肺炎患者支气管肺泡洗液中激肽形成机制的探讨

目的：探讨下呼吸道急性炎症时激肽生成途径。方法：测定肺炎患者（肺炎组）和健康志愿者（对照组）支气管肺泡灌洗液（ＢＡＬＦ）中激肽,激肽形成酶活性,血浆血管舒缓素（ＰＫ）和α２－巨球蛋白（α２－Ｍ）,并鉴定激肽形成酶活性分子来源。结果：肺炎组ＢＡＬＦ中的各种检测指标均明显高于对照组（Ｐ〈０．００１）;经凝胶过滤和酶抑制试验鉴定,肺炎患者ＢＡＬＦ中主要激肽形成酶活性位于高分子量部分,ＰＫ抑制物能显著抑制     

肺泡灌洗液炎性因子对急性呼吸窘迫综合征患者肺复张潜能的评估价值

背景 目前临床上缺少实用有效的对急性呼吸窘迫综合征(ARDS)患者肺可复张性评估方法。目的探究肺泡灌洗液(BALF)中炎性因子对ARDS患者肺复张(RM)潜能的预测价值。方法 选取2020年3月至2022年3月浙江大学医学院附属金华医院ICU收治的需有创机械通气的ARDS患者62例为研究对象,所有患者在RM前及RM后第3天进行纤维支气管镜下肺泡灌洗,检测BALF中白介素(IL)-6、IL-8、IL-10水平,肺部超声评分(LUS)及氧合指数(PaO₂/FiO₂)。根据RM前后LUS差值(ΔLUS)是否大于5分分为RM有效组(RM-E组)及RM无效组(RM-N组),比较两组患者BALF中炎性因子变化;分析两组RM前后炎性因子差值(ΔIL-6、ΔIL-8、ΔIL-10)和ΔLUS的相关性。采用受试者工作特征(ROC)曲线分析BALF炎性因子差值对RM潜能的预测价值。结果 RM-E组患者38例,RM-N组患者24例,RM前两组患者的LUS及BALF中IL-6、IL-8、IL-10水平比较,差异均无统计学意义(P>0.05);两组患者的潮气量(...     

Effect of preoperative inhaled budesonide on pulmonary injury after cardiopulmonary bypass: A randomized pilot study

Background

Cardiopulmonary bypass can result in lung injury. This prospective, double-blinded, randomized trial aimed to evaluate the protective effect of inhaled budesonide on lung injury after cardiopulmonary bypass.

支气管肺泡灌洗液诊断肺结核的诊断的价值应用

目的评价纤维支气管镜防污染支气管肺泡灌洗液技术对肺结核分支杆菌快速培养和痰菌阴的不典型肺结核的诊断价值应用。方法对98例肺结核患者采用支气管镜进行检查,并对病变部位灌洗标本液,并且培养出结核杆菌。结果98例结核分支杆菌检出率为66.3%、84.8%,其中30例活检,20例确诊为结核内芽肿,检出率为66.7%。结论纤支镜下进行BALF快培对不典型肺结核具有良好的诊断及时,阳性率较高,通过支气管镜下不同的取材方法能够有效的提高诊断率。     

TARC expression in the circulation and cutaneous granulomas correlates with disease severity and indicates Th2-mediated progression in patients with sarcoidosis

Background

Sarcoidosis is a systemic disorder characterized by the accumulation of lymphocytes and monocyte/macrophage lineage cells that results in the formation of non-caseating granulomas. Thymus- and activation-regulated chemokine (TARC)/CCL17 is an important chemokine in the amplification of Th2 responses, which are achieved by recruiting CCR4-expressing CD4⁺ T lymphocytes. TARC concentrations are known to increase in the serum of sarcoidosis patients; however, its role in the assessment of severity and prognosis of sarcoidosis remains unknown. The objective of this study is to elucidate the role of TARC in sarcoidosis by investigating its expression in peripheral blood and at inflammatory sites. We also examined its relationship with clinical features.

