弥漫性泛细支气管炎初探

目的探讨弥漫性泛细支气管炎（DPB）的临床表现、实验室检查和治疗方案以及疗效。方法对1例长期咳嗽、咳痰的临床疑似弥漫性泛细支气管炎的患者进行X线、CT、肺功能、痰菌、动脉血气分析等检查，并采用阿奇霉素或罗红霉素治疗3个月。结果1个星期后咳嗽、咳痰明显减轻，3个月后症状基本消失。复查肺功能、CT、X线较治疗前明显改善。结论弥漫性泛细支气管炎发病确诊率低、易误诊，临床上要提高警觉。该病对大环内酯类药物较敏感，及时使用大环内酯药物治疗有效。     

弥漫性泛细支气管炎5例临床分析

弥漫性泛细支气管炎(DPB)是以肺部呼吸性细支气管为主要病变区域的特发性、弥漫性、炎性和阻塞性气道疾病,可表现为慢性咳嗽、咯痰和劳力性呼吸困难,并伴有气流受限[1].近年来国内陆续有报道,现结合2004年1月至2007年8月我科经病理或临床确诊的5例DPB病例,进一步阐明DPB的临床表现、诊断和治疗方法.     

弥漫性泛细支气管炎10例临床诊治分析

目的探讨弥漫性泛细支气管炎的临床特点,误诊原因,鉴别诊断,治疗和转归,以提高对该病的认识。方法回顾性分析10例弥漫性泛细支气管炎患者的临床资料。结果 10例弥漫性泛细支气管炎均有明确的鼻窦炎病史,临床表现均有持续性咳嗽,咳痰,活动后呼吸困难,病情轻重差异很大,易误诊,在我院就诊前,其中6例误诊为支气管扩张,2例误诊为慢性阻塞性肺疾病,2例误诊为肺间质纤维化。所有患者的血清冷凝集试验效价﹥1:64,肺功能FEV1/FVC%﹤70%,高分辨胸部CT表现为两肺弥漫大小不等颗粒状小结节影,伴有分枝"Y"字形树芽征,小结节影多在2~5mm左右,肺功能示阻塞性通气功能障碍,所有患者均口服罗红霉素0.3每日1次,疗程6个月,取得较好的效果。结论弥漫性泛细支气管炎是以两肺弥漫性呼吸性细支气管及其周围的慢性炎症为特征的气道疾病,临床对于表现为持续性咳嗽咳痰、活动后呼吸困难,伴有鼻窦炎的患者应结合胸部CT、肺功能、血清冷凝集试验效价,想到弥漫性泛细支气管炎可能,红霉素等14元环大环内酯类药物治疗弥漫性泛细支气管炎有显著疗效,如能早期应用效果更佳。     

1例弥漫性泛细支气管炎伴肺炎患者的用药分析

目的：了解弥漫性泛细支气管炎的病因、药物治疗方案、大环内酯类治疗该病的机制以及药学监护计划的实施。方法对本例患者的发病原因、药物治疗方案的选择、药学监护计划的实施以及用药指导进行逐一分析。结果发现弥漫性泛细支气管炎的确诊很重要，确诊后药物治疗需根据临床疗效及时调整方案，大环内酯类药物治疗弥漫性泛细支气管炎的机制不是抗感染。结论临床药师参与临床药物治疗方案设计有积极地作用。     

弥漫性泛细支气管炎的误诊分析

目的 总结和分析弥漫性泛细支气管炎的误诊现状,提高该病的诊疗水平.方法 回顾性分析24例确诊于中国医科大学呼吸疾病研究所的弥漫性泛细支气管炎病例和利用中国生物医学文献数据库(CBM)检索2000-2012年报道的50例弥漫性泛细支气管炎病例的临床资料.结果 所有患者确诊前均被多次误诊.误诊疾病前5名按误诊率依次为支气管扩张症、慢性支气管炎、慢性阻塞性肺疾病、支气管哮喘、肺结核.按Akira分期第1期17例,第2期14例,第3期21例,第4期22例.58.1％(43/74)的患者确诊时已经处于中晚期.铜绿假单胞菌感染率达43.2％(32/74).74例患者均有慢性鼻窦炎,仅25例(33.8％,25/74)有明确慢性鼻窦炎病史.8例(10.8％,8/74)患者咯血.结论 我国弥漫性泛细支气管炎误诊的现状仍非常严峻,支气管扩张症是最常见的误诊疾病.特征性的影像学异常和慢性鼻窦炎是与其他疾病相鉴别的重要依据.     

