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Changes of myocardial oxidative stress injury and intervention of edaravone in intermittent hypoxic rat model 间歇性缺氧大鼠心肌氧化应激损伤的变化及依达拉奉的干预作用
Pub Date : 2020-03-20 DOI: 10.3760/CMA.J.CN131368-20190312-00334
Y. Duan, Jizu Ling, Xinhui Yuan, Lifang Li, Qin Yu
Objective To investigate the effect of intermittent hypoxia (IH) on myocardial oxidative stress injury and its possible mechanism by establishing IH rat model, and to further understand the intervention effect of edaravone, provide new ideas for the research and prevention of obstructive sleep apnea-hypopnea syndrome and related cardiovascular complications. Methods Eighty healthy male Wistar rats were randomly divided into normal control (NC) group, IH group, IH+ edaravone group, and IH+ normal saline (NS) group, 20 rats in each group.The IH rat model was established by using a gas control device to fill the closed simulation chamber with nitrogen, oxygen and compressed air.After four weeks of modeling, the serum levels of lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase-MB (CK-MB) and malondialdehyde (MDA), superoxide dismutase (SOD) and hydroxyl radicals were measured.The mitochondrial adenosine triphosphate (ATP) level in cardiomyocytes was measured.Myocardial morphology and ultrastructure were observed by light microscopy and transmission electron microscopy.Transcription-polymerase chain reaction technique was used to detect the expressions of Bcl-2, Bax and Caspase-3 mRNA in myocardial tissue. Results (1)Compared with the NC group, the levels of LDH, CK, CK-MB, MDA and hydroxyl radicals, the expressions of Bax and Caspase-3 mRNA were significantly increased, while the SOD activity, ATP content, and the expression of Bcl-2 mRNA were significantly decreased in the IH group and the IH+ NS group (all P<0.05). (2)Under light microscope and transmission electron microscope, no obvious damage was found in myocardial tissue of NC group, but the morphology and ultrastructure of myocardial tissue in IH group and IH+ NS group were damaged.(3)After intervention with edaravone, serum LDH, CK, CK-MB and myocardial tissue MDA, hydroxyl radicals, Bax and Caspase-3 mRNA expressions decreased, SOD activity and ATP content increased, Bcl-2 mRNA expression level was elevated (all P<0.05), and the degree of myocardial tissue damage under light and electron microscopy was alleviated.(4)Caspase-3 mRNA expression in cardiomyocytes was positively related with CK (r=0.575), CK-MB (r=0.460), MDA (r=0.643), hydroxyl radical (r=0.454), and Bax mRNA (r=0.741), negatively related with ATP (r=-0.525) and Bcl-2 mRNA (r=-0.578). Conclusions (1)IH can induce myocardial oxidative stress damage in rats by increasing oxidants, reducing antioxidants and activating Bcl-2, Bax and Caspase-3.(2)The myocardial oxidation stress injury induced by IH may be achieved by mitochondria-mediated apoptosis.(3)Edaravone has an intervention effect on myocardial injury induced by IH. Key words: Intermittent hypoxia; Oxidative stress; Myocardial injury; Adenosine triphosphate; Edaravone; Apoptosis
