Reduced area of the normal lung on high-resolution computed tomography predicts poor survival in patients with lung cancer and combined pulmonary fibrosis and emphysema

Background

This study aimed to determine the radiologic predictors and clarify the clinical features related to survival in patients with combined pulmonary fibrosis and emphysema (CPFE) and lung cancer.

The effect of enteral tube feeding in cystic fibrosis: A registry based study

Background

Long-term effect of enteral tube feeding (ETF) in cystic fibrosis (CF) remains equivocal.

小儿定喘口服液联合甲泼尼龙治疗重症支气管哮喘的临床研究

目的探讨小儿定喘口服液联合甲泼尼龙治疗重症支气管哮喘的临床疗效。方法选取2015年2月—2016年2月在西电集团医院呼吸内科接受治疗的小儿重症支气管哮喘患者86例,随机分成对照组和治疗组,每组各43例。对照组患儿静脉滴注注射用甲泼尼龙琥珀酸钠,1 mg/kg加入到5%葡萄糖溶液250 m L中,1次/d。治疗组在对照组的基础上口服小儿定喘口服液,3~6岁患儿10 m L/次,7~10岁患儿15 m L/次,10岁以上患儿20 m L/次,均为3次/d。所有患儿均连续治疗2周。比较两组临床疗效、肺功能变化、动脉血气指标、临床症状和体征消失时间以及肿瘤坏死因子α(TNF-α)、白介素-8(IL-8)和免疫球蛋白E(Ig E)表达水平。结果治疗后,对照组和治疗组总有效率分别为81.40%和95.35%,两组比较差异有统计学意义(P0.05)。治疗后,两组一秒用力呼气容积(FEV1)、最大呼气流量(PEF)、用力肺活量(FVC)和FEV1/FVC均较同组治疗前显著升高,同组比较差异具有统计学意义(P0.05);且治疗组这些观察指标显著高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组氧分压(p O2)和血氧饱和度(Sp O2)升高,二氧化碳分压(p CO2)较治疗前下降,同组治疗前后差异具有统计学意义(P0.05);且治疗组这些观察指标显著优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组患儿喘憋消失时间和肺部哮鸣音消失时间短于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患儿TNF-α、IL-8和Ig E表达水平均下降,同组治疗前后差异具有统计学意义(P0.05);且治疗组这些观察指标水平低于对照组,两组比较差异具有统计学意义(P0.05)。结论小儿定喘口服液联合甲泼尼龙治疗重症支气管哮喘的疗效显著,可有效改善患儿肺功能及降低血清炎性因子水平,具有一定的临床推广应用价值。     

Forced vital capacity (FVC) as an indicator of survival and disease progression in an ALS clinic population

In a large cohort of 1034 patients with the diagnosis of definite or probable amyotrophic lateral sclerosis (ALS), the association of forced vital capacity (FVC) at baseline with (a) time to progression of 20 points in Appel ALS (AALS) score or (b) tracheostomy free survival was investigated. The median survival of ALS patients with baseline FVC <75% was 2.91 years, compared with 4.08 years for patients with baseline FVC >75% (p<0.001). Patients with baseline FVC <75% progressed more rapidly (taking 8.0 months to progress 20 AALS points) compared with patients with baseline FVC >75% (10.0 months, p<0.001). Moreover, FVC at first examination was identified as a significant predictor of survival and disease progression in both univariate and multivariate Cox regression models, after adjustment for age, sex, site of onset, diagnostic delay, riluzole therapy, and use of bilateral positive airway pressure and percutaneous endoscopic gastrostomy (p<0.001). We conclude that a single FVC value obtained at an initial visit may serve as a clinically meaningful predictor of survival and disease progression in ALS.     

The lowest VE/VCO2 ratio best identifies chronic thromboembolic pulmonary hypertension

Introduction

The natural history of acute pulmonary embolism (PE) under treatment is about a gradual resolution of the thrombi, and uncommonly, the development of chronic thromboembolic pulmonary hypertension (CTEPH). We hypothesized that ventilatory efficiency parameters during cardiopulmonary exercise testing (CPET) may be able to monitor the process and predict CTEPH.

Methods

15 patients rehabilitated from acute PE (total resolution of thrombi), 44 patients with chronic PE (with residual thrombi), 66 patients with CTEPH, and 36 sedentary healthy controls performed incremental CPET.

