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Effect of budesonide on lipopolysaccharides-induced acute lung injury in rats 布地奈德对脂多糖所致大鼠急性肺损伤的影响
Pub Date : 2020-02-05 DOI: 10.3760/CMA.J.ISSN.1673-436X.2020.03.006
Yuan Luo, Hongyun Yue, Shiyuan Li
Objective To investigate the effect of budesonide on lipopolysaccharides (LPS)-induced acute lung injury (ALI) in rats. Methods Thirty healthy adult Sprague-Dawley male rats were randomly divided into control group, LPS group and budesonide treated group, ten in each group.LPS (5 mg/kg) was given by intubation to establish ALI model in rats.In budesonide group, budesonide (500 μg/kg) was given through airway after LPS given for 24 hours.After 48 hours, the clearance rate of lung water and the ratio of wet to dry weight of lung were measured.The level of interleukin-1β in bronchoalveolar lavage fluid was measured by enzyme-linked immunosorbent assay.The histopathological changes of lung were observed by hematoxylin-eosin staining.The expression of intercellular adhesion molecule-1 was observed by immunohistochemistry. Results Compared with LPS group, the lung structure damage was alleviated, the infiltration of inflammatory cells decreased, alveolar fluid clearance increased significantly (all P<0.01), the ratio of wet to dry weight of lung decreased (P<0.05), the protein content and the exudation of neutrophils and macrophages in bronchoalveolar lavage fluid decreased (P<0.05 or P<0.01), and the expression of intercellular adhesion molecule-1 decreased in budesonide treated group. Conclusions Budesonide has a protective effect on ALI rats induced by LPS.The mechanism may be associated with decreasing inflammation, reducing intercellular adhesion molecule-1 expression and enhancing alveolar fluid clearance. Key words: Acute lung injury; Lipopolysaccharides; Budesonide; Alveolar fluid clearance; Intercellular cell adhesion molecule-1
目的探讨布地奈德对脂多糖(LPS)致大鼠急性肺损伤(ALI)的影响。方法30只健康成年雄性sd大鼠随机分为对照组、脂多糖组和布地奈德治疗组,每组10只。采用LPS (5 mg/kg)插管建立大鼠ALI模型。布地奈德组在LPS给予24 h后经气道给予布地奈德(500 μg/kg)。48 h后测定肺水清除率和肺干湿重比。采用酶联免疫吸附法测定支气管肺泡灌洗液中白细胞介素-1β的水平。苏木精-伊红染色观察肺组织病理变化。免疫组化观察细胞间粘附分子-1的表达。结果与LPS组比较,布地奈德治疗组大鼠肺结构损伤减轻,炎性细胞浸润减少,肺泡液清除率显著升高(均P<0.01),肺干湿重比降低(P<0.05),支气管肺泡灌洗液中中性粒细胞和巨噬细胞的蛋白含量及渗出量降低(P<0.05或P<0.01),细胞间粘附分子-1表达降低。结论布地奈德对LPS诱导的ALI大鼠有保护作用。其机制可能与减少炎症、减少细胞间粘附分子-1表达和增强肺泡液清除有关。关键词:急性肺损伤;脂多糖;布地奈德;肺泡液清除率;细胞间细胞粘附分子-1
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引用次数: 0
HMGB1/RAGE signal and respiratory diseases and its research progress HMGB1/RAGE信号与呼吸系统疾病及其研究进展
Pub Date : 2020-02-05 DOI: 10.3760/CMA.J.ISSN.1673-436X.2020.03.014
Jingyi Sun, Yabing Sun
High mobility group box-1 protein (HMGB1) is widely involved in various inflammatory response processes in the body.The receptor for advanced glycation end-products (RAGE) and some Toll-like receptors are its main receptors.A large number of studies have confirmed that HMGB1 can induce various physiological and pathological effects of inflammatory response, immune response, tumor occurrence through the RAGE receptor pathway, and participate in the occurrence and development of various diseases.HMGB1 is widely expressed in lung tissues, and HMGB1/RAGE signal has been shown to be involved in the pathogenesis of many chronic airway diseases.Especially in the occurrence and development of asthma, HMGB1/RAGE signal has been confirmed to play an important role in it, but the specific mechanism is still unclear.This article preliminarily explains the role of HMGB1/RAGE in respiratory diseases, especially asthma, and related research progress. Key words: HMGB1/RAGE signal; Respiratory diseases; Asthma
