CT扫描联合计算机软件系统对支气管内单向活瓣肺减容术筛查的价值研究

目的评估CT扫描联合计算机软件系统对支气管内单向活瓣(EVB)肺减容术患者筛查的价值。方法收集2013年11月至2014年11月广州医科大学附属第一医院诊断为重度慢性阻塞性肺疾病(慢阻肺)且行胸部高分辨率CT(HRCT)检查的患者550例。随机抽取121例,将HRCT导入VIDA软件系统自动分析各肺叶肺气肿含量及叶间裂完整性,计算、分析符合EVB置入肺减容术CT要求的概率及靶区肺叶分布情况。结果均匀性肺气肿101例(83.5%),非均匀性肺气肿20例(16.5%);叶间裂完整97例(80.2%),叶间裂不完整24例(19.8%);同时符合非均匀性肺气肿、叶间裂完整15例(12.4%)。靶区肺叶分布为:右上叶10例,左上叶1例,双上叶2例,双下叶1例,左下肺1例;上叶占83.3%(15/18),下叶占16.7%(3/18)。结论仅有少数重度慢阻肺患者符合EBV肺减容术CT筛查标准,CT扫描联合计算机软件系统是对重度慢阻肺患者行EVB肺减容术筛查的重要评估手段。     

64层螺旋CT肺容积成像在慢性阻塞性肺疾病中的诊断价值

目的研究64层螺旋CT肺容积成像技术在慢性阻塞性肺疾病诊断中的应用价值。方法选取124例肺疾病患者应用64层螺旋CT对其进行肺容积扫描,同时给予常规肺功能检查,根据检查结果分析64层螺旋CT肺容积成像技术在COPD诊断中的应用价值。结果观察组FEV1和FEV1/VCMAX均较对照组明显降低(P0.01),肺功能分级、RV、TLC、RV/TLC、FEV1和FEV1/VCMAX与右侧、左侧、全肺E/L指标呈现明显的相关性(P0.01)。结论 64层螺旋CT肺容积成像能快速、准确的测定肺气肿与肺总容积之比,对COPD的临床早期诊断具有明确意义。     

64 层螺旋 CT 肺容积成像在慢性阻塞性肺疾病中的诊断价值简

目的 研究64层螺旋CT肺容积成像技术在慢性阻塞性肺疾病诊断中的应用价值.方法 选取124例肺疾病患者应用64层螺旋CT对其进行肺容积扫描,同时给予常规肺功能检查,根据检查结果分析64层螺旋CT肺容积成像技术在COPD诊断中的应用价值.结果 观察组FEV1和FEV1/VCMAX均较对照组明显降低（P〈0.01）,肺功能分级、RV、TLC、RV/TLC、FEV1和FEV1/VCMAX与右侧、左侧、全肺E/L指标呈现明显的相关性（P〈0.01）.结论 64层螺旋CT肺容积成像能快速、准确的测定肺气肿与肺总容积之比,对COPD的临床早期诊断具有明确意义.     

经支气管镜肺减容术研究进展

肺减容术是治疗晚期肺气肿的选择之一,外科肺减容术由于其并发症、病死率及治疗费用等限制其发展.但促进了经支气管镜肺减容术的发展.目前包括经支气管镜旁路通气法肺减容术,经支气管镜生物学肺减容术,经支气管镜单向活瓣放置肺减容术,其微创、简便、痛苦及其并发症少等特点展现了其巨大的临床应用前景.     

