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Refractory granulomatous Pneumocystis jirovecii pneumonia masquerading as malignancy 伪装成恶性肿瘤的难治性肉芽肿性肺孢子虫肺炎
IF 1 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-20 DOI: 10.1136/thorax-2024-221457
Chi Wan Koo, Ananya Panda, Jennifer Boland Froemming
An elderly female, lifelong non-smoker, with rheumatoid arthritis treated with methotrexate and prednisone for 10 years was referred for evaluation of incidentally detected, randomly distributed pulmonary nodules on a CT performed for pleuritic chest pain and dyspnoea (figure 1A). Subsequent [18F]fluoro-d-glucose (FDG)-positron emission tomography (PET) showed the nodules had increased in size and were FDG-avid (figure 1B). Patient underwent percutaneous biopsy at an external institution with pathology reported to be highly suspicious for lung adenocarcinoma. Figure 1 (A) CT angiogram performed for evaluation of pleuritic chest pain and dyspnoea demonstrated incidental solid, non-calcified left lower lobe subpleural predominant pulmonary nodules (arrow, additional nodules not shown). Note dependent atelectasis presenting as ground-glass opacities. (B) [18F]fluoro-d-glucose (FDG)-positron emission tomography performed 4 months later showed these nodules had more than doubled in size and were FDG-avid (arrow). No additional FDG avidity was detected elsewhere. After an unrevealing bronchoscopy with bronchoalveolar lavage, the patient was referred to our institution for further care. Re-evaluation of the previous percutaneous …
一名终生不吸烟的老年女性,患有类风湿性关节炎,接受甲氨蝶呤和泼尼松治疗 10 年,因胸膜炎性胸痛和呼吸困难而进行 CT 检查,偶然发现随机分布的肺部结节(图 1A)。随后进行的[18F]氟-d-葡萄糖(FDG)-正电子发射断层扫描(PET)显示,结节增大且与 FDG 相关(图 1B)。患者在一家外部机构接受了经皮活检,病理报告高度怀疑为肺腺癌。图 1 (A) 为评估胸膜炎性胸痛和呼吸困难而进行的 CT 血管造影显示,患者左下叶胸膜下偶见实性、非钙化的肺结节(箭头,其他结节未显示)。注意依赖性肺不张表现为磨玻璃不透光。(B) 4 个月后进行的[18F]氟-d-葡萄糖(FDG)-正电子发射断层扫描显示,这些结节的大小增加了一倍多,并且与 FDG 相关(箭头)。其他部位未检测到额外的 FDG 阳性。在进行支气管镜检查和支气管肺泡灌洗未发现异常后,患者被转到我院接受进一步治疗。重新评估之前的经皮...
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引用次数: 0
Integrated disease management: good news but more work to do. 综合疾病管理:好消息,但还有更多工作要做。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2024-221754
Christine R Jenkins
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引用次数: 0
Respiratory rescue is the new frontier. 呼吸救援是新领域。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2024-221830
Sarath Ranganathan
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引用次数: 0
Quantifying sustained health system benefits of primary care-based integrated disease management for COPD: a 6-year interrupted time series study. 量化基于初级保健的慢性阻塞性肺病综合疾病管理对医疗系统的持续益处:一项为期 6 年的间断时间序列研究。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2023-221211
Christopher Licskai, Anna Hussey, Véronique Rowley, Madonna Ferrone, Zihang Lu, Kimball Zhang, Emilie Terebessy, Andrew Scarffe, Shannon Sibbald, Cathy Faulds, Tim O'Callahan, Teresa To

Background: Severe exacerbation of chronic obstructive pulmonary disease (COPD) is a trajectory-changing life event for patients and a major contributor to health system costs. This study evaluates the real-world impact of a primary care, integrated disease management (IDM) programme on acute health service utilisation (HSU) in the Canadian health system.

Methods: Interrupted time series analysis using retrospective health administrative data, comparing monthly HSU event rates 3 years prior to and 3 years following the implementation of COPD IDM. Primary outcomes were COPD-related hospitalisation and emergency department (ED) visits. Secondary outcomes included hospital bed days and all-cause HSU.