目的通过建立间歇性缺氧大鼠模型,探讨间歇性缺氧(IH)对心肌氧化应激损伤的影响及其可能机制,进一步了解依达拉奉的干预作用,为阻塞性睡眠呼吸暂停低通气综合征及相关心血管并发症的研究和预防提供新思路。方法80只健康雄性Wistar大鼠随机分为正常对照(NC)组、IH组、IH+依达拉奉组和IH+生理盐水(NS)组,每组20只。采用气体控制装置向密闭模拟室内充入氮气、氧气和压缩空气,建立IH大鼠模型。造模4周后,测定大鼠血清乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶- mb (CK- mb)、丙二醛(MDA)、超氧化物歧化酶(SOD)和羟基自由基水平。测定心肌细胞线粒体三磷酸腺苷(ATP)水平。光镜、透射电镜观察心肌形态和超微结构。采用转录聚合酶链反应技术检测心肌组织中Bcl-2、Bax和Caspase-3 mRNA的表达。结果(1)与NC组比较,IH组和IH+ NS组细胞LDH、CK、CK- mb、MDA、羟基自由基水平及Bax、Caspase-3 mRNA表达均显著升高,SOD活性、ATP含量、Bcl-2 mRNA表达均显著降低(P<0.05)。(2)光镜和透射电镜下,NC组心肌组织未见明显损伤,但IH组和IH+ NS组心肌组织形态和超微结构均有损伤。(3)依曲奉干预后,血清LDH、CK、CK- mb及心肌组织MDA、羟基自由基、Bax、Caspase-3 mRNA表达降低,SOD活性和ATP含量升高,Bcl-2 mRNA表达水平升高(均P<0.05);(4)心肌细胞Caspase-3 mRNA表达与CK (r=0.575)、CK- mb (r=0.460)、MDA (r=0.643)、羟基自由基(r=0.454)、Bax mRNA (r=0.741)呈正相关,与ATP (r=-0.525)、Bcl-2 mRNA (r=-0.578)呈负相关。结论(1)IH可通过增加氧化剂、减少抗氧化剂、激活Bcl-2、Bax和Caspase-3等途径诱导大鼠心肌氧化应激损伤。(2)IH所致心肌氧化应激损伤可能通过线粒体介导的细胞凋亡实现。(3)依达拉奉对IH所致心肌损伤具有干预作用。关键词:间歇性缺氧;氧化应激;心肌损伤;三磷酸腺苷;药物不良反应;细胞凋亡
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引用次数: 0
Sex differences of cardiopulmonary exercise testing parameters in cardiac output prediction for patients with chronic thromboembolic pulmonary hypertension 慢性血栓栓塞性肺动脉高压患者心输出量预测中心肺运动试验参数的性别差异
Pub Date : 2020-03-20 DOI: 10.3760/CMA.J.CN131368-20190327-00438
Zuogang Wang, Zi-Long Zhao, Y. Huang, Liang Yu, Qinhua Zhao, S. Gong, P. Yuan, Jinming Liu
Objective To evaluate the sex differences of cardiopulmonary exercise testing (CPET) parameters in cardiac output (CO) prediction for patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods From May 2010 to February 2016, 73 cases (32 males and 41 females) with CTEPH were enrolled from Shanghai Pulmonary Hospital, all of whom underwent both right-heart catheterization and CPET.Multivariate regression analysis was applied to assess the prognostic value of CPET parameters. Results Sex differences were of no significance in both demographic and hemodynamic parameters in total patients, but younger in female patients.Male patients had higher O2 pulse at anaerobic threshold (AT), peak minute ventilation (VE), end-tidal partial pressure of oxygen output (PETO2) at AT, peak O2 pulse, VE at AT and nadir VE/carbon dioxide (VCO2), but lower oxygen uptake efficiency slope compared with female patients (all P<0.05). There was no significant difference in CPET parameters between male event group and male event-free group, but peak oxygen uptake(VO2)in female event group was lower than that in female event-free group (P<0.05). Female event group had lower peak VO2, VE at AT and peak VE compared to the male event group (all P<0.05). Nadir VE/VCO2 and peak PETO2 were independent predictors of CO for male and female CTEPH patients, respectively. Conclusions The independent predictors of CPET parameters are different in the assessment of CO in male and female CTEPH patients, which suggests that sex differences of CPET should be considered to be the better clinical assessment of CTEPH patients. Key words: Chronic thromboembolic pulmonary hypertension; Cardiopulmonary exercise testing; Sex characteristic; Cardiac output