高迁移率组盒-1蛋白(HMGB1)广泛参与机体各种炎症反应过程。晚期糖基化终产物受体(RAGE)和一些toll样受体是其主要受体。大量研究证实HMGB1可通过RAGE受体途径诱导炎症反应、免疫反应、肿瘤发生等多种生理病理作用,参与多种疾病的发生发展。HMGB1在肺组织中广泛表达,HMGB1/RAGE信号已被证明参与了许多慢性气道疾病的发病。特别是在哮喘的发生发展中,HMGB1/RAGE信号已被证实在其中发挥重要作用,但具体机制尚不清楚。本文就HMGB1/RAGE在呼吸系统疾病特别是哮喘中的作用及相关研究进展作初步阐述。关键词:HMGB1/RAGE信号;呼吸系统疾病;哮喘
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引用次数: 0
Misdiagnosis analysis of 40 cases of focal organizing pneumonia 局灶性组织性肺炎40例误诊分析
Pub Date : 2020-02-05 DOI: 10.3760/CMA.J.ISSN.1673-436X.2020.03.004
Y. Ge, Nan Li, Yan Zhu, Shu-xian Jin
Objective To discuss the clinical manifestations, pathological features and imaging features of focal organizing pneumonia (FOP) in order to improve the understanding of the disease among clinicians. Methods The clinical data of 40 patients with FOP misdiagnosed as lung cancer in the People′s Hospital of Jiangsu Province from 2013 to 2018 were retrospectively analyzed.The clinical manifestations, pathological features, imaging features, laboratory tests were analyzed. Results (1)Of the 40 patients with FOP, 34 cases were male, six cases were female, the age was 26-82 years old, and the average age of onset was (55.55± 10.52) years old.(2)In clinical manifestations, there were 21 cases of cough and expectoration, six cases of fever, 11 cases of hemoptysis, 12 cases of chest pain, and 14 cases had no any symptoms.(3)The lesions occurred in the field, middle and inner zones and in the lobes of the lungs.CT manifestations were varied.In addition to nodular shadow and solid change, there were lobulation, marginal burr sign, bronchial inflation sign, vacuole sign, uneven density, pleural traction and so on.There were 26 cases with lesions larger than 3 cm and 14 cases with lesions less than 3 cm.(4)A total of 8 patients underwent PET-CT examination, six patients showed different degrees of increased fluorodeoxyglucose metabolism, suggesting malignant lesions, two cases did not see increased fluorodeoxyglucose metabolism, considering inflammatory changes.(5)Among 40 patients, carcinoembryonic antigen, carbohydrate antigen199 and D-dimer were normal, neuron-specific enolase was increased in only one case.(6)Pathology results showed interstitial fibroplasia, alveolar cavity expansion, fibrous mucoid plug in the cavity, interstitial lymphocytic infiltration with lymphoid follicle formation.(7)Among the 40 surgical patients, one patient recurred after half a year. Conclusions FOP is relatively rare in clinic.Because of its special imaging manifestations, it is easily misdiagnosed.Clinicians need to constantly strengthen their understanding of FOP, and make comprehensive diagnosis through basic information, clinical manifestations, imaging performance, laboratory examination and pathological features, so as to reduce clinical misdiagnosis. Key words: Focal organic pneumonia; Clinical manifestations; Pathological features; Imaging features; Diagnostic errors
