Clinical Respiratory Journal最新文献_第6页

OM-85, a Bacterial Lysate, Reduces Pulmonary Nodule Malignant Probability: A Retrospective Study 细菌裂解物OM-85降低肺结节恶性概率：一项回顾性研究

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2025-07-21 DOI: 10.1111/crj.70109

Mengting Sun, Yuqing Ni, Xueling Wu, Hao Tian, Yijun Song, Yinzhou Feng, Yunxin Guo, Yong Zhang, Jun Yin, Charles A. Powell, Chunxue Bai, Yuanlin Song, Dawei Yang

Introduction

The current clinical management of pulmonary nodules relies heavily on CT follow-up, without early intervention. This retrospective study investigated the efficacy of OM-85, a standardized lysate of human respiratory bacteria, in the treatment of high-risk pulmonary nodules detected by computed tomography (CT) in patients with chronic bronchitis.

Methods

This study included 72 patients (93 enrolled nodules) who underwent treatment with OM-85 and a matched control group of 90 patients (111 control nodules). The primary endpoint included reduced size of high-risk ground glass nodules based on thin-layer CT scans during follow-up. Flow cytometry, multiplex immunofluorescence (mIF) analysis, and scRNA-seq data were employed to determine differences in the immune cell subsets between the treatment and control groups.

Results

Oral OM-85 treatment significantly reduced lung nodule diameter (p = 0.031), the risk probability of malignancy (p = 0.003), and the likelihood of clinical disease progression (p = 0.0091). The effects of OM-85 treatment were more pronounced in older patients (> 65-year-old) (p = 0.029) and those with longer follow-up cycles (> 200 days) (p = 0.011). The peripheral blood samples showed a significantly higher proportion of natural killer (NK) cells in the treatment group. Furthermore, mIF staining of the pulmonary nodules and scRNA-seq data demonstrated a higher percentage of NK cells in the treatment group compared with the control group (p = 0.0003).

Conclusion

OM-85 reduced the size of high-risk pulmonary nodules and decreased the risk of malignant probability and disease progression in patients with chronic bronchitis by increasing the proportion of NK cells. Therefore, OM-85 is a potential drug for the treatment of high-risk pulmonary nodules in patients with chronic bronchitis.

目前临床对肺结节的处理主要依靠CT随访，缺乏早期干预。本回顾性研究探讨了OM-85（一种人类呼吸道细菌的标准化裂解物）治疗慢性支气管炎患者计算机断层扫描（CT）检测到的高危肺结节的疗效。方法本研究包括72例接受OM-85治疗的患者（93个登记的结节）和匹配的对照组90例（111个对照结节）。主要终点包括随访期间基于薄层CT扫描的高风险磨砂玻璃结节的缩小。采用流式细胞术、多重免疫荧光（mIF）分析和scRNA-seq数据来确定治疗组和对照组之间免疫细胞亚群的差异。结果口服OM-85治疗可显著降低肺结节直径（p = 0.031）、发生恶性肿瘤的危险概率（p = 0.003）和临床疾病进展的可能性（p = 0.0091）。OM-85治疗的效果在老年患者（65岁）（p = 0.029）和随访周期较长的患者（200天）（p = 0.011）中更为明显。治疗组外周血自然杀伤细胞（NK）比例明显增高。此外，肺结节的mIF染色和scRNA-seq数据显示，与对照组相比，治疗组的NK细胞百分比更高（p = 0.0003）。结论OM-85通过增加NK细胞的比例降低慢性支气管炎患者高危肺结节的大小，降低恶性概率和疾病进展的风险。因此，OM-85是治疗慢性支气管炎高危肺结节的潜在药物。

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引用次数: 0

A Pulmonary Abscess Caused by Porphyromonas gingivalis Infection: A Case Report and Literature Review 牙龈卟啉单胞菌感染致肺脓肿1例并文献复习

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2025-07-16 DOI: 10.1111/crj.70099