目的探讨慢性血栓栓塞性肺动脉高压(CTEPH)患者心输出量(CO)预测中心肺运动试验(CPET)参数的性别差异。方法选取2010年5月至2016年2月上海肺科医院收治的73例CTEPH患者(男32例,女41例),均行右心导管置管和CPET。采用多因素回归分析评价CPET参数的预后价值。结果患者总体人口学和血流动力学参数性别差异无统计学意义,但女性患者年龄差异明显。男性患者无氧阈值(at) O2脉搏、分钟通气量(VE)峰值、潮汐末氧输出分压(PETO2)、at O2脉搏峰值、VE和最低点VE/ co2 (VCO2)均高于女性患者,但吸氧效率斜率低于女性患者(均P<0.05)。男性事件组与无事件组CPET参数差异无统计学意义,但女性事件组的峰值摄氧量(VO2)低于无事件组(P<0.05)。女性事件组的VO2峰值、at时VE和VE峰值均低于男性事件组(均P<0.05)。Nadir VE/VCO2和峰值PETO2分别是男性和女性CTEPH患者CO的独立预测因子。结论CPET参数的独立预测因子在评价男女CTEPH患者CO时存在差异,提示CPET的性别差异可作为CTEPH患者较好的临床评价指标。关键词:慢性血栓栓塞性肺动脉高压;心肺运动试验;性特征;心输出量
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引用次数: 0
Research progress on mechanical prevention of venous thromboembolism 机械预防静脉血栓栓塞的研究进展
Pub Date : 2020-03-20 DOI: 10.3760/CMA.J.CN131368-20191011-01395
Yue Zhao, Yuan-yuan Liu, Zhaozhong Cheng
With the increasement of the morbidity and mortality of venous thromboembolism (VTE), and the increasement of social burden, medical staff pay more attention to VTE and improve their awareness of it.As a preventable disease, the prevention of VTE is especially important.VTE prevention mainly includes drug prevention and mechanical prevention.However, drug prevention may cause the risk of bleeding, which limits the application of drug prevention.Mechanical prevention has extensive applications due to non-invasiveness, high patient compliance, fewer complications, simpleness and convenience, and excellent effectiveness.This article mainly summarizes the methods, advantages and disadvantages of mechanical prevention. Key words: Venous thromboembolism; Mechanical prophylaxis; Epidemiology
随着静脉血栓栓塞(venous thromboembolism, VTE)发病率和死亡率的增加,以及社会负担的增加,医护人员对VTE的重视程度越来越高,对VTE的认识也在不断提高。作为一种可预防的疾病,静脉血栓栓塞的预防尤为重要。静脉血栓栓塞的预防主要包括药物预防和机械预防。然而,药物预防可能造成出血的危险,这限制了药物预防的应用。机械预防具有无创、患者依从性高、并发症少、简单方便、疗效好等优点,应用广泛。本文主要总结了机械防护的方法、优缺点。关键词:静脉血栓栓塞;机械预防;流行病学
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引用次数: 0
Effect of probiotics on prevention of ventilator-associated pneumonia and intestinal function in critically ill patients 益生菌对危重患者呼吸机相关性肺炎及肠道功能的预防作用
Pub Date : 2020-03-20 DOI: 10.3760/CMA.J.CN131368-20190906-01252
Ying Xu, Rui-Xiang Chen, Jun Jin
Objective To observe the effect of probiotics on prevention of ventilator-associated pneumonia (VAP) and intestinal function in critically ill patients. Methods In this prospective, randomized, controlled study, 155 patients who met the conditions for enrollment were randomly divided into control group and test group.The same treatment was given to all patients, in addition, the patients in test group were given probiotics (Bifidobacterium, Lactobacillus mixture) for three weeks.The incidence of VAP, changes in gut microbiota and incidence of gastrointestinal symptoms were compared between the two groups. Results 120 patients finished the study, including 58 cases in the control group and 62 cases in the test group.The incidence of VAP in the test group was lower than that in the control group (38.7% vs 62.1%, χ2=6.541, P<0.05). The total detection rate of microbial colonization in the