Systemic inflammation in chronic obstructive pulmonary disease and asthma: Similarities and differences

Background and objective:   While recent studies have shown that patients with COPD and patients with asthma exhibit evidence of airway and systemic inflammation, markers of systemic inflammation have not been compared between the two diseases.
Methods:   To evaluate circulating inflammatory markers, blood was sampled from 111 patients with COPD, 75 control subjects and 46 asthmatic patients (some of whom were smokers). Measurements of WCC, serum levels of fibrinogen, high-sensitivity (hs)-CRP, IL-8, IL-6, tumour necrosis factor-α (TNF-α), transforming growth factor (TGF)-β1, tissue inhibitors of metalloproteinase (TIMP)-1, neutrophil elastase and alpha1-antitrypsin (α1-AT) were performed.
Results:   Serum TNF-α, IL-6 and TIMP-1 concentrations were significantly higher in patients with stable COPD and patients with asthma than in control patients. Serum α1-AT levels were significantly higher in COPD patients than in asthmatic patients and control subjects, and serum TGF-β1 levels were higher in asthma patients than in COPD patients. Smoking status had no effect on markers in COPD and asthmatic patients.
Conclusions:   Although COPD and asthma share common markers of systemic inflammation, serum levels of TGF-β1 and α1-AT may reflect differences between the diseases.     

Continuous positive airway pressure therapy in sleep apnoea

Sleep apnoea is associated with increased mortality and morbidity. The treatment goal is to reduce the neurocognitive and cardiovascular sequelae. CPAP therapy in sleep apnoea is discussed in two parts in the article. The first part will consider CPAP therapy in the more common form of sleep apnoea (i.e. obstructive or mixed sleep apnoea) and the second part will consider CPAP therapy in central sleep apnoea. Alternative positive airway pressure modalities are discussed. CPAP therapy has been extensively studied and it remains the mainstay of treatment in obstructive sleep apnoea, as it is still the most consistently efficacious and safe option. However, its major disadvantage is that it does not confer a cure to this disorder and hence therapy is generally life long with its usual treatment compliance problems. As such, there are continuous improvement strategies. The role of CPAP therapy in central sleep apnoea is more limited. There has been increasing data on the beneficial effect of CPAP on central sleep apnoea/Cheyne-Stokes respiration in congestive heart failure. Evidence for CPAP therapy in sleep apnoea has evolved significantly over the last decade. However, more research and publication of large-scale long-term randomized trials of treatment in sleep apnoea to assess patient-orientated outcomes and preferences are necessary.     

虎杖苷对慢性阻塞性肺疾病大鼠PI3K/AKT/mTOR通路以及气道炎症的影响

目的 构建慢性阻塞性肺疾病（COPD）大鼠模型,探讨虎杖苷对COPD大鼠PI3K/AKT/mTOR通路以及气道炎症的影响。方法 100只Wistar大鼠随机分为对照组、模型组、地塞米松（0.2 mg/kg,阳性药）组和虎杖苷低、高剂量（30、60 mg/kg）组,每组20只。除对照组外,其他组熏香烟加气管注射内毒素法制备COPD模型,COPD造模前1 d开始ig给药,每天1次,持续30 d。ELISA法检测支气管肺泡灌洗液（BALF）中肿瘤坏死因子（TNF）-α和白细胞介素（IL）-6水平;RSE3020肺功能检测仪测定用力肺活量（FVC）、第1秒用力呼气容积（FEV₁）、呼气峰流速（PEF）;取肺组织4%甲醛固定后制作切片,HE染色,并进行肺组织损伤病理评分;Western blotting检测肺组织PI3K、AKT、mTOR蛋白表达。结果 虎杖苷高、低剂量组大鼠BALF中TNF-α和IL-6表达水平、肺组织损伤病理评分以及PI3K、AKT和mTOR蛋白表达均显著低于模型组（P<0.01）;虎杖苷高、低剂量组大鼠FVC、FEV1、PEF肺功能指标显著高于模型组（P<0.01）。结论 虎杖苷可以抑制COPD大鼠PI3K/AKT/mTOR通路,抑制气道炎症,发挥肺损伤保护作用。     

