中药脑肺康对地鼠实验性肺气肿及肺动脉高压的防治作用

目的 观察中药肺康对缺氧性肺动脉高压和肺气肿的防治效果并探讨其作用机制。方法 以弹性蛋白酶溶液滴注入金黄地鼠气管内,正常饲养３０ｄ后,常压下缺氧１５ｄ,分别设立中药脑肺康预防组、治疗组、肺气肿＋缺氧组及正常对照组。于处死动物前,测量平均肺动脉压,取静脉血进行循环内皮细胞计数;处死后测量右心肥大指数,光镜下计数左侧肺支气管肺泡灌洗液内细胞总数,对右侧肺进行光镜图像分析。结果 中药脑肺康预防组和治疗３     

理肺通络方对肺炎支原体肺炎大鼠肺泡灌洗液中sIgA的干预作用

目的 观察肺炎支原体肺炎大鼠肺泡灌洗液sIgA的含量及理肺通络方的干预作用。方法 将40只大鼠随机分为正常组、模型组、中药组、西药组，每组10只。一次性滴鼻感染肺炎支原体国际标准株（MPFH）菌液（每毫升含肺炎支原体10^7变色单位）造成肺炎支原体肺炎模型。造模第11 d起，除正常组外，其余各组分别灌服生理盐水、理肺通络方水煎剂、阿齐霉素溶液，2mL／只。中药组连续服药10d，西药组前、后3d灌药液，中间4d灌生理盐水。在治疗的第11d处死动物，观察各组大鼠血清MP—IgM滴度及右肺组织形态学，采用放免双抗夹心法检测sIgA含量。结果 模型组大鼠血清MP—IgM阳性，光镜下显示肺组织炎性细胞浸润和组织损伤明显；与正常组比较，模型组、中药组、西药组肺泡灌洗液中sIgA含量显著降低，有高度统计意义（P〈0．01）；与模型组比较，中药组、西药组sIgA含量显著升高（P〈0．01）；中药组与西药组比较有统计意义（P〈0．05）。结论 肺炎支原体肺炎大鼠肺泡灌洗液sIgA含量下降，理肺通络合剂能提高呼吸道局部sIgA含量，且优于西药阿齐霉素，可能有助于降低再次感染的几率。     

Differences in cellular and inflammatory cytokine profiles in the bronchoalveolar lavage fluid in bagassosis and silicosis

BACKGROUND: Little is known about the crucial mediators involved in the inflammation and fibrogenesis in bagassosis. The aim of this study was to characterize the cellular and cytokine patterns in the airways of bagassosis and to compare these with silicosis subjects and controls. METHODS: Bronchoalveolar lavage (BAL) was performed in 11 patients with bagassosis, 16 cases with silicosis, and 8 controls. Differential cell counts, total protein concentration, TNF-alpha, IL-1beta, IL-5, IL-6, and IL-8 were analyzed in the bronchoalveolar lavage fluid (BALF). RESULTS: Bagassosis was characterized with hypercellularity with neutrophilia in BALF; while the predominant cell in the BALF in silicosis was macrophage. Compared with control subjects, increased TNF-alpha, IL-1beta, IL-8, and IL-6 levels were found in the BALFs in both bagassosis and silicosis. Furthermore, IL-6 levels in the BALF of silicosis subjects were significantly higher than that seen in bagassosis. In contrast, bagassosis had higher level of IL-8 in BALF than that in silicosis. Relationship among these parameters were found between IL-8 levels and neutrophils, lymphocytes and IL-1 beta in bagassosis, macrophages and IL-1beta in silicosis. No significant differences of total protein concentrations and IL-5 in BALF were found between controls or bagassosis, and silicosis. CONCLUSIONS: The findings of this study suggest that neutrophils, TNF-alpha, IL-1beta, IL-8, and IL-6 are involved in the pathogenesis in bagassosis. The mechanisms underline the different cellular and cytokine profiles in bagassosis and silicosis warrant further investigation.     

Acute pulmonary inflammation induced by exposure of the airways to staphylococcal enterotoxin type B in rats

Staphylococcus aureus is a gram-positive bacterium that produces several enterotoxins, which are responsible for most part of pathological conditions associated to staphylococcal infections, including lung inflammation. This study aimed to investigate the underlying inflammatory mechanisms involved in leukocyte recruitment in rats exposed to staphylococcal enterotoxin B (SEB). Rats were anesthetized with pentobarbital sodium and intratracheally injected with either SEB or sterile phosphate-buffered saline (PBS, 0.4 ml). Airways exposition to SEB (7.5-250 ng/trachea) caused a dose- and time-dependent neutrophil accumulation in BAL fluid, the maximal effects of which were observed at 4 h post-SEB exposure (250 ng/trachea). Eosinophils were virtually absent in BAL fluid, whereas mononuclear cell counts increased only at 24 h post-SEB. Significant elevations of granulocytes in bone marrow (mature and immature forms) and peripheral blood have also been detected. In BAL fluid, marked elevations in the levels of lipid mediators (LTB(4) and PGE(2)) and cytokines (TNF-alpha, IL-6 and IL-10) were observed after SEB instillation. The SEB-induced neutrophil accumulation in BAL fluid was reduced by pretreatment with dexamethasone (0.5 mg/kg), the COX-2 inhibitor celecoxib (3 mg/kg), the selective iNOS inhibitor compound 1400 W (5 mg/kg) and the lipoxygenase inhibitor AA-861 (200 microg/kg). In separate experiments carried out with rat isolated peripheral neutrophils, SEB failed to induce neutrophil adhesion to serum-coated plates and chemotaxis. In conclusion, rat airways exposition to SEB causes a neutrophil-dependent lung inflammation at 4 h as result of the release of proinflammatory (NO, PGE(2), LTB(4), TNF-alpha, IL-6) and anti-inflammatory mediators (IL-10).     

