肺力咳合剂联合布地奈德福莫特罗治疗慢性阻塞性肺疾病急性加重期的临床研究

目的 探讨肺力咳合剂联合布地奈德福莫特罗治疗慢性阻塞性肺疾病急性加重期（AECOPD）的临床效果。方法 选取2018年10月—2020年9月天津医科大学宝坻临床学院收治的102例AECOPD患者,随机分为对照组（51例）和治疗组（51例）。对照组吸入布地奈德福莫特罗吸入剂,2吸/次,2次/d。治疗组口服肺力咳合剂,20 mL/次,3次/d。两组连续治疗2周。观察两组患者临床疗效,比较治疗前后两组患者肺部哮鸣音、呼吸症状缓解时间,肺功能参数第1秒用力呼气容积与用力肺活量比值（FEV1/FVC）、深吸气量与肺总量比值（IC/TLC）、一氧化碳弥散量与肺泡通气量比值（DLCO/VA）和FEV1占预计值%,咳痰的评估问卷（CASA-Q）总分,中性粒细胞与淋巴细胞比值（NLR）和呼出气一氧化氮（FeNO）浓度及血清白细胞介素-17（IL-17）、淀粉样蛋白A（SAA）和肺表面活性蛋白D（SP-D）水平。结果 治疗后,治疗组临床有效率为96.1%,显著高于对照组的84.3%（P<0.05）。治疗后,治疗组肺部哮鸣音和呼吸症状缓解时间均显著短于对照组（P<0.05）。治疗后,两组肺功能参数FEV1/FVC、IC/TLC、DLCO/VA、FEV1占预计值%和CASA-Q总分均显著升高（P<0.05）,并均以治疗组改善更显著（P<0.05）。治疗后,两组患者NLR和FeNO浓度及血清IL-17、SAA、SP-D水平均显著低于治疗前（P<0.05）,且治疗组对NLR和FeNO浓度及血清IL-17、SAA、SP-D水平的降低作用较对照组更显著（P<0.05）。结论 肺力咳合剂联合布地奈德福莫特罗治疗AECOPD的整体疗效确切,可安全、有效且迅速地缓解患者症状,改善气流受限,抑制体内炎症反应。     

Frequency and Implication of Autoimmune Serologies in Idiopathic Pulmonary Fibrosis

ObjectiveTo assess the frequency and clinical implications of positive autoimmune serologies in patients with biopsy-confirmed idiopathic pulmonary fibrosis (IPF).Patients and MethodsWe reviewed the records of patients at our institution with biopsy-confirmed usual interstitial pneumonia (UIP) from January 1, 1995, through December 31, 2010, for frequency and distribution of autoimmune serologies. Patients with IPF with and without positive serologies were compared.ResultsThree hundred eighty-nine consecutive patients with biopsy-confirmed IPF underwent serologic testing, with positive serologic test results being found in 112 (29%). Of 2051 individual screening serologic tests performed, results of 163 tests were positive (8%), with antinuclear antibody being the most frequent (47%). There was no difference in age at biopsy (P=.21), gender (P=.21), or presenting radiologic features between those with or without positive serology. More frequent use of immunosuppressive treatment (P=.02) was noted in those with positive serology. No survival difference was observed (log-rank; P=.43). Median follow-up for the whole cohort was 43.5 months.ConclusionPositive autoimmune serology may occur in as much as one-third of the patients with biopsy-confirmed IPF with no associated clinical implication or survival advantage. Systematic use of autoimmune laboratory panels in patients without clinical features of connective tissue disease should be reconsidered in patients with suspected UIP on chest computed tomography scan or confirmed UIP on biopsy.     

Interstitial Lung Disease and Other Pulmonary Manifestations in Connective Tissue Diseases

Lung involvement in connective tissue diseases is associated with substantial morbidity and mortality, most commonly in the form of interstitial lung disease, and can occur in any of these disorders. Patterns of interstitial lung disease in patients with connective tissue disease are similar to those seen in idiopathic interstitial pneumonias, such as idiopathic pulmonary fibrosis. It may be difficult to distinguish between the 2 ailments, particularly when interstitial lung disease presents before extrapulmonary manifestations of the underlying connective tissue disease. There are important clinical implications in achieving this distinction. Given the complexities inherent in the management of these patients, a multidisciplinary evaluation is needed to optimize the diagnostic process and management strategies. The aim of this article was to summarize an approach to diagnosis and management based on the opinion of experts on this topic.     

Association between reduced pulmonary diffusing capacity and cardiac autonomic dysfunction in Type 1 diabetes

Background In Type 1 diabetes mellitus (DM), it has been suggested that autonomic nervous system dysfunction (NAD) impairs lung diffusion capacity. Heart rate variability (HRV), a measure of cardiac autonomic function, is a sensitive method of detecting NAD. To our knowledge, no previous study has assessed whether cardiac sympatho‐vagal balance is associated with lung diffusion capacity in diabetes. Methods Twenty Type 1 DM patients without pulmonary abnormalities and systemic NAD underwent measurement of lung diffusion capacity for carbon monoxide (DLCO) by single‐breath method and assessment of cardiac autonomic function by HRV analysis on 24‐h electrocardiographic Holter recordings. Results Standard respiratory function tests and peripheral autonomic tests were normal in all patients. DLCO was lower than normal reference values in six patients (30%). DLCO correlated significantly with most HRV variables, independent of the clinical and laboratory variables. The strongest correlation was found with standard deviation of all RR intervals (SDNN; r = 0.62, P = 0.003) in the time domain and low frequency (LF) power (r = 0.73, P < 0.001) in the frequency domain. Conclusions In Type 1 diabetes, a significant association exists between cardiac NAD and reduced DLCO in the absence of clinical respiratory and autonomic abnormalities. Thus, NAD may be involved in the early reduction of DLCO in these patients, possibly through abnormalities in the regulation of pulmonary blood flow at the microvascular level.     