Xu Chen, Ling Wu, Ruoxi Wu, Jiajia Dong

Lung abscess is a common disease in respiratory medicine, which is a suppurative lesion caused by various pathogens, and microbiological examination is crucial for the treatment of lung abscess. Due to the widespread use of antibiotics, it is difficult to obtain reliable microbiological evidence through routine tests. There are various pathogens present in the oral cavity, and periodontitis is a risk factor for the formation of lung abscess. Enhancing understanding of lung abscesses caused by Porphyromonas gingivalis and the importance of accurately interpreting NGS reports. This article will present a case report of a lung abscess related to oral bacteria (Porphyromonas gingivalis). The patient was initially treated with empirical anti-infective therapy, which was ineffective, and despite multiple sputum cultures and bronchoalveolar lavage fluid analysis using metagenomic next-generation sequencing (mNGS), the pathogen could not be identified clearly. However, based on the significant presence of oral bacteria in the NGS of the bronchoalveolar lavage fluid, which guided the examination to discover periodontitis. Subsequently, a percutaneous lung tissue biopsy was performed for NGS testing, which further suggested Porphyromonas gingivalis as the pathogenic bacterium. This article summarizes the clinical manifestations, imaging findings, and characteristics of the pathogenic microorganisms in this case of lung abscess, reviews relevant literature to enhance the understanding of lung abscess caused by Porphyromonas gingivalis. It also confirms the importance of careful analysis of background bacteria in bronchoalveolar lavage fluid NGS based on objective risk factors, and highlights that combining patient clinical features with multisample NGS examination can promptly clarify the microbiology.

肺脓肿是呼吸内科常见疾病，是由多种病原体引起的化脓性病变，微生物学检查对肺脓肿的治疗至关重要。由于抗生素的广泛使用，很难通过常规检测获得可靠的微生物证据。口腔内有多种病原体，牙周炎是肺脓肿形成的危险因素。提高对牙龈卟啉单胞菌引起的肺脓肿的认识及准确解读NGS报告的重要性。本文将报告一例与口腔细菌（牙龈卟啉单胞菌）有关的肺脓肿。患者最初接受经验性抗感染治疗，但无效，尽管多次痰培养和支气管肺泡灌洗液分析使用宏基因组新一代测序（mNGS），仍无法明确鉴定病原体。然而，基于NGS在支气管肺泡灌洗液中明显存在口腔细菌，从而指导检查发现牙周炎。随后，经皮肺组织活检进行NGS检测，进一步提示牙龈卟啉单胞菌为致病菌。本文就本例肺脓肿的临床表现、影像学表现及病原微生物特点进行总结，并对相关文献进行复习，以加深对牙龈卟啉单胞菌所致肺脓肿的认识。同时也证实了基于客观危险因素仔细分析支气管肺泡灌洗液NGS背景菌的重要性，并强调将患者临床特征与多样本NGS检查相结合可以及时明确微生物学。

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引用次数: 0

Association of COPD With Clinical Outcomes After Hospital Admission in SARS-CoV-2 Patients During the Omicron Variant Period: A Retrospective Cohort Study 组粒变异期SARS-CoV-2患者入院后COPD与临床结局的关系：一项回顾性队列研究

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2025-07-15 DOI: 10.1111/crj.70104

Rui Tang, Lijuan Li, Shuwei Wang, Fen Zhou, Renwei Li, Yue Zhao, Li Zhou, Wanying Tian, Yadong Yuan

Background

Pre-Omicron studies identified chronic obstructive pulmonary disease (COPD) as a significant risk factor for adverse COVID-19 outcomes. Given Omicron's altered pathogenicity and widespread population-level immunity, the association between COPD and COVID-19 outcomes warrants reassessment in light of the variant's distinct clinical profile. We evaluated whether COPD remained a risk factor for poor clinical outcomes among hospitalized patients with SARS-CoV-2 infection during Omicron predominance.

Methods

We conducted a two-center retrospective cohort study of 1176 adults hospitalized with confirmed Omicron infection between January 2022 and December 2023 in Northern China. Patients were stratified by pre-existing COPD status. To address confounding by treatment selection, inverse probability weighting (IPW) was applied based on the likelihood of receiving inhaled corticosteroids. Multivariable logistic regression models, adjusted for comorbidities, disease severity (as measured by the PSI), inflammatory markers (CRP, D-dimer, NLR, LDH), and treatment regimens, were used to evaluate the associations between COPD and in-hospital outcomes.

