毛细支气管炎CD4+ CD25+调节性T细胞和Foxp3 mRNA表达与激素调控

目的 探讨毛细支气管炎(简称毛支)的发病机制与激素治疗.方法 对呼吸道合胞病毒(RSV)阳性的毛支患儿,根据血清总IgE是否增高以及有无湿疹、皮炎等过敏病史,分为特应体质和非特应体质2组,各50例,另选健康对照组25名.毛支患儿按临床评分分为轻、中、重度(18、62、20例);再随机分成激素组(49例)和非激素组(51例).流式细胞仪检测外周血CD4+ CD25+调节性T细胞(Treg)的比例;反转录(RT)-PCR检测Foxp3 mRNA的表达量.结果 CD4+ CD25+ Treg的数量和Foxp3 mRNA表达量:健康对照组、非特应体质组、特应体质组分别为(10.5±1.6)%和0.34±0.11、(8.8±2.2)%和0.26±0.08、(7.6±1.8)%和0.21±0.09,差异均有统计学意义(均P<0.05);轻、中、重组分别为(9.7±1.6)%和0.28±0.08、(7.8±2.1)%和0.24±0.06、(6.7±1.3)%和0.20±0.07(均P<0.05).CD4+ CD25+ Treg数量、Foxp3 mRNA的表达量与临床评分均呈显著负相关(r=-0.62、-0.71,均P<0.01);激素治疗后两者均升高[(9.5±2.1)%和0.33±0.10分别比(8.5±1.8)%和0.27±0.12,P<0.05和<0.01].结论 CD4+ CD25+ Treg和Foxp3 mRNA与RSV毛支气道炎症关系密切,可反映毛支的病情严重程度.激素可促进CD4+ CD25+ Treg的发育和功能.     

六分钟步行试验在慢性支气管炎需做肺功能筛选中的价值

目的 探讨在慢性支气管炎发展为慢性阻塞性肺疾病(COPD)的诊断过程中,6min步行试验(6-MWT)与肺功能的相关性.方法 选择以慢性支气管炎就诊的患者360例,全部做肺功能检测,根据肺功能检测结果 ,符合2002年中华医学会COPD诊断标准,分为COPD组和肺功能正常组.同时做6-MWT,测定6 min步行距离(6-MWD),根据2次6-MWD取其平均值;研究肺功能与6-MWT的相关性,选择50例健康志愿者作对照(对照组).结果 COPD组中142例(95.95%,142/148)6-MWD<420 m.而肺功能正常组中206例(97.17%,206/212)6-MWD≥420 m.6-MWD≥420 m者第1秒用力呼气容积占用力肺活量百分比、第1秒用力呼气容积占预计值百分比、最大通气量均显著高于6-MWD<420m者,差异有统计学意义(JP<0.05);而6-MWD≥420m的慢性支气管炎患者与对照较差异无统计学意义(P>0.05).结论 6-MWT简便易行,可较好地反映患者的肺功能,可作为慢性支气管炎患者需做肺功能的筛选.     

六君子汤对慢性支气管炎模型大鼠血清ICAM-1、NF—κB影响的研究

目的检测细胞间粘附分子1（ICAM-1）、核因子-κB（NF—κB）在慢性支气管炎大鼠血清中的表达,探讨二者在慢性支气管炎气道炎症中的作用,并观察六君子汤治疗后对以上指标的影响。方法通过SO2烟熏法建立慢性支气管炎大鼠模型,采用实时荧光定量PCR技术检测ICAM-1、NF—κB在慢性支气管炎大鼠以及六君子汤治疗后大鼠血清中的表达。并对肺组织的病理进行了观察。结果慢性支气管模型纽大鼠的ICAM-1、NF—κB均较正常组明显升高（P〈0．05）;经过六君子汤治疗后,治疗组大鼠血清ICAM-1较生理盐水模型对照组明显下降（P〈0．05）;NF—κB的阳性表达也较生理盐水模型对照组有下降趋势（P〈0．05）。慢性支气管炎模型大鼠支气壁组织病理损害明显,六君子汤治疗后病理损害较模型对照组显著恢复。结论气道炎症时NF—κB表达上调,并可能参与了ICAM-1基因的表达调控;而六君子汤能够通过下调NF—κB,可能在转录水平上抑制ICAM—1的表达,并能减轻支气壁组织损伤程度。     

