Morphological characterization of basophilic cells in bronchoalveolar lavage fluids from patients with bronchial asthma and idiopathic pulmonary fibrosis

A marked increase in the number of basophilic cells (BCs) was found in the bronchoalveolar lavage (BAL) fluids from the patients with bronchial asthma and idiopathic pulmonary fibrosis (IPF). Histochemical analysis revealed that basophils were the major components of BCs in asthmatic patients, while formalin-insensitive BCs, which are presumed to be connective tissue mast cells, were observed in BAL fluids from IPF patients. In control subjects, almost all of BCs were mucosal mast cells.     

Protein expression patterns associated with progression of chronic obstructive pulmonary disease in bronchoalveolar lavage of smokers

BACKGROUND: We modeled the expression of proteins in baseline bronchoalveolar lavage (BAL) samples from asymptomatic 60-year-old lifelong current smokers or healthy never-smokers, who were reevaluated after 6 to 7 years to record clinical outcome. METHODS: Applying a technology toolbox consisting of replicate 2-dimensional gel separations, image annotation, and mass spectrometry identification, we catalogued a global set of proteins that were differentially expressed in individuals by presence, absence, and intensity scores. RESULTS: By use of multivariate analysis, we selected a subset of proteins that accurately separated smokers from never-smokers based on composite scoring. Follow-up after 6 to 7 years identified a group of individuals who had progressed to chronic obstructive pulmonary disease (COPD), Global Initiative for Chronic Obstructive Lung Disease stage 2. The baseline BAL samples of these eventual COPD patients shared a distinct protein expression profile that could be identified using partial least-squares discriminant analysis. This pattern was not observed in BAL samples of asymptomatic smokers free of COPD at 6- to 7-year follow-up. CONCLUSIONS: Our model suggests that certain patterns of protein expression occurring in the airways of long-term smokers may be detected in smokers susceptible to a progression of COPD disease, before disease is clinically evident.     

吸烟对慢性阻塞性肺疾病患者支气管肺泡灌洗液中T细胞功能的影响

目的:评价吸烟对慢性阻塞性肺疾病(COPD)患者急性期、稳定期支气管肺泡灌洗液(BALF)中T细胞功能的影响。方法:根据患者吸烟史将患者分为无吸烟史的正常组(A组)、非吸烟的COPD组(B组)、持续吸烟的COPD组(C组)、已戒烟的COPD组(D组);用流式细胞术检测各组患者急性期、稳定期BALF中CD3+、CD4+、CD8+T细胞和CD+4/CD+8水平。结果:COPD患者无论在急性期还是稳定期,BALF中CD+3、CD+4、CD+8、CD+4/CD+8与正常组比较均有明显差异(P<0.05);持续吸烟COPD患者与非吸烟COPD患者、已戒烟的COPD患者相比较,急性期CD+4、CD+4/CD+8显著下降(P<0.05)、CD+8显著上升(P<0.05);稳定期CD+3、CD+4、CD+8无明显差异(P>0.05),CD+4/CD+8明显下降(P<0.05)。结论:持续吸烟的COPD患者在急性期和稳定期气道T细胞功能明显低下。     

慢性阻塞性肺疾病患者肺泡灌洗液中IL-17和IL-23检测的意义

目的检测慢性阻塞性肺疾病（COPD）患者支气管肺泡灌洗液（BALF）中白细胞介素17（IL-17）、白细胞介素23（IL-23）在发病过程中的变化,为临床判断和了解COPD的炎症发展提供依据。方法参照BALF的细胞百分计数分类、临床资料及肺功能第1秒用力呼气容积占预计值百分比（FEV1％）实验对COPD急性期组、COPD缓解期组及非COPD对照组分别进行检测。采用酶联免疫吸附试验（ELISA）对BALF中IL-17、IL-23的浓度进行测定。结果COPD急性期组BALF中IL-17、IL-23的浓度较COPD缓解期组、对照组明显增加（P〈0．01）;COPD急性期组FEV1％较COPD缓解期组和对照组亦明显增加（P〈0．01）;COPD患者BALF中IL-23与IL-17浓度呈直线正相关（r2=0．6985,P〈0．001）,COPD患者BALF中IL-17、IL-23浓度与FEV1％均呈直线负相关（r2=-0．5279、-0．5410,尸均〈0．001）。结论肺局部炎症时IL-17、IL-23的浓度与COPD的变化和临床症状呈一定的相关性,其中IL-17的浓度与局部炎症情况相关性较IL-23强,其浓度的维持可能与炎症的持续存在有一定关系。检测COPD患者BALF中IL-17、IL-23水平对病情判断和治疗具有指导意义。     

