不同表型慢性阻塞性肺疾病治疗应答性差异比较

目的：分析不同表型的慢性阻塞性肺疾病( COPD)患者对长效β2受体激动剂/吸入型糖皮质激素的治疗应答性差异。方法纳入我院呼吸科门诊2013年1月至2015年1月连续使用沙美特罗/替卡松(50/500μg)12周的稳定期COPD患者。根据HRCT结果以低衰减区百分比( LAA%)≥15%定义为肺气肿型COPD,其余患者为慢性支气管炎型COPD。对患者进行常规体检、肺功能检测,使用改良英国医学研究委员会呼吸困难量表( MMRC)评价患者呼吸困难程度,使用圣乔治呼吸问卷( SGRQ)由患者自评呼吸问题给自身带来的困扰。结果纳入稳定期COPD患者297例,肺气肿型及慢性支气管炎型COPD患者在平均年龄、性别比例方面差异无统计学意义( P>0．05),两组患者BMI差异有统计学意义(P<0．05)。治疗前两组患者MMRC、SGRQ差异均无统计学意义(P>0．05),FEV1pre、FEV1/FVC、ICpre、RVpre差异有统计学意义(P<0．05)。治疗12周后,两组患者肺功能指标比较,△FEV1、△RV差异有统计学意义(P<0．05),△TLC、△IC差异无统计学意义(P>0．05)。结论①不同表型的COPD患者对长效β2受体激动剂/吸入型糖皮质激素的治疗应答性有明显差异。②肺气肿型与慢性支气管炎型相比分级更高,FEV 1下降的速度更快,治疗应答性更差。     

诱导痰细胞分类在嗜酸细胞性支气管炎诊断和治疗中的应用

目的探索诱导痰细胞分类在嗜酸细胞性支气管炎(EB)诊断和治疗中的作用。 方法回顾性分析我院门诊239例慢性咳嗽患者,依据慢性咳嗽中诊断标准,分为非EB组和EB组,分析两组诱导痰中细胞分类情况;同时给予EB患者进行8周治疗,观察经治疗后诱导痰中各细胞分类的改变情况。 结果239例慢性咳嗽患者中,非EB患者216例,占90.7%,EB患者23例,占9.3%,两组中共有121例(50.6%)患者诱导痰中嗜酸细胞百分比升高;非EB患者组细胞总计数为(4.83±2.61)×10⁶个/g、嗜酸细胞比例为(4.56±10.07)%、中性粒细胞比例为(50.32±26.12)%、淋巴细胞比例为(5.14±7.27)%、单核巨噬细胞比例为(40.30±16.70)%,EB患者组痰中细胞总计数为(5.46±3.07)×10⁶个/g、嗜酸细胞比例为(13.85±1 2.23)、中性粒细胞比例为(46.16±16.89)、淋巴细胞比例为(4.83±2.98)、单核巨噬细胞比例为(35.91±16.35),两组间EB组嗜酸细胞比例有显著的增多(P<0.05),在性别、年龄以及其余细胞成分差异无统计学意义(P>0.05);EB患者组经治疗后,痰中细胞总计数为(4.07±3.89)×10⁶个/g、嗜酸细胞比例为(2.52±3.80)%、中性粒细胞比例为(54.18±17.97)%、淋巴细胞比例为(5.59±4.33)%、单核巨噬细胞比例为(38.32±17.23)%,嗜酸细胞较治疗前有显著减少(P<0.05),其余细胞改变无显著差异(P>0.05)。 结论诱导痰细胞分类检查是诊断EB的重要方法,在其诊断和治疗过程中有着重要的指导作用,可作为EB治疗过程的监测指标。     

婴幼儿法洛四联症矫治术后毛细血管渗透症的诊断与治疗

目的:探讨婴幼儿法洛四联症(tetralogy of Fallot,TOF)矫治术后,毛细血管渗透症发病机制、诊断及处理。方法:我院2005年3月至2010年1月施行婴幼儿TOF矫治术161例,术后并发毛细血管渗透症6例,男性4例,女性2例,年龄9~36个月,平均(8±0.6)个月;体质量8.5~15.5kg,平均(8.2±2.10)kg。全组均及时给予提高胶体渗透压、应用血管活性药、腹膜透析、呼吸机辅助维持呼吸、循环稳定和组织灌注治疗。结果:治愈5例,死亡1例,死于肾、肺、心多脏器衰竭。结论:婴幼儿心脏术后毛细血管渗透症发病机制与补体致炎性介质释放,使毛细血管通透性增加有关,低心排出量综合征(低心排)、呼吸衰竭、急性肾衰竭、脑损害是致死主要原因,及时采用腹膜透析和免疫球蛋白可获得较好疗效。     