目的探讨局灶性组织性肺炎(FOP)的临床表现、病理特征及影像学特征,提高临床医师对该病的认识。方法回顾性分析2013 ~ 2018年江苏省人民医院40例被误诊为肺癌的FOP患者的临床资料。分析其临床表现、病理特征、影像学特征及实验室检查结果。结果(1)40 FOP患者,男性34例,女性6例,年龄26 - 82岁,发病的平均年龄(55.55±10.52)岁。(2)在临床表现,有21例咳嗽和咳痰,6例发热、咳血的11例,12例胸部疼痛,和14例没有任何症状。(3)病变发生,内部区域和叶的肺。CT表现多样。除结节影、实变外,还可见分叶征、边缘毛刺征、支气管膨大征、空泡征、密度不均、胸膜牵拉等。病变大于3cm者26例,小于3cm者14例。(4)8例患者行PET-CT检查,6例患者氟脱氧糖代谢不同程度增高,提示为恶性病变,2例考虑炎性改变未见氟脱氧糖代谢增高。(5)40例患者癌胚抗原、碳水化合物抗原199、d -二聚体正常。(6)病理结果显示间质纤维增生,肺泡腔扩张,腔内纤维黏液样塞,间质淋巴细胞浸润伴淋巴滤泡形成。(7)40例手术患者中,1例术后半年复发。结论FOP在临床上较为少见。由于其特殊的影像学表现,容易误诊。临床医生需要不断加强对FOP的认识,通过基础资料、临床表现、影像学表现、实验室检查、病理特征等综合诊断,减少临床误诊。关键词:局灶性器质性肺炎;临床表现;病理特征;成像功能;诊断错误
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引用次数: 0
Progress in aspiration pneumonia 吸入性肺炎的进展
Pub Date : 2020-02-05 DOI: 10.3760/CMA.J.ISSN.1673-436X.2020.03.011
Fangmao Shu, Ning Song
Aspiration pneumonia is one kind of respiratory disease with high morbidity, high recurrence rate and heavy medical burden.Despite the cognition of aspiration pneumonia has improved in these years, a consistent definition or diagnostic criteria of aspiration pneumonia still lacks.This article focuses on the definition, epidemiology, microbiology, pathophysiology, diagnosis and treatment of aspiration pneumonia. Key words: Pneumonia, aspiration; Epidemiology; Microbiology; Pathophysiology; Diagnosis; Treatment
吸入性肺炎是一种发病率高、复发率高、医疗负担重的呼吸道疾病。尽管近年来对吸入性肺炎的认识有所提高,但吸入性肺炎的定义或诊断标准仍然缺乏一致性。本文就吸入性肺炎的定义、流行病学、微生物学、病理生理学、诊断和治疗作一综述。关键词:肺炎;误吸;流行病学;微生物学;病理生理学;诊断;治疗
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引用次数: 0
Progresses of interstitial pneumonia with autoimmune features 具有自身免疫特征的间质性肺炎的进展
Pub Date : 2020-02-05 DOI: 10.3760/CMA.J.ISSN.1673-436X.2020.03.012
Jieh-Juen Yu, Canglang Mou, D. Pan, Wencheng Yu
Interstitial pneumonia with autoimmune features refers to one of idiopathic interstitial pneumonia that has underlying autoimmune clinical characteristics but does not meet established criteria for connective tissue disease.With the development of the term and its diagnostic criteria, a series of cohort studies have been carried out in multi-centers around the world.Based on the domestic and foreign literatures in the past five years, this review discusses and summarizes the clinical manifestations, serology, morphology and other aspects, which may provide new ideas and insights for clinical diagnosis and treatment. Key words: Interstitial pneumonia with autoimmune features; Classification criteria; Progress
具有自身免疫性特征的间质性肺炎是指一种特发性间质性肺炎,具有潜在的自身免疫性临床特征,但不符合结缔组织病的既定标准。随着该术语及其诊断标准的发展,世界各地多中心开展了一系列队列研究。本文结合近5年来国内外文献,对其临床表现、血清学、形态学等方面进行探讨和总结,以期为临床诊治提供新的思路和见解。【关键词】自身免疫性间质性肺炎;分类标准;进步
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引用次数: 0
Progress of cystic fibrosis 囊性纤维化的进展
Pub Date : 2020-02-05 DOI: 10.3760/CMA.J.ISSN.1673-436X.2020.03.015
X. Ji, Li Huang, Zhipeng Du, Weijie Li, Fushun Yang
