雾化吸入高渗盐水治疗婴幼儿毛细支气管炎疗效分析

目的观察雾化吸入高渗盐水在婴幼儿毛细支气管炎治疗中的临床疗效,探讨其在临床中的应用价值。方法选择本院儿科病房2010年10月至2012年10月收住的毛细支气管炎患儿共89例,随机分为两组,两组在一般常规治疗的基础上,治疗组加以高渗盐水（3％氯化钠）2ml＋沙丁胺醇2．5mg雾化吸人;对照组加以生理盐水（0．9％氯化钠）2ml＋沙丁胺醇2．5mg雾化吸入;均使用氧气驱动的空气压缩雾化泵雾化吸入治疗,雾化吸入频率为Q8h,雾化治疗时间持续到治愈出院。比较两组治疗后喘息缓解时间、咳嗽缓解时间、肺部哕音消失时间以及治疗前后临床病情严重程度评分改变。结果治疗组的喘息缓解时间、咳嗽缓解时间、肺部哕音消失时间、住院时间分别为（3．31±1．13）天、（4．61±0．72）天、（3．84±1．22）天、（5．75±1．40）天,均明显短于对照组的（4．50±0．94）天、（5．93±1．11）天、（5．15±1．31）天、（6．81±1．64）天,两组比较差异均具有统计学意义（P〈0．01）。治疗组在治疗后第1、2、3、4天临床病情严重程度评分分别为（5．88±0．78）分、（5．01±0．59）分、（4．13±0．68）分、（3．59±0．70）分,均明显低于对照组的（6．95±0．82）分,（6．36±0．84）分、（5．57±0．64）分、（4．45±0．83）分,两组比较差异均具有统计学意义（P〈0．01）。两组均未发生与雾化相关的严重不良反应（如急性支气管痉挛、血氧饱和度下降等）。结论雾化吸人高渗盐水对于治疗婴幼儿毛细支气管炎的疗效显著优于生理盐水,其不仅可明显缩短喘息缓解时间、咳嗽缓解时间以及肺部哕音消失时间,并且能降低患JLIl~床病情严重程度评分,还可以明显缩短住院时间,且无明显不良反应,是一种安全有效的治疗手段。     

嗜酸粒细胞性支气管炎与咳嗽变异性哮喘患者的气道炎症特征的研究

目的 探究嗜酸粒细胞性支气管炎(EB)和咳嗽变异性哮喘(CVA)患者气道炎症细胞、细胞因子和炎性介质的特征,阐明两者存在不同气道炎性特征的可能机制.方法检测杭州市第一人民医院门诊收治的15例EB患者(EB组)、15例CVA患者(CVA组)、14例支气管哮喘(简称哮喘)患者(哮喘组)和14名健康体检者(健康对照组)诱导痰中嗜酸粒细胞(EOS)百分比;流式细胞仪检测白细胞介素(IL)-5及干扰素(IFN)-γ刺激的EOS表面CD69的表达;实时荧光定量PCR方法检测各组诱导痰上清液中前列腺素E2(PGE2)、白三烯C4(LTC4)、IL-5、IFN-γ mRNA的表达水平;酶联免疫吸附法(ELISA)检测各组诱导痰上清液中PGE2、LTC4、IFN-γ和IL-5蛋白表达水平.结果 EB组、CVA组、哮喘组诱导痰中EOS百分比分别为(15.8±3.2)%、(13.0±2.7)%和(11.6±4.5)%,均明显高于健康对照组的(1.0±0.4)%(均P<0.05).在IL-5和IFN-γ刺激下,EB组诱导痰中EOS表达CD69分别为1.49±0.42和1.51±0.52、CVA组分别为1.37±0.41和1.42±0.32、哮喘组分别为1.42±0.72和1.37±0.46,3组间差异无统计学意义,但较健康对照组(分别为0.42±0.21和0.39±0.12)差异均有统计学意义(均P<0.05).EB组、CVA组、哮喘组诱导痰中IL-5的mRNA及蛋白表达水平明显高于健康对照组(均P<0.05),但3组间差异无统计学意义;各组诱导痰中IFN-γ的mRNA及蛋白表达水平较健康对照组差异均无统计学意义.EB组诱导痰中PGE2浓度为(839±69)ng/L,明显高于CVA组的(33±8)ng/L、哮喘组的(25±6)ng/L和健康对照组的(24±8)ng/L(均P<0.01),后3组差异无统计学意义;EB组PGE2限速酶前列腺素氧化环化酶2(PTGS2)的mRNA水平表达量显著增加,较CVA组、哮喘组及健康对照组差异均有统计学意义(均P<0.01);CVA、EB和哮喘组诱导痰中LTC4浓度明显高于健康对照组(均P<0.05),CVA、EB及哮喘组中LTC4限速酶白三烯C4合成酶(LTC4S)的mRNA表达水平明显高于健康对照组(均P<0.05),EB组LTC4的mRNA及蛋白表达水平与CVA组和哮喘组比较,差异也有统计学意义(均P<0.05).CVA组、哮喘组诱导痰中LTC4/PGE2比值明显高于EB组(t值分别为8.67和13.12,均P<0.05).结论 EB患者诱导痰中PGE2高表达以及CVA组LTC4/PGE2比值较EB组显著增高,这两者可能是EB缺乏气道高反应性的炎症基础.

