Environmental and occupational lung diseases in Indonesia

Abstract Indonesia as a developing country has air pollution which is mainly caused by motor vehicle emissions and industrial smoke. The most important indoor air pollution is cigarette smoke. The prevalence of smoking among Indonesian men is 45.7%. Of the population, 10.8% are ex-smokers and 43.5% are non-smokers. Among the female population, only 1.8% smoke. There are some important factors that influence the air pollution in Indonesia; this paper identifies the real problems and their impact. The paper reviews various studies that have been carried out in Indonesia which were related to ambient air quality, industrial air pollutants and the respiratory problems resultant. From all available data, it is concluded that the air pollutants levels (SO₂, NOx, Ox, Pb, CO, HC) in large cities in Indonesia have exceeded the acceptable level, especially in industrial trade and heavy traffic areas. The more cigarettes inhaled and the deeper the inhalation, especially the kretek cigarettes, the risk of lung function abnormality becomes greater. Smoking high dose kretek cigarettes, that is ≥ 116 cigarettes/day x years, the risk of abnormal lung function is 13-fold that of a non-smoker; if added with the deep inhalation of smoke, the risk becomes 20-fold. Smoking increases the risk of occupational lung diseases. The level of dust in some industrial areas exceeded the standard level and correlated with respiratory problems. The existence of industry-caused air pollution in the environment increased the incidence of obstructive airway diseases. We conclude that the main cause of air pollution in Indonesia is motor vehicle emissions, followed by industrial smoke. Cigarette smoke is also related to abnormal lung function.     

肺癌侵及主动脉手术方法改进的探讨

目的介绍肺癌侵犯主动脉外膜手术方法改进的经验。方法回顾性分析11例肺癌侵犯主动脉的外科手术方法。结果11例患者经弹力层外部分主动脉外膜完整切除肿瘤,未行胸主动脉置换,达到了肺癌根治的效果。结论经弹力层外切除部分主动脉外膜进而完整切除瘤体治疗侵及主动脉的肺癌,是一种值得推广的方法。     

经纤维支气管镜肺活检对弥漫性间质性肺疾病的诊断价值

目的探讨经纤维支气管镜肺活检（TBLB）对弥漫性间质性肺疾病（D ILD）的诊断价值。方法报道168例D ILD患者,其中行TBLB病理检查确诊45例（26.79%）,分析患者性别、病理诊断构成比及误诊情况等。结果 45例患者中,误诊为非特异性肺炎8例,肺结核6例,肺癌5例,肺淋巴瘤4例,肺动脉高压3例,气道中心纤维化2例;女性患者明显多于男性（27 vs 18,P〈0.01）。D ILD患者中特发性间质性肺炎最多（32例）,其次是结缔组织病相关D ILD（8例）、结节病（5例）。结论 TBLB是诊断D ILD的有效手段,对D ILD的鉴别诊断和分类诊断有重要意义。     

Interstitial lung disease in the connective tissue diseases

The connective tissue diseases (CTDs) are inflammatory, immune-mediated disorders in which interstitial lung disease (ILD) is common and clinically important. Interstitial lung disease may be the first manifestation of a CTD in a previously healthy patient. CTD-associated ILD frequently presents with the gradual onset of cough and dyspnea, although rarely may present with fulminant respiratory failure. Infection and drug reaction should always be ruled out. A diagnosis of idiopathic ILD should never be made without a careful search for subtle evidence of underlying CTD. Treatment of CTD-ILD typically includes corticosteroids and immunosuppressive agents.     

