Ultrafast computerized tomography of the chest in cystic fibrosis: a new scoring system

Assessing the presence and severity of bronchiectasis (BR) and mucoid impaction (MI) of the airways in cystic fibrosis (CF) is difficult by non-invasive methods. We hypothesized that scoring ultrafast computerized tomograms (UFCT) of the chest for BR and MI could be useful in detecting early lung changes in 28 patients with CF. To do this, UFCT scores were compared to established clinical and chest X-ray (CXR) scores. Results showed that UFCT scores correlated highly with clinical (r = 0.88) and CXR (r = 0.93) scores, and several pulmonary function tests. Regression analysis indicated that BR influenced clinical and CXR scores more than MI. Both BR and MI were found in all areas of the lungs without a major propensity for one region, although there was significantly more BR in the right upper lobe than the right lower lobe. In patients with CXR score greater than or equal to 21 BR was present in 8/9 and MI in 3/9, while in those with CXR score less than 21 UFCT showed BR in 19/19 and MI in 17/19. We conclude: 1) scored UFCTs correlate well with CXR and clinical scores; 2) BR influences clinical and CXR scores more than MI; 3) UFCTs detect BR and MI in CF patients with minimal evidence of pulmonary disease; and 4) CXR scores less than 21 reflect the presence of both BR and MI.     

噻托溴铵治疗慢性呼吸道疾病的研究进展

噻托溴铵是一种长效抗胆碱能药物,作用于M受体,有改善患者肺功能、抗炎、减少分泌物等作用。慢性呼吸道疾病是由多种炎性细胞介导的呼吸道炎症,从而引起气流受限、呼吸道重构破坏、黏液分泌增多等系列复杂病理生理过程。大量的试验证明慢性阻塞性肺疾病患者能从噻托溴铵的治疗中获得收益。噻托溴铵治疗哮喘获得的疗效,与长效β受体激动剂相当,可能成为哮喘治疗的新方法。也有报道噻托溴铵对少见的支气管扩张、弥漫性泛细支气管炎有一定的治疗作用。总之,噻托溴铵在治疗呼吸道性疾病中具有应用前景。     

卡特金纳综合征三例报告及文献复习

目的提高对卡特金纳综合征的临床认识,以提高对原发性纤毛运动障碍（PCD）的诊断水平。方法对3例卡特金纳综合征患者临床症状、体征、肺部影像学表现及家族史进行综合分析,并复习相关文献。结果 3例患者均因自幼年其反复发作的上、下呼吸道感染而引起临床医生重视,其中病例3幼年时主要表现为＂鼻窦炎＂症状,成年后才出现明显的肺部感染表现。进一步检查发现3例患者均同时合并慢性鼻窦炎,支气管扩张及全内脏转位。追问患者家族史发现病例2及病例3的父母均为近亲结婚。取病例1的支气管黏膜组织在电子显微镜下观察纤毛超微结构发现纤毛内动力臂缺失。3例患者经祛痰、抗感染等治疗后症状好转。结论对于幼年起反复出现上下呼吸道感染症状患者,不论有无内脏转位,应考虑存在原发性纤毛运动障碍可能。     

老年COPD合并支气管扩张的危险因素分析

目的探讨老年慢性阻塞性肺疾病(COPD)合并支气管扩张的危险因素。 方法回顾性分析2015年6月至2018年6月我院收治的153例COPD患者病例资料。按照是否合并支气管扩张,将患者分为单纯COPD组(n＝96)和合并支气管扩张组(n＝57)。比较两组患者的一般资料、临床症状、血常规指标及红细胞沉降率(ESR)、血气分析检测指标,分析患者痰标本中细菌组成,合并支气管扩张的危险因素。 结果单纯COPD组与合并支气管扩张组患者性别、年龄、吸烟史、肺结核史及住院时间相比有明显差异(P<0.05);合并支气管扩张患者症状持续时间及伴脓痰症状人数明显高于单纯COPD组(P<0.05);单纯COPD组患者血清中血红蛋白(Hb)水平明显高于合并支气管扩张组患者,C反应蛋白(CRP)及ESR明显低于合并支气管扩张组患者(P<0.05);合并支气管扩张组患者二氧化碳分压(PaCO₂)水平明显高于单纯COPD组患者(P<0.05);合并支气管扩张组患者痰涂片铜绿假单胞菌感染例数明显高于单纯COPD组患者(P<0.05);COPD患者中,女性、有肺结核史、痰涂片有铜绿假单胞菌感染、伴脓痰症状、症状持续时间长及住院时间长是合并支气管扩张的危险因素(P<0.05)。 结论女性、住院时间长、肺结核史、痰涂片铜绿假单胞菌感染、伴脓痰症状、症状持续时间长及住院时间长的COPD患者更易患支气管扩张,是老年COPD患者合并支气管扩张的危险因素。     