Results

Among 1176 patients (337 COPD; 839 non-COPD), COPD patients had significantly lower PSI scores and lower levels of systemic inflammation despite a higher prevalence of respiratory comorbidities. In unadjusted models, COPD was associated with reduced odds of mortality (OR 0.52), respiratory failure (OR 0.24), and ventilatory support. However, after IPW adjustment, these associations were no longer statistically significant (mortality: adjusted OR 0.90, 95% CI 0.22–3.74, p = 0.887).

Conclusions

COPD was not independently associated with increased risk of mortality, respiratory failure, or ventilatory support in hospitalized Omicron-infected patients after rigorous adjustment for confounding. These findings suggest a shifting risk profile for COPD during Omicron predominance, likely influenced by variant tropism, treatment effects, and altered inflammatory responses. Future prospective studies are warranted to validate these findings and explore the mechanisms underlying this observed shift.

前期研究发现慢性阻塞性肺疾病（COPD）是COVID-19不良结局的重要危险因素。鉴于Omicron的致病性改变和广泛的人群免疫水平，COPD与COVID-19结果之间的关系值得根据该变体的独特临床特征重新评估。我们评估了在Omicron优势期间，COPD是否仍然是SARS-CoV-2感染住院患者临床预后不良的危险因素。方法对2022年1月至2023年12月中国北方1176名确诊欧米克隆感染的成人进行双中心回顾性队列研究。患者按既往COPD状态分层。为了解决治疗选择的混淆，基于吸入皮质类固醇的可能性应用逆概率加权（IPW）。采用多变量logistic回归模型，调整合并症、疾病严重程度（由PSI测量）、炎症标志物（CRP、d -二聚体、NLR、LDH）和治疗方案，评估COPD与住院预后之间的关系。结果1176例患者中(337例COPD；839例非COPD)， COPD患者的PSI评分和全身性炎症水平显著降低，尽管呼吸道合并症的患病率较高。在未调整的模型中，COPD与死亡率（OR 0.52）、呼吸衰竭（OR 0.24）和呼吸支持的降低相关。然而，调整IPW后，这些关联不再具有统计学意义（死亡率：调整OR 0.90, 95% CI 0.22-3.74, p = 0.887）。结论：在严格调整混杂因素后，住院欧米克隆感染患者的COPD与死亡率、呼吸衰竭或通气支持风险增加没有独立相关。这些发现表明，在Omicron优势期间，COPD的风险谱发生了变化，可能受到变异倾向、治疗效果和炎症反应改变的影响。未来的前瞻性研究有必要验证这些发现并探索这种观察到的转变的机制。

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引用次数: 0

Evaluation of the Effects of Switching COPD Patients From LAMA/LABA Therapy to ICS/LAMA/LABA Therapy Using the Impulse Oscillation System (IOS) Capable of Separating Inspiratory and Expiratory Measurements 使用能够分离吸气和呼气测量的脉冲振荡系统（IOS）评估COPD患者从LAMA/LABA治疗转换为ICS/LAMA/LABA治疗的效果

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2025-07-15 DOI: 10.1111/crj.70105

Yosuke Tanaka, Ken Okamura, Shota Kaburaki, Toru Tanaka, Akiko Yoshikawa, Ayumi Shimizu, Akihiko Miyanaga, Namiko Taniuchi, Koichiro Kamio, Kazuo Kasahara, Masahiro Seike, Mitsunori Hino

Introduction

Noninvasive evaluation of airway conditions is considered useful in the management of COPD, although assessing airway remodeling remains difficult in routine clinical practice. The impulse oscillometry system used in this study allows separate analysis of inspiratory and expiratory phases, offering detailed insights into airway function. This study examined the effects of inhaled corticosteroids (ICSs) on airway remodeling and assessed the utility of this system in COPD management.

Methods

Stable COPD patients on LAMA/LABA for over a year were assessed by spirometry and impulse oscillometry at baseline and after 48 weeks of ICS/LAMA/LABA therapy. Symptoms, imaging, and blood tests were also evaluated.

Results

Among 52 patients (mean baseline %FEV1/predicted: 56.9% ± 22.1%), all had one to two moderate exacerbations in the past year despite LAMA/LABA therapy. Significant correlations were observed between spirometry and MostGraph (e.g., baseline FEV1 vs. R5: r = −0.54). Although spirometry showed no significant changes, Fres improved significantly (−2.11 ± 0.35, p < 0.0001), with reductions in both expiratory and inspiratory phases.

