外周血CD64表达与老年慢阻肺急性加重期患者预后的相关性

目的 分析外周血CD64表达与老年慢阻肺急性加重期患者预后的相关性,探讨CD64表达预测患者预后的价值。方法 选择医院2017年1月至2018年11月期间收治的198例老年慢阻肺急性加重期患者作为急性加重组,纳入同期在医院接受常规检查的稳定期慢阻肺患者100例作为稳定组,同期医院接受常规体检证实为健康的100例老年人群作为健康对照组。检测并比较3组入院当天外周血CD64表达;急性加重组出院后随访1年,将再住院与死亡的患者纳入预后不良组,其他则纳入预后良好组;分别于入院时、治疗开始第3d、第7d、出院时,检测并比较不同预后患者的外周血CD64表达;检验外周血CD64表达对急性加重期患者预后的影响,分析其预测预后的价值。结果 3组中健康对照组CD64指数最低,其次为稳定组,急性加重组CD64指数最高,组间比较差异有统计学意义(P＜0.05);入院后各时点,不同预后组患者CD64指数均较入院当天降低(P＜0.05);但入院时及入院后各时点,预后不良组CD64指数均高于预后良好组,差异有统计学意义(P＜0.05);外周血CD64指数高表达是增加急性加重期慢阻肺患者预后不良的影响因素(P＜0.05);外周血CD64高表达与患者预后不良风险呈正相关(B＞0,P＜0.05);绘制ROC曲线得到各时点曲线下面积均＞0.9,预测价值高。结论 老年慢阻肺急性加重期患者治疗后伴较高的再住院与死亡风险,住院治疗期间各时点外周血CD64表达与患者预后相关,其过表达可能提示预后不良高风险,可考虑将外周血CD64表达用于老年慢阻肺急性加重期预后不良的预测中,指导合理治疗方案的设计,以减少不良预后的发生。     

NT-proBNP 对评估 COPD 急性加重风险的意义简

目的 主要探讨检测血浆N端脑钠肽前体（NT-proBNP）对评估慢性阻塞性肺疾病（COPD）急性加重风险的意义.方法 选取2012.1~2012.8 在我院住院治疗的COPD患者63名,根据2011版GOLD策略综合评估分为COPD低危组22人（包含A组和B组）和COPD高危组23人（包含C组和D组）,分别测定并比较2组NT-proBNP、肺功能、体重指数及并发症情况.结果 COPD低危组患者血浆NT-proBNP水平（245.7±166.2 pg/ml）明显低于COPD高危组患者（1326.7±198.8 pg/ml）（P〈0.05）.肺功能FEV1（perd%）与NT-proBNP（pg/ml）成负相关（r=-0.395,P=0.001）.而年龄、性别与体重指数则与NT-proBNP（pg/ml）无相关性（P＞0.05）.结论 NT-proBNP能较好反应COPD的急性加重风险.     

慢性阻塞性肺疾病急性加重期血清皮质醇的表达特征

目的探讨慢性阻塞性肺疾病急性加重期（AECOPD）血清皮质醇的表达特征。方法随机选取2011年10月至2012年10月在我院住院的AECOPD患者65例为COPD组,根据肺功能结果分为轻中度组33例及重度、极重度组32例,同期住院的非COPD患者33例为非COPD组。全部研究对象分别于人院后第二天的8am、4pm及0am三个时间段各抽取肘静脉血,分别检测血清皮质醇和促肾上腺皮质激素水平。结果三个不同时间段轻、中度组及重度、极重度组皮质醇水平明显低于非COPD组（P〈0．01）;8am时段轻、中度组明显低于重度、极重度组（P〈0．01）。三个不同时段轻、中度组及重度、极重度组促肾上腺皮质激素水平高于非COPD组（P〈0．05）。结论AECOPD患者存在肾上腺皮质代谢紊乱,表现为血清皮质醇水平降低,促肾上腺皮质激素水平升高。     

Asthma prevalence and exacerbations in children: is there an association with childhood vaccination?

Infections and vaccinations may have a potential role in the normal maturation of the immune system, in the development and balance of regulatory pathways, and in the development and exacerbations of asthma. Asthma exacerbations often result from respiratory viral infections, and, while vaccination towards common viral infections may reduce the occurrence of such exacerbations, there has been concern that vaccinations can increase the risk of asthma. Current studies show that childhood vaccines, including inactivated influenza vaccine, are generally safe. However, there is some concern regarding possible exacerbations in infants or children with frequent wheezing or persistent asthma who are given live-attenuated influenza vaccination. Although severe allergic adverse events attributable to vaccination are extremely rare, all serious allergic reactions should be further assessed to detect the likely causative vaccine component, such as egg protein or gelatin. The risks of not vaccinating children far outweigh the risks of allergy and asthma exacerbations. Therefore, childhood vaccination should remain an essential part of child health programs and should not be withheld, even from children with asthma or those predisposed to allergy.     

从GOLD治疗目标谈莫西沙星在慢性阻塞性肺疾病治疗中的作用

慢性阻塞性肺疾病(COPD)是一种具有气流受限特征的可以预防和治疗的疾病,气流受限不完全可逆、呈进行性发展,与肺部对香烟烟雾等有害气体或有害颗粒的异常炎症反应有关[1]。在世界范围内COPD的发病率和病死率都很高,并导致重大且持续增长的经济和社会学压力[2]。据估计,至2020年COPD将位居世界疾病经济负担的第3位,近期     

信必可吸入治疗轻中度哮喘急性发作的疗效观察

目的观察布地奈德福莫特罗吸入剂(信必可)治疗轻中度哮喘急性发作的疗效、安全性。方法选择轻中度哮喘患者63例随机分为两组,试验组吸入信必可,对照组静脉使用甲强龙,两组均予吸氧、止咳化痰对症治疗。两组均于治疗前及治疗后第7天测定肺功能及动脉血气。结果试验组总有效率93.75%,对照组总有效率90.32%,两组肺功能及PaO2较前均明显改善,但试验组肺功能改善更明显,且副作用少。结论信必可吸入治疗轻中度哮喘急性发作治疗更有效、安全。     

Exacerbation of pulmonary fibrosis following single lung transplantation

Acute exacerbations of interstitial lung disease present as clinical deteriorations, with progressive hypoxemia and parenchymal consolidation not related to infection, heart failure or thromboembolic disease. Following single lung transplantation, patients receive maintenance immunosuppression, which could mitigate the development of acute exacerbations in the native lung. A 66-year-old man with fibrotic, nonspecific interstitial pneumonitis presented with fever, hypoxemia and parenchymal consolidation limited to the native lung four years after single lung transplantation. Investigations were negative for infection, heart failure and thromboembolic disease. The patient worsened over the course of one week despite broad-spectrum antimicrobial therapy, but subsequently improved promptly with augmentation of prednisone dosed to 50 mg daily and addition of N-acetylcysteine. Hence, the patient fulfilled the criteria for a diagnosis of an acute exacerbation of pulmonary fibrosis in his native lung. Clinicians should consider acute exacerbation of parenchymal lung disease of the native lung in the differential diagnosis of progressive respiratory deterioration following single lung transplantation for pulmonary fibrosis.