肺气肿的CT肺功能成像:CT技术与肺功能检查的对照研究

目的　比较高分辨CT(HRCT)、CT肺功能成像及肺功能检查 (PFT)对肺气肿及阻塞性肺疾病 (COPD)的诊断效用。方法　阻塞性通气障碍组 37例 ,正常对照组 2 0名。所有入选者均在 1周内完成CT检查和PFT。比较HRCT视觉评分、CT肺功能成像参数与PFT结果的相关性和差异性。结果　 (1)CT检查发现 ,阻塞性通气障碍组 37例中有 2 3例有肺气肿征象归属肺气肿亚组。 (2 )HRCT视觉评估仅与PFT参数中一氧化碳弥散量 (DLCO)占预计值百分比存在相关性 (r =- 0 731,P <0 0 0 1)。 (3)肺气肿亚组的视觉分数与最大吸气末、呼气末各像素指数 (PI)存在相关性 ,其中分别与PI 950in、PI 950ex相关性最好 (r分别 =0 5 0 6、0 6 10 ,P均 <0 0 0 1)。 (4)利用PI 910in、PI 910ex分别对两组的肺功能进行分级 ,与一秒钟用力呼气容积 /用力肺活量 (FEV1/FVC)比值的分级结果比较 ,差异无显著性 (χ2 分别 =0 5 2 7、3 6 4 5 ,P分别 =0 913、0 30 2 ) ,采用PI 910in对肺气肿亚组分级与FEV1/FVC的分级结果比较 ,差异无显著性 (χ2 =2 5 9,P =0 4 5 9)。结论　HRCT诊断肺气肿较普通CT敏感 ,但受层厚和照射剂量的限制 ,不能用于对全肺的评估。CT肺功能成像结果客观 ,操作简单 ,与HRCT视觉评分及PFT结果相关性好 ,对早期肺气肿的诊     

肺减容手术治疗重度阻塞性肺气肿

目的 :为了提高肺气肿患者的生存质量 ,探讨肺减容手术治疗重度慢性阻塞性肺气肿的可行性及预后。方法 :本组肺减容手术 6例 ,其中同期双侧肺减容手术 2例 ,分期双侧肺减容手术 1例 ,标准后外侧切口单侧肺减容手术 3例。术前根据计算机断层摄影术 (CT)和同位素肺通气灌注扫描选择肺气肿手术“靶区” ,术中使用带牛心包垫的直线切割缝合器切除病变 ,防止肺泡漏气。结果 :手术时间 110～ 2 6 0min ,平均 16 6min ;术后主要并发症有肺持续漏气≥ 7d 4例 ,呼吸衰竭 1例 ,心房颤动 1例 ,肺部感染 1例。 4例手术结束即拔除气管内插管 ,2例带管回病房需要机械通气。随访 2～ 4 3个月 ,4例健在 ,术后患者呼吸困难指数上升为Ⅰ级 1例 ,Ⅱ级 2例 ,Ⅲ级 1例。结论 :慢性阻塞性肺气肿病人选择性手术能改善患者肺功能 ,提高生存质量 ,长期效果有待进一步观察     

支气管镜肺减容术之旁路通气法治疗肺气肿的研究进展

本文对支气管镜肺减容术尤其是旁路通气法治疗肺气肿研究成果和最新进展等进行综述.     

多层螺旋CT肺容积测定与肺功能检查对肺气肿诊断价值的比较

目的比较多层螺旋CT(MSCT)肺容积测定与肺功能检查(PFT)对肺气肿的诊断价值。方法42例肺气肿患者和40例门诊健康体检者均行MSCT肺容积测定和PFT检查。比较两组MSCT肺容积测定指标与PFT指标,并分析MSCT肺容积测定指标与PFT指标之间的相关性。结果肺气肿组患者Vin、Vex、Vex/Vin等指标明显高于对照组(P0.05),而Vin-Vex明显低于对照组(P0.05);肺气肿组患者TLC、RV、RV/TLC等指标明显高于对照组(P0.05),而FVC、FEV1、FEV1/FVC明显低于对照组(P0.05);Vin、Vex等MSCT肺容积测定指标与TLC、RV等PFT指标相关性最明显(P0.01),Vin-Vex与FVC、Vin/Vex与RV/TLC之间的相关性也最为显著(P0.01)。结论 MSCT可迅速和准确评估肺组织容积指标,与PFT检测指标具有良好的相关性,对肺气肿诊断和评估肺组织通气功能状况有一定的临床价值。     

