炎琥宁治疗小儿毛细支气管炎64例疗效观察

目的：进一步探讨了解炎琥宁治疗小儿毛细支气管炎的临床效果。方法：以本院在2009年10月～2010年10月收治的64例小儿毛细支气管炎患者作为本组的研究对象,对其临床资料进行回顾性分析,将所有的患者随机分为两组,两组常规给予抗感染、吸氧、止咳等治疗,治疗组在常规治疗的基础上给予患儿静脉滴注炎琥宁,观察两组患儿的症状和体征变化。结果：治疗组中治愈的有30例,治愈率为93.75%,对照组中治愈的有22例,治愈率为68.75%。两组毛细支气管炎患儿症状消失时间和住院时间、疗效比较,差异均有统计学意义（P〈0.05）。结论：临床中炎琥宁治疗小儿毛细支气管炎的疗效确切,可以取得满意的治疗效果,值得在临床中推广应用。     

宣肺止嗽合剂与氨溴特罗口服液治疗小儿急性支气管炎的疗效比较

目的观察中成药宣肺止嗽合剂与化学成分药品氨溴特罗口服液(商品名:易坦静)在治疗小儿急性支气管炎中的止咳、祛痰的临床疗效。方法将112例小儿急性支气管炎患儿分成观察组58例和对照组54例,两组患儿均给予降温、抗病毒、抗感染、雾化吸入化痰等常规治疗,观察组在常规治疗的基础上给予宣肺止嗽合剂口服,对照组在常规治疗的基础上给予氨溴特罗口服液口服,两组均连用7日,观察两组患儿咳嗽及肺部啰音消失的时间。结果观察组的有效率为94.8%,对照组的有效率为87.0%,差异有统计学意义(P0.05)。观察组的咳嗽及肺部啰音消失时间早于对照组(P0.05﹚。结论宣肺止嗽合剂治疗小儿急性支气管炎疗效显著,能有效的加速咳嗽和肺部啰音的消失,缩短病程,两者均未见明显的不良反应。     

Comparative Genomics of Korean Infectious Bronchitis Viruses (IBVs) and an Animal Model to Evaluate Pathogenicity of IBVs to the Reproductive Organs

The K-I and nephropathogenic K-II genotypes of infectious bronchitis virus (IBV) have been isolated since 1995 and 1990, respectively, in Korea and commercial inactivated oil-emulsion vaccines containing KM91 (K-II type) and Massachusetts 41 strains have been used in the field. To date, genomic analyses of Korean IBV strains and animal models to test the pathogenicity of Korean IBVs to the reproductive organs have been rare. In the present study, comparative genomics of SNU8067 (K-I type) and KM91 IBVs was performed, and an animal model to test the pathogenicity of SNU8067 was established and applied to vaccine efficacy test. The genome sizes of SNU8067 (27,708 nt) and KM91 (27,626 nt) were slightly different and the nucleotide and amino acid identities of the S1 (79%, 77%), 3a (65%, 52%), and 3b (81%, 72%) genes were lower than those of other genes (94%–97%, 92%–98%). A recombination analysis revealed that SNU8067 was a recombinant virus with a KM91-like backbone except S1, 3a, and 3b genes which might be from an unknown virus. An SNU8067 infection inhibited formation of hierarchal ovarian follicles (80%) and oviduct maturation (50%) in the control group, whereas 70% of vaccinated chickens were protected from lesions.     

支气管哮喘和慢性喘息型支气管炎患者发作期呼吸音的分析研究

目的:探讨支气管哮喘和慢性喘息型支气管炎(慢喘支)患者发作期呼吸音的频谱特点,并对两者进行分析比较.方法:利用传感器和微型计算机等设备录取10例发作期哮喘患者和8例发作期慢喘支患者的呼吸音,并对其进行快速付里叶转换(FastFourier transform,FFT)频谱分析.结果:发作期哮喘和发作期慢喘支患者产生喘鸣音时的呼气频率[2组的最高峰处频率(PF)和曲线下面积4等份处频率(Q25%、Q50%和Q75%)分别为(388.42±82.43)Hz、(312.96±66.88)Hz、(422.24±91.16)Hz、(538.76±110.22)Hz比(359.43±45.46)Hz、(296.98±67.84)Hz、(421.43±91.82)Hz、(523.29±60.16)Hz]和呼吸音强度[LSI,分别为(23.18±0.86)dB比(23.11±0.56)dB]无显著性差别(P均＞0.05);发作期慢喘支患者吸气时的频率比发作期哮喘患者低[2组的PF、Q25%、Q50%和Q75%分别为(176.68±36.84)Hz,(171.32±32.64)Hz,(229.69±31.87)Hz,(382.36±55.21)Hz比(354.21±67.58)Hz,(286.42±53.68)Hz,(386.77±74.18)Hz,(554.68±84.72)Hz],P＜0.05或P＜0.01.结论:哮喘和慢喘支患者发作期呼吸音的频谱分析有助于发作期哮喘和发作期慢喘支的诊断和鉴别诊断.     

