硫酸特布他林雾化溶液及吸入用布地奈德混悬液联合吸入治疗小儿毛细支气管炎临床分析

目的研究硫酸特布他林(博利康尼)雾化溶液和吸入用布地奈德混悬液(普米克令舒)联合雾化吸人治疗毛细支气管炎的临床疗效。方法选择2004年1月—2006年2月因毛细支气管炎入院的患儿131例,在家长知情同意后,将患儿分为观察组101例和对照组30例。对照组采用综合治疗,观察组在此综合治疗基础上加用硫酸特布他林雾化溶液和吸入用布地奈德混悬液氧气驱动雾化吸入治疗。比较两种治疗方法的疗效,患儿气促缓解、哮鸣音消失、肺部湿啰音消失和咳嗽消失的时间,不良事件的发生率,以及住院天数和住院费用的差异。结果观察组痊愈49例,显效35例,进步16例,无效1例,有效率(痊愈 显效)为83.2%;对照组痊愈8例,显效10例,进步11例,无效1例,有效率为60.0%;观察组的治疗有效率显著高于对照组(P= 0.012)。观察组的气促缓解、哮鸣音消失、肺部湿啰音消失及咳嗽消失时间均显著短于对照组(P值均<0.05)。两组不良事件发生率的差异无统计学意义(P>0.05)。观察组住院天数和住院费用均显著少于对照组(P值分别<0.05、0.01)。结论硫酸特布他林雾化溶液和吸入用布地奈德混悬液氧气驱动联合雾化吸入治疗小儿毛细支气管炎疗效显著,方便安全,具有广阔的临床应用前景。     

86例细支气管肺泡癌高分辨率CT影像分析

目的：提高细支气管肺泡癌的CT诊断水平。方法：回顾86例细支气管肺泡癌的高分辨CT影像的及病理的结果，对其征象进行分析。结果：细支气管肺泡癌具有三种类型，其中结节型24例，为单发结节；弥漫型46例，其中腺泡样结节22例，大片实变12例，磨砂玻璃征12例；炎症型16例。结论：高分辨率CT对于细支气管肺泡癌具有重要的诊断价值；细支气管肺泡癌表现多样，结节内细支气管气像对诊断具有一定的价值；炎症型和弥漫型需与肺结核、肺炎鉴别。     

支气管肺血管成形重建治疗中叶肺癌

目的：探讨中叶肺癌最大限度保留健肺的手术方法。方法：1994年6月至1999年8月，对16例中叶肺癌分别采取了中叶切除加气管楔形切除12例，其中6例伴肺动脉部分切除，2例肺动脉袖式切除；另3例行中叶切除加支气管袖式切除，其中1例伴肺动脉部分切除；另1例行中下叶切除、肺上静脉与肺下静脉重建。结果：16例手术全部获得成功。1年生存率88％，3年生存率50％。结论：中叶肺癌采用支气管肺血管成形重建术，既最大限度切除病变，又充分保留健肺，扩大了手术适应症。     

Immunocytochemical evidence for the expression of GST1, GST2, and GST3 gene loci for glutathione S-transferase in human lung

Immunocytochemical studies demonstrate that significant amounts of glutathione S-transferase (GST) are associated with alveoli and bronchioles of human lung. The immunofluorescence in human lung sections was observed with the antibodies which were raised against GSTω and GSTα-ɛ of human liver and GSTπ of human placenta indicating that the isoenzymes corresponding to three gene loci, GST1, GST2, and GST3 are present in human lung. Presence of GST isoenzymes in significant amounts in bronchioles and alveoli of human lung indicate that these isoenzymes may play an important role in the detoxification of xenobiotics as well as in combating oxidative stress through glutathione peroxidase II activity.     

Reactive airways dysfunction syndrome presenting as a reversible restrictive defect

A 25-year-old farm worker developed acute bronchopneumonia after heavy exposure to a respiratory irritant in a silo. He recovered from the acute episode but then experienced chronic dyspnea and fatigue. Pulmonary function testing showed small lung volumes with a normal ratio of 1 s forced expiratory volume/forced vital capacity (restrictive defect). This defect improved markedly with bronchodilator treatment and changed to a mixed obstructive/restrictive defect with methacholine challenge. We believe that this is an example of the reactive airways dysfunction syndrome manifested by a restrictive rather than obstructive defect. Constriction of airways at the bronchoile or alveolar duct level is the most likely cause of the syndrome.     

超微型光纤成像系统行离体猪肺细支气管成像

目的 探索利用超微型光纤成像系统获得离体猪肺细支气管（直径<1 mm）图像的可行性。方法 将超微型光纤成像系统的光纤（直径0.82 mm）自10具完整新鲜猪肺标本的喉部插入,连接CPAP（Continuous Positive Airway Pressure）模式无创呼吸机,观察并记录各级细支气管解剖结构、黏膜颜色、气管内分泌物等;插入到支气管远端遇到阻力时停止,固定光纤后行肺CT扫描,并行支气管三维重建,获取超微型光纤到达最远端支气管的直径。结果 超微型光纤成像系统能实时获得各级细支气管图像;三维重建图像显示超微型光纤成像系统能到达直径<1 mm的细支气管。结论 利用超微型光纤成像系统能获得离体猪肺直径<1 mm的细支气管的图像,可为获得活体肺细支气管图像提供前期动物研究基础。     