慢性支气管炎患者自然杀伤T细胞的表达与临床意义

目的:探索自然杀伤T细胞(NKT)在慢性支气管炎患者的表达及意义。方法:收集慢性支气管炎患者30例(慢支组),以30例健康志愿者为对照组;采用流式细胞术分析NKT及其胞内细胞因子γ干扰素(IFN-γ)及肿瘤坏死因子α(TNF-α)的含量。结果:与对照组比较,慢支组NKT及IFN-γ含量明显降低(P0.05),但TNF-α含量明显升高。结论:NKT及IFN-γ含量降低、TNF-α含量增加,是慢性支气管炎的一个重要免疫学现象,可能是慢性炎症导致TNF-α蓄积,而NKT及IFN-γ消耗过多所致。     

应用全自动毛细血管电泳技术对杭州地区地中海贫血的筛查

目的 了解杭州地区地中海贫血的检出情况,探讨产检中筛查地中海贫血的意义,评价平均红细胞体积（MCV）、平均血红蛋白量（MCH）及血红蛋白电泳对地中海贫血进行产前筛查的价值。方法 以2019年2月～2020年3月在我院检查的3968例育龄期妇女为研究对象,进行血常规、血红蛋白电泳及β-地贫基因检测。结果 筛查3968例育龄期妇女,疑似α-地中海贫血或缺铁性贫血共有366例（9.22%）,其中妊娠中晚期孕妇有255例;疑似β-地中海贫血共有19例（0.48%）,其中有4例进行β-地贫基因检测,均被确诊为β-地中海贫血,分别为βIVS-II-654/βN 突变1例,βCD17/βN 突变2例,βCD41/42/βN 1例。结论 MCV、MCH及血红蛋白电泳可以对地中海贫血进行产前筛查,整体操作较为简便。加强地中海贫血筛查及检测,可以降低出生缺陷,对优生优育具有重要意义。     

急支糖浆联合阿奇霉素治疗小儿支原体肺炎的疗效及对炎症因子水平的影响

目的 分析急支糖浆联合阿奇霉素治疗小儿支原体肺炎的疗效及对炎症因子水平的影响。方法 回顾性选取2014年7月-2016年9月成都市郫都区人民医院收治的小儿支原体肺炎患儿94例,根据治疗方法不同分为对照组和观察组。对照组患儿采用阿奇霉素序贯疗法进行治疗,首先iv阿奇霉素10 mg/（kg·d）,连续用药5 d;之后口服阿奇霉素颗粒5 mg/（kg·d）,连续用药3 d,停药4 d为1个疗程。观察组患儿在对照组基础上同时口服急支糖浆,根据年龄确定剂量,<3岁者7 mL/次;3~7岁者10 mL/次;7~12岁者15 mL/次,均为3次/d。两组均治疗2个疗程。观察两组患儿症状、体征消失时间、住院时间、不良反应情况、血清炎症因子、基质金属蛋白酶-9（MMP-9）、丙二醛（MDA）、超氧化物歧化酶（SOD）水平变化情况。结果 观察组患儿退热时间、咳嗽消失时间、肺部湿啰音消失时间及住院时间均短于对照组,差异有统计学意义（P<0.05）。两组患儿治疗后超敏C-反应蛋白（hs-CRP）、白介素-4（IL-4）、降钙素原（PCT）、MMP-9及MDA水平均较治疗前下降,γ-干扰素（IFN-γ）和超氧化物歧化酶（SOD）水平较治疗前上升,同组治疗前后比较差异均有统计学意义（P<0.05）。观察组患儿治疗后hs-CRP、IL-4、PCT、MMP-9及MDA水平低于对照组,IFN-γ和SOD水平高于对照组,组间差异有统计学意义（P<0.05）。观察组患儿不良反应率为8.16%,对照组为37.78%,观察组患儿不良反应率低于对照组,差异有统计学意义（P<0.05）。结论 急支糖浆联合阿奇霉素治疗小儿支原体肺炎疗效确切,可调节患儿血清炎症因子水平,抑制患儿氧自由基产生,且安全性较高。     