oropharynx and stomach of the test group was significantly lower than that of the control group (51.6% vs 89.7%, χ2=20.052, P<0.05). The incidences of increased intra-abdominal pressure, diarrhea, and weakened or disappeared bowel sounds were significantly reduced in the test group (χ2=8.439, 10.849, 13.327, all P<0.05). The proportion of lactobacillus in the intestinal tract of the test group was significantly increased.The time of mechanical ventilation and length of stay in intensive care unit in the test group were also significantly shortened compared with the control group (t=8.051, 6.538, all P<0.05). Conclusions Probiotics preparation can significantly increase the proportion of lactobacillus in the intestinal tract, reduce the incidence of VAP in critically ill patients, reduce the incidence of gastrointestinal symptoms, reduce the time of mechanical ventilation and the length of stay in intensive care unit, then have the value of clinical promotion. Key words: Probiotics; Pneumonia, ventilator-associated; Gut microbiota; Lactobacillus
目的观察益生菌对危重患者呼吸机相关性肺炎(VAP)及肠道功能的预防作用。方法采用前瞻性、随机、对照研究,将155例符合入组条件的患者随机分为对照组和试验组。所有患者均给予相同治疗,试验组患者给予益生菌(双歧杆菌、乳酸菌混合物)治疗3周。比较两组患者VAP发生率、肠道菌群变化及胃肠道症状发生率。结果120例患者完成研究,其中对照组58例,试验组62例。试验组VAP发生率低于对照组(38.7% vs 62.1%, χ2=6.541, P<0.05)。试验组口咽、胃微生物定植总检出率显著低于对照组(51.6% vs 89.7%, χ2=20.052, P<0.05)。试验组患者腹内压升高、腹泻、肠音减弱或消失的发生率均显著降低(χ2=8.439、10.849、13.327,均P<0.05)。试验组肠道乳酸菌比例显著升高。试验组机械通气时间、重症监护病房住院时间均显著缩短(t=8.051、6.538,P均<0.05)。结论益生菌制剂可显著提高肠道乳酸菌比例,降低危重症患者VAP发生率,降低胃肠道症状发生率,减少机械通气时间和重症监护病房住院时间,具有临床推广价值。关键词:益生菌;与机械通气相关;肺炎,肠道微生物群;乳酸菌
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引用次数: 0
New progress in diagnosis and treatment of community-acquired pneumonia 社区获得性肺炎诊疗新进展
Pub Date : 2020-03-20 DOI: 10.3760/CMA.J.CN131368-20191018-01433
Xiao-yu Li, Jian-ping Bo
In recent years, the morbidity and mortality of community-acquired pneumonia have increased gradually, with more severe cases.However, in clinical diagnosis and treatment, there are some phenomena such as unclear etiology diagnosis, insufficient understanding of the significance of serological detection, inaccurate severity evaluation and unreasonable use of antibiotics.This paper refers to a large number of the latest literatures on community-acquired pneumonia published at home and abroad in recent years, and reviews in serology, etiology, rational use of antibiotics, whether glucocorticoids should be used, adjuvant therapy and the latest advances of diagnosis and treatment. Key words: Community-acquired pneumonia; Severity score; Treatment; New progress
近年来,社区获得性肺炎的发病率和死亡率逐渐上升,重症病例增多。但在临床诊疗中,存在病因诊断不清、血清学检测意义认识不足、严重程度评价不准确、抗生素使用不合理等现象。本文参考近年来国内外发表的大量关于社区获得性肺炎的最新文献,从血清学、病因学、抗生素的合理使用、是否应使用糖皮质激素、辅助治疗以及诊疗的最新进展等方面进行综述。关键词:社区获得性肺炎;严重程度得分;治疗;新进展
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引用次数: 1
Validity of modified Padua risk assessment model in identifying high venous thromboembolism risk among hospitalized medical patients 改进的Padua风险评估模型识别住院患者静脉血栓栓塞高危风险的有效性
Pub Date : 2020-03-20 DOI: 10.3760/CMA.J.CN131368-20171204-01476