长期被动吸烟对北京社区居民呼吸系统的影响

目的：调查长期被动吸烟对北京市社区居民肺功能、呼吸系统症状、慢性气道疾病及气道炎症的影响。方法入组北京市西城区35岁以上不吸烟居民835例,其中长期被动吸烟组380例(45.5%),对照组455例。采用调查问卷方式,了解受试者基本信息、慢性呼吸系统症状情况、呼吸系统疾病状况。检测所有受试者肺通气功能,包括FEV1和FEV6;采集血样、呼出气冷凝液(EBC),检测血清肺泡表面活性蛋白D(SPD),EBCpH值及IL-6水平。比较2组受试者上述指标的差异,并采用回归分析方法评价被动吸烟时间对肺功能、呼吸系统症状及疾病的影响;采用Spearman相关检验评价被动吸烟时间与血清SPD、EBCpH及IL-6的相关性。结果被动吸烟组年龄低于对照组,女性所占比例高于对照组。被动吸烟组FEV1%pred显著低于对照组,多元线性回归提示被动吸烟时间与FEV1呈负相关。被动吸烟组呼吸症状及气道疾病比例均略高于对照组,但差异无统计学意义,Logistic回归显示,被动吸烟时间是慢性咳嗽(OR=1.243,95%CI：1.058~1.459)及慢性支气管炎(OR=1.326,95%CI：1.031~1.704)的危险因素。被动吸烟组EBCpH略低于对照组,2组间SPD、EBCIL-6无明显差异;被动吸烟组中,被动吸烟时间与血清SPD水平呈正相关。结论北京市城区居民中,被动吸烟者FEV1%pred偏低、气道炎症指标偏高,并且这种改变随暴露时间增加而加重;慢性咳嗽及慢性支气管炎患病率随被动吸烟时间延长而增加。     

Oscillatory Positive Expiratory Pressure in Chronic Obstructive Pulmonary Disease

Evidence-based guidance for the use of airway clearance techniques (ACT) in chronic obstructive pulmonary disease (COPD) is lacking in-part because well-established measurements of pulmonary function such as the forced expiratory volume in 1s (FEV₁) are relatively insensitive to ACT. The objective of this crossover study was to evaluate daily use of an oscillatory positive expiratory pressure (oPEP) device for 21–28 days in COPD patients who were self-identified as sputum-producers or non-sputum-producers.

COPD volunteers provided written informed consent to daily oPEP use in a randomized crossover fashion. Participants completed baseline, crossover and study-end pulmonary function tests, St. George's Respiratory Questionnaire (SGRQ), Patient Evaluation Questionnaire (PEQ), Six-Minute Walk Test and ³He magnetic resonance imaging (MRI) for the measurement of ventilation abnormalities using the ventilation defect percent (VDP).

Fourteen COPD patients, self-identified as sputum-producers and 13 COPD-non-sputum-producers completed the study. Post-oPEP, the PEQ-ease-bringing-up-sputum was improved for sputum-producers (p = 0.005) and non-sputum-producers (p = 0.04), the magnitude of which was greater for sputum-producers (p = 0.03). There were significant post-oPEP improvements for sputum-producers only for FVC (p = 0.01), 6MWD (p = 0.04), SGRQ total score (p = 0.01) as well as PEQ-patient-global-assessment (p = 0.02). Clinically relevant post-oPEP improvements for PEQ-ease-bringing-up-sputum/PEQ-patient-global-assessment/SGRQ/VDP were observed in 8/7/9/6 of 14 sputum-producers and 2/0/3/3 of 13 non-sputum-producers. The post-oPEP change in ³He MRI VDP was related to the change in PEQ-ease-bringing-up-sputum (r = 0.65, p = 0.0004) and FEV₁ (r = –0.50, p = 0.009).

