全反式维甲酸对大鼠肺气肿模型的早期干预作用

目的 研究全反式维甲酸(ATRA)对木瓜蛋白酶所致大鼠肺气肿模型的早期干预作用.方法 采用木瓜蛋白酶气管内滴注的方法,将体质量170～220 g 60只SPF级SD大鼠随机分为对照组(N),模型组(R),ATRA治疗组(R1),棉籽油组(R2)各15只.后3组向大鼠气管内滴注5％木瓜蛋白酶1 ml/kg,N组同样滴注等量生理盐水,14d后,分别向R1组和R2组大鼠腹腔内连续注入1 000 μg/kgATRA和棉籽油,第90天杀死全部大鼠.取出肺组织,行HE染色观察各组大鼠的肺脏的病理变化,和病理形态学图像分析了解肺气肿模型是否建立及ATRA对于木瓜蛋白酶复制的大鼠肺气肿模型的早期干预效果.行免疫组织化学染色,计算各组Ⅱ型肺泡上皮细胞(AECⅡ)凋亡率,及Bax蛋白、Bcl-2蛋白阳性细胞个数,比较各组之间AECⅡ凋亡率,及Bax蛋白、Bcl-2蛋白阳性细胞个数的差异.结果 肺体积结果显示:R、R1、R2组的肺体积与N组比较,明显增大；R、R2组之间差异无统计学意义.肺泡形态学结果显示:R、R1、R2与N组比较,每个视野内的肺泡数明显减少,平均肺泡面积增大,平均内衬间隔较大,R2组相对于R组,肺泡形态学各项指标差异无统计学意义.R、R1、R2组与N组比较,大鼠肺组织AECⅡ凋亡明显增多,R1与R组比较,AECⅡ凋亡率明显下降,R2与R组比较,AECⅡ凋亡率无明显变化,R、R1、R2组在造模后肺泡壁细胞Bcl-2阳性细胞百分比显著高于N组,R组肺泡壁细胞Bcl-2阳性细胞百分比显著低于R1组,R组肺泡壁细胞Bcl-2阳性细胞百分比与R2组差异无统计学意义.R、R1、R2组在造模后肺泡壁Bax蛋白阳性细胞百分比显著高于N组,R组肺泡壁细胞Bax蛋白阳性细胞百分比显著高于R1组,R组肺泡壁Bax蛋白阳性细胞百分比与R2组差异无统计学意义.R1组Bcl-2/Bax比例明显高于R、R2组,而与N组差异无统计学意义.结论 ATRA治疗可降低大鼠肺气肿模型AECⅡ凋亡率,调节Bax蛋白、Bcl-2蛋白表达,对大鼠肺气肿进程起到干预作用.     

老年肺间质纤维化合并肺气肿病例45例临床分析

目的：探讨分析老年肺间质纤维化合并肺气肿患者的临床特点。方法分析2012年6月—2014年6月该院确诊肺间质纤维化合并肺气肿的45例（>70岁）患者的既往病史、临床症状、肺功能、血气分析、胸部高分辨CT（HRCT）等结果。结果大多数肺气肿合并肺间质纤维化患者均存在较长的吸烟史,HRCT是临床诊断该种疾病的主要手段,在HRCT下先发表现为肺气肿,临床表现上不仅存在肺间质纤维化特点,同时也存在肺气肿特点。结论虽然肺气肿、肺间质纤维化是不同的两种疾病,但两者常常会同时出现在老年患者身上,鉴于老年患者的生理特殊性,HRCT是临床诊断该种疾病的理想选择,可为疾病诊断提供重要参考。     

乙酰半胱氨酸泡腾片合用噻托溴铵吸入剂治疗慢性阻塞性肺疾病的临床分析

目的分析乙酰半胱氨酸泡腾片合用噻托溴铵吸入剂对慢性阻塞性肺疾病(COPD)患者的临床疗效。 方法选择2018年4月至2020年10月我院收治的COPD患者124例,分为观察组63例,对照组61例。给予对照组噻托溴铵吸入剂及其它常规治疗,观察组在对照组的治疗基础上加用乙酰半胱氨酸泡腾片治疗。比较两组治疗前及治疗3个月时的肺功能指标值、血气指标值及血清炎性因子水平;比较两组治疗3个月时的气流受限严重程度及呼吸困难程度。 结果治疗3个月时,两组患者的FEV₁、FVC、FEV₁/FVC值较治疗前提高,观察组高于对照组(P<0.05),两组血清IL-6、INF-γ、TNF-α水平较治疗前降低;观察组治疗3个月时的PaO₂值高于对照组,PaCO₂低于对照组,组间比较差异有统计学意义(P<0.05);治疗3个月时的气流受限程度两组间比较差异有统计学意义(P<0.05)。 结论乙酰半胱氨酸泡腾片联合噻托溴铵吸入剂治疗COPD具有较好临床疗效。     

High prevalence of airway obstruction and pulmonary emphysema in urothelial (renal pelvis,ureter, and bladder) cancer patients

BackgroundCigarette smoking is a major cause of COPD, with patients also presenting complications that stem from other smoking-related diseases, including urothelial cancer. However, the prevalence of COPD or airflow obstruction in urothelial cancer patients has not been well studied.MethodsWe investigated the prevalence of airflow obstruction (FEV1/FVC < 70%) in newly diagnosed urothelial cancer patients and identified the risk factors for airflow obstruction in existing urothelial cancer patients. Additionally, we compared the characteristics of subjects who had been diagnosed with both airflow obstruction and urothelial cancer, and subjects whose airflow obstruction was discovered during health screenings.ResultsA total of 217 patients were newly diagnosed with urothelial cancer during the study period at our institution. Among all patients, 210 (96.8%) underwent an evaluable lung function test, in which 38.6% (81 patients) displayed airflow obstruction defined as FEV1/FVC < 70%. In urothelial cancer patients, age, smoking index (pack-years), and BMI proved to be significant risk factors for airflow obstruction in multivariate logistic regression (p = 0.007, p < 0.0001, and p = 0.035, respectively). Gender, cancer stage, and cancer location were not significant risk factors. Patients with both airflow obstruction and urothelial cancer showed a more advanced emphysematous change than subjects presenting with airflow obstruction alone (unpaired t-test, p = 0.0003).ConclusionsAirflow obstruction was identified in 38.6% of urothelial cancer patients. Age, smoking index (pack-years), and BMI were significant risk factors. A significantly higher emphysematous score was observed in subjects with urothelial cancer than in subjects with airway obstruction alone.