Heng Liu, Jing Wang, Yuhong Pi, Sun Zhang, S. Qing, Chunli Liu, Nuofu Zhang
Objective To retrospectively test the validity of modified Padua risk assessment model in identifying high venous thromboembolism (VTE) risk among hospitalized medical patients. Methods A retrospective case-control study was performed among hospitalized medical patients admitted into the First Affiliated Hospital of Guangzhou Medical University from January 2013 to December 2016.A total of 432 patients with definite VTE during hospitalization were recruited and a tota1 of 864 controls were randomly selected from the patients without VTE admitted into the same department within the same period.The medical history, laboratory examination results and other clinical data of two groups was retrospectively collected.The risks of both groups were retrospectively assessed with the Padua risk assessment model and modified Padua risk assessment model and the two risk assessment models were compared. Results The score of the two risk assessment models in VTE group was significant higher than that in control group (Padua: 2.92±0.18 vs 1.25±0.10, t=16.241, P<0.05; modified Padua: 3.27±0.19 vs 1.64±0.11, t=14.245, P<0.05). With the increase in risk score, the occurrence of VTE increased accordingly.By Padua risk assessment model and modified Padua risk assessment model, the risk of VTE of high-risk patients was 12.27 times (95% CI: 9.00-17.98, P<0.05) and 8.17 times (95% CI: 6.00-11.12, P<0.05) as high as that of low-risk patients.The proportion of high-risk patients judged by modified Padua risk assessment model was significant higher than that by Padua risk assessment model (48.61% vs 39.12%, P<0.05). Conclusions Modified Padua risk assessment model can effectively and quantitatively assess the risk of VTE among medical patients based on their individual VTE risk factors. Key words: Modified Padua risk assessment model; Medical patients; Venous thromboembolism; Case-control study
目的回顾性检验改良的Padua风险评估模型在识别住院患者高静脉血栓栓塞(VTE)风险中的有效性。方法对2013年1月至2016年12月广州医科大学第一附属医院住院患者进行回顾性病例对照研究。共招募住院期间确诊静脉血栓栓塞患者432例,从同期同一科室就诊的无静脉血栓栓塞患者中随机抽取对照864例。回顾性收集两组患者的病史、实验室检查结果等临床资料。采用Padua风险评估模型和改进的Padua风险评估模型对两组患者进行回顾性风险评估,并对两种风险评估模型进行比较。结果VTE组两种风险评估模型评分均显著高于对照组(Padua: 2.92±0.18 vs 1.25±0.10,t=16.241, P<0.05;改良Padua: 3.27±0.19 vs 1.64±0.11,t=14.245, P<0.05)。随着风险评分的增加,静脉血栓栓塞的发生率也相应增加。通过Padua风险评估模型和改进的Padua风险评估模型,高危患者的VTE风险分别是低危患者的12.27倍(95% CI: 9.00 ~ 17.98, P<0.05)和8.17倍(95% CI: 6.00 ~ 11.12, P<0.05)。改良Padua风险评估模型判定的高危患者比例显著高于Padua风险评估模型(48.61% vs 39.12%, P<0.05)。结论改进的Padua风险评估模型可以根据患者的个体化静脉血栓栓塞危险因素,有效定量地评估患者静脉血栓栓塞的风险。关键词:修正帕多瓦风险评估模型;医疗的病人;静脉血栓栓塞;病例对照研究
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引用次数: 0
Anaesthetic management of montgomery T-tube insertion for subglottic stenosis 蒙氏t管置入术治疗声门下狭窄的麻醉处理
Pub Date : 2020-03-20 DOI: 10.3760/CMA.J.CN131368-20190811-01139
Hongli Yue, Juan Wang, Y. Pei, Chen-yang Zhang, Min Xu