Conclusions

Fres measured by MostGraph significantly improved after ICS addition, whereas no significant changes were observed in spirometry or resistance parameters. Fres also showed significant correlations with FEV1, suggesting that it may capture airway changes not detected by spirometry. These findings support further investigation into its role as a noninvasive marker in COPD.

Trial Registration

UMIN-CTR Clinical Trial: UMIN000040764 (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042394)

尽管在常规临床实践中评估气道重塑仍然很困难，但无创气道状况评估被认为对COPD的治疗有用。本研究中使用的脉冲振荡测量系统可以对吸气和呼气相进行单独分析，从而提供对气道功能的详细了解。本研究探讨了吸入皮质类固醇（ICSs）对气道重塑的影响，并评估了该系统在COPD治疗中的效用。方法采用ICS/LAMA/LABA治疗1年以上的稳定期COPD患者，分别在基线和治疗48周后进行肺活量测定和脉冲振荡测定。还对症状、影像学和血液检查进行了评估。结果在52例患者中（平均基线%FEV1/预测：56.9%±22.1%），尽管进行了LAMA/LABA治疗，但在过去的一年中，所有患者均有1至2次中度加重。肺活量测定和MostGraph之间观察到显著相关性（例如，基线FEV1与R5: r = - 0.54）。虽然肺活量测定没有明显变化，但Fres明显改善（- 2.11±0.35,p < 0.0001），呼气期和吸气期均减少。结论加入ICS后，MostGraph测量Fres明显改善，肺活量和阻力参数无明显变化。Fres也显示出与FEV1的显著相关性，表明它可能捕捉到肺活量测定法未检测到的气道变化。这些发现支持进一步研究其作为COPD非侵入性标志物的作用。UMIN-CTR临床试验：UMIN000040764 （https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042394）

{"title":"Evaluation of the Effects of Switching COPD Patients From LAMA/LABA Therapy to ICS/LAMA/LABA Therapy Using the Impulse Oscillation System (IOS) Capable of Separating Inspiratory and Expiratory Measurements","authors":"Yosuke Tanaka, Ken Okamura, Shota Kaburaki, Toru Tanaka, Akiko Yoshikawa, Ayumi Shimizu, Akihiko Miyanaga, Namiko Taniuchi, Koichiro Kamio, Kazuo Kasahara, Masahiro Seike, Mitsunori Hino","doi":"10.1111/crj.70105","DOIUrl":"https://doi.org/10.1111/crj.70105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Noninvasive evaluation of airway conditions is considered useful in the management of COPD, although assessing airway remodeling remains difficult in routine clinical practice. The impulse oscillometry system used in this study allows separate analysis of inspiratory and expiratory phases, offering detailed insights into airway function. This study examined the effects of inhaled corticosteroids (ICSs) on airway remodeling and assessed the utility of this system in COPD management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Stable COPD patients on LAMA/LABA for over a year were assessed by spirometry and impulse oscillometry at baseline and after 48 weeks of ICS/LAMA/LABA therapy. Symptoms, imaging, and blood tests were also evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 52 patients (mean baseline %FEV1/predicted: 56.9% ± 22.1%), all had one to two moderate exacerbations in the past year despite LAMA/LABA therapy. Significant correlations were observed between spirometry and MostGraph (e.g., baseline FEV1 vs. R5: <i>r</i> = −0.54). Although spirometry showed no significant changes, Fres improved significantly (−2.11 ± 0.35, <i>p</i> < 0.0001), with reductions in both expiratory and inspiratory phases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Fres measured by MostGraph significantly improved after ICS addition, whereas no significant changes were observed in spirometry or resistance parameters. Fres also showed significant correlations with FEV1, suggesting that it may capture airway changes not detected by spirometry. These findings support further investigation into its role as a noninvasive marker in COPD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>UMIN-CTR Clinical Trial: UMIN000040764 (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042394)</p>\u0000 </section>\u0000 </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 7","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/crj.70105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Electrical Impedance Tomography–Guided Airway Clearance in Elderly Patients With Severe Pneumonia: A Prospective Study 电阻抗断层扫描引导老年重症肺炎患者气道清除率：一项前瞻性研究

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2025-07-13 DOI: 10.1111/crj.70110

Jiaping Zhao, Wenchao Mao, Yi Zhang, Saichan Xu, Fei Qian, Liang Wu, Shijin Gong, Weihang Hu, Changyun Zhao

Background

Elderly patients are prone to secretion retention and exacerbated lung infections due to weakened respiratory muscle strength and reduced ability to cough and expectorate. Airway clearance techniques (ACTs) can help to clear airway secretions, but objective bedside assessment of secretion clearance efficacy is lacking. Electrical impedance tomography (EIT) can dynamically monitor lung ventilation and provide a basis for clinical decision-making.