In COPD patients with chronic sputum production, PEQ and SGRQ scores, FVC and 6MWD improved post-oPEP. FEV₁ and PEQ-ease-bringing-up-sputum improvements were related to improved ventilation providing mechanistic evidence to support oPEP use in COPD. Clinical Trials # NCT02282189 and NCT02282202.     

Lymphoscintigraphy in plastic bronchitis,A pediatric case report

Plastic bronchitis (PB) is an uncommon, potentially fatal disease, marked by endobronchial cast formation causing variable degrees of respiratory distress. Primary and secondary pulmonary lymphatic abnormalities have been identified among the underlying mechanisms of cast formation. We present a case of PB where lymphoscintigraphy demonstrated the underlying lymphatic defect. A 6‐year‐old Hispanic male with congenital heart disease (CHD; post‐Fontan) presented with recurrent pneumonia, respiratory distress. Bronchoscopy showed inflamed hypervascular mucosa and thick mucus plugs; no casts were seen. Later, PB was diagnosed after the patient expectorated a bronchial cast. Cast analysis showed lymphocytic aggregates with mucin and fibrin. Lymphoscintigraphy revealed abnormal lymphatic collaterals and retrograde trace reflux into the superior mediastinum, a picture consistent with thoracic duct lymph leakage into the tracheobronchial tree. The pathogenesis of PB is not fully understood, especially in patients with CHD. Chyle in bronchial casts suggests abnormal lymphatic flow. Reports of lymph flow abnormalities, especially endobronchial lymph leakage in CHD are limited. Lymphoscintigraphy in our case demonstrated clear evidence of retrograde lymph reflux and leakage into the bronchial tree. The case presented suggests that in some patients following Fontan surgery, high intrathoracic lymphatic pressure and retrograde lymph flow may contribute to recurrent cast formation. Finding the underlying lymphatic abnormality helps in specific case management. Lymphoscintigraphy is a safer and easier method than lymphangiography. Surgical lymphatic–venous shunting may be possible in select cases. Pediatr Pulmonol. 2013; 48:515–518. © 2012 Wiley Periodicals, Inc.     

血液流变学在常见几种疾病检测中的临床意义

对242例8种疾病患者血液进行血液流变学指标测定，并与40名体检健康者血液作比较分析。结果显示，临床常见的高血压，糖尿病，脑梗塞，脑动脉硬化，冠心病，慢性支气管炎，肺炎及脑中风等八种疾病的血液流变性都存在异常变化。提示在临床上可通过血液流变学指标的检查来帮助预防，诊断和治疗这些疾病。     

超短波综合治疗急性支气管炎

目的　观察超短波综合治疗急性支气管炎的疗效。　 方法　采用超短波综合治疗急性支气管炎 ,并与单纯超短波治疗组进行对照。结果　超短波综合组优于对照组。结论　超短波综合治疗急性支气管炎疗效显著。     

Pseudomembranous Aspergillus tracheobronchitis in a heart transplant recipient

A. Ramos, J. Segovia, M. Gómez-Bueno, C. Salas, M.T. Lázaro, I. Sanchez, L. Pulpón. Pseudomembranous Aspergillus tracheobronchitis in a heart transplant recipient.
Transpl Infect Dis 2010: 12: 60–63. All rights reserved
Abstract: Aspergillus tracheobronchitis (AT) is an uncommon clinical presentation of pulmonary aspergillosis that frequently progresses to invasive pulmonary aspergillosis. Diagnosis of AT may be delayed because of its insidious onset, non-specific signs and symptoms, and scarcity of radiographic abnormalities. We report the case of a patient who received a heart transplant (HT) because of cardiac amyloidosis and who developed pseudomembranous AT. Possible risk factors concurrent in this case were splenectomy, lymphocytopenia, and previous cytomegalovirus infection. Chest computed tomography scan showed thickening of the left bronchi and a 'tree-in-bud' pattern with multiple small nodules. Bronchoscopic examination revealed raised yellowish pseudomembranous plaques on the tracheobronchial tree. Bronchoalveolar lavage and aspirate cultures yielded Aspergillus fumigatus . The patient recovered with voriconazole. Clinicians should be aware of AT as a potential cause of respiratory symptoms with few radiographic abnormalities in HT recipients, as delay in performing bronchoscopy could result in an unfavorable prognosis.