弥漫性泛细支气管炎探讨-附24例报告

目的：提高对弥漫性泛细支气管炎（DPB）临床特点的认识。方法：对24例DPB进行回顾性分析。结果：所有患者均有咳嗽，咳痰和活动后气促三大症状，合并有鼻窦炎或既往有鼻窦炎和鼻息肉摘除史100％，本组患者人体白细胞抗原（HLA）B54阳性率53．8％，冷凝集试验＞1：64占87．5％，动脉血氧分压（PaO2)＜80mmHg占91．3％，FEV1／FVC＜70％占95．2％，胸部X线显示两肺弥漫性小结节阴影伴肺过度膨胀占60．8％，胸部HRCT显示双中下肺野弥漫性小叶中心性结节影占86．9％，病理组织学确诊19例，临床诊断5例。结论：识别DPB的临床特点，结合特征性胸部影像学表现，有助于本病的早期诊断，小剂量红霉素治疗有肯定疗效。     

大环内酯类抗生素在呼吸科中的运用探讨

大环内酯类抗生素是一种呼吸科常用的抗生素,临床上发现它除了抗生素作用外,还对弥漫性泛细支气管炎(DPB)、副鼻窦-支气管综合征(SBS)、支气管扩张、肺结核、哮喘等具有良好的治疗作用,故越来越受到临床医生的重视。1大环内酯类药物的抗生素作用大环内酯类(macrolides)的抗菌谱与青霉素G相似,属窄谱抑菌抗生素,对需氧革兰阳性菌如葡萄糖菌属、链球菌属、李斯德菌属、炭疽杆菌属等有较强抗菌活性,对肠球菌属也有一定作用。对革兰阴性球菌作用较差,支原体(Mycoplasma)和衣原体(Chlamydia)属对本类特别敏感。大多数厌氧菌对本类敏感,脆弱类…     

继发性弥漫性双肺间质肉芽肿1例

1 临床资料 患者,男,53岁.因咳嗽,咯痰,气短1月于2000年12月11日入院.该患者于2000年11月初出现咳嗽,咯痰,气短,至12月7日增重.在门诊查双肺CT,考虑为间质性肺炎,结节病,弥漫性泛细支气管炎.     

继发性弥漫性双肺间质肉芽肿1例

1 临床资料 患者,男,53岁。因咳嗽,咯痰,气短1月于2000年12月11日入院。该患者于2000年11月初出现咳嗽,咯痰,气短,至12月7日增重。在门诊查双肺CT,考虑为间质性肺炎,结节病,弥漫性泛细支气管炎。患者从事柴油发电机工作30年。查体:T 36.1℃,BP 130/80mmHg。双肺听诊呼吸音     

弥漫性泛细支气管炎

弥漫性泛细支气管炎(ｄｉｆｆｕｓｅｐａｎｂｒｏｎｃｈｉｏｌｉｔｉｓ,ＤＰＢ)是日本的本间、山中、谷本等于1969年首次确立的,以弥漫性呼吸性细支气管区域的慢性炎症为特征的难治性疾病,常可导致呼吸衰竭。本病病因未明,多合并慢性鼻窦炎或有既往史,与人类白细胞抗原(ＨＬＡ)Ｂｗ54密切相关,提示与遗传因素有关。ＤＰＢ预后不良,根据1981年日本厚生省的调查结果发现,自初诊开始后5年生存率为42%,若合并铜绿假单胞菌感染,则仅为8%;自1984年开始应用小剂量红霉素(ＥＭ)以来,预后明显改善,5年生存率高达9034%[1]。本病或有人种特异性,在日本…     

Modeling of HLA class II susceptibility to Type I diabetes reveals an effect associated with DPB1.

