利巴韦林与α-IFN治疗偏肺病毒感染引起的小儿毛细支气管炎效果研究

目的 分析利巴韦林与α-IFN治疗偏肺病毒(metapneiimovirus,MPV)感染引起的小儿毛细支气管炎的临床治疗指标及疗效的影响.方法 选取2010年8月-2015年8月于就诊的210例偏肺病毒感染引起的小儿毛细支气管炎患者,按照随机数字表法分为三组:对照组(n=70)采用激素、支气管扩张等常规方法治疗;利巴韦林组(n=70)采用传统治疗方法伴以利巴韦林静点治疗;α-IFN组(n=70)采用传统治疗方法伴以α-IFN肌注治疗,两两比较不同组别的临床治疗指标及疗效的情况.结果 利巴韦林组及α-IFN组与对照组相比,在咳嗽、喘息、肺部罗音消失时间和住院天数明显缩短(P＜0.05).利巴韦林组及α-IFN组与对照组相比,总有效率提高显著(P＜0.05).结论 利巴韦林与α-IFN在治疗偏肺病毒感染引起的小儿毛细支气管炎上,具有改善临床治疗指标、提高总有效率的作用.     

Castleman病所致的与副肿瘤性天疱疮相关的闭塞性细支气管炎的临床病理与影像

目的 探讨与Castleman病所致的副肿瘤性天疱疮（PNP）相关的闭塞性细支气管炎（BO）的临床，病理与影像学特征。方法 5例患者包括男3例。女2例，平均年龄21岁。4例BO患者经临床诊断，1例经病理证实，所有患者均行吸气相和呼气相X线胸片和高分辨率CT（HRCT）扫描检查。结果 5例患者分别在PNP出现1-8个月后继发BO症状，胸片4例表现为双肺透亮度增加和血管纹理稀疏等过度充气改变，HRCT显示为弥漫性空气潴留征者5例。双肺多个亚段及其远端较大的细支气管柱状扩张4例。小叶核心和支气管管壁增厚4例。纵隔积气3例。片状肺泡实变（磨玻璃影）2例。术后随访5个月至3年均预后不良，呈现不同程度的Ⅱ型呼吸衰竭症状。结论 BO是伴有PNP的Castleman病的少见而严重的合并症，是导致预后不良的主要原因。HRCT上，BO的HRCT最常见表现包括呼气相空气潴留征，支气管扩张和小叶核心或支气管壁增厚。     

Predictors of successful telephone follow-up in a multicenter study of infants with severe bronchiolitis

PurposeTo identify the characteristics that predict successful telephone follow-up with parents of infants with severe bronchiolitis.MethodsWe analyzed data from a 17-center, prospective cohort study of infants (age <1 year) hospitalized with bronchiolitis during three consecutive fall/winter seasons. Participant contact information and clinical data were collected during the index hospitalization. Parents were called at 6-month intervals (based on the child's age) after discharge to assess respiratory problems. The primary outcome was age 12-month telephone interview status. Participants were classified as unreachable after 28 days of unsuccessful attempts.Results798 of 916 children (87%) completed the age 12-month telephone interview. In unadjusted analyses, factors associated with successful follow-up included: private health insurance, annual household income $60,000 or more, and residing in the Northeast, Midwest, or West. Follow-up was less common among non-Hispanic blacks, Hispanics, and households with 3 or more children. In multivariable analyses, follow-up was more likely among parents of females, and, compared with the South, in the Northeast and Midwest (all P < .05). Compared with non-Hispanic whites, non-Hispanic blacks and Hispanics remained less likely to complete the interview as did households with 3 or more children (all P < .05).ConclusionSociodemographic and geographic factors predict successful telephone follow-up, even among parents of infants with severe illness.     

Usefulness of Exhaled Nitric Oxide to Guide Risk Stratification for Bronchiolitis Obliterans Syndrome After Lung Transplantation

The aim of this study was to assess fractional exhaled nitric oxide (FeNO) for the early diagnosis of bronchiolitis obliterans syndrome (BOS) after lung transplantation (LTX). 611 FeNO measurements in 166 consecutive patients were classified depending on BOS stage at the time of assessment and course during minimum follow‐up of 3 months: (1) stable non‐BOS, (2) unstable non‐BOS, (3) stable BOS and (4) unstable BOS. Unstable course was defined as new onset of BOS≥1 or progression of BOS. FeNO before unstable course was significantly increased in comparison to their stable counterparts (non‐BOS: 28.9 ± 1.2 ppb, n = 40 vs. 16.4 ± 0.8 ppb, n = 131 and BOS: 32.5 ± 1.3 ppb, n = 35 vs. 15.3 ± 0.8 ppb, n = 26; p = 0.01 each). Average time from FeNO reading to onset of deterioration was 117 ± 9 days in non‐BOS and 136 ± 9 days in BOS patients. The positive and negative predictive value of FeNO >20 ppb for BOS was 69.0% and 96.9%, respectively. Serial measurements demonstrated significantly lower mean individual variation in stable recipients as compared to stable patients switching to unstable course (3.2 ± 0.3 ppb vs. 12.7 ± 1.4 ppb, p = 0.02). In particular, the excellent negative predictive value of persistently low FeNO readings for future BOS make FeNO assessments a useful tool for continuous risk stratification after LTX.     