MORPHOLOGIC CHANGES IN THE BRONCHIOLAR EPITHELIA OF RATS EXPOSED TO VOLCANIC ASHES

This study reports the quantitative,and qualitative changesin the small airways after exposure to volcanic ash and quartz,and fol-lowed by an additional nine months of clean air.Three matched groupsof 75 rats were exposed to volcanic ash,quartz,and clean air in a Ro-chester exposure chamber 6 hours daily for 14 days.Animals were sac-rificed and studied,at pariodic intervals.Morphologic and morphometricevaluations were made using light microscope,transmissional electron mi-croscope and scanning electron microscope.The results showed:a.volcanicash produced the same damage in the small ailway as quartz did but lesssevere,b.Clara cells were the most severely damaged cell type occuringmost often at the end of exposure,and c.the damaged epithelial cellsmight be repaired by means of proliferation and differentiation of re-maining Clara cells,and perhaps type Ⅱ cells and Clara cells couldtransform mutually,and d.peribronchiolar fibrosis was greater after3 month exposure which may be persistent.These evidences indicate the exposure to either quartz or volcanic ashhas a persistent fibrogenic effect on the small airways in rats,butbronchiolar epithelium can be repaired as the stimulus is terminated.     

Bronchodilator action of an agonist for histamine H3-receptors in guinea pig perfused bronchioles and lung parenchymal strips

Isolated guinea pig perfused bronchioles and lung parenchymal strips were examined as an in vitro model for assessment of the direct effect of pharmacologic agents on the airway smooth muscle. The experiments were performed with a perfusion technique in bronchioles, the input pressure being measured as an index of the state of dilation, while changes in tension of the lung parenchymal strips were measured with an isometric force transducer. In both preparations, histamine and acetylcholine elicited dose-related contractile responses whereas fenoterol induced a concentration-dependent relaxation. After the 3 agonists' activities were compared in these 2 preparations, we tested the intrinsic effects of a specific H₃ agonist, (R)-methylhistamine ([R]-MeHA). Statistical analysis was by Student's t test on the E_max (expressed as a percentage of 10^–4 M papaverine relaxation), EC₅₀, and slopes of regression lines calculated from the concentration-response curves plotted for (R)-MeHA alone or in presence of antagonists. Our results showed that (R)-MeHA induced a concentration-dependent relaxation of perfused bronchioles and lung parenchymal strips competitively inhibited by 10^–7 M thioperamide (H₃-antagonist), whereas 10^–5 M cimetidine (H₂-antagonist) failed to prevent this effect. These results suggest the presence of H₃-histaminergic dilatory receptors in the guinea pig airway. Offprint requests to: J.-L. Burgaud     

人细支气管上皮细胞的ROCK激酶抑制剂培养体系扩增及气液相模型的建立

背景：人类原代肺脏上皮细胞在体外难以分离培养,表现为组织来源有限、细胞存活率低、增殖速度慢,缺乏上皮细胞表型分化能力等。目的：体外扩增人细支气管上皮细胞,建立其气液相分化模型,用于肺脏上皮细胞功能研究。方法：采用Pronase和DnaseⅠ联合消化法分离人细支气管上皮细胞。利用ROCK激酶抑制剂培养体系对其进行扩增,免疫荧光染色鉴定细胞类型。建立气液相培养模型,扫描电镜、相差显微镜和免疫荧光染色鉴定细胞分化类型。结果与结论：通过ROCK激酶抑制剂培养体系,体外成功培养扩增了人细支气管上皮细胞。扩增细胞经免疫荧光染色鉴定绝大部分都表达基底细胞标记角质蛋白14,提示人细支气管的基底细胞可能是肺脏上皮干细胞的主要亚群。同时,扩增细胞在气液相培养条件下分化成纤毛细胞和无纤毛柱状细胞,表明ROCK激酶抑制剂培养体系扩增的上皮细胞仍然保持干细胞的增殖分化能力,体外气液相培养模型可以促进人细支气管上皮细胞分化。 中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

Toxic Inhalational Injury-Associated Interstitial Lung Disease in Children

Interstitial lung disease in children (chILD) is a group of disorders characterized by lung inflammation and interstitial fibrosis. In the past recent years, we noted an outbreak of child in Korea, which is possibly associated with inhalation toxicity. Here, we report a series of cases involving toxic inhalational injury-associated chILD with bronchiolitis obliterans pattern in Korean children. This study included 16 pediatric patients confirmed by lung biopsy and chest computed tomography, between February 2006 and May 2011 at Asan Medical Center Children''s Hospital. The most common presenting symptoms were cough and dyspnea. The median age at presentation was 26 months (range: 12-47 months), with high mortality (44%). Histopathological analysis showed bronchiolar destruction and centrilobular distribution of alveolar destruction by inflammatory and fibroproliferative process with subpleural sparing. Chest computed tomography showed ground-glass opacities and consolidation in the early phase and diffuse centrilobular nodular opacity in the late phase. Air leak with severe respiratory difficulty was associated with poor prognosis. Although respiratory chemicals such as humidifier disinfectants were strongly considered as a cause of this disease, further studies are needed to understand the etiology and pathophysiology of the disease to improve the prognosis and allow early diagnosis and treatment.