清热散结胶囊联合头孢克肟治疗儿童急性支气管炎的临床研究

目的探讨清热散结胶囊联合头孢克肟治疗急性支气管炎患儿的临床疗效。方法选取2018年2月—2018年11月在成都市第三人民医院治疗的急性支气管炎患儿118例,根据用药的差别分为对照组(59例)和治疗组(59例)。对照组口服头孢克肟分散片,0.1 g/次,2次/d;治疗组在对照组基础上口服清热散结胶囊,1.75 g/次,3次/d。两组均治疗14 d。观察两组患者临床疗效,同时比较治疗前后两组患者临床症状改善时间和炎症因子水平。结果治疗后,对照组和治疗组临床有效率分别为81.36%和96.61%,两组比较差异具有统计学意义(P0.05)。经治疗,治疗组患者体温、咳嗽和肺部啰音复常时间均明显早于对照组,两组比较差异具有统计学意义(P0.05)。经治疗,两组患者血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、半胱氨酰白三烯(CysLTs)、可溶性髓系细胞触发因子-1(sTREM-1)、白细胞介素-6(IL-6)水平显著降低(P0.05),且治疗组患者hs-CRP、TNF-α、CysLTs、sTREM-1、IL-6水平明显低于对照组患者(P0.05)。结论清热散结胶囊联合头孢克肟治疗急性支气管炎患儿可有效改善患者临床症状,降低机体炎症反应,具有一定的临床推广应用价值。     

Chronic bronchitis in the general population: influence of age, gender and socio-economic conditions

Chronic bronchitis (CB) is an indicator of an increased risk of developing COPD, but its symptoms are often underestimated. Demographic and socio-economic conditions might influence its prevalence, reporting and impact. Data from a large epidemiological survey of the French general population were analyzed to determine the burden of CB, the magnitude of under-diagnosis and the influence of age, gender and socio-economic conditions. Altogether, 9050 participants aged 45 years or more provided complete data. The prevalence of symptoms and diagnosis of CB was 3.5% and 3.4%, respectively. CB was associated with impaired health status and activity and, in women, work loss. Among subjects with symptoms of CB, only 28.6% declared a known diagnosis of respiratory disease. Factors associated with symptoms of CB in multivariate analysis were male gender, active smoking, lower income and occupational category: the highest prevalence was observed in manual workers (5.6%) and self-employed subjects (5.2%). The under-diagnosis of CB was more marked in men and subjects of higher socio-economic categories. These results confirm that CB is markedly under-diagnosed in the general population. Socio-economic conditions influence both its prevalence (higher in low categories) and rate of diagnosis (lower in high categories), which should be considered when elaborating prevention and detection campaigns.     

The determinants of chronic bronchitis in Aboriginal children and youth

BACKGROUND:

There is limited knowledge concerning chronic bronchitis (CB) in Canadian Aboriginal peoples.

OBJECTIVE:

To determine the prevalence (crude and adjusted) of CB and its associated risk factors in Canadian Aboriginal children and youth six to 14 years of age.

METHODS:

Data from the cross-sectional Aboriginal Peoples Survey were analyzed in the present study. Logistic regression analysis was used to determine risk factors influencing the prevalence of CB among Aboriginal children and youth. The balanced repeated replication method was used to compute standard errors of regression coefficients to account for clustering inherent in the study design. The outcome of interest was based on the question: “Have you been told by a doctor, nurse or other health professional that you have chronic bronchitis?” Demographics, environment and population characteristics (predisposing and enabling resources) were tested for an association with CB.

RESULTS:

The prevalence of CB was 3.1% for boys and 2.8% for girls. Other significant risk factors of CB were age (OR 1.38 [95% CI 1.24 to 1.52] for 12 to 14 year olds versus six to eight year olds), income (OR 2.28 [95% CI 2.02 to 2.59] for income category <$25,000/year versus ≥$85,000/year), allergies (OR 1.96 [95% CI 1.78 to 2.16] for having allergies versus no allergies), asthma (OR 7.61 [ 95% CI 6.91 to 8.37] for having asthma versus no asthma) and location of residence (rural/urban and geographical location). A significant two-way interaction between sex and body mass index indicated that the relationship between the prevalence of CB and body mass index was modified by sex.

DISCUSSION:

The prevalence of CB was related to well-known risk factors among adults, including older age and lower annual income.