Results: There were 2451 participants. COPD-related and all-cause HSU rates increased in the 3 years prior to IDM implementation. With implementation, there was an immediate decrease (month 1) in COPD-related hospitalisation and ED visit rates of -4.6 (95% CI: -7.76 to -1.39) and -6.2 (95% CI: -11.88, -0.48) per 1000 participants per month, respectively, compared with the counterfactual control group. After 12 months, COPD-related hospitalisation rates decreased: -9.1 events per 1000 participants per month (95% CI: -12.72, -5.44) and ED visits -19.0 (95% CI: -25.50, -12.46). This difference nearly doubled by 36 months. All-cause HSU also demonstrated rate reductions at 12 months, hospitalisation was -10.2 events per 1000 participants per month (95% CI: -15.79, -4.44) and ED visits were -30.4 (95% CI: -41.95, -18.78).

Conclusions: Implementation of COPD IDM in a primary care setting was associated with a changed trajectory of COPD-related and all-cause HSU from an increasing year-on-year trend to sustained long-term reductions. This highlights a substantial real-world opportunity that may improve health system performance and patient outcomes.

背景:慢性阻塞性肺病(COPD)的严重恶化是改变患者生活轨迹的事件,也是医疗系统成本的主要来源。本研究评估了初级保健、综合疾病管理(IDM)计划对加拿大医疗系统中急性医疗服务利用率(HSU)的实际影响:方法:使用回顾性健康管理数据进行间断时间序列分析,比较慢性阻塞性肺病综合疾病管理计划实施前 3 年和实施后 3 年的每月医疗服务使用率。主要结果是慢性阻塞性肺病相关的住院和急诊就诊。次要结果包括住院天数和全因 HSU:共有 2451 名参与者。在实施 IDM 之前的 3 年中,慢性阻塞性肺病相关住院率和全因 HSU 率均有所上升。与反事实对照组相比,实施 IDM 后,慢性阻塞性肺病相关住院率和急诊室就诊率立即下降(第 1 个月),分别为每月每 1000 名参与者-4.6(95% CI:-7.76 至-1.39)和-6.2(95% CI:-11.88,-0.48)。12 个月后,慢性阻塞性肺病相关住院率有所下降:与慢性阻塞性肺病相关的住院率在 12 个月后有所下降:每 1000 名参与者每月的住院率为-9.1(95% CI:-12.72, -5.44),急诊室就诊率为-19.0(95% CI:-25.50, -12.46)。这一差异在 36 个月后几乎翻了一番。12 个月后,全因 HSU 的发病率也有所下降,每 1000 名参与者每月的住院率为-10.2(95% CI:-15.79, -4.44),急诊室就诊率为-30.4(95% CI:-41.95, -18.78):在基层医疗机构实施慢性阻塞性肺疾病 IDM 与慢性阻塞性肺疾病相关和全因 HSU 的变化轨迹有关,即从逐年增加的趋势转变为持续的长期减少。这凸显出现实世界中存在着巨大的机会,可以改善医疗系统的绩效和患者的预后。
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引用次数: 0
Children’s interstitial lung disease (chILD): less rare than we thought? 儿童间质性肺病 (chILD):没有我们想象的那么罕见?
IF 1 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2024-221951
Andrew Bush, Lawrence Nogee
The presentation of childhood interstitial lung disease (chILD) is non-specific,1 and chILD is usually low on the list of diagnoses in children with combinations of respiratory symptoms, feeding difficulties and failure to thrive. However, if a diagnosis is not considered, it will never be made. In this issue of the Journal , Fletcher et al describe nearly 800 French children, suggesting that chILD may not be as rare as once thought.2 The French RespiRare network has long been systematically collecting incidence and prevalence data of rare diseases, and in this excellent publication, they report a chILD prevalence of 44/million children (95% CI 40.76 to 47.46) and thus a computed incidence of 4.4/million children (95% CI 3.44 to 5.56). This is similar to a recent Spanish study,3 and far greater than previous studies,4 5 which were likely underestimated due to incomplete ascertainment. The major strength of the present study is the collection of data from a well-organised network spanning the whole of France, with multiple different ways of ensuring chILDs were captured. Despite this, cases may still have been missed. For example, it is a surprise that they reported not a single ILD related to e-cigarettes.6 Newborns with rapidly progressive disease due to …
儿童间质性肺病(children interstitial lung disease,chILD)的表现无特异性1,对于合并呼吸道症状、喂养困难和发育不良的儿童,chILD 通常在诊断名单中排名靠后。然而,如果不考虑诊断,就永远不会做出诊断。法国RespiRare网络长期以来一直在系统地收集罕见病的发病率和流行率数据,在这篇出色的文章中,他们报告了罕见病的流行率为44/百万儿童(95% CI 40.76-47.46),因此计算出的发病率为4.4/百万儿童(95% CI 3.44-5.56)。这与西班牙最近的一项研究3 相似,也远远高于之前的研究4 5 ,而之前的研究很可能由于不完全确定而低估了发病率。本研究的主要优势在于从一个覆盖全法国的组织良好的网络中收集数据,并通过多种不同方式确保chILDs被采集到。尽管如此,仍有可能遗漏病例。例如,令人惊讶的是,他们没有报告一起与电子烟有关的 ILD。
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引用次数: 0
Physical activity and body mass related to catch-up lung function growth in childhood: a population-based accelerated cohort study. 体力活动和体重与儿童期肺功能追赶性增长的关系:一项基于人群的加速队列研究。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2022-219666
Sarah Koch, Gabriela Prado Peralta, Anne-Elie Carsin, Alicia Abellan, Celine Roda, Maties Torrent, Carmen Iñiguez, Ferran Ballester, Amparo Ferrero, Carlos Zabaleta, Aitana Lertxundi, Mònica Guxens, Martine Vrijheid, Jordi Sunyer, Maribel Casas, Judith Garcia-Aymerich