Objective To discuss the anaesthetic management of Montgomery T-tube insertion for subglottic stenosis. Methods The data including characteristics, clinical features, anaesthetic methods, operation procedures and postoperative recovery of 20 patients with subglottic stenosis underwent Montgomery T-tube insertion were reviewed and analyzed. Results The causes of stenosis were tracheal intubation (12 cases), tracheal trauma (four cases), internal and external tracheal tumors (three cases). On the degree of stenosis, there was one case of Myer-Cotton grade Ⅰ, three cases of grade Ⅱ, nine cases of grade Ⅲ, seven cases of grade Ⅳ.Bronchoscopic examination showed tracheal collapse in nine cases.All patients were tracheotomized before operation and used a rigid bronchoscope as working channel during operation.All patients were anaesthetized with total intravenous anaesthesia.The anaesthesia of all patients was stable, and ventilation modes were alternated smoothly.Postoperative complications such as cough (80%), sore throat (45%), fever (45%), difficulty in sputum evacuation (40%), difficulty breathing (25%), infection (10%), airway obstruction (5%), aspiration (5%) were cured after active treatment. Conclusions During montgomery T-tube insertion for subglottic stenosis, total intravenous anaesthesia can ensure depth of anaesthesia and stability of circulatory parameters.Controlled ventilation or high frequency ventilation by tracheotomy tube, T-tube, and laryngeal mask on demand can ensure oxygen supply.Communication closely during perioperation and active treatment of postoperative complications are beneficial for the safety and the recovery of patients. Key words: Acquired subglottic stenosis; Tracheal T-tube; Anesthesia
目的探讨蒙氏t管置入术治疗声门下狭窄的麻醉处理。方法回顾性分析20例声门下狭窄患者行Montgomery t管置入术的特点、临床特点、麻醉方法、手术方法及术后恢复情况。结果气管狭窄的原因为气管插管(12例)、气管外伤(4例)、气管内外肿瘤(3例)。狭窄程度方面,Myer-Cotton级Ⅰ1例,Ⅱ级3例,Ⅲ级9例,Ⅳ级7例。支气管镜检查显示气管塌陷9例。所有患者术前均行气管切开术,术中采用刚性支气管镜作为工作通道。所有患者均采用全静脉麻醉。所有患者麻醉稳定,通气方式交替顺利。术后并发症如咳嗽(80%)、咽痛(45%)、发热(45%)、排痰困难(40%)、呼吸困难(25%)、感染(10%)、气道阻塞(5%)、误吸(5%)等经积极治疗均治愈。结论在声门下狭窄患者置入蒙哥马利t管时,静脉全麻醉能保证麻醉深度和循环参数的稳定性。控制通气或高频通气,气管切开管、t型管、喉罩按需通气,可保证供氧。围手术期密切沟通,积极处理术后并发症,有利于患者的安全和康复。关键词:获得性声门下狭窄;气管丁字管;麻醉
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引用次数: 0
Analysis of clinical features and related risks of prognosis in 68 non-human immunodeficiency virus immunosuppressed patients with cytomegalovirus pneumonia 68例非人类免疫缺陷病毒免疫抑制患者巨细胞病毒肺炎的临床特点及预后风险分析
Pub Date : 2020-03-20 DOI: 10.3760/CMA.J.CN131368-20190923-01323
Wensen Pan, Ranran Xiao, Xin Liu, X. Gong, J. Zhao, Jing Yu
Objective To analyze the clinical characteristics of 68 non-human immunodeficiency virus immunosuppressed patients with cytomegalovirus pneumonia, and the risk factors related to death, so as to provide reference for clinical diagnosis and treatment. Methods A retrospective case analysis study was used.The clinical data of 68 patients with cytomegalovirus pneumonia admitted to the Second Department of Respiratory Medicine of the Second Hospital of Hebei Medical University were collected.According to the patient′s 28d outcome, the patients were divided into the survival group and the death group.The general conditions and clinical data of the two groups were compared, and risk factors were analyzed. Results