Abstract：

Objective To explore the characteristics of airway inflammatory cells, cytokines and inflammatory mediators in eosinophilic bronchitis (EB) and cough variant asthma (CVA) patients and to elucidate the underlying mechanism of distinct airway inflammation between EB and CVA. Methods This study included 15 patients with EB (EB group), 15 patients with cough variant asthma (CVA, CVA group), 14 patients with bronchial asthma (asthma group) and 14 healthy controls (healthy group). Percentage of eosinophils (EOS) in sputum induced by hypertonic saline was detected by FACS. The percentage of CD+69 EOS stimulated by interleukin-5 (IL-5) and interferon γ (IFN-γ) was also detected by FACS. The expression of leukotriene C4 synthase (LTC4S) and prostaglandin-endoperoxide synthase-2 (PTGS2) mRNA in sputum was measured by real-time PCR and the concentration of leukotriene C4 (LTC4) and prostaglandin E2(PGE2) in sputum was measured by ELISA. Results The percentage of EOS in induced sputum was 15.8±3.2 (EB group), 13.0±2.7 (CVA group) and 11.6±4.5 (asthma group), respectively, which were significantly higher than 1.0±0.4 in the healthy group. The difference was significant and the t value was 16.31, 15.23 and 14.21 respectively (P<0.05). After stimulated by IL-5 and IFN-γ, the percentage of CD+69 EOS in induced sputum was 1.5±0.4 and 1.5±0.5 (EB group), 1.4±0.4 and 1.4±0.3 (CVA group) and 1.42±0.72 and 1.37±0.46 (asthma group) respectively. There was no statistical significance between these 3 groups, but when compared with 0.4±0.2 and 0.4±0.1 in healthy group, the difference was significant(P<0.05). The expression of IL-5 mRNA and protein in induced sputum of EB group, CVA group and asthma group were higher than the healthy group and the difference was all statistically different (P<0.05), but there was no statistical significance between EB group, CVA group and asthma group. The expression of IFN-γ mRNA and protein in induced sputum of each group was not different when compared with healthy group (P＞0.05). The concentration of PGE2 in induced sputum of EB group was(839±69)ng/L, which was higher than (33±8) ng/L of CVA group, (25±6) ng/L of asthma group and (24±8) ng/L of healthy group (all P<0.01). There was no statistical difference between CVA group, asthma group and healthy group. The expression of PTGS2 in induced sputum of EB group increased significantly; when compared with CVA group, asthma group and healthy group, the difference was significant (all P<0.01). The concentration of LTC4 in induced sputum of EB group, CVA group and asthma group was all higher than the healthy group (all P<0.05). The expression of LTC4S mRNA of EB group, CVA group and asthma group was also higher than the healthy group (all P<0.05). The expression of LTC4S mRNA and LTC4 in the EB group was higher than that in the CVA group and the asthma group (P<0.05). The value of LTC4/PGE2 in the CVA group and the asthma group was higher than that in the EB group (t=8.7 and 13.1, P<0.05). Conclusion These data suggest that the difference in airway function observed in subjects with eosinophilic bronchitis and CVA (or asthma) may be due to the results of differences in PGE2 production and an imbalance between the production of bronchoconstrictor LTC4 and bronchoprotective PGE2 lipid mediators.     

Investigation on the production of anti-neutrophil cytoplasmic antibodies in chronic bronchitis rats

