1　资料和方法1 1　一般资料　本组 43例 ,其中男 2 9例 ,女 14例。年龄 60～ 82岁 ,平均 67 7岁。临床症状 :咳嗽 2 9例 ,咳痰 2 3例 ,咯血或痰中带血 2 0例 ,胸闷…     

螺旋CT诊断支气管扩张症的局限性

支气管造影是公认的诊断支气管扩张症的金标准 ,但因是侵入性检查 ,病人不容易接受 ;而且造影剂残留可引起机化性肺炎等副作用 ,近几年已被 CT取代。胸部 CT扫描具有非侵入性 ,病人耐受性好的优点 ,文献报导其敏感性及特异性都比较高 ,很多人都指出薄层螺旋 CT扫描可代替支气管造影用以诊断支扩 [1～ 3] 。但是 ,CT作为支气管扩张症新的诊断手段是否能解决所有问题 ?临床上一些高度怀疑的支气管扩张为什么会被螺旋 CT诊断为正常 ?我们使用改良的选择性支气管造影技术解决了气道造影剂残留的问题 ,而且以止血药调制造影剂可起到止血作用 …     

高分辨率CT与数字减影支气管造影诊断支气管扩张症的对 …

评价高分辩率ＣＴ在肺段水平对支气管张症的诊断价值。方法对２９例临床诊断为支扩症的患者共５２２个肺段分别行ＨＲＣＴ及数字减影支气管造影检查。结果ＨＲＣＴ与ＤＳＢ对支扩诊断具有良好的一致性;以ＤＳＢ作为诊断金标准,ＨＲＣＴ显示支扩的灵敏度为９４％,特异度为９８％;     

78例支气管扩张症急性加重患者临床分析

目的研究支气管扩张症急性加重患者主要临床表现、CT评分、病原菌分布。方法 2007年4月~2008年3月在四川大学医院就诊住院的78例支气管扩张症急性加重患者的临床资料。根据其是否合并其他系统合并症将其分为单纯支扩组,合并症组。根据CT评分系统进行支扩分布范围评分、行痰细菌及真菌学检查。比较两组患者在临床表现、CT评分、细菌感染率方面的差异。结果两组患者在临床表现、反映病变范围的CT评分均无明显差异。存在合并症组患者痰培养阳性率（53.85%）,与单纯支扩组（46.15%）比较,差异无统计学意义（P〉0.05）。在有合并症组患者中,其混合感染率（19.23%）较单纯支扩组（3.85%）明显增高,差异具有统计学意义（P〈0.05）。结论支扩患者中,存在合并症患者发生混合感染几率较单纯患者增高。     

慢性阻塞性肺疾病与支气管扩张症并存的相关性研究

COPD和支气管扩张症是两种不同、但又有着密切关联的慢性气道炎症性疾病.2015年全球慢性阻塞性肺疾病防治倡仪指出COPD合并支气管扩张症是一个特殊表型,而且是一种常见的恶化表型,其中长期带有铜绿假单胞菌定植的COPD合并支气管扩张症患者预后更差.其与更多的潜在的病原微生物和更频繁的急性加重有关.有针对性的同步治疗COPD与支气管扩张症可能增加患者获益.本文讨论了COPD合并支气管扩张症的相关性研究进展.     

支气管扩张症的外科治疗56例分析

目的探讨支气管扩张症的外科治疗经验。方法分析我科行手术治疗的支气管扩张症56例临床资料,总结手术指征、术前准备措施、手术技巧和并发症。结果 56例患者30例行单纯肺叶切除,26例行联合肺叶切除,术后13(23%)例患者出现房颤、室上速等心律失常,3(5.4%)例出现心功能不全,19(34%)例肺部感染。1例支气管残端瘘。56例患者中治愈35例(62.5%)、好转21例(37.5%)、死亡0例(0%)。无围手术期死亡病例。结论外科治疗是终末期支气管扩张症患者有效的治疗方法,特别是大咯血患者,可挽救患者生命。     

胸腔镜手术治疗支气管扩张症

目的探讨胸腔镜手术在支气管扩张症中的应用价值。方法2002年7月～2010年3月,对20例支气管扩张症行胸腔镜手术治疗。12例施行胸腔镜辅助小切口肺叶切除术,8例施行胸腔镜肺楔形切除术。结果1例因出血中转开胸。全组无围手术期死亡,围手术期并发症3例：术后肺持续漏气2例,肺部感染1例。平均胸管置管时间3．6d（2～7d）,术后住院平均9d（7～14d）。20例随访3～36个月,均恢复良好。结论胸腔镜手术治疗支气管扩张症在技术上是安全可行的,对于具有手术指征需行肺楔形切除或肺叶切除的支气管扩张症患者,胸腔镜手术是一种值得推荐的手术方式。     