Simultaneous two-level esophageal 24-hour pH monitoring in patients with mild and severe esophagitis

Simultaneous ambulatory esophageal pH monitoring was performed in 10 patients (group 1) with normal distal acid exposure and in 40 patients (group 2) with pathological distal reflux. The probes were placed 5 and 10 cm above the lower esophageal sphincter to quantify variations of pH values that can be due to a displacement of pH sensor. In group 1 the median percent time with pH<4 for total and upright monitoring periods and composite score were significantly lower at the proximal than the distal level. In group 2 all pH data were significantly lower at the proximal than the distal level. The patients with pathological reflux were subdivided into two subgroups based on endoscopic findings (mild and severe esophagitis). The patients with severe esophagitis showed a proximal acid reduction higher than in patients with mild esophagitis. Nine patients with mild esophagitis showed normal values at 10 cm, but all patients with severe esophagitis had abnormal proximal acid exposure.     

Infiltrative lung diseases in pregnancy

Pregnancy may affect the diagnosis, management, and outcome of infiltrative lung disease (ILD). Conversely, ILD may affect pregnancy. ILD may occur as a result of drugs administered commonly or specifically during pregnancy. Most ILDs predominate in patients older than 40 years and are thus rare in pregnant women. During pregnancy ILD may arise de novo and preexisting ILD may be exacerbated or significantly worsened. Some ILDs generally do not alter the management of pregnancy, labor, or delivery. Preexisting ILD no longer contraindicates pregnancy systematically, but thorough evaluation of ILD before pregnancy is required to identify potential contraindications and adapt monitoring.     

Metabolomics in chronic lung diseases

Chronic lung diseases represent a significant global burden. Their increasing incidence and complexity render a comprehensive, multidisciplinary and personalized approach to each patient, critically important. Most recently, unique biochemical pathways and disease markers have been identified through large‐scale metabolomic studies. Metabolomics is the study of metabolic pathways and the measurement of unique biomolecules in a living system. Analysing samples from different compartments such as bronchoalveolar lavage fluid (BALF) and plasma has proven useful for the characterization of a number of pathological conditions and offers promise as a clinical tool. For example, several studies using mass spectrometry (MS) have shown alterations in the sphingolipid metabolism of chronic obstructive pulmonary disease (COPD) sufferers. In this article, we present a practical review of the application of metabolomics to the study of chronic lung diseases (CLD): COPD, idiopathic pulmonary fibrosis (IPF) and asthma. The insights, which the analytical strategies employed in metabolomics, have provided to the dissection of the biochemistry of CLD and future clinical biomarkers are explored.     

凋亡与几种常见的肺疾病

凋亡是细胞的主动死亡过程,此过程涉及一系列基因的激活、表达和调控.在细胞的正常发育过程中,约有半数细胞通过凋亡途径被清除.20世纪80年代,凋亡开始成为研究热点,从凋亡角度探讨肺疾病的发生机制取得了一些进展,也为将来从凋亡角度治疗肺疾病奠定了基础.本文就细胞凋亡在几种常见肺疾病的发生机制研究中的最新进展作一综述.     

术前呼吸操训练对老年腹部手术患者肺功能及并发症的影响

目的探讨术前呼吸操训练对老年腹部手术患者肺功能及并发症的影响。方法选取107例在本院进行腹部手术的老年患者作为研究对象,随机将其分为观察组（54例）和对照组（53例）。对照组患者采用常规腹部手术围手术期护理方法;观察组患者在常规腹部手术围手术期护理方法的基础上进行术前呼吸操训练。记录并比较2组患者术后血氧饱和度（SpO2）、肺部并发症和术后住院时间的差异。结果观察组患者术后SpO2值高于对照组,差异有统计学意义（P〈0.05）;观察组患者肺部感染发生率为3.70%,显著低于对照组的32.08%,差异有统计学意义（RR=0.71;P〈0.05）;观察组患者的术后平均住院时间为（12.7±1.5）d,低于对照组的（16.6±6.3）d,差异有统计学意义（P〈0.05）。结论术前呼吸操训练能够改善老年腹部手术患者术后呼吸功能、降低肺部并发症风险和缩短术后住院时间。     

潮气呼吸肺功能测定在婴幼儿喘息性疾病中的应用及意义

儿童喘息疾病是一种综合性呼吸疾病,患儿通常患有变应性鼻炎、变应性皮炎等一些过敏性症状,同时还可能有家族遗传史的倾向,具有气道高反应性.潮气呼吸方法测定肺功能在儿科临床主要应用于婴幼儿,目前已成为临床测定婴幼儿肺功能的首选方法.本文对潮气呼吸肺功能各参数的临床意义及潮气呼吸肺功能在婴幼儿喘息性疾病中的应用作一综述,为其在婴幼儿喘息性疾病中的临床应用提供参考.     