微小RNA-21和程序性细胞死亡因子4在慢性阻塞性肺疾病患者支气管肺泡灌洗液肺泡巨噬细胞中的表达研究

目的 探讨微小RNA-21(miR-21)、程序性细胞死亡因子4(PDCD4)在慢性阻塞性肺疾病(COPD)患者支气管肺泡灌洗液(BALF)肺泡巨噬细胞(AM)中的表达水平及意义。方法 选取135例COPD患者进行研究(COPD组),依据患者病情分为COPD稳定组62例、COPD急性加重期(AECOPD)组73例;并选取同期因喉部异物感等原因做纤支镜检查的健康者73例进行对照研究(正常组)。比较COPD组与正常组一般资料;采用实时荧光定量聚合酶链反应(qRT-PCR)检测BALF AM中miR-21、PDCD4 mRNA相对表达量;Pearson法分析COPD患者BALF AM中miR-21、PDCD4 mRNA表达水平与肺功能指标,miR-21表达水平与PDCD4 mRNA的相关性;采用受试者工作特征曲线(ROC)评估BALF AM中miR-21、PDCD4 mRNA表达水平对COPD的诊断价值。结果 与正常组相比,COPD组患者第1秒用力呼气容积(FEV₁)占预计值百分比(FEV₁%)及FEV₁/用力肺活量(FVC)...     

支气管肺泡灌洗联合无创正压通气治疗慢性阻塞性肺疾病合并呼吸衰竭的临床研究

目的探讨支气管肺泡灌洗联合无创正压通气治疗慢性阻塞性肺疾病合并呼吸衰竭的临床疗效。方法选择本科住院治疗的慢性阻塞性肺疾病合并呼吸衰竭的患者104例,按照治疗方法的不同随机分为对照组(常规治疗组)和观察组(BAL+NIPPV治疗组),观察记录2组患者治疗前、治疗后2 h、治疗后12 h以及治疗后24 h动脉血气分析,以及治疗期间2组患者的不良反应发生情况。结果 2组患者治疗后24 h,p H值均较治疗前显著提高(P0.05),观察组p H值较对照组升高显著(P0.05);2组患者治疗后各时间点p(CO_2)、p(O_2)与治疗前比较,p(CO_2)降低,p(O_2)升高,且观察组患者改善状况优于对照组(P0.05);2组患者气管插管、腹胀和鼻面部压伤的不良反应发生率差异显著(P0.05)。结论支气管肺泡灌洗联合无创正压通气治疗慢性阻塞性肺疾病合并呼吸衰竭可显著提高患者p(O_2),降低p(CO_2),提高血p H值,有效改善患者的呼吸衰竭症状,纠正患者酸碱失衡,值得临床推广应用。     

Comparison of cell profiles of bronchial and bronchoalveolar lavage fluids between normal subjects and patients with idiopathic pulmonary fibrosis

The cell profiles of bronchial and bronchoalveolar lavage fluids (BLF and BALF) of patients with idiopathic pulmonary fibrosis (IPF) were compared with those of normal volunteers (NV) and age-matched control patients (CP), to characterize the cell profiles of the bronchoalveolar region in normals and patients with IPF. In BALF of nonsmokers from both control groups (NV and CP), alveolar macrophages (AM) were predominant and the percentage of neutrophil leukocytes and that of eosinophil leukocytes below 1% of the total cells. The percentage of neutrophils and that of bronchial epithelial cells were higher in BLF than in BALF of both control groups. Of the immune and inflammatory cells in BLF, the mean percentage of neutrophils was 12% in NV group and 42% in CP group. The percentage of neutrophils and that of eosinophils in BALF were higher in IPF group than in CP group, but the percentage of neutrophils in BLF of IPF group was comparable to that of CP group. In the IPF group, the percentage of neutrophils in BALF was lower than that in BLF. These results indicated that even in healthy subjects, a considerable number of neutrophils are present in the bronchial region and that the cell profile of the lavage fluid of the bronchoalveolar tree changes depending on the method of lavage. Presumably the higher percentage of neutrophils in BALF of patients with IPF is partly due to derangements of the alveolar structure, because the amount of saline infused into this region is limited.     