Methods

This study was a prospective randomized controlled trial that included 50 elderly patients with severe pneumonia, who were randomized into EIT and non-EIT groups. The EIT group received personalized ACTs guided by real-time EIT imaging with dynamic adjustment of posture, percussion intensity, and active circulatory breathing technique (ACBT) frequency, whereas the non-EIT group received fixed-schedule ACTs (postural drainage every 2 h + percussion/vibration twice daily) without EIT feedback. The main observation indices included Clinical Pulmonary Infection Score (CPIS), respiratory mechanics indices, blood gas analysis indices, and extubation success rate.

Results

The EIT group showed significantly lower CPIS scores (p = 0.0137 on Day 7), higher dynamic compliance (p = 0.0193), lower airway resistance (p = 0.0039), lower peak airway pressure (p = 0.0288), and higher oxygenation index (p = 0.0143 on Day 5 and p = 0.0005 on Day 7) than the non-EIT group. The extubation success rate was significantly higher in the EIT group (88% vs. 56%, p = 0.0255). Additionally, the EIT group demonstrated progressive improvements in ventilation in specific regions (D7 vs. D1: p = 0.0004 for region of interest [ROI]3; p = 0.0059 for ROI4) and a significant decrease in the global inhomogeneity index at D7 (D7 vs. D1: p = 0.0025).

Conclusion

EIT-guided ACT is safe and enhances treatment efficacy by significantly improving respiratory function and extubation success rate in elderly patients with severe pneumonia.

背景老年患者由于呼吸肌力减弱，咳嗽和咳痰能力下降，容易出现分泌物潴留，加重肺部感染。气道清除技术（act）有助于清除气道分泌物，但缺乏对分泌物清除效果的客观床边评估。电阻抗断层扫描（EIT）可以动态监测肺通气情况，为临床决策提供依据。方法采用前瞻性随机对照试验，将50例老年重症肺炎患者随机分为EIT组和非EIT组。EIT组接受实时EIT成像指导下的个性化act，动态调整体位、打击强度和主动循环呼吸技术（ACBT）频率，而非EIT组接受固定时间act（每2小时体位引流+每天两次打击/振动），无EIT反馈。主要观察指标包括临床肺部感染评分（CPIS）、呼吸力学指标、血气分析指标、拔管成功率。结果EIT组CPIS评分（第7天p = 0.0137）、动态顺应性（p = 0.0193）、气道阻力（p = 0.0039）、气道压力峰（p = 0.0288）、氧合指数（第5天p = 0.0143、第7天p = 0.0005）显著低于非EIT组。EIT组拔管成功率明显高于对照组（88%比56%，p = 0.0255）。此外，EIT组在特定区域的通气表现出进行性改善(D7 vs. D1：感兴趣区域[ROI]3 p = 0.0004；ROI4的p = 0.0059)， D7时全球不均匀性指数显著下降（D7 vs. D1: p = 0.0025）。结论eit引导ACT治疗老年重症肺炎患者呼吸功能和拔管成功率明显提高，安全可靠，可提高治疗效果。

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引用次数: 0

Causal Associations Between Cystatin and Lung Cancer: A Two-Sample Mendelian Randomization Study 胱氨酸抑素与肺癌的因果关系：一项双样本孟德尔随机研究

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2025-07-11 DOI: 10.1111/crj.70112

Chunling Zhang, Riya Wu, Hang Liu, Shihuan Yu

Introduction

The cystatin family is particularly relevant in lung cancer research due to its links to inflammation, protease balance, and tumor progression. Although population-based studies have documented associations between cystatin and lung cancer, causal relationships remain undetermined.