Memory switched B cell percentage and not serum immunoglobulin concentration is associated with clinical complications in children and adults with specific antibody deficiency and common variable immunodeficiency

Although idiopathic humoral immunodeficiencies are arbitrarily classified into specific antibody deficiency (SAD) or common variable immunodeficiency (CVID), this distinction does not accurately predict the risk of the bronchiectasis, one of the major long-term clinical complications in these patients. In this study, clinical complications were compared with laboratory markers of cellular and humoral immunity in fifty-five consecutive patients (27 children and 28 adults) attending regional immunology clinics in Manchester, United Kingdom. Reduced CD19(+)CD27(+)IgD(-) B cell percentage but not serum immunoglobulin levels or classification of patients into SAD and CVID was associated with a significantly higher prevalence of bronchiectasis (OR 0.4 (0.2-0.8), P = 0.001), splenomegaly (OR 0.2 (0.1-0.5), P = 0.001) and autoimmunity (OR 0.4 (0.2-0.7), P = 0.003). We conclude that in patients with idiopathic humoral immunodeficiencies assessment of B cell switching more accurately predicts clinical prognosis than either classification of patients into SAD and CVID or serum immunoglobulin concentrations.     

支气管肺泡灌洗联合小剂量罗红霉素治疗支气管扩张症的临床观察

目的:观察支气管肺泡灌洗联合小剂量罗红霉素口服治疗支气管扩张症的临床疗效。方法:30例支气管扩张症患者随机分为治疗组和对照组各15例,治疗组在常规治疗的基础上行支气管镜下局部病灶所属支气管的肺泡灌洗,同时加用罗红霉素150mg,qd,po;对照组仅用常规治疗,包括:吸氧、止咳化痰药物和抗感染治疗,但不使用其它大环内酯类药物和激素。治疗6个月后观察2组患者的临床疗效、咳痰量、肺功能变化和病情急性加重次数。结果:治疗组6个月内急性发作次数显著低于对照组;咯痰量明显减少(P<0.05),第1秒用力呼气容积(FEV1)、FEV1/用力肺活量(FVC)均高于对照组(P<0.05)。结论:支气管肺泡灌洗联合小剂量罗红霉素口服,可以改善支气管扩张症患者的临床症状、肺功能,降低急性发作频率。     

支气管扩张合并支气管哮喘的诊治探讨

目的探讨支气管扩张合并支气管哮喘的诊断、治疗方法及治疗效果。方法选42例支气管扩张合并支气管哮喘患者给予常规止咳、化痰、排痰及抗感染、必要时静脉使用糖皮质激素治疗,同时联合普米克令舒、硫酸特步他林雾化吸入治疗。结果治疗前后症状评分别为12.65分和5.3分,较治疗前明显降低,治疗后FEV1、FVC、FEV1/FVC、PEF指标较治疗前均有不同程度提高,治疗后与治疗前比较差异具有显著性,有统计学意义(P<0.05)。结论胸部薄层CT、支气管舒张或激发试验是诊断支气管扩张合并支气管哮喘的有效方法,患者一经确诊,在积极给予对症治疗的基础上结合糖皮质激素和β受体激动剂可迅速缓解症状,取得较好的效果。     

38例高原藏族结核性支气管扩张症的临床分析

目的分析高原藏族结核性支扩的临床表现、影像学检查特点及治疗。方法对我院2010年1月至2012年11月收治的38例高原藏族结核性支气管扩张的住院患者分析。结果病变范围一个肺叶以内19例,经内科治疗后,3年内随访无咳嗽、咯痰、咯血者16例,占84.21%,超过一个肺叶仅累及单侧者12例,经内科治疗后无反复咳嗽、咯痰、咯血5例,占41.66%,因出现大咯血作手术者1例,占8.33%。结论对结核性支气管扩张患者,管腔严重狭窄,远端肺组织反复感染,合并顽固性咳嗽、咯痰、咯血等,并呈现毁损肺等,应及早手术治疗。     

张燕萍教授治疗支气管扩张经验总结

支气管扩张症是一种常见的慢性呼吸道疾病,是各种原因引起的支气管树的病理性、永久性扩张,导致反复化脓性感染的气道慢性炎症,其患者人数随着年龄增加而逐渐上升。张燕萍教授是中国中医科学院西苑医院呼吸科学术带头人,从事肺系病证临床研究30余年,擅长中医防治肺系疾病以及临床疑难杂症的中医辨治,尤其对支气管扩张证治别具一格,疗效卓著。