Bronchoalveolar lavage in diagnosis of chronic obstructive pulmonary disease]

In addition to understanding the pathophysiology, bronchoalveolar lavage (BAL) and bronchial lavage (BL) are used for the diagnosis of chronic obstructive pulmonary disease (COPD). Abundant neutrophils and mononuclear cells (lymphocytes) with a few of eosinophils are observed in BAL or BL fluids from chronic bronchitis patients, while abundant neutrophils and macrophages are seen in BAL fluids from emphysema patients. COPD patients combined with bronchial asthma show an increase in eosinophil number in BAL or BL fluid. In BAL fluids from diffuse panbronchiolitis (DPB) patients, increased neutrophils alone are observed without any increases in eosinophils or mononuclear cells.     

Role of galactomannan determinations in bronchoalveolar lavage fluid samples from critically ill patients with chronic obstructive pulmonary disease for the diagnosis of invasive pulmonary aspergillosis: a prospective study

ABSTRACT: INTRODUCTION: Critically ill chronic obstructive pulmonary disease (COPD) patients are at particular risk of invasive pulmonary aspergillosis (IPA). Our aims were to determine whether bronchoalveolar lavage fluid (BALF) galactomannan (GM) has a higher sensitivity and specificity than serum GM or lower respiratory tract (LRT) sample culture. Furthermore, we aimed to investigate what the optimal cut-off value would be for BALF GM. METHODS: In this prospective single-center study, BALF and serum samples were collected from critically ill COPD patients on the first day of their intensive care unit admission. RESULTS: Of 50 critically ill COPD patients admitted, BALF and serum samples were collected in 34 patients. According to the receiver operating characteristics (ROC) curve, an optical density (OD) ratio of 0.8 was chosen as the cut-off value for GM in BALF. Compared to serum GM and LRT Aspergillus isolation, BALF GM yield a better sensitivity, specificity, positive and negative predictive values of 88.9%, 100%, 100% and 94.4%, respectively. Areas under the ROC curve were 0.912 (95%CI, 0.733 to 0.985) for BALF GM, and 0.879 (95%CI, 0.691 to 0.972) for serum GM results from the first day of ICU admission. Pairwise comparison of ROC curves showed P = 0.738. The OD ratio of BALF GM in IPA patients were significantly higher than those of non-IPA patients (2.88 ± 2.09 versus 0.49 ± 0.19, P = 0.009), and the OD ratio of BALF GM was significantly higher than serum GM in IPA patients (2.88 ± 2.09 versus 0.87 ± 0.47, P = 0.023). Positive BALF GM was seen earlier than LRT secretion culture (1 day versus 3.8 days). CONCLUSIONS: Compared to serum GM and LRT Aspergillus isolation, BALF GM seems to have a better sensitivity in the diagnosis of IPA in critically ill COPD patients. The ROC curve suggests a possible cut-off value of 0.8 for GM from BALF specimens in critically ill COPD patients.     

Tryptase concentrations in bronchoalveolar lavage from patients with chronic eosinophilic pneumonia

In order to characterize BAL (bronchoalveolar lavage) in CEP (chronic eosinophilic pneumonia) and to investigate the possible role of mast cells and tryptase in the pathogenesis of this interstitial disease, cells and tryptase levels were determined in BAL of patients with CEP and in a group of healthy controls. The results show that a statistically significant increase in tryptase concentration was found in patients with CEP compared with the healthy controls. This is the first report that shows an increase in tryptase levels in CEP and could reflect higher mast cell activation as well as larger mast cell populations in the lungs of these patients. These results strongly support the involvement of mast cells and eosinophils in the immunopathogenesis of CEP.     