单肺移植结合对侧肺减容术治疗终末期肺气肿一例

目的　探讨单肺移植结合对侧肺减容术治疗终末期肺气肿的手术适应证及疗效。方法　对 1例呼吸机依赖的重症肺气肿、肺功能严重下降的 4 7岁患者行左肺移植。术后第 7天因患者对侧肺逐渐过度膨胀致纵隔左移 ,压迫移植肺 ,而行右侧胸腔镜辅助小切口肺减容术。结果　肺减容术后第 1天患者纵隔移位明显改善 ,移植肺扩张良好 ;术后第 9、15天移植肺 2次出现急性排斥反应 ,用免疫抑制剂治疗 ,并于术后第 15天行气管切开、呼吸机间断辅助呼吸 ,病情缓解 ;术后第 2 4天患者下床活动 ,第 2 6天拔除气管插管 ;术后 2个月检查患者肺功能明显改善 ;术后第 71天出院。结论　单肺移植结合对侧肺减容术能治疗重症肺气肿单肺移植后的对侧肺过度膨胀 ,明显改善肺功能。     

高分辨力CT扫描与肺功能测验对肺气肿诊断价值的研究

对32例慢性阻塞性肺病（COPD）患者同期进行肺功能测验和肺部高分辨力CT扫描。结果显示肺CT分级与反映肺气肿程度有关的肺功能指标有非常显著的相关性。与肺功能检查相比较，高分辨力肺CT检查是探查有无肺气肿较好的方法，它可以区分正常肺质和轻或中度肺气肿，为肺气肿的定量诊断及早期诊断提供了一种无创伤性的检查方法。     

Collagen vascular disease-associated interstitial lung disease

Interstitial lung disease (ILD) is an important manifestation of collagen vascular diseases. It is a common feature of scleroderma, and also occurs in dermatomyositis and polymyositis, mixed connective tissue disease, Sjogren’s syndrome, rheumatoid arthritis, systemic lupus erythematosus, and Antineutrophil cytoplasmic antibody-associated vasculitis. When present, it is associated with increased morbidity and mortality, thus making early diagnosis important. In fact, in many patients, ILD may be the first manifestation of a collagen vascular disease. The most common symptoms are cough and dyspnea. The diagnosis is made based on pulmonary function tests showing restrictive lung disease and impaired oxygen diffusion and chest imaging showing ground glass infiltrates, interstitial thickening, and/or fibrosis. The most common histologic finding on lung biopsy is non-specific interstitial pneumonia, though organizing pneumonia and usual interstitial pneumonia may also be seen. Treatment is focused on addressing the underlying collagen vascular disease with immunosuppression, either with corticosteroids or a steroid-sparing agent such as cyclophosphamide, azathioprine, or mycophenolate, although the optimal agent and duration of therapy is not known. There are few clinical trials to guide therapy that focus specifically on the progression of ILD. The exception is in the case of scleroderma-associated ILD, where cyclophosphamide has been shown to be effective.     

The “horseshoe” lung: Six new cases

Six cases of horseshoe lung have been found in a group of 147 scimitar syndrome cases collected in a cooperative multicenter study. These cases were associated either with the severe infantile or with the benign adult form of the scimitar syndrome. The aim of this paper is to describe the clinical and imaging signs as well as the prognosis of 6 new cases of horseshoe lung in association with scimitar syndrome. The authors conclude (1) that the diagnosis of horseshoe lung may be strongly suspected on standard chest radiographs and confirmed by thoracic CT scan; (2) that the prognosis of scimitar syndrome does not seem to be worse when associated with horseshoe lung. Pediatr Pulmonol. 1994; 17:124–130 . © 1994 Wiley-Liss, Inc.     

