支气管扩张症发病的免疫机制研究进展

支气管扩张症是一种常见的慢性支气管疾病。其发病基础为支气管壁的炎性损伤和支气管阻塞的相互作用。病因涉及诸多方面，其中免疫学方面的有关发病机制受到了各国学者的关注。本文就体液免疫、细胞免疫、其它致病因素及治疗方面阐述了支气管扩张症发病机制中可能存在的免疫学因素。     

支气管扩张症发病机制及治疗进展

支气管扩张症在世界范围内发病率均有所增加,但其异质性较强,目前对其病因、发病机制及有效治疗等方面的研究相对较少,我们对这一疾病还有待进一步认识.目前认为其发病机制主要有免疫失调及细菌定植两个方面.近来大环内酯类抗生素对支气管扩张症的治疗方面也取得了一些进展.本文就非囊性纤维化支气管扩张症流行病学、病因学、发病机制及治疗方面的进展进行综述.     

非囊性纤维化性支气管扩张症的免疫调节机制

支气管扩张症是慢性炎症性支气管疾病的一种,病理上表现为一个或多个支气管的永久性扩张。非囊性纤维化性支气管扩张症的发病往往与反复感染、免疫缺陷或自身免疫性疾病相关,也有相当一部分呈特发性。细菌定植、气道炎症和气道结构损伤这样一个恶性循环导致了支气管扩张症的发生,其中气道炎症承前启后,是整个恶性循环的关键,因此研究气道炎症的免疫调节机制对理解其发病机理具有重要意义,并可指导支气管扩张症的药物研发。本文着重讨论了与支气管扩张症的发病密切相关的细胞与分子免疫调节机理,并阐述了细菌慢性定植的机理,还结合免疫调节讨论了支气管扩张症的新药研发。     

吸入性β2受体激动剂联合盐酸氨溴索治疗支气管扩张症疗效观察

支气管扩张症是常见的慢性支气管感染性疾病,支气管、肺组织感染和支气管阻塞是其主要的发病因素。2006年1月～2007年4月,我们对支气管扩张症急性加重期患者应用吸入性β2受体激动剂和盐酸氨溴索治疗,取得良好的效果。现报告如下。     

炎症细胞和细胞因子在支气管扩张症中的作用

支气管扩张症是一种常见的慢性支气管疾病.其发病基础为支气管壁的炎性损伤和支气管阻塞的相互作用.炎症细胞、细胞因子在支气管扩张症的气道炎症中起重要作用,抗炎治疗受到了各国学者的关注.     

支气管扩张症患者肺部微生态研究进展

支气管扩张症近年来发病率及患病率显著升高, 其发病与加重机制尚未完全阐明, 有研究表明, 肺部微生物群的构成和丰度变化是导致支气管扩张患者病情加重的重要原因之一, 因而受到广泛关注。支气管扩张症患者肺部有多种微生物定植, 其中, 不同患者肺部定植的核心菌群不同, 以铜绿假单胞菌为代表的核心菌定植是导致支气管扩张症患者肺功能下降和加重频率增加的独立危险因素。本文就支气管扩张症稳定期和加重期肺部微生态的变化进行综述, 希望对支气管扩张症的治疗带来启发。     

050 稳定期支气管扩张的痰弹性蛋白酶[英]/Tsang KW…∥Chest.-2000,117 (2).-420 ～426

支气管扩张的病理学定义是指永久性的支气管扩张.表现为慢性咳痰、反复加重,有时呈进行性肺部破坏.其发病机制尚不清楚,但新近有研究证实感染、炎症,酶成份之间的相互作用导致了气管支气管破坏的恶性循环.常见病原体如绿脓杆菌、肺炎链球菌、流感嗜血杆菌的致病作用也已受到重视.由于前炎症介质包括白介素-1、白介素-8、肿瘤坏死因子-α、白三烯B4的介导使扩张的支气管内中性粒细胞过多聚积.活化的中性粒细胞释放弹性蛋白酶.在实验中可见该酶引起纤毛摆动减慢及气道粘膜破坏.因此该酶对支气管扩张的发病起了重要作用.因为尚无金标准,所以有些学者提出了一些临床和实验室指标,包括肺量计检查、痰量、发作频率和痰内前炎症介质的浓度. (康卫国摘宋吉波校)     

支气管扩张症的诊治进展

支气管扩张症临床上比较多见,本文综述其可能的病因如感染、原发性纤毛运动障碍、免疫缺陷、囊性纤维化、风湿性疾病与其它原因引起的支气管扩张及其可能的发病机制;诊断手段如影像学检查进展与肺功能变化、急性加剧期的判断;处理方面如抗生素的选择、雾化吸入治疗、支气管卫生保健的方法与祛除痰液的手段,外科手术治疗的适应证与咯血的处理原则与进展等。     

支气管扩张患者气管黏膜纤毛结构、功能及气道重塑相关血液指标的变化观察

目的观察支气管扩张患者的气管黏膜纤毛结构、功能及气道重塑相关血液指标变化的研究。方法选取2015年7月-2016年8月期间本院呼吸内科收治的60例支气管扩张患者为观察组,同期选取60例健康人员为对照组,比较两组患者的气管黏膜纤毛结构、功能及气道重塑相关血液指标,同时将观察组患者在不同Reid分级和疾病分期中的指标检测结果进行比较。结果观察组患者的气管黏膜纤毛结构指标和气道重塑血液指标明显高于与对照组,而黏膜纤毛功能指标均明显低于对照组,并且上述检测指标在观察组中不同Reid分级和疾病分期的患者之间也存在显著性差异,P均0.05。结论支气管扩张患者气管黏膜纤毛结构、功能及气道重塑相关血液指标呈现明显异常的状态,且上述指标对于疾病的严重程度和分期也有一定的反应价值,可作为此类患者的重要监测指标。     

我院支气管扩张症患病情况及其影响因素分析

目的探讨支气管扩张症的发病情况以及相关的因素,以期为支气管扩张症患者的诊断提供参考。方法回顾性分析2010年1月至2014年1月在我院接受治疗的疑似支气管扩张疾病患儿2 137例,对所有疑似病例进行临床确诊,并收集患者一般资料以及临床症状,进行统计分析。结果调查的2 137例疑似病例中,有65例确诊为支气管扩张病,检出率为3.04%。单因素分析结果显示,慢性咳嗽时间、结核病病史、居住地以及小儿支原体肺炎病史等因素可能是支气管扩张症的相关因素;经多因素Logistic回归分析,支气管扩张症发病的危险因素由大到小分别是:居住地(OR=20.950)、咳嗽时间(OR=6.716)、反复呼吸道感染(OR=2.808)、支原体肺炎(OR=2.561)。结论患儿支气管扩张症受到多种因素的影响,对于疑似支气管扩张症患儿应注意临床检查,留意患儿的咳嗽时间。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.