Fatigue in patients with chronic obstructive pulmonary disease

BACKGROUND: Fatigue is a frequently occurring symptom in patients with chronic obstructive pulmonary disease (COPD). Despite this, relatively few studies have objectively assessed patients' perceptions of fatigue and the impact of perceived fatigue on their everyday lives. OBJECTIVE: The purpose of this study was to describe the prevalence, duration and severity of fatigue among patients with COPD and the impact of perceived fatigue on cognitive, physical and psychosocial functioning in comparison with controls. METHOD: The Fatigue Impact Scale, including physical, psychosocial and cognitive dimension and structured questions about the frequency, duration, and severity of fatigue was mailed to 44 outpatients with COPD and 88 randomly selected age- and sex-matched controls. In total 36 patients and 37 controls completed the questionnaire. RESULTS: Almost half of the patients (47.2%), reported fatigue every day during the preceding month compared with 13.5% of the control group (P < 0.001). The duration of fatigue was more than 6 hours in 52.7% of the patients and 44.4% reported that fatigue was either the worst or one of the worst symptoms they had, compared with 18.9% (P < 0.001) and 10.8% (P < 0.01) in the control group. The patients reported a significantly greater impact of fatigue on cognitive, physical and psychosocial functioning compared with the control group (P < 0.001). CONCLUSION: These findings indicate that fatigue is a highly prevalent symptom, which impacts on patients' functional condition and needs to be professionally assessed and managed.     

Arrhythmias in patients with chronic obstructive pulmonary disease

Cardiac arrhythmias are commonly associated with chronic obstructive lung disease and these arrhythmias can impair arterial blood oxygenation. The etiology of the arrhythmias is multifactorial. The treatment of the arrhythmias is largely the treatment of the deranged physiology and the underlying pulmonary disease. The association of arrhythmias with chronic obstructive lung disease portends a poor prognosis.     

Depression in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in adults in the United States and worldwide. Depression is a common comorbidity in this population, but often goes undiagnosed in persons with COPD. Because the presence of depression has the potential to negatively impact COPD-related outcomes, it is essential for health care practitioners involved in the care of patients with COPD to diagnose and treat COPD and the associated comorbidities, including depression. Although there is a lack of comprehensive guidelines for treating depression in those with COPD, an algorithm has been proposed to screen and manage depression in these patients. Several questionnaires are available that can be used to assess and assist in diagnosing depression in these patients. Following diagnosis, antidepressant therapy should be considered along with nonpharmacological strategies, such as pulmonary rehabilitation and cognitive behavioral therapy.     

慢性阻塞性肺疾病合并支气管软骨瘤一例

患者,男性,48岁,农民,因“咳嗽、气促、间断咯血3年,加重伴发热4 d”于2016年11月12日入住高州市人民医院。患者4年前有肺结核病史,自诉已治愈,具体不详。患者3年前无明显诱因反复出现咳嗽,间断性咯鲜红色血,多为痰中带血丝,伴活动后气促,可自闻及喘鸣音,反复在当地医院治疗,具体用药不详,症状反复。个人史及家族史无特殊。查体:双肺呼吸音减弱,可闻及大量散在痰鸣音及少许哮鸣音,心律齐,双下肢无水肿。     

纤维支气管镜吸痰和灌洗对重症阻塞性肺病的治疗作用

对１５例常规治疗无缓解的重症阻塞性肺病患者进行纤维支气管镜吸痰和灌洗。吸痰和灌洗前、吸痰和灌洗后即刻和吸痰和灌洗后４小时测定肺功能〔时间肺活量第１秒率占预计值的百分比（ＦＥＶ１．０％）〕，吸痰和灌洗时监测血氧饱和度（ＳａＯ２）的变化。结果显示吸痰和灌洗后即刻ＦＥＶ１．０％无显著变化（Ｐ＞０．０５），吸痰和灌洗后４小时ＦＥＶ１．０％由０．４２±０．１２升至０．５７±０．１９，较前显著增高（Ｐ＜０．０１）。吸痰和灌洗时ＳａＯ２稍降低，但吸痰和灌洗后显著增高（Ｐ＜０．０５）。未发现严重的并发症。作者认为：纤维支气管镜吸痰和灌洗是重症慢性阻塞性肺病的有效治疗方法     