α-细辛脑雾化吸入辅治毛细支气管炎50例疗效观察

目的:观察α-细辛脑雾化吸入治疗毛细支气管炎的疗效。方法:对确诊100例毛细支气管炎患儿随机分为治疗组和对照组,每组50例。治疗组应用α-细辛脑4mg/次雾化吸入治疗,对照组用地塞米松2mg加α-糜蛋白酶雾化吸入,以上治疗每日2次。结果:治疗组总有效率100%,高于对照组96%(P<0.05);治疗组与对照组在喘憋、哮鸣音消失、咳嗽缓解、住院时间上均明显缩短,两组比较差异有统计学意义(t分别为3.60、3.68、2.62、3.94,P<0.05)。结论:α-细辛脑吸入治疗毛细支气管炎具有明显的疗效。     

Development of Microscopic Polyangiitis in Patients with Chronic Airway Disease

Microscopic polyangiitis (MPA) is a rare systemic vasculitis syndrome, which is often accompanied by positive myeloperoxidase-specific antineutrophil cytoplasmic antibody (MPO-ANCA). While pulmonary involvement of MPA consists mainly of diffuse alveolar hemorrhage and interstitial pneumonia, bronchiectasis has been reported as a pulmonary lesion in association with MPA. To investigate the clinical features of patients with MPA, focusing on the presence or the absence of preceding chronic airway diseases (CAD), we conducted a retrospective observational study of 26 patients in the last 13 years at Saga University Hospital. The clinical records and radiologic chest examinations were reviewed retrospectively. Pulmonary manifestations were alveolar hemorrhage in 3 patients (12%) and interstitial pneumonia in 5 (19%). Bronchiectasis, defined by the findings of chest radiograph and computed tomography, was found in 9 patients (35%). Four patients (15%) with bronchiectasis and one patient (4%) with chronic bronchitis had experienced chronic bronchial suppuration prior to the onset of MPA. Ten patients were classified as having chronic airway disease (CAD) before the onset of MPA. MPO-ANCA tended to be lower in the CAD group than in the non-CAD group. None of the patients in the CAD group had pulmonary hemorrhage or interstitial pneumonia. Only one patient (10%) in the CAD group died within 90 days of the onset of MPA, while 7 (43.8%) of the non-CAD group died. Our study suggests that MPA may result in part from CAD and that the clinical course of MPA with CAD may be different from MPA without CAD.     

The Effect of Chronic Sputum Production on Respiratory Symptoms in Severe COPD

Background: Chronic sputum production is a significant but variable complaint in COPD; its effect on symptom burden has not been comprehensively described. We sought to characterize the daily burden of chronic sputum production in severe COPD and the phenotype of those with chronic sputum symptoms. Methods: We studied 50 outpatients with severe COPD who used an electronic diary to document peak expiratory flow (PEF) and respiratory symptoms daily for up to 2 years. A sputum index was derived based on complaints of sputum quantity, color, and consistency, and patients were divided into groups based on average daily sputum index (Low, Medium, High). The presence and severity of respiratory symptoms were scored by a novel method using daily changes in symptoms and PEF from baseline and were categorized into mild, moderate, and severe. Percent emphysema was measured using quantitative CT. Results: In the 14,500 observation days, severe symptom days were greater in the Medium and High groups (379/6089, 1609/4091, and 2624/4317 observation days in Low, Medium, and High, p < 0.0001). The same trend was found even when sputum complaints were removed from the symptom severity score. Observed/predicted PEF ratio was lower in the High group (0.56 ± 0.24, 0.55 ± 0.19, and 0.42 ± 0.12 in each group, p < 0.05 for High compared to Medium and Low). Percent emphysema inversely correlated with average sputum index and quantity (r = ?0.449 and r = ?0.584, respectively, p < 0.05). Conclusions: Increased sputum production in severe COPD is frequently encountered daily and is associated with more respiratory symptoms, worse airflow obstruction, and less emphysema.     