老年长期下呼吸道感染患者肺泡灌洗液中溶菌酶检测的意义

本文用溶菌板分析法测定了老年人长期下呼吸道感染者肺泡灌洗液(BALF)中溶菌酶(Lym)的水平,发现长期下呼吸道感染的老年人BALF中的Lym明显低于非下呼吸道感染的老年人(P<0.05);同时显示老年非下呼吸道感染者明显低于中青年对照组(P<0.025),中青年下呼吸道感染者明显高于非下呼吸道感染的同龄人(P<0.01)。说明老年人细胞免疫功能显著降低,长期肺部感染时更加重了细胞免疫功能的损害。这可能是老年人易感染、不易治愈和反复发作的原因之一。测定长期下呼吸道感染的老年患者BALF中的Lym有助于判断患者的免疫状况,对疾病的治疗及预后有一定的指导意义。     

Aspiration Pneumonia and Related Syndromes

Aspiration is a syndrome with variable respiratory manifestations that span acute, life-threatening illnesses, such as acute respiratory distress syndrome, to chronic, sometimes insidious, respiratory disorders such as aspiration bronchiolitis. Diagnostic testing is limited by the insensitivity of histologic testing, and although gastric biomarkers for aspiration are increasingly available, none have been clinically validated. The leading mechanism for microaspiration is thought to be gastroesophageal reflux disease, largely driven by the increased prevalence of gastroesophageal reflux across a variety of respiratory disorders, including chronic obstructive pulmonary disease, asthma, idiopathic pulmonary fibrosis, and chronic cough. Failure of therapies targeting gastric acidity in clinical trials, in addition to increasing concerns about both the overuse of and adverse events associated with proton pump inhibitors, raise questions about the precise mechanism and causal link between gastroesophageal reflux and respiratory disease. Our review summarizes key aspiration syndromes with a focus on reflux-mediated aspiration and highlights the need for additional mechanistic studies to find more effective therapies for aspiration syndromes.     

Long-term treatment with fasudil improves bleomycin-induced pulmonary fibrosis and pulmonary hypertension via inhibition of Smad2/3 phosphorylation

Pulmonary hypertension (PH) associated with pulmonary fibrosis (PF) considerably worsens prognosis of interstitial lung diseases (ILD). RhoA/Rho-kinases (ROCK) pathway is implicated in high pulmonary vascular tone and pulmonary fibrosis but the effect of ROCK inhibitors on PH associated with PF is not known. We therefore aimed to determine whether long-term treatment with fasudil, a selective ROCK inhibitor, could attenuate PF and PH induced by bleomycin in mice. Male C57BL/6 mice received a single dose of intratracheal bleomycin (3.3 U/kg) to induce PF. Treatment with fasudil (30 mg kg^?1 day^?1) was given intraperitoneally for 7, 14 or 21 days until mice underwent hemodynamic measurements. Right ventricular systolic pressure (RVSP) and RV/(LV + S) ratio were assessed. Lung inflammatory cells profiles, including macrophages, neutrophils, lymphocytes B and lymphocytes T were assessed by immunohistochemistry. Lung fibrosis was evaluated by histological and biochemical methods. Pulmonary arteriole muscularization and medial wall thickness (MWT) were evaluated by immunohistochemical staining for α-SMA. Bleomycin induced severe PF and PH in mice, associated with an increased RhoA/ROCK activity in the lung. Fasudil reduced lung inflammation and lung collagen content, and attenuated the increased RVSP, RV hypertrophy, and pulmonary vascular remodeling in bleomycin-intoxicated mice. Fasudil inhibited the increased activity of RhoA/ROCK pathway, and partly altered bleomycin-associated activation of TGF-β1/Smad pathway, via inhibition of Smad2/3 phosphorylation. The efficacy of long-term treatment with fasudil suggests that the blockade of RhoA/ROCK pathway may be a promising therapy for patients with ILD-associated PH.