川芎嗪防治肺纤维化大鼠自由基损伤作用的实验研究

目的研究川芎嗪防治肺纤维化大鼠自由基损伤的作用。方法 SD雄性大鼠40只,随机分为正常组、模型组、阳性药物对照组及川芎嗪组,共4组,每组10只。于给药28d后取肺组织,测定各组大鼠肺组织中SOD、GSH-Pxi、NOS活性和MDA水平。结果川芎嗪能提高肺纤维化大鼠体内的GSH-Px和SOD活性,降低MDA水平和iNOS活性。结论川芎嗪能调节肺纤维化大鼠体内自由基水平,减轻自由基对肺组织结构的氧化损伤,对特发性肺纤维化起到防治作用。     

重组人干扰素-γ联合激素治疗特发性肺间质纤维化30例

目的探讨重组人干扰素-γ联合激素治疗特发性肺间质纤维化的临床疗效。方法选择2009年1月～2012年1月在我院治疗的特发性肺间质纤维化患者60例为研究对象,随机分为联合组和激素组,同时选择健康体检者30例为对照组,比较联合组和激素组治疗前后临床症状情况,检测肺间质纤维化患者与对照组的血清胶原蛋白与透明质酸的水平。结果在刺激性干咳、呼吸困难、活动能力、肺弥散功能方面,两组好转比例差异有高度统计学意义(P<0.01)。治疗前,特发性肺纤维化患者血清纤维化指标显著高于对照组(P<0.01),而联合组和激素组之间差异无统计学意义(P>0.05);治疗后,联合组血清纤维化指标下降程度高于激素组(P<0.01)。结论联合重组人IFN-γ和激素治疗特发性肺间质纤维化,可以延缓患者肺间质纤维化的进程,减轻患者的症状和体征。     

特发性肺间质纤维化无创通气支持的护理

目的：总结特发性肺间质纤维化患者应用无创正压通气（NIPPV）治疗前后的临床观察与护理。方法：分析特发性肺间质纤维化使用无创通气患者的护理,并追踪治疗结果。结果：本组30例患者中,21例（70％）治疗后好转,9例（30％）患者病情恶化接受有创机械通气,最终死亡3例（10％）。血氧饱和度、PaO2/FiO2、RR在治疗前后对比差异具有统计学意义,而pH、PaO2及PaCO2在治疗前后对比差异无统计学意义。结论：NIPPV为IPF的抢救和康复创造了条件,对患者实施良好的护理是应用无创正压通气的关键。     

对数线性模型的IPF算法及其软件实现

目的　采用Ｎｅｗ ｔｏｎ－Ｒａｐｈｓｏｎ 法拟合对数线性模型时，如果列联表的维数太高（≥５），使得设计矩阵复杂，以及迭代精度等原因，出现病态的信息矩阵，而无法收敛，导致算法失败。本文从应用角度探讨了ＩＰＦ算法的有效性。方法　采用ＩＰＦ算法对一个五维表进行了分析。结果　ＩＰＦ算法能够很好地拟合高维表的模型，并得出了合理的结果。结论　ＩＰＦ算法简便、稳健，在Ｎｅｗ ｔｏｎ－Ｒａｐｈｓｏｎ 法失效时，不失为处理高维表的解决办法     

特发性肺纤维化患者支气管─肺泡灌洗液促凝活性测定及临床意义

应用复钙法测定１８例特发性肺纤维化（研究组）和１２例无肺疾病健康人（对照组）的支气管─肺泡灌洗液促凝活性。结果显示，研究组的促凝活性明显高于对照组（Ｐ＜０．０１）。相关分析表明，支气管─肺泡灌洗液中促凝活性与巨噬细胞有一定相关性（ｒ＝０．４５６，Ｐ＜０．０５）。提示在间质性肺疾病患者肺内可能存在着促凝活性亢进。这种亢进对间质纤维化的形成和发展可能有一定影响。     