慢性阻塞性肺疾病患者侵袭性肺曲霉病

曲霉(aspergillus)在自然界中分布广泛,空气中每立方米含有1~100个曲霉孢子,分生孢子的大小约2~3μm,完全可以通过呼吸到达肺泡,造成机会性感染。曲霉的种类很多,但只有少部分致病,90%的人类曲霉感染由烟曲霉所致。临床上一般将肺曲霉病分为曲霉球、变态反应性支气管肺曲霉病(allergic bronchopulmonary aspergillosis,ABPA)和侵袭性肺曲霉病(invasive pulmonary aspergillo-sis,IPA)等3种类型,其中IPA危害最大、病死率最高。过去20年中,随着艾滋病、血液病及实体器官移植患者的增多,广谱抗生素、免疫抑制剂及激素等治疗增加,IPA的发生率也逐渐升高。慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者痰标本中培养出曲霉通常被认为是污染,但越来越多的证据表明,严重COPD患者也存在发生IPA的高风险,COPD患者曲霉感染是个值得重视的问题[1-2]。一、流行病学长期以来,人们对COPD患者并发IPA的认识不多,目前有限的临床资料大多来源于尸检结果,因此COPD患者IPA的发生...     

Clinical characteristics and condition of the bronchial tree in patients with bronchial asthma and chronic obstructive pulmonary disease in combination with hyperoxaluria

AIM: To evaluate peculiarities of a clinical course and changes in bronchial mucosa in bronchial asthma (BA) patients with chronic obstructive pulmonary disease (COPD) in combination with hyperoxaluria (HOU); informative value of some laboratory and device findings including oxalates assay in bronchial lavage fluid for specification of the diagnosis, role of oxalates in development of obstructive syndrome and choice of optimal therapy. MATERIAL AND METHODS: Oxalates were examined in daily urine, bronchoalveolar lavage fluid and exhaled air condensate of 104 patients with BA and COPD, 77 of which had HOU and an atypical course of bronchial obstruction syndrome. RESULTS: Conception of airways inflammation in patients with oxalate metabolism disturbances is proposed. It is shown that insoluble oxalates participate in pathogenesis of bronchial obstruction. CONCLUSION: Oxalate metabolism disturbances are an important factor in pathogenesis of airways inflammation and development of bronchial obstruction in predisposed patients. Therefore, administration of insoluble oxalates lowering therapy may effectively prevent formation and progression of obstructive pulmonary diseases in this group of patients.     

The myocardial condition in chronic obstructive pulmonary disease and bronchial asthma

The purpose of the study was to assess the influence of structural and functional changes in the myocardium of the right and left ventricle (RVand LV) on the development of ischemia and arrhythmia in chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA). The subjects of the study were 156 patients with either persistent BA (81 patients) or COPD (75 patients). Patients with decompensated cor pulmonale were excluded. ECG, 24-hour ECG monitoring, and echocardioscopy were performed. The study found that the occurrence of supraventricular and ventricular extrasystoles (SVES and VES) in patients with mild COPD or BA depended on the condition of RV diastolic function and on LV diastolic function and myocardial ischemia as well in COPD. In moderate BA the processes of myocardial remodeling correlate with myocardial ischemia, RV dysfunction and increased pulmonary arterial pressure (PAP), as well as with lipid dismetabolism. The appearance of SVES in patients with severe BA is connected with interventricular septal hypertrophy, LV dysfunction, and increased PAP, while VEC appear due to myocardial ischemia and hypercholesterolemia. In severe COPD the occurrence of SVES and VES does not depend on structural and functional changes in the myocardium, while myocardial ischemia is connected with LV hypertrophy. In BA ischemia depends on the development of RV and LV diastolic dysfunction, as well as hypercholesterolemia.     

Dispersion of QT interval during holter monitoring in patients with chronic obstructive pulmonary disease and bronchial asthma

The aim of the work was to estimate dispersion of QT interval during Holler monitoring in patients with chronic obstructive pulmonary disease (COPD) and arterial hypertension (AH). The study involved 28 patients with COPD (including 17 with COPD + AH), 31 patients with bronchial asthma (BA) (including16 with BA + AH), and 17 practically healthy subjects. It was shown that a combination of COPD and AH is associated with high-grade ventricular arrhythmia (by Lown-Wolf classification). Dispersion of QT interval indicates that the risk of life-threatening arrhythmia in patients with COPD and AH is unrelated to ventricular extrasystole and ventricular myocardium mass. Patients with BA and AH exhibited electrical instability regardless of myocardial mass only in the presence of ventricular arrhythmia. In the patients with BA and AH the QTcd interval increased in the second half of day, in COPD patients from morning till evening, and in patients with COPD + AH during 24 hours.