Objective: The existence of catch-up lung function growth and its predictors is uncertain. We aimed to identify lung function trajectories and their predictors in a population-based birth cohort.

Methods: We applied group-based trajectory modelling to z-scores of forced expiratory volume in 1 second (zFEV1) and z-scores of forced vital capacity (zFVC) from 1151 children assessed at around 4, 7, 9, 10, 11, 14 and 18 years. Multinomial logistic regression models were used to test whether potential prenatal and postnatal predictors were associated with lung function trajectories.

Results: We identified four lung function trajectories: a low (19% and 19% of the sample for zFEV1 and zFVC, respectively), normal (62% and 63%), and high trajectory (16% and 13%) running in parallel, and a catch-up trajectory (2% and 5%) with catch-up occurring between 4 and 10 years. Fewer child allergic diseases and higher body mass index z-score (zBMI) at 4 years were associated with the high and normal compared with the low trajectories, both for zFEV1 and zFVC. Increased children's physical activity during early childhood and higher zBMI at 4 years were associated with the catch-up compared with the low zFEV1 trajectory (relative risk ratios: 1.59 per physical activity category (1.03-2.46) and 1.47 per zBMI (0.97-2.23), respectively). No predictors were identified for zFVC catch-up growth.

Conclusion: We found three parallel-running and one catch-up zFEV1 and zFVC trajectories, and identified physical activity and body mass at 4 years as predictors of zFEV1 but not zFVC catch-up growth.

目的:是否存在肺功能追赶性增长及其预测因素尚不确定。我们旨在确定基于人群的出生队列中的肺功能轨迹及其预测因素:我们对 1151 名分别在 4、7、9、10、11、14 和 18 岁左右接受评估的儿童的 1 秒用力呼气容积 (zFEV1) z 值和用力肺活量 (zFVC) z 值进行了分组轨迹建模。我们使用多叉逻辑回归模型来检验潜在的产前和产后预测因素是否与肺功能轨迹相关:我们发现了四种肺功能轨迹:低轨迹(zFEV1和zFVC分别占样本的19%和19%)、正常轨迹(62%和63%)和高轨迹(16%和13%)并行,以及追赶轨迹(2%和5%),追赶发生在4至10岁之间。就 zFEV1 和 zFVC 而言,高轨迹和正常轨迹与低轨迹相比,儿童过敏性疾病较少,4 岁时体重指数 z 值(zBMI)较高。与低zFEV1轨迹相比,儿童早期体力活动的增加和4岁时较高的zBMI与追赶轨迹相关(相对风险比:1.59/体力活动类别(zBMI)):每个体力活动类别的相对风险比为 1.59(1.03-2.46),每个 zBMI 的相对风险比为 1.47(0.97-2.23))。没有发现zFVC追赶增长的预测因素:我们发现了三个并行和一个追赶的 zFEV1 和 zFVC 增长轨迹,并确定了 4 年时体力活动和体重是 zFEV1 增长的预测因素,但不是 zFVC 追赶增长的预测因素。
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引用次数: 0
Undertreating cardiovascular disease in people with chronic obstructive pulmonary disease (COPD). 对慢性阻塞性肺病(COPD)患者的心血管疾病治疗不足。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2023-221141
Andrea S Gershon, Alina Blazer, Dennis Ko
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引用次数: 0
Distinct trajectories of lung function from childhood to mid-adulthood. 从童年到成年中期肺功能的不同轨迹。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2023-220436
Xian Zhang, Andrew R Gray, Robert J Hancox