桂龙咳喘宁胶囊联合福多司坦治疗慢性阻塞性肺疾病急性加重期的临床研究

目的探讨慢性阻塞性肺疾病急性加重期应用桂龙咳喘宁胶囊联合福多司坦治疗的效果。方法 2015年2月-2018年4月天津市宝坻区人民医院呼吸科收治的114例慢性阻塞性肺疾病急性加重期患者,随机分成对照组(n=57)和治疗组(n=57)。对照组口服福多司坦片,0.4 g/次,3次/d,餐后服用。治疗组患者在对照组基础上口服桂龙咳喘宁胶囊,3粒/次,3次/d。两组均连续治疗14 d。比较两组临床疗效和呼吸系统症状体征的缓解时间,治疗前后肺功能参数[第1秒用力呼气容积(FEV1)占预计值百分比(FEV1占预计值%)、FEV1与用力肺活量(FVC)比值(FEV1/FVC)、呼气峰值流量(PEF)]值、慢性阻塞性肺疾病患者自我评估测试问卷(CAT)评分、外周血嗜酸性粒细胞绝对值(EOS#)及中性粒细胞(NEUT)与淋巴细胞(LYM)比值(NLR)和血清学相关指标[嗜酸性粒细胞阳离子蛋白(ECP)、白介素(IL)-13、8-羟基脱氧鸟苷(8-OHdG)、总抗氧化能力(TAC)]水平变化,不良反应发生情况。结果对照组和治疗组的总有效率分别是86.0%、96.5%,两组比较差异有统计学意义(P<0.05)。与对照组相比,治疗组咳嗽、咳痰等急性加重的呼吸系统症状体征的缓解时间均显著更短(P<0.05)。与治疗前对比,两组治疗后FEV1占预计值%、FEV1/FVC及PEF值均显著增高(P<0.05),CAT评分则均显著降低(P<0.05);但治疗后,治疗组上述肺功能参数值较对照组同期均显著更高(P<0.05),而CAT评分显著更低(P<0.05)。两组治疗后外周血EOS#、NLR值及血清ECP、IL-13、8-OHdG水平均显著低于治疗前(P<0.05),血清TAC水平则均显著升高(P<0.05);且治疗后,治疗组以上指标(EOS#、NLR、ECP、IL-13、8-OHdG、TAC)的改善效果均更显著(P<0.05)。两组均无严重不良反应发生。结论桂龙咳喘宁胶囊联合福多司坦治疗慢性阻塞性肺疾病急性加重期的整体疗效显著,能有效缩短稳定患者病情的时间,改善肺通气功能,缓解气道炎症及全身炎症状态,纠正氧化/抗氧化失衡,具有一定的临床推广应用价值。     

益生菌制剂对儿童反复呼吸道感染的疗效和免疫功能影响的系统评价

目的 系统评价益生菌制剂防治儿童反复呼吸道感染（RRTIs）的有效性和安全性,为临床提供循证参考。方法计算机检索PubMed、EMBase、Cochrane图书馆、中国生物医学文献数据库（CBM）、中国学术期刊全文数据库（CNKI）、维普中文期刊全文数据库（VIP）和万方数据库,收集益生菌制剂（试验组）防治儿童RRTIs的随机对照试验（RCT）,检索时限均为建库起至2019年3月。提取资料,用Rev Man 5.3软件进行Meta-分析。结果 共纳入12项研究,878例患者。Meta-分析结果显示,试验组在总有效率［RR=1.31,95%CI（1.22,1.41）,P<0.001］、抗菌药用药时间［MD=-4.42,95%CI（-5.92,-2.91）,P<0.001］、年呼吸道感染次数［MD=-2.30,95%CI（-2.70,-1.89）,P<0.001］、临床体征改善时间均优于对照组（P<0.05）;免疫球蛋白IgG ［MD=1.80,95%CI （1.60,2.01）,P<0.001］、IgA ［MD=0.37,95%CI（0.23,0.51）,P<0.001］、IgM［MD=0.06,95%CI（0.02,0.09）,P=0.002］,T淋巴细胞亚群CD3+［MD=4.48,95%CI（1.48,7.49）,P=0.03］、CD4⁺［MD=3.17,95%CI（1.01,5.55）,P=0.009］和CD8⁺［MD=-4.44,95%CI（-6.52,-2.36）,P<0.05］改善情况均显著优于对照组,差异均有统计学意义（P<0.05）。结论 益生菌可有效治疗儿童反复呼吸道感染,安全性较好。但由于纳入研究数量少,研究质量不统一,尚需要大样本、高质量的临床随机对照研究予以证实。     