Alterations of the Notch pathway in lung cancer

Notch signaling regulates cell specification and homeostasis of stem cell compartments, and it is counteracted by the cell fate determinant Numb. Both Numb and Notch have been implicated in human tumors. Here, we show that Notch signaling is altered in approximately one third of non–small-cell lung carcinomas (NSCLCs), which are the leading cause of cancer-related deaths: in ≈30% of NSCLCs, loss of Numb expression leads to increased Notch activity, while in a smaller fraction of cases (around 10%), gain-of-function mutations of the NOTCH-1 gene are present. Activation of Notch correlates with poor clinical outcomes in NSCLC patients without TP53 mutations. Finally, primary epithelial cell cultures, derived from NSCLC harboring constitutive activation of the Notch pathway, are selectively killed by inhibitors of Notch (γ-secretase inhibitors), showing that the proliferative advantage of these tumors is dependent upon Notch signaling. Our results show that the deregulation of the Notch pathway is a relatively frequent event in NSCLCs and suggest that it might represent a possible target for molecular therapies in these tumors.     

药物性肺损伤的临床诊断与治疗

目的探讨药物性肺损伤的临床、病理和影像学特征。方法回顾性分析北京协和医院2003年1月至2005年10月就诊的7例药物致肺损伤患者的临床、影像学、病理学特点、治疗及预后。结果7例患者中胺碘酮引起的肺损伤3例，α干扰素、阿托伐他汀、卡马西平及丙基硫氧嘧啶引起的各1例。临床表现为咳嗽、发热、胸闷气短，肺部可闻及爆裂音。胸部CT检查示双肺片状浸润影、磨玻璃样变、弥漫索条及网格状改变。1例病理可见肺泡间隔增宽及慢性炎症细胞（淋巴细胞、浆细胞、组织细胞）浸润，2例为富细胞性间质性肺炎改变，2例为闭塞型细支气管炎伴机化性肺炎表现，2例表现为弥漫性肺泡出血。结论药物性肺损伤诊断有一定困难，有服药史患者新近出现的或持续存在的呼吸系统症状均需除外药物性肺损伤。     

微卫星多态性分析鉴别非小细胞肺癌术后肺内转移与第二原发癌

目的 利用微卫星多态性分析探寻非小细胞肺癌（NSCLC）术后肺内复发转移与第二原发肿瘤（Second primary tumor，SPT）的分子遗传学差异以助鉴别诊断。方法 1994年1月至2002年8月接受手术治疗的21例Ⅰ-ⅢA期NSCLC患者，术后2—7年（中位2．8年）发现病理类型与原发NSCLC相同的肺内孤立肿瘤（腺癌7例，鳞癌14例），将之与相应的原发NSCLC石蜡包埋组织配对，以非恶性肺组织为对照，在显微组织切割基础上分离其DNA，应用PCR为基础的微卫星分析方法检测8个定位于染色体3p、9p及17p区域的高密度微卫星位点，确定每一位点在相应配对肿瘤组织中杂合性丢失的异同，并结合临床特点分析肺内孤立肿瘤是复发转移还是SPT。结果 根据临床及影像学特点，9例患者肺内孤立肿瘤转移的可能性较大，其中7例配对肿瘤组织在3p、9p及17p8个微卫星标志上等位基因杂合性丢失的位点相同，提示肺内孤立肿瘤与原发NSCLC具有共同的克隆起源，支持肺内转移癌的诊断。4例肺内孤立肿瘤患者的临床病理及影像学特点倾向SPT，其配对肿瘤3p、9p及17p上8个微卫星位点等位基因杂合性丢失条带不一致，表明肺内孤立肿瘤克隆起源相异于原发NSCLC，支持临床SPT的诊断。另8例肺内孤立肿瘤患者术前不能判定系SPT还是肺内转移，其中6例配对组织3p或3p与17P微卫星位点杂合性丢失模式一致，但9p或17p杂合性丢失不一致，临床随访发现该6例肺内孤立肿瘤术后6—13个月内可见肺内或远处转移，支持肺内孤立肿瘤为转移癌的诊断；2例配对肿瘤虽有一致的9p或17p微卫星位点杂合性丢失，但3p的杂合性丢失模式不一致，临床倾向SPT。结论 对NSCLC术后肺内孤立病灶，3p、9p、17p微卫星多态性分析其等位基因杂合性丢失有助于鉴别系肺内转移还是SPT，其中3p的杂合性丢失可能是鉴别诊断的重要生物学标志，需扩大样本进一步研究。     