In this report, we present evidence that the HLA class II DPB1 locus (or a locus with alleles in linkage disequilibrium with DPB1) contributes to Type I diabetes (IDDM) susceptibility in addition to the contribution of the HLA DR and DQ loci. The marker association segregation chi-square (MASC) method, which fits both genotype frequency and affected sib-pair identity-by-descent (IBD) distributions, was applied to 257 sib pairs affected with IDDM. Fitting DR-DQ as the sole HLA susceptibility loci was strongly rejected. Next, we considered the DPB1 contribution to disease susceptibility. Published reports indicate a predisposing role for alleles DPB1*0301 and DPB1*0202, including our previous stratification analyses of association data on this sample. IDDM probands were stratified into those not carrying the alleles DPB1*0301 and DPB1*0202 (group DPB1-A), and those carrying at least one copy of either allele (group DPB1-B). Both groups of probands have almost identical frequencies of DR and DQ haplotypes but significantly different IBD distributions in the subset of families with probands who do not carry the highly predisposing DR3/DR4 genotype. In these data, DPB1 (or a locus in linkage disequilibrium), in addition to DR-DQ, is involved in IDDM susceptibility and affects IBD in the HLA region. Addition of DPB1 in a genetic model of IDDM gives a better fit to the data than consideration of DR-DQ alone. Our results are consistent with previous reports implicating DPB1 in IDDM susceptibility.     

Importance of HLA-DQ and HLA-DP polymorphisms in cytokine responses to naturally processed HLA-DR-derived measles virus peptides

We studied the association between class II human leukocyte antigen (HLA)-DRB1*0301 presented measles virus (MV) peptide-specific cytokine responses and DQB1 and DPB1 alleles among 313 individuals who received two doses of measles-mumps-rubella-II vaccine. The overall median IFN-gamma secretion levels (first and third quartiles) for the 19-amino acid MV phosphoprotein (MV-P)- and 14-amino acid MV nucleoprotein (MV-N)-derived peptides were 27.7 pg/ml (1.8, 109.4) and 1.9 pg/ml (-6.2, 13.0), respectively; median IL-4 secretion levels were -0.6 pg/ml (-7.1, 6.2) and 2.4 pg/ml (-3.2, 9.3), respectively. Primary statistical analyses were adjusted for previously identified DRB1 associations. A marginally significant increase in the frequency of the DQB1*0604 (p=0.02) allele was found among subjects who demonstrated detectable IL-4 levels to the MV-P peptide. Further, DPB1*0201 (p=0.02) and DPB1*1301 (p=0.09) alleles provided suggestive evidence of an association with MV-P-induced IL-4 secretion. Examination of IFN-gamma responses to MV-P and MV-N indicated that none of the individual alleles of the DQB1 and DPB1 loci were associated with peptide-induced T cell response. An increase in the frequency of DPB1*0501 (p=0.01) was found among subjects who failed to produce MV-N peptide-specific IL-4 responses. These data further confirm that HLA-DRB1 alleles are the major restriction molecules for MV-P and MV-N measles virus antigen presentation to T cells. We speculate that MV-P and MV-N peptides derived from DRB1*0301 could potentially be recognized in association with different HLA molecules, including DQB1 and DPB1; however, statistical adjustments for the effect of HLA-DR locus could potentially alter these genetic relationships. This concept provides important information supporting the use of promiscuous peptides in a peptide-based vaccine approach.     

CT pathologic correlative study of diffuse panbronchiolitis

We studied CT-pathologic correlations of diffuse panbronchiolitis. The CT images of five DPB patients were compared with inflated lung specimens taken from three open lung biopsy, one lobectomy and one autopsy. The specimens were observed using a stereomicroscope, contact radiographs and histological section. All cases were diagnosed histologically by the presence of unit lesion of panbronchiolitis. The CT findings of DPB were: 1. diffuse small rounded and linear opacities, 2. dilation of small bronchi and bronchioles, 3. bronchial wall thickening. Because small rounded opacities on the CT images were usually separated from the pleura and PV shadows (the edge of secondary lobules) as a constant distance (2 to 3 mm), they were distributed in centrilobular regions. They corresponded to the collection of foamy histiocytes and lymphoid cells, where the unit lesion of panbronchiolitis were included. Although peripheral airways could never be seen in normal CT images, small linear opacities or enlarged peripheral vascular opacities just continuous with small rounded opacities corresponded to bronchioles dilated with intrabronchial secretion. In addition, peripheral airways were sometime seen to be dilated in CT images. Cylindrical airway dilation was more prominent in the peripheral portion of airways in both CT images and lung specimens. Thickening of bronchial wall observed in CT of a case could not be confirmed in lung specimen, in which probably intrabronchial secretion might contribute to bronchial wall thickening. From the viewpoint of diagnosis, the problem is that small nodular shadows are too large to show respiratory bronchiolitis itself. Moreover, because bronchiectasis is often found in the cases of DPB, the relationship between DPB and other causes of bronchiectasis should be evaluated.     