玉屏风制剂联合匹多莫德治疗儿童反复呼吸道感染的Meta分析

目的：系统评价玉屏风制剂联合匹多莫德治疗儿童反复呼吸道感染的临床疗效和安全性,为临床循证医学研究提供参考。方法：计算机检索PubMed、EMBase、中国生物医学文献数据库（CBM）、中国知网（CNKI）、维普数据库（VIP）和万方数据库,收集常规治疗+玉屏风制剂联合匹多莫德（试验组）对比单用常规治疗或常规治疗+匹多莫德（对照组）治疗儿童反复呼吸道感染（RRTI）的随机对照试验（RCT）,检索时间为2000年1月至2018年3月,提取资料并评价质量后,采用RevMan 5.2软件进行Meta分析。结果：共纳入12篇文献,1 175例患儿。Meta分析结果显示,试验组总有效率高于对照组（RR=1.25,95% CI 1.19~1.32,P<0.01）;退热时间、咳嗽缓解时间、肺部啰音和扁桃体红肿消失时间均短于对照组（P均<0.01）;治疗后免疫球蛋白水平（IgA、IgM和IgG）和T淋巴细胞水平（CD3+、CD4+和CD4+/CD8+）均高于对照组（P均<0.01）。所有文献均未报道不良反应。结论：玉屏风制剂联合匹多莫德能够显著改善儿童RRTI的免疫功能及临床体征,从而提高总有效率。     

Retrospective analysis of T-lymphocyte subsets and cytokines in malignant obstructive jaundice before and after external and internal biliary drainage

ObjectiveTo study changes in T lymphocyte subsets, cytokines, and liver enzymes in patients with malignant obstructive jaundice (MOJ) before and after external biliary drainage (percutaneous transhepatic cholangiography drainage, PTCD) and internal biliary drainage (percutaneous transhepatic insertion of biliary stents, PTIBS).MethodsMOJ patients undergoing PTCD (n = 44) and PTIBS (n = 38) at our hospital were enrolled in the study from January 2017 until December 2019. Peripheral blood total bilirubin (TBIL), direct bilirubin (DBIL), aspartate aminotransferase (AST), alanine aminotransferase (ALT), CD3⁺%, CD4⁺%, CD4⁺/CD8⁺ ratio, interleukin (IL)-2, IL-6, and tumor necrosis factor (TNF)-α were measured before and 1 week after biliary drainage.ResultsThere was no significant difference in any parameter between the two groups before biliary drainage. TBIL, DBIL, AST and ALT following PTCD were significantly lower than before PTCD. By contrast, CD3⁺%, CD4⁺%, CD4⁺/CD8⁺ ratio, IL-2, IL-6 and TNF-α showed no significant difference before and 1 week after PTCD. TBIL, DBIL, AST, ALT, IL-6 and TNF-α were significantly lower following PTIBS than before PTIBS. CD3⁺%, CD4⁺%, CD4⁺/CD8⁺ ratio and IL-2 were significantly higher following PTIBS than before PTIBS.ConclusionBoth PTCD and PTIBS were effective for treatment of MOJ, but PTIBS was more beneficial for recovery of immune function.     

Association of IL-8 gene polymorphisms with non small cell lung cancer in Tunisia: A case control study

Interleukin 8 (IL-8), is a proinflammatory chemokine, has been reported to have angiogenic activity and to be responsible for tumor-associated angiogenesis in several cancers. In this study, we aimed to study the (IL-8) gene polymorphism in relation with risk development of non small cell lung cancer in Tunisian patient. Two single nucleotide polymorphisms (−251T/A [rs4073], +781C/T [rs2227306]) of the IL-8 gene were screened in 170 patients with NSCLC and 225 healthy controls by PCR–RFLP.     

82例AECOPD患者肝功能异常临床处置方案初探

目的分析慢性阻塞性肺疾病急性加重（AECOPD）合并肝损害患者的临床特点、保肝治疗对其预后的影响。方法回顾性分析82例AECOPD合并肝损害者的外周血白细胞计数、中性粒细胞百分比、肝功能及动脉血气分析,并对治疗前后检验结果、住院天数、住院费用、肝功能转归和死亡率进行比较分析。结果 AECOPD患者治疗后症状、动脉血氧分压（PaO2）、外周血白细胞、中性粒细胞百分比和肝功能各参数值较治疗前均有明显改善（P〈0.01）;随pH值、PaO2、PaCO2指标的改善及感染的控制,肝功能亦逐渐恢复至正常。酸中毒时（pH〈7.35）pH值与ALT、AST结果显著负相关,PaO2与ALT、AST结果显著负相关,PaCO2与ALT、AST结果显著正相关。结论 AECOPD患者肝脏功能有明显的损害,给予抗感染等原发病治疗,肝功能可恢复正常,但常规护肝降酶治疗对转归无显著影响。