Modelos animales de enfermedad pulmonar obstructiva crónica

Animal models of disease have always been welcomed by the scientific community because they provide an approach to the investigation of certain aspects of the disease in question.Animal models of COPD cannot reproduce the heterogeneity of the disease and usually only manage to represent the disease in its milder stages. Moreover, airflow obstruction, the variable that determines patient diagnosis, not always taken into account in the models. For this reason, models have focused on the development of emphysema, easily detectable by lung morphometry, and have disregarded other components of the disease, such as airway injury or associated vascular changes.Continuous, long-term exposure to cigarette smoke is considered the main risk factor for this disease, justifying the fact that the cigarette smoke exposure model is the most widely used. Some variations on this basic model, related to exposure time, the association of other inducers or inhibitors, exacerbations or the use of transgenic animals to facilitate the identification of pathogenic pathways have been developed. Some variations or heterogeneity of this disease, then, can be reproduced and models can be designed for resolving researchers’ questions on disease identification or treatment responses.     

COPD: To Be or Not to Be,That is the Question

As our knowledge on the natural history of chronic obstructive pulmonary disease (COPD) progresses, a conceptual model simply based on an accelerated decline of lung function in adult life in response to smoking has become inadequate to capture the complexity of this disease, and increasing attention is being given to possible contributions from events or alterations of developmental processes that take place earlier in life. In addition, a remarkable heterogeneity has emerged among the pathobiological mechanisms that are involved in different phenotypes of COPD, suggesting that an effective disease management will require individualized treatment approaches largely based on the underlying biological mechanisms (endotypes). In this review, we will discuss the many faces of COPD from an epidemiological, pathobiological, and clinical standpoint and argue that airflow limitation encompasses a number of manifestations that are too diverse to be still clustered under the same diagnostic label.     

Improving Diagnosis and Management of Alpha-1 Antitrypsin Deficiency in Primary Care: Translating Knowledge into Action

ABSTRACT

Alpha-1 antitrypsin (AAT) deficiency is an established genetic risk factor for pulmonary disease and may lead to severe emphysema. Despite accessible, inexpensive, and straightforward testing procedures, the disorder is still widely undiagnosed due mainly to a lack of awareness among the medical community. AAT deficiency often results in the development of non-specific respiratory symptoms that can be confused with those of other non-hereditary chronic obstructive pulmonary disease or asthma. However, there are published guidelines that provide detailed recommendations on patient testing. Early diagnosis of AAT deficiency is fundamental to improve patient outcomes; it allows preventive measures to be taken, such as smoking cessation, and allows monitoring and initiation of appropriate therapy while lung function is still relatively preserved. Diagnosis should not solely be the domain of the specialist pulmonologist; testing can be easily initiated in the primary care setting. The establishment of process maps and diagnosis algorithms, as suggested in this review, should encourage appropriate suspicion, testing, and follow-up of AAT deficiency in the patient's primary care medical home setting. Primary care physicians have a key role in increasing the awareness, diagnosis, and effective management of this disorder.     

慢性阻塞性肺气肿临床治疗效果观察

目的探讨慢性阻塞性肺气肿的临床治疗方法。方法将慢性阻塞性肺气肿患者102例随机分为治疗组和对照组各51例。对照组行抗生素治疗,同时行辅助治疗措施;治疗组在对照组西药治疗基础上行中药治疗。比较2组患者治疗效果。结果治疗组总有效率为96.08%高于对照组的82.35%(P<0.05)。结论中西药结合治疗慢性阻塞性肺气肿,可有效缓解患者的各种临床症状,取得较满意的治疗效果,值得临床推广应用。     