Rationale: Life course trajectories of lung function development and decline influence the risk for lung disease but are poorly documented.

Objective: To document lung function trajectories from childhood to mid-adult life.

Methods: We modelled forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC at ages 9, 11, 13, 15, 18, 21, 26, 32, 38 and 45 years from a population-based cohort using latent profile analysis to identify distinct subgroups of participants with similar lung function trajectories. Regression analyses were used to assess associations between the trajectories, early life factors and postbronchodilator airflow obstruction at age 45.

Results: Among 865 participants with ≥6 measures of lung function, we identified 10 distinct FEV1 trajectories. Most were approximately parallel except for a childhood airway hyper-responsiveness-related persistently low trajectory (3% of study population); two accelerated-decline trajectories, one of which (8%) was associated with smoking and higher adult body mass index (BMI) and a catch-up trajectory (8%). Findings for FEV1/FVC trajectories were similar. Nine trajectories were identified for FVC: most were also approximately parallel except for a higher BMI-related accelerated-decline trajectory. The three FEV1 trajectories leading to the lowest FEV1 values comprised 19% of the cohort but contributed 55% of airflow obstruction at age 45.

Conclusions: Lung function trajectories to mid-adult life are largely established before adolescence, with a few exceptions: a childhood airway hyper-responsiveness-related persistently low trajectory, which starts low and gets worse with age, and accelerated adult decline trajectories associated with smoking and obesity. Adverse trajectories are associated with a high risk of airflow obstruction in mid-adult life.

理由:肺功能发展和衰退的生命历程轨迹影响着肺部疾病的风险,但却鲜有记录:肺功能发展和衰退的生命过程轨迹会影响肺部疾病的风险,但这方面的文献却很少:目的:记录从童年到成年中期的肺功能轨迹:方法:我们利用潜伏特征分析,从基于人群的队列中模拟了 9、11、13、15、18、21、26、32、38 和 45 岁时的 1 秒用力呼气容积 (FEV1)、用力肺活量 (FVC) 和 FEV1/FVC,以识别具有相似肺功能轨迹的不同参与者亚群。回归分析用于评估肺功能轨迹、早期生活因素和45岁时支气管扩张剂后气流阻塞之间的关系:结果:在肺功能测量指标≥6项的865名参与者中,我们发现了10种不同的FEV1轨迹。除了一条与儿童气道高反应性相关的持续低值轨迹(占研究人群的 3%)、两条加速下降轨迹(其中一条(8%)与吸烟和成年体重指数(BMI)较高有关)和一条追赶轨迹(8%)外,大多数轨迹大致平行。FEV1/FVC轨迹的研究结果类似。发现了九条 FVC 的轨迹:除了一条与较高的 BMI 相关的加速下降轨迹外,大多数轨迹也近似平行。导致 FEV1 值最低的三个 FEV1 轨迹占队列的 19%,但在 45 岁时造成了 55% 的气流阻塞:到中年时的肺功能轨迹大多在青春期之前就已确定,但也有少数例外:与儿童气道高反应性相关的持续低水平轨迹(起始值低且随年龄增长而恶化),以及与吸烟和肥胖相关的成年加速下降轨迹。不良轨迹与中年气流阻塞的高风险有关。
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引用次数: 0
Survival outcomes following urgent lung transplantation in France and the USA. 法国和美国紧急肺移植手术后的存活率。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2023-220847
Arnaud Roussel, Edouard Sage, Pierre-Emmanuel Falcoz, Pascal Alexandre Thomas, Yves Castier, Elie Fadel, Françoise Le Pimpec-Barthes, François Tronc, Jacques Jougon, Philippe Lacoste, Johanna Claustre, Laurent Brouchet, Richard Dorent, Edward Cantu, Michael Harhay, Raphaël Porcher, Pierre Mordant