Objective To investigate the pathogenesis of the production of anti-neutrophil cytoplasmic antibodies (ANCA) in the rat models of chronic bronchitis (CB) with recurrent infections. Methods The CB models were made by double element of smoking and lipopolysaccharide (LPS) stimulation. The rats were divided into four groups, including normal control group (n=5), phorbol-12-myristate-13-acetate (PMA)-treated healthy rats control group (n=5), CB rats group (n=5) and PMA-treated CB rats group (n=6). Renal function of rats was detected. The histopathological lung and kidney tissues were observed by HE staining of paraffin section. Immunological markers, including myeloperoxidase anti-neutrophil cytoplasmic antibodies (MPO-ANCA), proteinase 3 anti-neutrophil cytoplasmic antibodies (PR3-ANCA) and citrullinated histone H3 (CitH3), were measured by enzyme-linked immune-sorbent assay (ELISA) at different time points. Correlation between CitH3 and MPO-ANCA was analyzed by the Spearman rank correlation. NETs components were further detected in lung and kidney tissue by confocal immunofluorescence and colocalization analysis. Results (1) The serum levels of CitH3 and MPO-ANCA in CB+PMA group showed an increased trend. Compared with those in the normal control group and CB rats group, the serum levels of CitH3 and MPO-ANCA in CB+PMA group increased significantly at the sixth week (both P＜0.05). Serum CitH3 levels in rats were positively correlated with serum MPO-ANCA levels (rs=0.490，P=0.024). (2) There were pathological manifestations of CB in the lung tissues of rats in CB group and CB+PMA group, and no obvious abnormalities in the lung tissues of rats in the normal control group and control group. In the rat kidney tissue of CB+PMA group, there were inflammatory cells infiltrated in the glomerular and around the renal tubules, but glomerular necrosis was not found. No obvious abnormalities were observed in the kidney tissues of rats in the normal control group, PMA-treated healthy rats control group and CB group. (3) In the lung and kidney tissues of CB+PMA group NETs could be detected by confocal immunofluorescence analysis. Conclusion CB rats with the recurrent infections can release large amounts of NETs, in which the exposure of MPO antigen will break the immune tolerance and result in the production of MPO-ANCA.     

百蕊颗粒结合氨溴索雾化吸入治疗慢性支气管炎急性发作临床研究

目的观察百蕊颗粒结合氨溴索雾化吸入治疗慢性支气管炎急性发作风热袭肺证的疗效。方法将本院2015年7月-2018年7月符合入选标准的150例慢性支气管炎急性发作患者,采用随机数字表法分为2组,每组75例。对照组在西医常规治疗基础上雾化吸入盐酸氨溴索,治疗组在对照组基础上冲服百蕊颗粒。2组均连续治疗2周。分别于治疗前后进行临床症状评分及风热袭肺证评分。采用肺功能仪检测FEV1占预计值百分比和FEV1/FVC;采用ELISA法分别检测血清及痰液中的TNF-α和IL-6水平,记录患者的咳嗽、喘息、咳痰、肺部啰音的消失时间,评价临床疗效。结果治疗组总有效率为98.6%(72/73)、对照组为88.9%(64/72),2组比较差异有统计学意义(χ^2=4.354,P=0.037)。治疗组咳嗽、喘息、咳痰、肺部啰音消失时间均早于对照组(t值分别为5.331、5.590、5.841、6.305,P<0.01)。治疗组治疗后咳嗽、喘息、咳痰、哮鸣音症状评分均低于对照组(t值分别为4.990、4.431、5.221、5.004,P值均<0.01);风热袭肺证咳喘、发热、口干咽痛、鼻塞、流涕评分均低于对照组(t值分别为5.652、5.190、5.311、5.793、5.643,P值均<0.01)。治疗后,治疗组FEV1占预计值百分比[(52.51±5.63)%比(47.30±5.21)%,t=8.931]、FEV1/FVC[(61.57±6.44)比(56.87±5.82),t=8.251]均高于对照组(P<0.01)。治疗组治疗后血清TNF-α、IL-6水平(t值分别5.331、4.908)及痰液中TNF-α、IL-6水平(t值分别6.001、4.803)均低于对照组(P<0.01)。结论百蕊颗粒结合雾化吸入氨溴索可有效降低慢性支气管炎急性发作患者的炎性细胞因子水平,改善临床症状,提高疗效。     

艾麻口服液对慢性支气管炎大鼠支气管TNFα、ICAM-1蛋白及mRNA表达的影响

目的:研究中药复方"艾麻口服液"对慢性支气管炎(chronicbronchitis,CB)支气管TNFα、ICAM-1蛋白及mRNA表达的影响,探讨其治疗CB的疗效机制。方法:雄性Wistar大鼠随机分为假手术(Sham)组、慢支(CB)组和慢支+艾麻口服液治疗(CB+AM)组,每组5只。大鼠CB模型通过气管内注入低剂量脂多糖制成,利用免疫组织化学和原位杂交法并结合半定量图像分析技术观察各组大鼠支气管TNFα、ICAM-1蛋白、mRNA的表达情况。结果:Sham组支气管上皮细胞中可见TNFα、ICAM-1蛋白和mRNA弱阳性表达;CB组TNFα蛋白和mRNA在支气管上皮细胞、支气管周围的淋巴滤泡炎性细胞和肺泡间质炎性细胞中可见强阳性表达,ICAM-1蛋白和mRNA在CB组支气管上皮细胞中可见阳性表达。半定量图像分析显示,CB组支气管上皮细胞中TNFα、ICAM-1蛋白、mRNA表达明显强于Sham组(P＜0.01),CB+AM组的表达则明显弱于CB组(P＜0.05)。结论:下调CB支气管上皮细胞中TNFα、ICAM-1mRNA和蛋白的表达,从而减轻气道炎症反应是艾麻口服液治疗CB有效的部分机制。     