多层螺旋CT评价肺气肿患者肺功能的可行性

目的探索建立肺气肿通气功能障碍的CT分级标准及可行性。方法147例受试者自愿接受多层螺旋CT（MSCT）及常规肺功能（PFT）检查，间隔不超过1周。以数字表法将患者随机分成2组：A组120例，比较MSCT肺功能与PFT之间的相关性，并以PFT为金标准将其分为正常、轻、中、重度肺功能损害4组，用来建立肺气肿通气功能障碍的MSCT分级标准。B组27例，评估上述分级标准的准确性。测定CT肺功能的定量指标：容积比（Vex／in）、吸气相平均肺密度（MLDin）、呼气相平均肺密度（MLDex）、平均肺密度比（MLDex／in）、吸气相-910HU的像素指数（Piin-910）、呼气相-910HU的像素指数（Piex-910）、-910HU的像素指数比（Piex／in-910）。结果MSCT肺定量指标与PFT之间存在相关性，其中以Piex／in-910与FEV1％的相关性最佳（r=-0．905，P＜0．01）。正常肺功能者60例，轻度下降者22例，中度下降者21，重度下降者17例，所建立的分级标准能较好地反映肺气肿通气功能障碍，其中以Piex／in-910诊断效能最高（x^2=0．267，P=0．966，准确性81．5％），其初步标准为：正常0～9．9，轻度10．0～34．9，中度35．0～74．9，重度≥75．0。结论MSCT肺定量指标评价肺气肿通气功能障碍是可行的，其中以Piex／in-910诊断效能最高。     

Emphysema quantification and lung volumetry in chest X-ray equivalent ultralow dose CT – Intra-individual comparison with standard dose CT

ObjectivesTo determine whether ultralow dose chest CT with tin filtration can be used for emphysema quantification and lung volumetry and to assess differences in emphysema measurements and lung volume between standard dose and ultralow dose CT scans using advanced modeled iterative reconstruction (ADMIRE).Methods84 consecutive patients from a prospective, IRB-approved single-center study were included and underwent clinically indicated standard dose chest CT (1.7 ± 0.6 mSv) and additional single-energy ultralow dose CT (0.14 ± 0.01 mSv) at 100 kV and fixed tube current at 70 mAs with tin filtration in the same session. Forty of the 84 patients (48%) had no emphysema, 44 (52%) had emphysema. One radiologist performed fully automated software-based pulmonary emphysema quantification and lung volumetry of standard and ultralow dose CT with different levels of ADMIRE. Friedman test and Wilcoxon rank sum test were used for multiple comparison of emphysema and lung volume. Lung volumes were compared using the concordance correlation coefficient.ResultsThe median low-attenuation areas (LAA) using filtered back projection (FBP) in standard dose was 4.4% and decreased to 2.6%, 2.1% and 1.8% using ADMIRE 3, 4, and 5, respectively. The median values of LAA in ultralow dose CT were 5.7%, 4.1% and 2.4% for ADMIRE 3, 4, and 5, respectively. There was no statistically significant difference between LAA in standard dose CT using FBP and ultralow dose using ADMIRE 4 (p = 0.358) as well as in standard dose CT using ADMIRE 3 and ultralow dose using ADMIRE 5 (p = 0.966). In comparison with standard dose FBP the concordance correlation coefficients of lung volumetry were 1.000, 0.999, and 0.999 for ADMIRE 3, 4, and 5 in standard dose, and 0.972 for ADMIRE 3, 4 and 5 in ultralow dose CT.ConclusionsUltralow dose CT at chest X-ray equivalent dose levels allows for lung volumetry as well as detection and quantification of emphysema. However, longitudinal emphysema analyses should be performed with the same scan protocol and reconstruction algorithms for reproducibility.     

结合珠蛋白遗传多态性与呼吸系统疾病关系的研究

目的：探讨血清结合珠蛋白的遗传多态性与呼吸系统几种常见疾病的关键。方法：应用聚丙烯酰胺凝胶垂直平板电泳技术，分析四川泸州地区肺气肿、支气管哮喘和肺癌患者的ＨＰ表型分布。结果：三种疾病患者的ＨＰ＾１基因频率都显著高于正常对照组。结论：ＨＰ＾１基因与呼吸系统常见的三种疾病发生有关，可能是促使机体对这三种疾病易感的遗传因子。