Introduction: Lung graft allocation can be based on a score (Lung Allocation Score) as in the USA or sequential proposals combined with a discrete priority model as in France. We aimed to analyse the impact of allocation policy on the outcome of urgent lung transplantation (LT).

Methods: US United Network for Organ Sharing (UNOS) and French Cristal databases were retrospectively reviewed to analyse LT performed between 2007 and 2017. We analysed the mortality risk of urgent LT by fitting Cox models and adjusted Restricted Mean Survival Time. We then compared the outcome after urgent LT in the UNOS and Cristal groups using a propensity score matching.

Results: After exclusion of patients with chronic obstructive pulmonary disease/emphysema and redo LT, 3775 and 12 561 patients underwent urgent LT and non-urgent LT in the USA while 600 and 2071 patients underwent urgent LT and non-urgent LT in France. In univariate analysis, urgent LT was associated with an HR for death of 1.24 (95% CI 1.05 to 1.48) in the Cristal group and 1.12 (95% CI 1.05 to 1.19) in the UNOS group. In multivariate analysis, the effect of urgent LT was attenuated and no longer statistically significant in the Cristal database (HR 1.1 (95% CI 0.91 to 1.33)) while it remained constant and statistically significant in the UNOS database (HR 1.12 (95% CI 1.05 to 1.2)). Survival comparison of urgent LT patients between the two countries was significantly different in favour of the UNOS group (1-year survival rates 84.1% (80.9%-87.3%) vs 75.4% (71.8%-79.1%) and 3-year survival rates 66.3% (61.9%-71.1%) vs 62.7% (58.5%-67.1%), respectively).

Conclusion: Urgent LT is associated with adverse outcome in the USA and in France with a better prognosis in the US score-based system taking post-transplant survival into account. This difference between two healthcare systems is multifactorial.

导言:肺移植的分配可以像美国那样基于评分(肺分配评分),也可以像法国那样基于顺序建议结合离散优先模式。我们旨在分析分配政策对紧急肺移植(LT)结果的影响:我们对美国器官共享联合网络(UNOS)和法国Cristal数据库进行了回顾性审查,分析了2007年至2017年间进行的肺移植手术。我们通过拟合Cox模型和调整后的限制平均生存时间分析了紧急LT的死亡风险。然后,我们采用倾向得分匹配法比较了UNOS组和Cristal组紧急LT术后的结果:在排除慢性阻塞性肺病/肺气肿和重做LT的患者后,美国分别有3775名和12561名患者接受了紧急LT和非紧急LT治疗,而法国分别有600名和2071名患者接受了紧急LT和非紧急LT治疗。在单变量分析中,紧急LT与Cristal组死亡HR的相关性为1.24(95% CI 1.05至1.48),与UNOS组死亡HR的相关性为1.12(95% CI 1.05至1.19)。在多变量分析中,紧急LT的影响在Cristal数据库中有所减弱,不再具有统计学意义(HR 1.1 (95% CI 0.91 to 1.33)),而在UNOS数据库中则保持不变,具有统计学意义(HR 1.12 (95% CI 1.05 to 1.2))。两国急诊LT患者的存活率比较结果显示,UNOS组患者的存活率明显高于急诊LT组(1年存活率分别为84.1%(80.9%-87.3%)vs 75.4%(71.8%-79.1%),3年存活率分别为66.3%(61.9%-71.1%)vs 62.7%(58.5%-67.1%)):结论:在美国和法国,急诊LT与不良预后有关,而在美国基于评分的系统中,考虑到移植后存活率,LT的预后更好。两种医疗体系之间的这种差异是多因素造成的。
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引用次数: 0
Human mesenchymal stromal cells inhibit Mycobacterium avium replication in clinically relevant models of lung infection. 在临床相关的肺部感染模型中,人间质基质细胞可抑制分枝杆菌的复制。
IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-07-16 DOI: 10.1136/thorax-2023-220819
Timothy D Shaw, Anna D Krasnodembskaya, Gunnar N Schroeder, Declan F Doherty, Johnatas Dutra Silva, Shikha M Tandel, Yue Su, David Butler, Rebecca J Ingram, Cecilia M O'Kane

