Factors associated with acid-fast bacillus isolation in patients with noncystic fibrosis bronchiectasis: A cross-sectional study

IntroductionAcid-fast bacillus (AFB) is a major pathogen that causes noncystic fibrosis bronchiectasis requiring multidrug chemotherapy. Bronchoscopic bronchial wash is performed to determine the causative pathogens of bronchiectasis; but, predictive factors for AFB isolation have not been fully elucidated. This study aimed to determine the factors associated with AFB isolation from bronchial wash samples.MethodsThis was a single-center, cross-sectional study. Patients undergoing bronchoscopic bronchial wash for bronchiectasis were included, whereas those who did not undergo high-resolution computed tomography (HRCT); had acute pneumonia, interstitial lung disease, and a positive polymerase chain reaction result but a negative culture result for AFB; or in whom a guide sheath was used for suspected lung cancer were excluded. Binomial logistic regression was used to analyze the factors associated with a positive culture for AFB.ResultsOf the 96 included cases, AFB isolation was observed in the bronchial wash fluid of 26 patients (27%). No smoking history, a positive result for antiglycopeptidolipid (GPL)-core IgA antibody, and the presence of tree-in-bud appearance, multiple granular and nodular images on HRCT were more commonly observed in patients with AFB isolation than in those without. In the multivariate analysis, the tree-in-bud appearance (odds ratio, 4.223; 95% CI, 1.046–17.052) and anti-GPL core IgA antibody (odds ratio, 9.443; 95% CI, 2.206–40.421) were significantly associated with AFB isolation.ConclusionsThe tree-in-bud appearance on HRCT is likely to predict AFB isolation independent of anti-GPL core IgA antibody results. Bronchoscopic bronchial wash should be recommended for bronchiectasis with multiple granulomas on HRCT.     

Double lung transplantation in patients with lung atelectasis and complete mediastinal shift

Mediastinal shift and chest wall retraction limit the indication of a double lung transplant in patients with complete destruction of lung parenchyma. We report outcomes as well as preoperative and operative management in two patients with significant lung volume reduction and mediastinal shift due to bronchiectasis of the right lung.     

千金清肺汤联合西药治疗痰热型支气管扩张的临床疗效及对外周血 Th17/Treg失衡及相关因子表达的影响

目的探究千金清肺汤联合西药头孢哌酮钠舒巴坦钠与硫酸阿米卡星注射液静脉滴注治疗痰热型支气管扩张的临床疗效及对病人外周血 Th17/Treg失衡及相关因子表达的影响。方法选取 2019年 5月至 2021年 3月在驻马店市中医院治疗的属痰热型支气管扩张病人 85例，采用随机数字表法将病人分为两组，对照组( 43例)采用西医治疗(头孢哌酮钠舒巴坦钠联合硫酸阿米卡星注射液静脉滴注 10 d治疗)研究组( 42例)采用中西医结合治疗，其中中医采用千金清肺汤口服，西药应用头孢哌酮钠舒巴坦钠联合硫酸阿米卡星注射液静，脉滴注 10 d治疗。比较两组病人的临床疗效、肺功能指标、 Th17/Treg水平及血清炎症指标白细胞介素 -6(IL-6)白细胞介素 -10(IL-10)白细胞介素 -17(IL-17)及转化生长因子 -β(TGF-β)水平。结果研究组治疗效果显著高于对照组( P<0.0、5)。治疗后，两组病人肺、功能第一秒用力呼气容积( FEV1)、用力肺活量( FVC)和 FEV1/FVC指标均上升，且研究组显著高于对照组［( 2.73±0.55)L比( 2.47±0.49)L、(3.41±0.68)L比( 3.05±0.61)L、(82.46±9.16)L比( 76.12±8.46)L］(P<0.05)；两组外周血辅助 T细胞 17(Th17)、 Th17/Treg表达水平下降，调节 T细胞( Treg)表达水平上升，且研究组 Th17、Th17/Treg水平显著低于对照组［(1.15±0.23)%比( 1.64±0.33)%、(0.22±0.04)%比( 0.35±0.07)%］Treg水平显著高于对照组［(5.35±1.07)%比( 4.82±0.96)%］(P<0.05)；两组炎性因子 IL-6、IL-17水平均下降， TGF-β、IL-10水上升，且研究组 IL-17、 IL-6水平显著低于对照组， IL-10T、GF-β水平显著高于对照组( P<0.05)。结论千金清肺汤联合抗生素治疗对痰热型支气管扩张症病人有较好疗效，可以改善病人肺功能及炎症反应，调节病人外周血 Th17/Treg平衡。     

哌拉西林他唑巴坦配合左氧氟沙星对支气管扩张的治疗效果

目的：研究哌拉西林他唑巴坦配合左氧氟沙星对支气管扩张患者的治疗效果。方法：择取赣州市赣县区人民医院2021年6月至2023年4月就诊的80例支气管扩张患者，通过随机数字表法分对照组和观察组，每组40例。对照组患者应用左氧氟沙星治疗，观察组患者在对照组基础上联合哌拉西林他唑巴坦治疗，比较两组患者的治疗效果。结果：观察组患者临床症状持续时间均短于对照组，差异具有统计学意义（P <0.05）；治疗后，观察组患者第1秒用力呼气量（FEV1）、用力肺活量（FVC）、呼气流量峰值（PEF）、最大通气量（MVV）、FEV1/FVC均高于对照组，差异具有统计学意义（P <0.05）；治疗后，观察组患者白细胞（WBC）、中性粒细胞计数（NEUT）、C反应蛋白（CRP）、白细胞介素–6(IL–6)、红细胞沉降率（ESR）、降钙素原（PCT）均低于对照组，差异具有统计学意义（P <0.05）。结论：哌拉西林他唑巴坦配合左氧氟沙星治疗支气管扩张患者，能有效缩短临床症状持续时间，改善肺功能以及降低炎症因子水平。     

支气管扩张伴感染患者接受支气管肺泡灌洗的临床疗效

目的探究支气管扩张伴感染患者应用支气管肺泡灌洗进行治疗的临床效果。方法随机抽取30例支气管扩张伴感染患者纳入本次研究范围,其均于2016年12月至2019年12月入本院接受诊治,应用等量数字随机方式分组,分别应用支气管肺泡灌洗(研究组,n=15)及常规治疗方式(对照组,n=15)进行临床治疗,分析临床干预效果。结果经研究,临床血气指标主要包括氧合指数、动脉血氧分压及血氧饱和度,研究组患者的临床血气指标均显著优于对照组,研究组患者临床治疗无效的患者数量显著少于对照组,差异显著,P<0.05。结论应用支气管肺泡灌洗方式对支气管扩张伴感染患者病症进行干预,能够改善患者的临床血气指标,优化治疗效果。