纤维支气管镜支气管肺泡灌洗术治疗重型颅脑损伤合并肺部感染

目的探讨应用纤支镜肺灌洗术治疗重度颅脑损伤合并肺部感染的临床疗效。方法通过对A和B两组病例采用常规治疗及常规治疗加纤维支气管镜灌洗术,观察两组病例的治疗效果。结果A组病例平均治愈时间12.5 d;B组病人平均治愈时间7.6 d,两组病例的疗效有显著差异(P<0.01),B组病人的细菌培养阳性率达83.3%,除少部分病人出现术中、术后一过性低氧血症,无严重并发症发生。结论纤维支气管镜灌洗术治疗重度颅脑损伤合并肺部感染,简便,安全,疗效确切,有很高的临床应用价值。     

肺泡蛋白沉积症的病理表现--附8例报告及文献复习

目的总结肺泡蛋白沉积症(PAP)的病理特征及病理诊断要点。方法对8例惠者的临床资料进行分析,并回顾复习有关文献。结栗8例中,男6例,女2例,年龄6～58岁,平均32．8岁,病程5个月～5年。8例均行肺组织活检,6例行支气管肺泡灌洗液检查。PAP在光镜下可见肺泡扩张,腔内充满颗粒状、嗜伊红性、过碘雪夫(PAS)染色阳性的蛋白物质;电镜下可见细胞碎片和板层小体。结论支气管肺泡灌洗液的病理和电镜检查可用于PAP的早期诊断,肺活检是最好的确诊PAP的手段。     

支气管肺泡灌洗液组织多肽抗原检测对肺癌诊断的价值

目的：探讨支气管肺泡灌洗液（BALF）中组织多肽抗原（TPA）含量对肺癌的诊断价值。方法：应用酶联免疫法检测60例初次确诊的肺癌和30例肺良性疾病患者BALF中TPA含量，并与血清中含量比较，采用ROC曲线确定BALF中TPA的阈值。结果：肺癌患者BALF中TP含量明显高于肺良性疾病患者（P＜0.05），BALF中TPA检测诊断肺癌的灵敏度为83.33%，特异度为86.67%。肺癌患者BALF中TPA含量显著高于血清中的含量（P＜0.01）。结论：BALF中TPA的检测对肺癌有较高的诊断价值。     

肺泡蛋白沉积症的临床分析和诊治的探讨

目的通过临床病例分析结合文献资料以提高对该病的诊断水平。方法回顾我院自2000年至2007年1月收治的6例肺泡蛋白沉积症（PAP）病人结合文献进行分析。结果6例患者中男性4例，女性2例。以30～50岁为主。渐进性呼吸困难是最主要的临床表现。胸片和CT表现为双肺弥漫性病变。高分辨CT上可有特征性的“铺路石样”或“地图样”改变。肺功能主要表现为限制性通气功能障碍、弥散障碍和低氧血症。6例均经纤维支气管镜下肺泡灌洗和肺活检获得确诊。全肺灌洗是治疗该病最有效的方法。结论PAP虽然是少见病，但由于其在HRCT上的特殊表现，以及通过纤维支气管镜下的灌洗液及肺活检对该病的重要诊断价值，提高对该病的认识可大大减少通过开胸肺活检诊断给病人带来的创伤和经济的负担。     

Performance of lateral flow device and galactomannan for the detection of Aspergillus species in bronchoalveolar fluid of patients at risk for invasive pulmonary aspergillosis

Early diagnosis of invasive pulmonary aspergillosis (IPA) remains difficult due to the variable performance of the tests used. We compared the performance characteristics of Aspergillus lateral flow device (LFD) in bronchoalveolar lavage (BAL) vs. BAL‐galactomannan (GM), for the diagnosis of IPA. 311 BAL specimens were prospectively collected from patients who underwent bronchoscopy from January to May 2013. Patients at risk for IPA were divided into haematological malignancy (HEM) and non‐HEM groups: solid organ transplants (SOT) (lung transplant (LT) and non‐LT SOT); chronic steroid use (CSU); solid tumour (STU) and others. We identified 96 patients at risk for IPA; 89 patients (93%) were in the non‐HEM groups: SOT 57 (LT, 46, non‐LT SOT, 11); CSU 21; STU 6, other 5. Only three patients met criteria for IA (two probable; one possible). Overall sensitivity (SS) was 66% for both and specificity (SP) was 94% vs. 52% for LFD and GM respectively. LFD and GM performance was similar in the HEM group (SS 100% for both and SP 83% vs. 100% respectively). LFD performance was better than GM among non‐HEM SOT patients (P = 0.02). Most false‐positive GM results occurred in the SOT group (50.8%), especially among LT patients (56.5%). LFD performance was superior with an overall SP of 95.6% in SOT (P < 0.002) and 97% in LT patients (P = 0.0008). LFD is a rapid and simple test that can be performed on BAL to rule out IPA.