Cystic fibrosis (CF) is an autosomal recessive hereditary disease with a low incidence in Asia.There are no epidemiological statistics on the incidence of CF in China.CF can lead to dysfunction in multi-system of the whole body.As a safe, fast and easy method, gene detection is becoming more and more important in CF diagnosis.However, the gene mutation spectrum of Chinese population has not yet been proposed.Multidisciplinary combination therapy and gene therapy are the new directions of CF study.At present, there are no guidelines and disease management suitable for the Chinese population.This article reviews the current situation, pathogenesis, clinical manifestations, gene diagnosis and treatment in China. Key words: Cystic fibrosis; Cystic fibrosis transmembrane conductance regulator; Sweat chloride test; Gene diagnosis
囊性纤维化(CF)是一种常染色体隐性遗传病,在亚洲发病率低。中国尚无CF发病率的流行病学统计资料。CF可导致全身多系统功能障碍。基因检测作为一种安全、快速、简便的方法,在CF诊断中越来越重要。然而,中国人群的基因突变谱尚未提出。多学科联合治疗和基因治疗是CF研究的新方向。目前,尚无适合中国人群的指南和疾病管理方法。本文综述了国内的现状、发病机制、临床表现、基因诊断和治疗。关键词:囊性纤维化;囊性纤维化跨膜电导调节剂;汗液氯化物试验;基因诊断
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引用次数: 0
Clinical characteristics of different drug-resistance genes of carbapenem resistant Klebsiella pneumoniae in department of respiratory medicine 呼吸内科耐碳青霉烯类肺炎克雷伯菌不同耐药基因的临床特点
Pub Date : 2020-02-05 DOI: 10.3760/CMA.J.ISSN.1673-436X.2020.03.002
Kangliang Zhang, Chang-Pan Liu, Bo Wang, Lin Ma, Jiyong Yang, Xizhou Guan
Objective To analyse the clinical characteristics of different drug-resistance genes (OXA-48 and KPC) of carbapenem resistant Klebsiella pneumoniae (CRKP) in the Department of Respiratory Medicine, Chinese PLA General Hospital, to find intrinsic differences and provide evidence for clinical prevention and treatment. Methods A total of 44 patients infected by CRKP strain in the Department of Respiratory Medicine, Chinese PLA General Hospital from July 2013 to July 2015 were collected.Repetitive strains from the same patient were eliminated.According to the different kinds of enzymes produced by carbapenem, those patients were divided into KPC group and OXA-48 group.The clinical characteristics, the drug susceptibility results and other indicators of two groups were compared. Results 14 cases (31.8%) carried KPC enzyme, 21 cases (61.4%) carried OXA-48 enzyme, two cases (4.5%) carried IMP enzyme.The results of univariate analysis showed that there were no statistical differences between two groups in days of hospitalization before infection, proportions of intensive care unit stay, basic conditions, exposure to invasive interventions (central venous catheter, chest drainage tube, gastric tube, dialysis or continuous renal replacement therapy, tracheal intubation or tracheotomy), mechanical ventilation and endoscopic surgery, medications before confirmation of CRKP and 90-day all-cause mortality.The resistance rate of meropenem in OXA-48 group and KPC group was respectively 55.6% and 92.9%, there was statistical difference between the two groups (P=0.038). The resistance rate of imipenem in OXA-48 group and KPC group was respectively 66.7% and 100.0%, there was statistical difference between the two groups (P=0.041). Conclusions Due to resistance of multiple antibiotics, severe conditions and complicated complications, patients with CRKP infection have high mortality.There is no significant difference in clinical features between different genotypes of CRKP.The different genotypes of CRKP exhibit heterogeneous carbapenem resistance patterns.With the reference of drug-resistant gene status, clinical practice will be more precise. Key words: Klebsiella pneumoniae; Carbapenem; Clinical features