扁头综合征相关研究进展

扁头综合征(DPB)是指婴儿头骨后位或侧位发生不同程度的扁平畸形,导致婴幼儿智力、运动等神经系统病变产生不可逆改变的疾病,亟需临床医生在儿童保健工作中尽早干预。随着医疗技术的革命性进步,目前国内外相关文献对该病的研究有长足的进展,本文拟从扁头综合征的危险因素、分型、诊治及预后进行综述,旨在为婴儿保健工作提供较为详尽的临床资料,临床尽早预防、纠正小儿头骨不同程度的异常,避免脑结构生长错位或受限,从而提高青少年的生活质量。     

A single question about a respondent’s perceived financial ability to pay monthly bills explains more variance in health utility scores than absolute income and assets questions

Purpose

To evaluate a general question about ability to meet monthly bills as an alternative to direct questions about income and assets in health utility studies.

Methods

We used data from the National Health Measurement Study—a US nationally representative telephone survey collected in 2005–2006. It included health utility measures (EuroQol-5D-3L, Health Utilities Index Mark 3, Short Form-6D, and Quality of Well-being Index) and household income, assets, and financial ability to meet monthly bills questions. Each utility score was regressed on: income and assets (Model 1); difficulty paying bills (DPB) (Model 2); income, assets, and DPB (Model 3). All models used survey weights and adjusted for demographics and education.

Results

Among 3666 respondents, as income and assets increased, DPB decreased. The DPB question had fewer missing values (n = 30) than income (n = 311) or assets (n = 373). Model 2 (DPB only) explained more variance in health utility than Model 1 (income and assets only). Including all measures (Model 3) had very modest improvement in R ², e.g., values were 0.112 (Model 1), 0.166 (Model 2), and 0.175 (Model 3) for EuroQol-5D-3L.

Conclusions

The single question on DPB yields more information and has less missing values than the traditionally used income and assets questions.

     

Response to hepatitis B vaccination is co-determined by HLA-DPA1 and -DPB1

Background and aimsNo report explored the combined effects of HLA-DPA1 and -DPB1 with long-term response to hepatitis B (HB) vaccination (HBVac). The specific aims of the study were to assess the combined effects and relative contributions of DPA1 and DPB1 genes.MethodsThe cases were 152 adolescents who had undetectable (<1.0 mIU/mL) post-booster anti-HBs titers and the controls were adolescents who had residual anti-HBs ≥ 10 mIU/mL at aged 16 years (n = 207) or had detectable (≥1.0 mIU/mL) anti-HBs titers after booster HBVac (n = 481). HLA-DPA1 and -DPB1 genotypes were determined by sequence-based typing.ResultsHLA-DPA1*01:03:01 was correlated with lower ORs of undetectable anti-HBs titers, while -DPA1*02:02:02 and -DPB1*05:01:01 were correlated with higher ORs. The ORs for HLA-DPA1*01:03:01-DPB1*05:01:01 and DPA1*02:02:02-DPB1*protective combinatory types were significantly less than 1.0. As compared with subjects who had no protective allele, the adjusted ORs (95% CI) were 0.545 (0.328–0.906), 0.350 (0.174–0.702), and 0.122 (0.058–0.257), for subjects who had protective alleles on DPA1only, DPB1 only, and both genes, respectively. Analyses of amino acid polymorphisms showed that subjects who carried Arg81-Pro158-Val191-Pro259α + Met234β and Gln62-Arg82α + Met234β combinations had 4.3-to-4.6 folds of risks.ConclusionBoth DPA1 and DPB1 genes contribute to the persistence of immunological response to primary infantile HBVac. The effects of HLA-DP risk alleles were dominated by the protective alleles and there were significant gene-gene interactions. Our findings provide evidences for the design of more potent HB vaccine.     