毛细支气管炎继发哮喘的高危因素分析及对策

目的探讨毛细支气管炎患儿继发哮喘的高危因素。方法对102例住院治疗的毛细支气管炎患儿进行继发哮喘的高危因素调查，对所获数据进行Logistic回归分析。结果102例中继发哮喘47例，占46．08％。多变量Logistic回归分析显示，居住环境、被动吸烟、患儿特异性体质、家族过敏和（或）哮喘病史与继发哮喘显著相关。结论毛细支气管炎患儿的生活环境、被动吸烟、特异性体质及家族过敏和（或）哮喘病史等是继发哮喘的重要因素，在这些方面要加强护理干预。     

布地奈德和沙丁胺醇联合雾化吸入治疗毛细支气管炎的疗效观察

目的评价布地奈德和沙丁胺醇联合雾化吸入治疗毛细支气管炎的疗效。方法将69例诊断为毛细支气管炎的住院惠儿随机分为治疗组和对照组，除抗病毒治疗外，治疗组采用布地奈德（普米克令舒）和沙丁胺醇（万托林）雾化液雾化吸入，对照组应用传统药物（地塞米松、庆大霉素等）雾化吸入，比较疗效并进行统计学分析。结果治疗组在疗效上优于对照组，住院时间较对照组缩短，经χ^2检验有统计学意义。结论布地奈德和沙丁胺醇联合雾化吸入治疗毛细支气管炎能明显改善症状，缩短疗程。     

盐酸氨溴索针剂佐治毛细支气管炎疗效观察

毛细支气管炎是婴幼儿较常见的下呼吸道疾病，病原以呼吸道合胞病毒最为常见。临床上以喘憋、三凹征和哮呜音为主要特点。发生于2岁以下的小儿，多数月龄在6个月以内。目前在毛细支气管炎患儿治疗中，清理呼吸道分泌物，保持呼吸道通畅至关重要。近年来国内外报道雾化吸人盐酸氨溴索治疗毛细支气管炎效果满意，而本科用静脉输注盐酸氨溴索针剂辅助治疗，亦获得较显著临床疗效。     

Correlation between autopsy findings for chronic obstructive airways disease and in-life disability in South African gold miners

Objectives: In South Africa chronic obstructive airway disease (COAD), which could be due to working in a dusty atmosphere in scheduled mines or works, is a compensatable disease. Miners are compensated for in-life respiratory disability and for findings at autopsy of COAD, which includes emphysema, bronchitis assessed by mucus gland hyperplasia in the main bronchus, and bronchiolitis assessed by goblet cell metaplasia. The question arises as to whether the autopsy findings correlate with in-life impairment. The objectives of the study were: (1) to determine whether autopsy COAD outcomes relate to lung function and to respiratory symptoms and signs; and (2) to quantify the individual contributions of emphysema, bronchiolitis and bronchitis to lung function impairment. Methods: On 724 gold miners, pathological findings of COAD – emphysema, bronchitis and bronchiolitis – were related to lung function measurements and respiratory symptoms and signs observed within 5 years prior to death. Results: Emphysema diagnosed at autopsy was the main determinant of airflow impairment. The emphysema score categories 0–5, 5–35, 35–65 and >65 were associated with decreased forced expiratory volume in 1 s, expressed as percentage predicted (FEV₁%) as follows: 78.8%, 66.2%, 52.0% and 46.0%, respectively. The score was also associated with increasing frequency of dyspnoea. After adjustment for emphysema, the bronchitis and bronchiolitis were not related to significant lung function loss, and in subjects without emphysema, the presence of moderate or marked bronchitis was associated with a mild impairment only. Bronchitis at autopsy was associated with increased frequency of rhonchi, sputum and cough, whereas bronchiolitis was associated with increased sputum only. Silicosis found at autopsy was associated with some obstructive and restrictive lung function impairment. Tobacco smoking was associated with all the COAD outcomes. Received: 5 May 1999 / Accepted: 11 December 1999     

吸入普米克令舒佐治小儿毛细支气管炎疗效观察

目的:探讨普米克令舒雾化吸入佐治小儿毛细支气管炎(毛支)的疗效。方法:将54例毛支患儿随机分为两组,两组均采用综合治疗,观察组加用普米克令舒雾化吸入,对治疗前后症状、体征持续时间、气道阻力参数进行比较。结果:观察组在治愈率、缓解喘憋、缩短哮鸣音及咳嗽持续时间、改善肺功能、降低气道阻力的作用均明显优于对照组(P<0.05)。结论:普米克令舒雾化吸入治疗小儿毛支,可缩短病程,改善肺功能,疗效确切,且方便、安全,可作为佐治毛支的主要药物。     

药物联用防治毛细支气管炎后哮喘发病的观察

目的:观察吸入激素布地奈德和口服酮替芬加肌注斯奇康联合应用能否降低毛细支气管炎后哮喘的发生率。方法:将我院2 0 0 0年1月至2 0 0 2年1月诊治的95例毛细支气管炎患儿(简称毛支炎)随机分为防治组和观察组。两组在急性期都给予常规治疗。4 7例防治组患儿应用了吸入皮质激素布地奈德1 0 0 μg/次,每天2次,2个月后减至1 0 0 μg/次,每天1次,维持4个月后停用。口服酮替芬3个月,肌注斯奇康6个月。对照组4 8例急性期后不给与任何药物防治。结果:完成随访>2年者,防治组4 1例中有2例发生哮喘,发生率4 88% ,而对照组完成随访的4 4例中有1 6例发生哮喘,发生率3 6 3 6 % ,两组差异有显著性,P <0.0 0 1。毛支炎干预治疗后各项肺功能指标明显改善。与对照组相比差异有显著性,P <0 .0 1。结论:吸入布地奈德、口服酮替芬、加肌注斯奇康可显著降低毛支炎后哮喘的发生率