目的分析中国人民解放军总医院呼吸内科耐碳青霉烯类肺炎克雷伯菌(CRKP)不同耐药基因(OXA-48和KPC)的临床特点,发现其内在差异,为临床防治提供依据。方法收集2013年7月至2015年7月中国人民解放军总医院呼吸内科收治的44例CRKP感染病例。排除同一患者的重复菌株。根据碳青霉烯产生的酶种类不同,将患者分为KPC组和OXA-48组。比较两组患者的临床特点、药敏结果等指标。结果携带KPC酶14例(31.8%),携带OXA-48酶21例(61.4%),携带IMP酶2例(4.5%)。单因素分析结果显示,两组患者感染前住院天数、重症监护病房住院日占比、基础条件、接受有创干预(中心静脉置管、胸引流管、胃管、透析或持续肾替代治疗、气管插管或气管切开术)、机械通气、内镜手术等方面均无统计学差异。在确认CRKP和90天全因死亡率之前服用药物。OXA-48组和美罗培南耐药率为55.6%,KPC组为92.9%,两组比较差异有统计学意义(P=0.038)。OXA-48组和KPC组亚胺培南耐药率分别为66.7%和100.0%,两组比较差异有统计学意义(P=0.041)。结论CRKP感染患者多种抗生素耐药,病情严重,并发症多,死亡率高。不同基因型的CRKP在临床表现上无显著差异。不同基因型的CRKP表现出不同的碳青霉烯抗性模式。有了耐药基因状况的参考,临床实践将更加精准。关键词:肺炎克雷伯菌;碳青霉烯;临床特征
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引用次数: 0
Research Progress on mechanism of inhibition of phagosome-lysosome formation by Mycobacterium tuberculosis 结核分枝杆菌抑制吞噬体-溶酶体形成机制的研究进展
Pub Date : 2020-02-05 DOI: 10.3760/CMA.J.ISSN.1673-436X.2020.03.010
Lingcen Qin
Phagocytosis is indispensable in the process of degradation, presentation, activation of adaptive immune response and clearance of Mycobacterium tuberculosis.In the process of phagocytosis, the development of phagosome vesicles into mature phagosomes requires a series of processes including lysosomal fusion, lowering the pH in the cavity, activation of enzymes, and finally destroying phagocytic microorganisms.Phagocytes, such as monocytes and macrophages, participate in host defense by forming phagolysosomes, while Mycobacterium tuberculosis exhibits a significant ability to block the maturation of phagosomes, thus escaping the host defenses and eventually leading to the disease.This article reviews the research progress on the mechanism of inhibition of phagocyte-lysosome formation by Mycobacterium tuberculosis, in order to provide a reference for the early control of disease and the development of new drugs. Key words: Tuberculosis; Mycobacterium tuberculosis; Phagocyte-lysosome fusion
在结核分枝杆菌的降解、呈现、活化适应性免疫反应和清除过程中,吞噬作用是必不可少的。在吞噬过程中,吞噬小泡发育为成熟的吞噬小体需要溶酶体融合、降低腔内pH值、激活酶,最后破坏吞噬微生物等一系列过程。吞噬细胞,如单核细胞和巨噬细胞,通过形成吞噬溶酶体参与宿主防御,而结核分枝杆菌则表现出显著的阻断吞噬体成熟的能力,从而逃避宿主的防御,最终导致疾病。本文综述了结核分枝杆菌抑制吞噬细胞-溶酶体形成机制的研究进展,以期为疾病的早期控制和新药的开发提供参考。关键词:肺结核;结核分枝杆菌;Phagocyte-lysosome融合
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引用次数: 0
Application of enhanced recovery after bronchoscopy in interventional rigid bronchoscopy 支气管镜检查后增强恢复在介入性刚性支气管镜检查中的应用
Pub Date : 2020-02-05 DOI: 10.3760/CMA.J.ISSN.1673-436X.2020.03.016
Hongwu Wang, Qinghao Cheng, L. Kong, Li Shen
Rigid bronchoscopy is an important tool for bronchoscope intervention, which can be performed under direct vision for a variety of operations.Bronchoscope intervention should be operated under intravenous anesthesia and jet ventilation.Anesthesia plays an important role in bronchoscope intervention.Based on the concept of enhanced recovery after surgery and clinical experiences, the author proposed enhanced recovery after bronchoscopy to accelerate the rapid rehabilitation development of bronchoscope intervention.In view of bronchoscope intervention, this article summarizes and discusses the best way of rigid bronchoscopy treatment from preoperative preparation, anesthesia, intraoperative operation and postoperative observation to improve the safety and comfort of perioperative patients and promote postoperative recovery of patients. Key words: Enhanced recovery after surgery; Bronchoscopes; Rigid bronchoscopy
