多层螺旋CT定量评估慢性阻塞性肺疾病病情的价值

目的探讨多层螺旋CT(MSCT)定量评估慢性阻塞性肺疾病病情的价值。方法选取2017年8月～2018年7月在湖州市第一人民医院就诊的73例慢性阻塞性肺疾病(COPD)患者作为研究对象,按照病情轻重分为Ⅰ组(轻度患者17例)、Ⅱ组(中度患者32例)、Ⅲ组(重度患者24例),并选取同期于该院体检的健康者20例为对照组。所有研究对象均行MSCT低剂量扫描,观察比较各组管腔面积(Ai)、支气管壁面积百分比(WA%)、管壁厚度与体表面积比值(T/BSA)、壁厚度与直径比值(TDR),同时予以肺功能检查,采用定量CT气道分析软件分别测量气道相关参数,并用Siemens Pulmo软件Pearson定量分析其相关性。结果对照组、Ⅰ组、Ⅱ组、Ⅲ组的FEV1均呈逐渐下降趋势,FEV1/FVC呈逐渐上升趋势,差异均有统计学意义(P0.05)。对照组、Ⅰ组、Ⅱ组、Ⅲ组的WA%、T/BSA、TDR比较,均呈逐渐上升趋势,Ai呈下降趋势,差异均有统计学意义(P0.05)。FEV1与WA%、TDR之间呈负相关(r=-0.291,P=0.000;r=-0.473,P=0.000),FEV1/FVC与WA%、TDR之间呈正相关(r=0.285,P=0.000;r=0.472,P=0.000)。结论 MSCT扫描及定量分析可为COPD患者气道病变情况提供可靠的评估信息。     

中性粒细胞与淋巴细胞比值对三阴性乳腺癌临床预后及与Ki - 67表达的影响

目的 探讨中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）对三阴性乳腺癌的临床预后影响及与Ki - 67表达的关系。方法 回顾性分析2006年1月 - 2012年12月于我院乳腺外科住院治疗的134例三阴性乳腺癌患者。NLR最佳临床分界值采用ROC曲线确定，并依此分NLR＜2.64组和NLR≥2.64组。临床独立预后因素采用单因素和多因素Cox回归模型分析。术后生存时间和生存曲线比较采用Kaplan - Meier和log - rank方法。Ki - 67的表达采用免疫组织化学方法检测。结果 NLR是三阴性乳腺癌的独立预后因素，最佳临界值为2.64。NLR＜2.64组术后中位DFS为39.10月，中位OS为52.30月；NLR≥2.64组术后中位DFS为27.35月，中位OS为37.35月。2组术后DFS和OS比较，差异具有统计学意义（P＜0.05）。NLR低组伴Ki - 67表达阴性的三阴性患者术后中位DFS和OS生存时间显著高于其他情况。结论 NLR是三阴性乳腺癌的关键影响预后因素，具有重复性强、非侵袭性、方便实用等特性，可用于预测三阴性乳腺癌临床预后。     

Comparison of inhaled nitric oxide with aerosolized prostacyclin or analogues for the postoperative management of pulmonary hypertension: a systematic review and meta-analysis

Abstract

Background: This study aims to compare the effectiveness of inhaled prostacyclin or its analoguesversus nitric oxide (NO) in treating pulmonary hypertension (PH) after cardiac or pulmonary surgery remains unclear.

Methods: PubMed, Cochrane, and Embase databases were searched for literature published prior to December 2019 using the following keywords: inhaled, nitric oxide, prostacyclin, iloprost, treprostinil, epoprostenol, Tyvaso, flolan, and pulmonary hypertension. Randomized controlled trials and multiple-armed prospective studies that evaluated inhaled NO versus prostacyclin (or analogues) in patients for perioperative and/or postoperative PH after either cardiac or pulmonary surgery were included. Retrospective studies, reviews, letters, comments, editorials, and case reports were excluded.

Results: Seven studies with a total of 195 patients were included. No difference in the improvement of mean pulmonary arterial pressure (pooled difference in mean change= ?0.10, 95% CI: ?3.98 to 3.78, p?=?.959) or pulmonary vascular resistance (pooled standardized difference in mean change= ?0.27, 95% CI: ?0.60 to 0.05, p?=?.099) were found between the two treatments. Similarly, no difference was found in other outcomes between the two treatments or subgroup analysis.

Conclusions: Inhaled prostacyclin (or analogues) was comparable to inhaled NO in treating PH after cardiac or pulmonary surgery.

• Key messages

• This study compared the efficacy of inhaled prostacyclin or its analogues versus inhaled NO to treat PH after surgery. The two types of agent exhibited similar efficacy in managing MPAP, PVR, heart rate, and cardiac output was observed.

• Inhaled prostacyclin may serve as an alternative treatment option for PH after cardiac or pulmonary surgery.

     

胸腔镜肺小结节切除术前微弹簧圈定位的临床应用研究

目的:研究孤立性肺结节(SPN)胸腔镜术前CT引导下双弹簧圈精准标记定位的应用价值。方法:回顾分析43例SPN胸腔镜术前定位病例资料，包括双弹簧圈组22例，Hook-wire定位组21例。统计双弹簧圈定位的术中、术后并发症，衔接期时间以及作楔形切除所用时间，并将两组结果进行对比分析。结果:两组病例定位均取得成功；双弹簧圈组的气胸发生率(9.0%)，肺出血发生率(9.0%)，胸痛发生率(9.0%)均低于Hook-wire组，其中肺出血发生率与Hook-wire组比较，差异有统计学意义(P＜0.01)；衔接时间双弹簧圈组（15.38±8.32）h长于Hook-wire组（4.21±3.29）h，差异有统计学意义（P＜0.05）；作楔形切除所用时间双弹簧圈组(21.01±7.14)min与Hook-wire组(18.22±5.18)min差异无统计学意义(P＞0.05)。结论:采用双微弹簧圈进行SPN胸腔镜手术前精准标记定位安全可靠、效果良好，与Hook-wire定位比较并发症发生率更低，并可获得更长的衔接期，具有较高的应用价值。