Results

The lowest VE/VCO₂ was higher in CTEPH patients than that in chronic PE and rehabilitated patients (43.4 L/min vs 29.9 L/min vs 27.1 L/min, p < 0.005). The VE/VCO₂ slope (48.4 L/min/L/min vs 29.9 L/min/L/min vs 28.0 L/min/L/min, p < 0.005) and oxygen uptake efficiency plateau (OUEP) (37.1 L/min vs 27.0 L/min vs 25.2 L/min, p < 0.005) had the similar changes. In logistic regression analysis, the lowest VE/VCO₂ ≥ 34.35 L/min was the best predictor of CTEPH (OR 159.0, 95% CI 36.0-702.3, p < 0.001). The lowest VE/VCO₂ was higher in chronic PE patients compared with the controls (29.9 L/min vs 26.5 L/min, p < 0.05), but there was no difference between the rehabilitated patients and the controls. In multiple linear regression analysis, the percentage of vascular obstruction by ventilation-perfusion lung scanning (PVO) was the most significant independent predictor for indices of ventilatory efficiency in chronic PE and rehabilitated patients.

Conclusions

CTEPH is associated with weakened ventilatory efficiency. The lowest VE/VCO2 ratio has the best capability to predict CTEPH. Ventilatory inefficiency improves along with recovery of acute PE.     

High-resolution computed tomography in young patients with cystic fibrosis: distribution of abnormalities and correlation with pulmonary function tests

Objective

To assess pulmonary abnormalities detected by high-resolution computed tomography (HRCT) in young children with cystic fibrosis (CF) and mild to moderate lung disease.

Study design

High-resolution computed tomography was performed in 60 children, 6 to 10 years old, with mild to moderate lung disease (forced expiratory volume in 1 minute [FEV₁], 52-137; mean, 102; SD, 15% predicted). HRCTs were scored by using a system that evaluates each lobe for severity and extent of CF lung disease. Findings of CF lung disease were tabulated in all subjects and in a subgroup with normal pulmonary function tests. HRCT scores were correlated with FEV₁, forced vital capacity (FVC), and forced expiratory flow between 25% and 75% of expired vital capacity (FEF_25-75) in 57 patients.

Results

Bronchiectasis was present in 35% of subjects, mucous plugging in 15%, and air trapping in 63%. No abnormality was detected in 25%. In 37 subjects with FEV₁, FVC, and FEF_25-75 >85% predicted, bronchiectasis was present in 30%. In 17% of these subjects, bronchiectasis was seen in ≥4 lobes. Correlations between HRCT scores and FEV₁ were significant and showed fair to moderate correlation (r = 0.36-0.46).

Conclusions

High-resolution computed tomography demonstrated a broad range of pulmonary abnormalities in young patients with CF with mild to moderate lung disease. In this study, abnormalities, including bronchiectasis, were common in young children with CF and normal pulmonary function tests.     

利肺片联合异丙托溴铵治疗支气管哮喘慢性持续期的临床研究

目的探讨利肺片联合异丙托溴铵气雾剂治疗支气管哮喘慢性持续期的临床疗效。方法选择2015年1月—2017年12月武汉市红十字会医院收治的支气管哮喘患者105例为研究对象,按随机数字表法随机分为对照组(52例)和治疗组(53例)。对照组雾化吸入异丙托溴铵气雾剂,2掀/次,2次/d。治疗组在对照组治疗的基础上饭后30 min口服利肺片,2片/次,3次/d。两组均连续治疗14 d。观察两组的临床疗效,比较两组的肺功能指标和血清因子水平。结果治疗后,对照组和治疗组的总有效率分别为84.62%、96.23%,两组比较差异有统计学意义(P0.05)。治疗后,两组用力肺活量(FVC)、1秒用力呼气容积(FEV1)和最大呼气流速(PEF)均显著升高,同组治疗前后比较差异有统计学意义(P0.05);且治疗组肺功能指标明显高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组血清白细胞介素17(IL-17)、白三烯B4(LTB4)、中性粒细胞(PMN)均显著下降,同组治疗前后比较差异有统计学意义(P0.05);且治疗组血清因子水平明显低于对照组,两组比较差异具有统计学意义(P0.05)。结论利肺片联合异丙托溴铵气雾剂治疗支气管哮喘慢性持续期具有较好的临床疗效,能改善肺功能,调节IL-17、LTB4水平,降低PMN计数,安全性较好,具有一定的临床推广应用价值。