支气管扩张症急性加重期研究进展

<正>支气管扩张症(支扩)是各种原因引起的支气管树的病理性永久性扩张,导致反复发生化脓性感染的气道慢性炎症。临床表现为持续或反复性咳嗽咳痰,有时伴有咯血,可导致呼吸功能障碍及慢性肺源性心脏病。支气管扩张症病程长,病变不可逆转,由于反复感染,特别是广泛性支气管扩张可严重损害患者肺组织和功能,严重影响患者的生活质     

258例严重急性呼吸综合征康复期患者肺功能与影像学动态随访与分析

目的　通过对严重急性呼吸综合征 (SARS)康复期患者进行定期临床随访 ,动态观察肺功能和肺部影像学的变化 ,了解SARS疾病的特点及预后。方法　 2 5 8例SARS患者康复后 2个月内先后 2次以上进行SARS冠状病毒特异性IgG抗体、肺功能和肺部影像学检查 ,并就发病期间的治疗情况进行回顾性分析。结果　 2 5 8例中有 2 0 8例SARS冠状病毒特异性IgG抗体为阳性 (80 6 % ) ,5 3例合并有肺一氧化碳弥散量 (DLCO)异常。IgG抗体阳性并DLCO异常的SARS康复者与DLCO正常的SARS康复者和IgG抗体阴性的康复者比较 ,发热病程较长 ,应用糖皮质激素剂量、接受氧疗比例和无创通气比例均较高。 5 1例DLCO异常的康复者动态肺功能复查结果 ,有 4 1例 (80 4 % )患者DLCO得到改善。 5 1例中有 4 0例肺部影像学检查有肺纤维化改变 ,1个月后再次复查有 2 2例 (5 5 % )有好转。结论　SARS康复者肺纤维化改变多发生在病情较重者 ,并在康复后一定时期内能够部分自行吸收 ,而肺部影像学改善要慢于肺弥散功能     

Bronchodilator response in adults with bronchiectasis: correlation with clinical parameters and prognostic implications

Background

Bronchial dilation testing is an important tool to assess airway reversibility in adults with bronchiectasis. This study aims to investigate the association of bronchodilator response (BDR) and clinical parameters in bronchiectasis, and the utility of BDR to indicate lung function decline and risks of bronchiectasis exacerbations (BEs).

Methods

We recruited 129 patients with clinically stable bronchiectasis. Baseline measurements included assessment of sputum inflammation and matrix metalloproteinase-8 and -9, sputum bacterial culture, spirometry, bronchial dilation test (for baseline FEV₁ less than 80% predicted only) and chest high-resolution computed tomography (HRCT). Bronchiectasis patients were followed-up for 1 year to determine the incidence of BEs and lung function trajectories. Significant BDR was defined as FEV₁ improvement from pre-dose value by at least 200 mL and 12%. Clinical trial registry No.: {"type":"clinical-trial","attrs":{"text":"NCT01761214","term_id":"NCT01761214"}}NCT01761214; URL: www.clinicaltrials.gov.

Results

BDR was negatively correlated with baseline FEV₁ percentage predicted, but not blood or sputum eosinophil count. Significant BDR was not associated with greater proportion of never-smokers, poorer past history, greater HRCT scores, poorer diffusing capacity or increased sputum matrix metalloproteinases (all P>0.05). There was a trend towards higher bronchiectasis severity index (BSI) and greater proportion of patients with Pseudomonas aeruginosa isolation or infection. Significant BDR at baseline was linked to poorer spirometry, but not more rapid lung function decline, throughout follow-up. Patients with significant BDR demonstrated non-significantly lower risks of experiencing the first BEs than those without (P=0.09 for log-rank test).

Conclusions

Significant BDR is associated with poorer lung function compared with non-significant BDR. Whether BDR predicts future risks of BEs needs to be tested in a larger cohort.     

High resolution computed tomography of the lungs in patients with rheumatoid arthritis

Pulmonary involvement is one of the most common extra-articular manifestations of rheumatoid arthritis (RA). The aim of this prospective study was to assess pulmonary involvement with high resolution computerized tomography (HRCT) in lifelong non-smoking patients with RA. Twenty-six female and eight male patients with a mean age of 45.26±11.6 years and without any evidence or symptoms of a respiratory disease were included in the study. Data were obtained regarding duration of disease, clinical symptoms and disease activity parameters. Standard chest roentgenographs, pulmonary function tests (PFT) and HRCT were performed. PFT was abnormal in eight (23.5%) and HRCT was abnormal in 23 patients (68%). The most frequent abnormalities obtained on HRCT were interstitial involvement including septal and peribronchial thickening and fibronodular infiltration, which were found in 23 patients, and bronchiectasis was found in nine patients. Using a highly sensitive technique such as HRCT the incidence of pulmonary abnormalities in asymptomatic rheumatoid patients may be much higher than previously reported. Received: 10 May 1999 / Accepted: 8 July 1999     

High resolution computed tomography findings in smear-negative pulmonary tuberculosis patients according to their culture status

Objective

The aim of this study was to assess the clinical features and high resolution computed tomography (HRCT) findings in smear-negative pulmonary tuberculosis (PTB) and to evaluate the correlation between these parameters and the culture results.