Combined pulmonary fibrosis and emphysema (CPFE): an entity different from emphysema or pulmonary fibrosis alone

Chronic obstructive pulmonary disease (COPD) and idiopathic interstitial pneumonias (IIP), with different radiological, pathological, functional and prognostic characteristics, have been regarded as separate entities for a long time. However, there is an increasing recognition of the coexistence of emphysema and pulmonary fibrosis in individuals. The association was first described as a syndrome by Cottin in 2005, named “combined pulmonary fibrosis and emphysema (CPFE)”, which is characterized by exertional dyspnea, upper-lobe emphysema and lower-lobe fibrosis, preserved lung volume and severely diminished capacity of gas exchange. CPFE is frequently complicated by pulmonary hypertension, acute lung injury and lung cancer and prognosis of it is poor. Treatments for CPFE patients with severe pulmonary hypertension are less effective other than lung transplantation. However, CPFE has not yet attracted wide attention of clinicians and there is no research systematically contrasting the differences among CPFE, emphysema/COPD and IIP at the same time. The authors will review the existing knowledge of CPFE and compare them to either entity alone for the first time, with the purpose of improving the awareness of this syndrome and exploring novel effective therapeutic strategies in clinical practice.     

Eicosanoid Lipid Mediators in Fibrotic Lung Diseases: Ready for Prime Time?

Recognition of a pivotal role for eicosanoids in both normal and pathologic fibroproliferation is long overdue. These lipid mediators have the ability to regulate all cell types and nearly all pathways relevant to fibrotic lung disorders. Abnormal fibroproliferation is characterized by an excess of profibrotic leukotrienes and a deficiency of antifibrotic prostaglandins. The relevance of an eicosanoid imbalance is pertinent to diseases involving the parenchymal, airway, and vascular compartments of the lung, and is supported by studies conducted both in humans and animal models. Given the lack of effective alternatives, and the existing and emerging options for therapeutic targeting of eicosanoids, such treatments are ready for prime time.     

Serum cytokine changes induced by direct hemoperfusion with polymyxin B-immobilized fiber in patients with acute respiratory failure

BackgroundPolymyxin B-immobilized Fiber therapy (PMX-DHP) may improve the prognosis of patients with rapidly progressive interstitial lung diseases (ILDs). However, the mechanisms by which PMX-DHP ameliorates oxygenation are unclear. The present study aimed to clarify the changes in serum cytokine concentrations during PMX-DHP with steroid pulse therapy.MethodsPatients with acute respiratory failure (ARF) and rapidly progressive ILDs, acute exacerbation of idiopathic pulmonary fibrosis (IPF), or acute respiratory distress syndrome (ARDS), and treated with PMX-DHP were assessed, including patients with IPF. The serum concentrations of 38 cytokines were compared between the ARF and IPF groups before treatment. In the ARF group, cytokine levels were compared before, immediately after PMX-DHP, and the day after termination of steroid pulse therapy.ResultsFourteen ARF and eight IPF patients were enrolled. A comparison of the cytokine levels before treatment initiation revealed that EGF, GRO, IL-10, MDC, IL-12p70, IL-15, sCD40L, IL-7, IP-10, MCP-1, and MIP-1β were significantly different between the two groups. In the ARF group treated with PMX-DHP, the concentrations of MDC, IP-10, and TNF-α continuously decreased during treatment (P < 0.01). Further, the cytokine levels of GRO, IL-10, IL-1Ra, IL-5, IL-6, and MCP-1 decreased after the entire treatment period, with no change observed during the steroid-only period (P < 0.01, except GRO and MCP-1). Although PMX-DHP significantly reduced eotaxin and GM-CSF serum levels (P < 0.01 and P < 0.05), these levels did not change after treatment.ConclusionsPMX-DHP combined with steroid pulse therapy might reduce GRO, IL-10, IL-1Ra, IL-5, IL-6, and MCP-1 levels in ARF, contributing to better oxygenation in the disorder.