呼出气一氧化氮和潮气呼吸肺功能检测在毛细支气管炎中的应用价值

背景　毛细支气管炎（简称毛支）是婴幼儿常见的下呼吸道疾病,如控制不佳相当一部分患儿将发展为支气管哮喘,因此,毛支患儿进行呼出气一氧化氮（FeNO）和潮气呼吸肺功能检测对于疾病的诊治疗效以及预后评估均有重要意义,但目前有关毛支患儿的FeNO和潮气呼吸肺功能的研究较少。目的　探讨FeNO和潮气呼吸肺功能检测在毛支中的应用价值。方法　采用便利抽样法选择厦门市儿童医院三病区2018年1-9月收治的38例首次诊断毛支的患儿（观察组）及同期厦门市儿童医院儿保中心体检的17例健康婴幼儿（对照组）为研究对象。分别在观察组急性期（治疗前）、恢复期（规范治疗1~2周后,出院前）及对照组进行FeNO和潮气呼吸肺功能检查,记录FeNO、潮气量（VT）、呼吸频率（RR）、吸呼比（Ti/Te）、达峰时间比（TPTEF/TE）、达峰容积比（VPEF/VE）等指标,并比较不同组及同组不同时期的差异。结果　观察组急性期及恢复期FeNO与对照组比较,差异均无统计学意义（P>0.05）;观察组急性期FeNO与恢复期比较,差异无统计学意义（P>0.05）。观察组急性期VT、Ti/Te、TPTEF/TE、VPEF/VE低于对照组,RR高于对照组（P<0.05）;观察组恢复期PTEF/TE和VPEF/VE高于急性期、低于对照组,RR低于急性期、高于对照组（P<0.05）。结论　潮气呼吸肺功能可反映毛支病情进展情况及临床治疗的效果,具有一定的应用价值;首次诊断毛支患儿治疗前、后以及健康儿童的FeNO无差异,因此FeNO在毛支中的应用价值有限。     

清热泻肺合剂治疗急性支气管炎疗效观察

目的 观察清热泻肺合剂治疗急性支气管炎的疗效。方法 ７７例患者分组,治疗组４７例,依据风热肺辨证,予口服清热泻肺合剂,７日为１疗程;对照组３０例,静脉点滴青霉素８００万单位,配合棕色合剂１０ｍｌ口服,７日为１疗程。１疗程结束后统计疗效。结果总有效率治疗组９５．７％,对照组８０．０％,治疗组疗效优于对照组且取效时间短。结论 清热泻肺合剂治疗急性支气管炎疗效确切,具有可重复性和科学性。     

CD11c和CD14在慢性支气管炎肺泡巨噬细胞上表达的变化

目的　了解慢性支气管炎肺泡巨噬细胞上 CD11c和 CD14表达的改变。方法　对慢性支气管炎缓解期患者和正常对照者各 10例进行局部支气管肺泡灌洗 ,获得的肺泡巨噬细胞经分离、纯化后 ,与藻红蛋白(phycoerythrin,PE)和异硫氰酸荧光素 (fluorescein isothiocyanate,FITC)标记的 CD11c和 CD14单克隆抗体孵化 ,以流式细胞仪分析其表面 CD11c和 CD14表达的百分率。结果　显示慢性支气管炎组肺泡巨噬细胞上 CD11c和 CD14表达的百分率分别为 (39± 6 ) %和 (36± 8) % ,均明显高于正常对照组 (16± 4) %、(15± 6 ) % ,(P <0 .0 0 1)。结论　慢性支气管炎缓解期患者的肺泡巨噬细胞上 CD11c和 CD14表达增加 ,可能参与其气道内慢性非特异性炎症。     

布地奈德雾化吸入治疗儿童中重度毛细支气管炎的效果分析

目的 探讨中重度毛细支气管炎患儿在常规治疗基础上加用布地奈德雾化吸入的效果.方法 选取2018年6月—2020年5月大连市妇女儿童医疗中心(集团)收治的47例中重度毛细支气管炎患儿为研究对象,随机分为对照组和布地奈德组,对照组给予常规治疗,布地奈德组在常规治疗基础上加用布地奈德雾化吸入,两组均持续治疗2周.比较两组住院...