The top three underlying diseases were kidney disease, rheumatic disease, and blood system disease.In the death group, the acute physiology and chronic health evaluation Ⅱ scores, hypersensitive C-reactive protein, the smallest absolute counts of white blood cells, neutrophil percentage were higher than those in the survival group (all P<0.05), and the absolute counts of lymphocyte, CD3+ lymphocyte, CD4+ lymphocyte were lower (all P<0.05). Long-term (more than three months) application of glucocorticoids or combination with immunosuppressive agents were significantly more in the death group (all P<0.05). The immunosuppressed patients who suffered from dermatological disease, had gram-positive coccal pneumonia or bloodstream infections, needed mechanical ventilation had a poor prognosis (all P<0.05). Conclusions Cytomegalovirus pneumonia patients who received long-term (more than three months) application of glucocorticoids or combination with immunosuppressive agents, had gram-positive coccal pneumonia or bloodstream infections, and needed mechanical ventilation have a poor prognosis. Key words: Cytomegalovirus pneumonia; Respiratory insufficiency; T lymphocyte subsets; Prognosis
目的分析68例非人类免疫缺陷病毒免疫抑制患者巨细胞病毒肺炎的临床特点及死亡相关危险因素,为临床诊断和治疗提供参考。方法采用回顾性病例分析方法。收集河北医科大学第二医院呼吸内科二科收治的巨细胞病毒肺炎68例患者的临床资料。根据患者28d预后分为生存组和死亡组。比较两组患者的一般情况及临床资料,分析两组患者的危险因素。结果肾脏疾病、风湿病、血液系统疾病占基础疾病的前3位。死亡组患者急性生理和慢性健康评价Ⅱ评分、超敏c反应蛋白、白细胞最小绝对计数、中性粒细胞百分比均高于生存组(P<0.05),淋巴细胞、CD3+淋巴细胞、CD4+淋巴细胞绝对计数均低于生存组(P<0.05)。死亡组长期(3个月以上)应用糖皮质激素或联合使用免疫抑制剂明显多于死亡组(均P<0.05)。皮肤疾病、革兰氏阳性球菌性肺炎或血流感染、需要机械通气的免疫抑制患者预后较差(P<0.05)。结论长期(3个月以上)应用糖皮质激素或联合免疫抑制剂治疗的巨细胞病毒肺炎,合并革兰氏阳性球菌肺炎或血流感染,需要机械通气的患者预后较差。关键词:巨细胞病毒性肺炎;呼吸衰竭;T淋巴细胞亚群;预后
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引用次数: 0
Pathological characteristics of digestive tract in rats with chronic obstructive pulmonary disease induced by tobacco smoke 烟草烟雾致慢性阻塞性肺疾病大鼠消化道病理特征
Pub Date : 2020-03-05 DOI: 10.3760/CMA.J.ISSN.1673-436X.2020.05.001
Difei Li, Defu Li, Zeguang Zheng, Wenju Lu, Jieying Hu, Rongchang Chen
Objective To observe the pathological changes of the digestive tract of rats with chronic obstructive pulmonary disease (COPD), as well as to provide a theoretical basis for exploring the mechanism of COPD dystrophy. Methods The COPD rat model was established by cigarette smoke (CS) exposure.Lung functions were measured using Buxco lung function measurement system.Arterial blood gas parameters were examined with GEM3000 blood gas analyzer.The inflammatory cells were counted and the level of interlukin-6 (IL-6), monocyte chemo-attractant protein-1 (MCP-1) and IL-10 in bronchoalveolar lavage fluid (BALF) were assayed with enzyme-linked immunosorbent assay.Pathological changes of lung tissue, liver, spleen, stomach, small intestine were observed. Results At the end of modeling, the weight of the model group rats were significantly lower than those of the control group.Compared with control rats, the CS exposed rats presented typical COPD-like lung function decline indicated by increases in functional residual volume (FRC), total lung capacity (TLC), Chord