Genetic risk factors for perinatally acquired HIV-1 infection

This study evaluates genetic influence on susceptibility to perinatal HIV-1 infection among 106 Black infants from New York and San Francisco born to mothers infected with HIV-1. Genes tested by molecular techniques are HLA class II loci DRB1, DPB1 and DQA1; HLA class III loci complement C4A and C4B; alpha and beta interferons; and the constant region of the T-cell receptor beta chain. Of the 106 infants analysed, 54 are infected with HIV and 52 remain uninfected at age 15 months and older. Genotypes in the HLA region appear to influence risk of HIV infection. Specifically, infants with the amino acid sequence -asp-glu-ala-val- at DPB1 positions #84-87 are more likely to be infected (P = 0.001) and infants with the allele DQA1*0102 are less likely to be infected (P = 0.031). Combinations of these two risk factors show a strong dose response (P = 0.0005). HLA DPB1 and DQA1 may play a direct role in immune response associated with HIV-1 infection, or the critical region may be located between these two genes. Characterisation of other class II HLA genes in these infants will allow more precise determination of the role of HLA loci in susceptibility to HIV-1 infection.     

Anti-caspase-8 autoantibody response in silicosis patients is associated with HLA-DRB1, DQB1 and DPB1 alleles

We reported previously the autoantibodies directed to caspase-8 among patients with silicosis, systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) , and in healthy individuals. In this study, we analyzed the correlation between anti-caspase-8 autoantibody responses and HLA class II alleles in silicosis patients. The frequencies of HLA-DRB1*0406 were significantly higher in antibody positive patients (16.67%) than in control individuals (3.03%, p=0.0006). The lysine (K) at position 71 as in DRB1*0406 has been reported to be associated with rheumatoid arthritis (RA) and insulin dependent diabetes mellitus (IDDM). The haplotype HLA-DR4; DQB1*0302 was detected in 4 of 12 antibody positive patients. RA, IDDM, or pemphygus vulgaris link to the haplotype. The frequencies of DQB1*0401 were significantly lower in antibody positive patients (0%) than that in controls (13.33%, p=0.0390). The aspartic acid at position 57 in the DQB1 molecule as in DQB1*0401 is reported to play a role in the resistance to IDDM. The frequency of DPB1*0601 in antibody positive patients (5.88%) was significantly higher than that in controls (0.56%, p=0.0003). DPB1*0601 is reported to be a risk factor among RA patients, and glutamate at position 69 of the DPB1 molecule may be involved. Repeated and continuous screening of autoantibodies seems to be necessary among workers in contact with Si-related substances for the detection of immunological disorders in the early stage.     

Toxicity of Degradation Products of the Antifouling Biocide Pyridine Triphenylborane to Marine Organisms

We evaluated the acute toxicities of the main degradation products of pyridine triphenylborane (PTPB), namely, diphenylborane hydroxide (DPB), phenylborane dihydroxide (MPB), phenol, and biphenyl, to the alga Skeletonema costatum, the crustacean Tigriopus japonicus, and two teleosts, the red sea bream Pagrus major and the mummichog Fundulus heteroclitus. DPB was the most toxic of the degradation products to all four organisms. The acute toxicity values of DPB for S. costatum, T. japonicus, red sea bream, and mummichog were 55, 70, 100, and 200–310 μg/L, respectively. The degradation products were less toxic than PTPB to S. costatum and T. japonicus; however, the toxicities of DPB and PTPB to the fish species were similar. We also examined changes in the inhibition of growth rate of S. costatum as well as the percentage of immobilization of T. japonicus as end points of toxicity of PTPB after irradiation of PTPB with 432 ± 45 W/m² of 290–700 nm wavelength light. After 7 days of irradiation with this light, the concentration of PTPB in the test solutions decreased markedly. A decrease in toxic effects closely coincided with the decrease in the concentration of PTPB caused by the irradiation. PTPB probably accounted for most of the toxicity in the irradiation test solutions. Because the concentrations of PTPB that were acutely toxic to S. costatum and T. japonicus were <10 % of the corresponding concentrations of its degradation products, PTPB probably accounted for most of the toxicity in the irradiation test solutions.