Dynamic diffusion lung capacity of carbon monoxide (DLCO) as a predictor of pulmonary microangiopathy and its association with extra pulmonary microangiopathy in patients with type II diabetes mellitus

Background and aimLung as a target end organ for microvascular disease often remains underdiagnosed. This study aims to assess occurrence of pulmonary microangiopathy among Type 2 diabetes mellitus (T2DM) using dynamic diffusion lung capacity of carbon monoxide (DLCO).MethodsA total of 120 participants aged >18 years were enrolled in this study. Group 1 comprised T2DM with microangiopathy (n = 40), group 2 include T2DM without microangiopathy (n = 40), group 3 were healthy controls (n = 40). Individuals with underlying lung disease, smoking history, heart failure, urinary tract infection, macrovascular complications of diabetes, microalbuminuria due to other causes were excluded from the study. Using electronic spirometry, Forced Expiratory Volume in first second (FEV1), Forced Vital Capacity (FVC) was measured and FEV1/FVC ratio calculated. DLCO (%predicted) using single breath method was measured in sitting position followed by supine position and delta DLCO was calculated. DLCO measured was compared between the three groups.ResultsDLCO (median [IQR]) in sitting (78 [70–82.75]) and supine position (70 [62–84]) among group one was significantly decreased when compared to other two groups (p value < 0.001, p value < 0.001 respectively). Delta DLCO (median, [IQR]) among patients with diabetic microangiopathy (?6 [-8 to ?2]) was significant on comparison with group two (4[2,6]) and control group (5[4,6]) (p < 0.001). Negative delta DLCO reflecting pulmonary microangiopathy was significantly associated with extrapulmonary microangiopathy (p value = 0.027).ConclusionPostural variation in DLCO is a useful non-invasive test for identifying pulmonary microangiopathy among T2DM patients. Presence of pulmonary microangiopathy has significant association with diabetic nephropathy and retinopathy.     

Follow‐up of two cases of suspected interstitial lung disease following severe COVID‐19 infection shows persistent changes in imaging and lung function

Physicians are observing persisting symptoms and unexpected organ dysfunction after severe COVID‐19. In this report, we present the follow‐up of two cases of suspected interstitial lung disease following the viral infection. Up to the last month of follow‐up, both patients presented with persistent changes in imaging and pulmonary function tests.     

Impact of induction chemoradiotherapy on pulmonary function after lobectomy for lung cancer

Objective

Our study aim was to determine whether there are differential changes in whole-lung and regional lung functions after lobectomy for lung cancer between propensity score-matched patients treated with and without induction chemoradiotherapy, by using single-photon emission computed tomography lung perfusion.

肺弥散功能在肺部疾病应用的研究

对150例健康人进行了一氧化碳弥散量(DLCO)测定。结果表明,DLCO与身高呈正相关,与年龄呈负相关,男女有显著差别。而转移系数(KCO)与性别无关。140例慢阻肺(COPD)和30例早期尘肺病人同时测定弥散量、血气、常规肺功能以及肺泡动脉氧分压差(A-aDO_2)和VD/VT。目的在于了解我国人弥散量常数及其影响因素,同时对弥散量的临床应用进行了探讨。     

痰热清胶囊联合乌美溴铵维兰特罗治疗慢性阻塞性肺疾病稳定期急性发作的临床研究

目的 探讨痰热清胶囊联合乌美溴铵维兰特罗吸入粉雾剂治疗慢性阻塞性肺疾病稳定期急性发作的临床疗效。方法选取2020年6月—2022年2月首都医科大学附属北京潞河医院收治的100例慢性阻塞性肺疾病患者,按随机数字表法将100例分为对照组和治疗组,每组各50例。对照组使用干粉吸入装置经口吸入乌美溴铵维兰特罗吸入粉雾剂,1吸/次,1次/d。治疗组在对照组治疗的基础上口服痰热清胶囊,3粒/次,3次/d。7 d为1个疗效,两组连续治疗2个疗程统计疗效。观察两组的临床疗效,比较两组症状消失时间、肺功能、血清可溶性CD40配体（sCD40L）、粒细胞–巨噬细胞集落刺激因子（GM-CSF）、白三烯B4(LTB4)水平。结果 治疗后,治疗组总有效率为96.00%,高于对照组的总有效率84.00%,组间比较有显著差异（P<0.05）。治疗后,治疗组的肺啰音、咳嗽、咯痰消失时间均明显短于对照组（P<0.05）。治疗后,两组的1秒用力呼气量（FEV1）/用力肺活量（FVC）、一氧化碳弥散量（DLCO）、第1秒用力呼气容积预测值（FEV1%pred）均显著增加（P<0.05）,治疗组FEV1/F...