compliance (Cchord), as well as a decrease in the FEV50/FVC ratio.Damaged alveolar walls and pulmonary bullae were observed in rats′ lungs exposed to CS.In alveolar lavage fluid, the total number of inflammatory cells and the categorical counts (neutrophils, macrophages, and lymphocytes) were higher than those of the control group, as well as the levels of IL-6 and MCP-1 as proinflammatory mediators.The anti-inflammatory cytokine IL-10 was lower than that of the control group.Moreover, the histological staining showed that a little congestion in the central hepatic lobule with inflammatory cell infiltration and mild hepatic edema, a small amount of congestion in the spleen, mild erosion in the stomach, small intestine mucosal atrophy with a small amount of inflammatory cell infiltration. Conclusions In COPD, gastrointestinal pathological changes including hyperemia, edema, congestion, erosion, and inflammatory cell infiltration are observed in the digestive tract tissues including liver, spleen, gastric mucosa, and small intestinal mucosa. Key words: Pulmonary disease, chronic obstructive; Inflammation; Pathological changes in the digestive tract
目的观察慢性阻塞性肺疾病(COPD)大鼠消化道的病理变化,为探讨COPD营养不良的发生机制提供理论依据。方法建立慢性阻塞性肺病大鼠香烟烟雾暴露模型。采用Buxco肺功能测量系统测定肺功能。采用GEM3000血气分析仪检测动脉血气参数。计数炎性细胞,酶联免疫吸附法检测支气管肺泡灌洗液(BALF)中白细胞介素-6 (IL-6)、单核细胞化学引诱蛋白-1 (MCP-1)和白细胞介素-10水平。观察肺、肝、脾、胃、小肠的病理变化。结果造模结束时,模型组大鼠体重明显低于对照组。与对照大鼠相比,CS暴露大鼠呈现典型的copd样肺功能下降,表现为功能残气量(FRC)、总肺活量(TLC)、Chord顺应性(Cchord)升高,FEV50/FVC比值降低。暴露于CS的大鼠肺中可见肺泡壁和肺大泡的损伤。肺泡灌洗液中炎症细胞总数、中性粒细胞、巨噬细胞和淋巴细胞的分类计数以及促炎介质IL-6和MCP-1的水平均高于对照组。抗炎细胞因子IL-10低于对照组。组织学染色显示肝中央小叶轻度充血伴炎性细胞浸润,轻度肝水肿,脾脏少量充血,胃轻度糜烂,小肠黏膜萎缩伴少量炎性细胞浸润。结论慢性阻塞性肺病患者消化道组织包括肝、脾、胃黏膜、小肠黏膜均出现充血、水肿、充血、糜烂、炎症细胞浸润等胃肠道病理改变。关键词:肺部疾病;慢性阻塞性肺疾病;炎症;消化道的病理改变
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引用次数: 0
Research progress on accurate treatment of bronchial asthma 支气管哮喘准确治疗的研究进展
Pub Date : 2020-03-05 DOI: 10.3760/CMA.J.ISSN.1673-436X.2020.05.011
Wang Luo, Y. Qiao, C. Ye, S. Cai, H. Dong
Bronchial asthma (asthma) is a heterogeneous disease characterized by chronic airway inflammation.It is one of the most common chronic diseases in the world which causes huge medical burden.Although the symptoms of most asthma patients can be effectively controlled by inhaled glucocorticoids and bronchodilators, some patients with severe asthma are still unable to achieve ideal control under conventional treatment.Therefore, more and more attention has been paid to targeted drugs at the molecular level.The purpose of this review is to discuss the current research progress in accurate treatment of asthma and to explore the application value of targeted therapy drugs in the treatment of severe asthma. Key words: Asthma; Precise treatment; Targeted therapy
支气管哮喘是一种以慢性气道炎症为特征的异质性疾病。它是世界上最常见的慢性疾病之一,造成巨大的医疗负担。虽然大多数哮喘患者的症状可通过吸入糖皮质激素和支气管扩张剂得到有效控制,但部分重症哮喘患者在常规治疗下仍无法达到理想控制。因此,分子水平上的靶向药物越来越受到重视。本文就目前哮喘精准治疗的研究进展进行综述,探讨靶向治疗药物在重症哮喘治疗中的应用价值。关键词:哮喘;精确的治疗;靶向治疗
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引用次数: 0
期刊
Chinese Journal of Asthma
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