Introduction: Novel therapeutic strategies are urgently needed for Mycobacterium avium complex pulmonary disease (MAC-PD). Human mesenchymal stromal cells (MSCs) can directly inhibit MAC growth, but their effect on intracellular bacilli is unknown. We investigated the ability of human MSCs to reduce bacterial replication and inflammation in MAC-infected macrophages and in a murine model of MAC-PD.

Methods: Human monocyte-derived macrophages (MDMs) were infected with M. avium Chester strain and treated with human bone marrow-derived MSCs. Intracellular and extracellular colony-forming units (CFUs) were counted at 72 hours. Six-week-old female balb/c mice were infected by nebulisation of M. avium Chester. Mice were treated with 1×106 intravenous human MSCs or saline control at 21 and 28 days post-infection. Lungs, liver and spleen were harvested 42 days post-infection for bacterial counts. Cytokines were quantified by ELISA.

Results: MSCs reduced intracellular bacteria in MDMs over 72 hours (median 35% reduction, p=0.027). MSC treatment increased extracellular concentrations of prostaglandin E2 (PGE2) (median 10.1-fold rise, p=0.002) and reduced tumour necrosis factor-α (median 28% reduction, p=0.025). Blocking MSC PGE2 production by cyclo-oxygenase-2 (COX-2) inhibition with celecoxib abrogated the antimicrobial effect, while this was restored by adding exogenous PGE2. MSC-treated mice had lower pulmonary CFUs (median 18% reduction, p=0.012), but no significant change in spleen or liver CFUs compared with controls.

Conclusion: MSCs can modulate inflammation and reduce intracellular M. avium growth in human macrophages via COX-2/PGE2 signalling and inhibit pulmonary bacterial replication in a murine model of chronic MAC-PD.

导言:复合分枝杆菌肺病(MAC-PD)迫切需要新的治疗策略。人间质基质细胞(MSCs)可直接抑制分枝杆菌的生长,但其对细胞内分枝杆菌的影响尚不清楚。我们研究了人类间充质干细胞在MAC感染巨噬细胞和MAC-PD小鼠模型中减少细菌复制和炎症的能力。方法:用M. avium Chester菌株感染人类单核细胞衍生巨噬细胞(MDM),并用人类骨髓间充质干细胞处理。72小时后对细胞内和细胞外的集落形成单位(CFU)进行计数。六周大的雌性 balb/c 小鼠通过雾化感染 M. avium Chester。感染后 21 天和 28 天,小鼠静脉注射 1×106 人间充质干细胞或生理盐水对照。感染后 42 天收获肺、肝和脾,进行细菌计数。用酶联免疫吸附法对细胞因子进行量化:结果:间充质干细胞在 72 小时内减少了 MDMs 细胞内的细菌数量(中位数减少 35%,P=0.027)。间充质干细胞治疗增加了前列腺素 E2(PGE2)的细胞外浓度(中位数增加 10.1 倍,p=0.002),并减少了肿瘤坏死因子-α(中位数减少 28%,p=0.025)。用塞来昔布抑制环氧化酶-2(COX-2)来阻断间叶干细胞 PGE2 的产生,可减弱抗菌效果,而加入外源性 PGE2 则可恢复抗菌效果。与对照组相比,间叶干细胞治疗小鼠的肺部CFU较低(中位数减少18%,P=0.012),但脾脏或肝脏CFU无明显变化:结论:在慢性 MAC-PD 小鼠模型中,间叶干细胞可通过 COX-2/PGE2 信号调节炎症,减少人巨噬细胞内的 M. avium 生长,并抑制肺部细菌复制。
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