慢性支气管炎急性发作期患者外周血T淋巴细胞凋亡的研究

目的 :实验观察慢性支气管炎急性发作期和稳定期患者外周静脉血 T淋巴细胞凋亡情况。方法 :选择急诊监护病房急性发作期住院患者 17例 (发作组 )和门诊随访稳定期患者 10例 (稳定组 ) ,分别抽取外周静脉血 ,用抗 CD3、CD95、CD2 5荧光单抗对 T淋巴细胞进行标记和记数。结果 :发作组 CD3T细胞总数 4 2 .6 3± 16 .37明显低于稳定组 6 2 .2 2± 2 3.90 ,t=- 4.2 83,P<0 .0 0 1;发作组 CD95 T细胞 14 .15± 11.0 6和稳定组 34.88± 9.82比较 ,t= - 8.796 ,P<0 .0 0 1,前者比后者显著降低 ;CD2 5 T细胞发作组 10 .89± 4 .1与稳定组 13.11± 3.0 2比较 ,t=-2 .10 5 ,P>0 .0 5无显著差异 ;CD3/ CD2 5活化 T细胞总数发作组 6 .2 6± 3.94与稳定组 10 .5 2± 3.4 1比较 ,显著降低 ,t=1.0 6 8,P<0 .0 5。结论 :慢性支气管炎急性发作期患者 T淋巴细胞凋亡率增加 ,总数减少和免疫功能紊乱 ,因此在治疗疾病过程中除对症处理外 ,另须配合使用减少凋亡和提高免疫功能的药物 ,有利于控制病情。     

毛细支气管炎患婴治疗前后肺功能变化

目的 :观察小儿毛细支气管炎 (毛支 )治疗前后肺功能的变化。方法 :对 48例毛支患儿综合治疗前进行肺功能测定 ;治疗 7～ 1 4d后有 36例患儿复查了肺功能。以 2 4例同龄健康儿做正常对照组。结果 :毛支治疗前潮气量 ( VT)、达峰容积比 ( VPTEF/VE)、达峰时间比 ( t PTEF/t E)、2 5 %潮气量时的潮气呼气流速 ( TEF2 5 % )下降 ,呼吸频率 ( RR)、功能残气量 ( FRCpleth)、有效呼吸道阻力 ( Reff )增加 ;治疗后 VT、TEF2 5 %上升 ,RR、FRCpleth、Reff下降 ( P<0 .0 5或 P<0 .0 1 ) ,VPTEF/VE、t PTEF/t E虽有上升但未恢复正常 ,潮气呼气峰流速 ( PTEF)、75 %潮气量时的潮气呼气流速 ( TEF75 % )、5 0 %潮气量时的潮气呼气流速 ( TEF5 0 % )治疗前后无明显变化。治疗前潮气呼吸流速 -容量环变窄 ,呼气曲线升支陡、高峰提前、峰值较高、降支凹陷。结论 :毛支患儿急性期存在不同程度的肺功能损害 ,呈一过性小呼吸道阻力增高、阻塞性通气功能障碍改变。     

孟鲁司特钠联合酮替芬在小儿支气管炎中的疗效观察

目的探讨孟鲁司特钠联合酮替芬在小儿支气管炎中的临床疗效。方法将98例小儿支气管炎患儿随机分为两组,对照组49例采用孟鲁司特钠治疗,观察组49例在对照组基础上给予酮替芬治疗,观察两组的临床疗效和体温恢复时间、咳嗽消失时间、干湿啰音消失时间。结果观察组总有效率为95.92%,对照组为83.67%,两组差异有统计学意义（P〈0.05）,观察组的体温恢复时间、咳嗽消失时间、干湿啰音消失时间及肺部喘鸣音消失时间均低于对照组（P〈0.05）。结论孟鲁司特钠联合酮替芬治疗小儿支气管炎能明显改善患儿的临床症状及体征,快速退热,缩短病程,减少住院时间,值得临床应用和推广。     

针刺肺俞及四花穴对慢性支气管炎迁延期老年患者免疫球蛋白的影响

目的观察针刺肺俞及四花(膈俞和胆俞)穴对慢性支气管炎迁延期老年患者免疫球蛋白的影响。方法将60例老年慢性支气管炎迁延期患者随机分为治疗组和对照组,每组30例。两组均采用常规药物治疗,治疗组采用针刺肺俞及四花穴治疗,对照组采用口服蜜炼川贝枇杷膏治疗。分别观察两组治疗前后免疫球蛋白变化。结果治疗组治疗后免疫球蛋白各项指标(IgA、IgM、IgG)与同组治疗前比较,差异均具有统计学意义(P0.05)。治疗组治疗后免疫球蛋白各项指标与对照组比较,差异均具有统计学意义(P0.05)。结论针刺肺俞及四花穴对慢性支气管炎迁延期老年患者免疫球蛋白具有升高作用。