Methods

We retrospectively studied 78 active smear-negative PTB patients. They were divided into two groups according to their culture results. The HRCT findings and clinical features at the beginning of the antituberculosis treatment were reviewed.

Results

The mean age was 22.48±3.18 years. Micronodules (87%), large nodules (63%) and centrilobular nodules (62%) were the most common HRCT findings. HRCT findings were observed in the right upper (72%), left upper (56%), right lower (32%), and left lower lobes (29%). Cough (37%) and chest pain (32%) were the most frequent symptoms at presentation.

Conclusions

There were no significant differences in the HRCT findings and clinical features between the two groups. Thus, in cases of smear-negative and culture-negative PTB, the patient with compatible clinical and radiological features should be considered for tuberculosis treatment.     

Yellow nail syndrome: dystrophic nails, peripheral lymphedema and chronic cough

A case involving a 41-year-old man with yellow nail syndrome (YNS) is reported. YNS is a rare disorder characterized by yellow, dystrophic nails, peripheral lymphedema and bronchiectasis with recurrent lower respiratory tract infections. YNS is often misdiagnosed because the syndrome is not well known. An interdisciplinary approach is required to recognize and collate the components of the syndrome accurately. Correct diagnosis is of utmost clinical importance because YNS can occur secondary to malignancies and autoimmune disorders. Hence, the diagnosis of YNS must prompt further investigation.     

类风湿关节炎合并支气管扩张临床及危险因素分析

目的 回顾性分析类风湿关节炎(RA)合并支气管扩张病例资料,探讨其临床特点及相关危险因素.方法 分析自2008年5月至2013年5月入住.北京同仁医院RA合并支气管扩张病例的一般临床特征、肺功能、高分辨率CT等,与同期收治的单一RA病例进行对照分析,并应用Logistic回归探讨相关危险因素.结果 RA患者共计66例,其中RA合并支气管扩张19例,单一RA 47例.RA合并支气管扩张组有呼吸道症状者8例(42.1％),有呼吸系统体征者8例(42.1％),RA病程(16.6±9.1)年,呼吸病程(4.6±11.7)年,14例(73.7％)为RA先于支气管扩张发病,平均提前12年.支气管扩张好发于右肺中及下叶,分别为52.6％及36.8％.与单纯RA组相比,RA病程(P=0.045)、PEF(P=0.000)、FEV1.0(P=0.032)、FEF25-75(P=0.002)、DLCO(P=0.008)有显著统计学差异,RA相关免疫指标(RF、APF、CCP)、炎症指标(ESR、CRP)、治疗等方面无差别.多因素分析显示RA病程(P=0.018)及应用来氟米特(P=0.006)具有显著统计学差异.结论 RA人群中支气管扩张并不少见,好发于右肺中下叶,多伴有肺功能异常,RA病程及应用来氟米特为其独立危险因素.     

The utility of three-dimensional computed tomography for prediction of tumor invasiveness in clinical stage IA lung adenocarcinoma

BackgroundIt is critical to have an accurate measurement of solid tumor size in order to predict the invasiveness of small lung adenocarcinomas. Some lesions cannot be measured accurately via High-resolution computed tomography (HRCT) due to their irregular shape and unclear borders. For this reason, we evaluated the relative efficacy of three-dimensional (3D) CT for predicting invasive adenocarcinoma.MethodsWe evaluated 195 patients with clinical stage IA adenocarcinomas, including 109 with lesions documented as invasive that were surgically resected at our institute during 2017. All lesions were categorized as either (I) lesions that were difficult to evaluate (i.e., hazy lesions; HL) or (II) more typical lesions (TL). The relationships between solid tumor size as determined by HRCT, solid tumor volume as determined by 3D CT and pathologic diagnosis were evaluated.ResultsFifty-seven patients (29%) were diagnosed with HL. We set the cut-off value for the solid volume at 225 mm³ as predictive for invasive adenocarcinoma. When evaluating all 195 patients as a group, the accuracy, sensitivity, and specificity based on the solid tumor volume were similar to those based on the solid tumor size. When we limit our analysis to the HL group, the specificity based on solid tumor volume (65.5%) was higher than that based on solid tumor size (44.8%) with a difference that approached statistical significance (P=0.070).Conclusions3D CT was equivalent to HRCT for predicting invasive adenocarcinoma and may be particularly useful for diagnosing lesions that are difficult to evaluate on HRCT.