Fungal Pseudoallescheria boydii lung infiltrates unresponsive to amphotericin B in leukaemic patients

The management of patients with acute leukaemia is often complicated by serious fungal infections, especially of the lungs. The outcome of therapy has historically depended on the early use, efficacy and tozicity of amphotericin B. Pseudoalksdttria boydii is an uncommon cause of such infections but as it is more often resistant to amphotericin B. early identification may enable the prompt use of alternative and newer antifungal agents. Here we report our experience and review the literature in three cases of P. boydii infection in patients with kukeamia, showing unique features such as childhood and central nervous system disease, positive blood cultures and response to itraconazole.     

Prognostic gene-expression signature of carcinoma-associated fibroblasts in non-small cell lung cancer

The tumor microenvironment strongly influences cancer development, progression, and metastasis. The role of carcinoma-associated fibroblasts (CAFs) in these processes and their clinical impact has not been studied systematically in non-small cell lung carcinoma (NSCLC). We established primary cultures of CAFs and matched normal fibroblasts (NFs) from 15 resected NSCLC. We demonstrate that CAFs have greater ability than NFs to enhance the tumorigenicity of lung cancer cell lines. Microarray gene-expression analysis of the 15 matched CAF and NF cell lines identified 46 differentially expressed genes, encoding for proteins that are significantly enriched for extracellular proteins regulated by the TGF-β signaling pathway. We have identified a subset of 11 genes (13 probe sets) that formed a prognostic gene-expression signature, which was validated in multiple independent NSCLC microarray datasets. Functional annotation using protein-protein interaction analyses of these and published cancer stroma-associated gene-expression changes revealed prominent involvement of the focal adhesion and MAPK signaling pathways. Fourteen (30%) of the 46 genes also were differentially expressed in laser-capture-microdissected corresponding primary tumor stroma compared with the matched normal lung. Six of these 14 genes could be induced by TGF-β1 in NF. The results establish the prognostic impact of CAF-associated gene-expression changes in NSCLC patients.     

Measurement of extravascular lung water in infants and children after cardiac surgery

Extravascular lung water (EVLW) was measured in 17 patients with congenital heart disease by the cold-green-dye, double indicator-dilution technique. In 5 control patients, EVLW was 4.7 ± 0.5 ml/kg (111 ± 13 ml/m²) (mean ± standard deviation). Twelve patients were studied immediately after correction of their heart defects. In 6 patients with normal or decreased pulmonary blood flow preoperatively (Group I), EVLW was 6.2 ± 1.9 ml/kg (122 ± 46 ml/m²). This value is not significantly different from that of the control patients. In 6 patients with increased pulmonary blood flow and congestive heart failure preoperatively (Group II), EVLW was 15.7 ± 3.8 ml/kg (270 ± 60 ml/m²), which is significantly different from both control and Group I patients (p < 0.01). There was no correlation of EVLW with pre- or postoperative left atrial pressure, length of cardiopulmonary bypass or deep hypothermic circulatory arrest, postoperative serum protein, albumin, hematocrit or cardiac index. Thus, EVLW in the immediate postoperative period is determined by preoperative pathophysiologic characteristics rather than by intraoperative management, and patients with congestive heart failure resulting from left-to-right shunts have increased EVLW despite normal left atrial pressures.