12例间质性肺疾病合并肺癌临床分析

目的 了解间质性肺疾病合并肺癌的临床特点和治疗.方法 回顾性分析12例北京协和医院住院患者中诊断间质性肺疾病合并肺癌患者的临床症状、影像学、病理、治疗及预后.结果 12例患者,平均年龄(61±8)岁,男女比例11:1,平均吸烟指数(26±5)包·年,8例为特发性肺纤维化.临床表现包括干咳(10/12)、活动后气短(9/...     

Correlation between circulating fibrocytes, and activity and progression of interstitial lung diseases

Background and objective: Interstitial lung diseases (ILD) are characterized by progressive interstitial pulmonary fibrosis and a decline in lung function. Fibrocytes are bone marrow‐derived mesenchymal progenitor cells that may play a role in the pathogenesis of pulmonary fibrosis. Circulating fibrocyte numbers have been correlated with the prognosis of patients with idiopathic pulmonary fibrosis. The aim of the present study was to evaluate the relationship between circulating fibrocytes, and parameters of disease activity and progression in several groups of patients with ILD. Methods: The study population comprised 41 patients with ILD and seven healthy control subjects. Circulating CD45⁺ collagen‐I⁺ fibrocytes were evaluated by flow cytometry. Results: The number of circulating fibrocytes was significantly increased in all patients with ILD and particularly in patients with idiopathic interstitial pneumonitis and interstitial pneumonitis associated with collagen vascular disease as compared with healthy control subjects. The numbers of circulating fibrocytes were significantly correlated with pulmonary function test parameters and with serum levels of sialylated carbohydrate antigen, a marker of disease activity. Temporal changes in circulating fibrocyte numbers were evaluated in two patients, and the results suggested that these changes correlated with the activity of ILD. Conclusions: The results from this study provide further evidence for the role of circulating fibrocytes in fibrotic lung diseases.     

几种弥漫性结缔组织病肺间质病变的影像分析

目的了解与弥漫性结缔组织病相关的肺间质病变（CTD—ILD）的发生率、影像学特征及其与病种和临床指标的相关性。方法回顾分析我院几种弥漫性结缔组织病患者（共412例）资料，X线胸片检查或有肺部临床症状患者作胸部高分辨CT（HRCT）进一步检查确诊。了解ILD在不同弥漫性CTD中的发生率，对比X线与HRCT的差异，统计常用CT分类在本组疾病中的分布比例．探讨CT分类与不同病种或临床特征之间的关系。结果在412例弥漫性结缔组织病中，HRCT诊断的ILD共40例，总发生率为9．7％。其中皮肌炎／多肌炎为25％，硬皮病为23．8％，原发性干燥综合征为9．6％，系统性红斑狼疮为6．3％。胸片与CT符合率40％，胸片误诊漏诊率60％。ILDCT分类以两种病变共存最多见，其中毛玻璃样变占40．1％，实变影32．8％，网格影16．4％，蜂窝状影9．8％。呼吸道症状和补体C3，C4水平在毛玻璃样变组及实变影组；C反应蛋白（CRP）水平在蜂窝状影和实变影组较其他对照组明显高，它们之间差异有统计学意义（P〈0．05）。结论HRCT发现CTD—ILD的敏感性及准确性明显优于X线，其中以毛玻璃及实变影最多见；影像学改变与呼吸道症状及炎症指标有一定关系，尽早进行HRCT的检查有助ILD的早期诊断及预后判断。