刚性支气管镜检查是支气管镜干预的重要工具,可在直视下进行多种手术。支气管镜介入治疗应在静脉麻醉和喷射通气下进行。麻醉在支气管镜干预中起着重要的作用。基于术后增强康复的概念,结合临床经验,笔者提出支气管镜术后增强康复,以促进支气管镜干预康复的快速发展。针对支气管镜干预,本文从术前准备、麻醉、术中操作、术后观察等方面对刚性支气管镜治疗的最佳方式进行总结和探讨,以提高围手术期患者的安全性和舒适性,促进患者术后康复。关键词:增强术后恢复;支气管镜;硬质支气管镜检查
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引用次数: 0
Relationships between airway resistances and activity-related dyspnea in patients with stable chronic obstructive pulmonary disease 稳定期慢性阻塞性肺疾病患者气道阻力与活动相关性呼吸困难的关系
Pub Date : 2020-01-20 DOI: 10.3760/CMA.J.ISSN.1673-436X.2020.02.001
Yuqing Chen, Mingjie Wang, Hai Zhang, Feng Li, D. Zhu, Chengjian Lyu, Ping Chen
Objective To observe the relationship between the airway resistance (Raw) and activity-related dyspnea in patients with chronic obstructive pulmonary disease (COPD). Methods This was a prospective study with 180 patients with COPD (Global Initiative for Chronic Obstructive Lung Disease 2017 stages Ⅰ-Ⅳ) who presented at the outpatient clinic of the Shanghai Chest Hospital and Shanghai general hospital, from December 2017 to March 2019.Spirometry testing and respiratory resistance components were measured by plethysmography after brochodilator (salbutamol 400 μg) inhalation. Results Compared with 42 healthy elder and 30 mild COPD patients, The first second forced expiratory volume and forced expiratory flow at 50% vital capacity in patients with GOLD stages Ⅱ-Ⅳ were significantly lower.The total airway resistance (Rtot), effective airway resistance (Reff), inspiratory airway resistance (Rinsp) and expiratory airway resistance (Rexp) of the moderate and severe COPD patients were significantly higher than those of the healthy elder group.The inspiratory capacity (IC) of patients with GOLD stages Ⅲ-Ⅳ is under 80% of the predicted value, which mMRC score was exceed 2.One patient (1.9%) with GOLD stageⅡ, 7(13.2%) patients with GOLD stage Ⅲ and 14(33.3%) patients with GOLD stage Ⅳ revealed inspiratory fraction (IC/TLC ratio) ≤25%. Conclusions Raw, especially expiratory airway resistance were obviously increased in stable moderate to severe COPD patients on account of the severe expiratory flow limitation. According to the aggravation of peripheral airway inflammation, activity-related dyspnea symptoms were more prone to occured in COPD patients with GOLD stages Ⅲ-Ⅳ, and IC/TLC ratio might more likely to be below 25%. Key words: Pulmonary disease, chronic obstructive; Airway resistance; Inspiratory fraction
目的观察慢性阻塞性肺疾病(COPD)患者气道阻力(Raw)与活动相关性呼吸困难的关系。方法:本研究是一项前瞻性研究,纳入了2017年12月至2019年3月在上海胸科医院和上海总医院门诊就诊的180例COPD(全球慢性阻塞性肺疾病倡议2017期Ⅰ-Ⅳ)患者。吸入舒张剂(沙丁胺醇400 μg)后,采用容积描记法测定肺活量测定及呼吸阻力指标。结果与42例健康老年人和30例轻度COPD患者相比,GOLD期患者的第一次第二次用力呼气量和50%肺活量时的用力呼气流量Ⅱ-Ⅳ均显著降低。中重度COPD患者总气道阻力(Rtot)、有效气道阻力(Reff)、吸气气道阻力(Rinsp)、呼气气道阻力(Rexp)均显著高于健康老年人组。GOLD期患者的吸气量(IC)Ⅲ~Ⅳ低于预测值的80%,mMRC评分大于2分。1例(1.9%)为GOLD期Ⅱ,7例(13.2%)为GOLD期Ⅲ,14例(33.3%)为GOLD期Ⅳ吸气分数(IC/TLC比)≤25%。结论稳定期中重度COPD患者由于严重的呼气流量限制,气道阻力明显增加,尤其是呼吸道阻力明显增加。根据外周气道炎症的加重程度,GOLD期COPD患者更容易出现活动相关呼吸困难症状Ⅲ-Ⅳ,IC/TLC比更可能低于25%。关键词:肺部疾病;慢性阻塞性肺疾病;气道阻力;吸气分数
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引用次数: 0
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Chinese Journal of Asthma
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