Methods

Based on genomic statistics of seven different cystatins and three subtypes of lung cancer, we conducted a two-sample Mendelian randomization (MR) study. The inverse-variance weighted (IVW) method was the main approach for causality estimation. The weighted median, simple mode, weighted mode, and MR-Egger regression methods were further employed to validate the main findings. In the sensitivity analysis, horizontal pleiotropy was assessed by MR-Egger regression and Cochran’s Q test. MR-PRESSO and Radial MR methods were used to identify heterogeneity and remove outliers.

Results

Genetically predicted Cystatin 8 was causally associated with squamous cell lung carcinoma (OR = 1.062, 95% CI: 1.004–1.124, p = 0.035). No causal relationships were found for genetically predicted cystatin 8, -B, -D, -F, or -M with squamous cell lung carcinoma, lung adenocarcinoma, and NSCLC. However, outliers were identified between Cystatin D, -M, and -F using MR-PRESSO and Radial MR. After the removal of outliers, the association between Cystatin D and lung adenocarcinoma turned significant (OR = 1.178, 95% CI: 1.023–1.358, p = 0.023). Sensitivity analyses confirmed the robustness of main results after outliers removal.

Conclusion

Genetically predicted Cystatin 8 was causally associated with squamous cell lung carcinoma. Future population-based studies are required to substantiate these results.

胱氨酸抑素家族在肺癌研究中特别重要，因为它与炎症、蛋白酶平衡和肿瘤进展有关。尽管以人群为基础的研究证实了胱抑素与肺癌之间的关联，但因果关系仍不确定。方法基于7种不同胱抑素和3种肺癌亚型的基因组统计数据，进行双样本孟德尔随机化（MR）研究。反方差加权法（IVW）是因果关系估计的主要方法。进一步采用加权中位数、简单模式、加权模式和MR-Egger回归方法对主要发现进行验证。在敏感性分析中，采用MR-Egger回归和Cochran’s Q检验评估水平多效性。MR- presso和Radial MR方法用于识别异质性和去除异常值。结果基因预测Cystatin 8与鳞状细胞肺癌相关（OR = 1.062, 95% CI: 1.004 ~ 1.124, p = 0.035）。基因预测的胱抑素8、-B、-D、-F或-M与鳞状细胞肺癌、肺腺癌和非小细胞肺癌没有因果关系。然而，使用MR-PRESSO和Radial mr发现了胱抑素D、-M和-F之间的异常值。在去除异常值后，胱抑素D与肺腺癌之间的相关性变为显著性（OR = 1.178, 95% CI: 1.023-1.358, p = 0.023）。敏感性分析证实了剔除异常值后主要结果的稳健性。结论基因预测Cystatin 8与鳞状细胞肺癌相关。需要未来以人群为基础的研究来证实这些结果。

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引用次数: 0

Comprehensive Analysis of Lung Cancer Metastasis: Sites, Rates, Survival, and Risk Factors—A Systematic Review and Meta-Analysis 肺癌转移的综合分析：部位、发生率、生存率和危险因素——一项系统综述和荟萃分析

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2025-07-11 DOI: 10.1111/crj.70107

Shilin Wang, Wen Tang, Fu Jin, Huanli Luo, Han Yang, Ying Wang

Objectives

Lung cancer metastasis constitutes a critical aspect of disease progression and patient outcomes. It is imperative to illuminate the complex landscape of lung cancer metastasis, offering a thorough evaluation of sites, rates, risk factors, and survival implications.

Methods

Studies on the prevalence of lung cancer metastasis, the risk factors, the overall survival (OS) after metastasis, or the risk factors for OS were included. Two independent reviewers used a standardized data extraction and quality assessment form. Hazard ratios and confidence intervals were calculated using random-effects or fixed-effects models.

Results

This systematic meta-analysis included 115 clinical trials. Prevalent metastatic sites in non-small cell lung carcinoma (NSCLC) encompassed brain (29%), bone (25%), adrenal gland (15%), liver (13%), and skin (3%). However, small cell lung carcinoma (SCLC) primarily metastasized to liver (33%), brain (30%), bone (27%), adrenal gland (10%), and pericardium (3%). The risk factors for brain metastases in NSCLC included lung adenocarcinoma, EGFR mutations, and prophylactic cranial irradiation (PCI); in SCLC brain metastasis, age and PCI were influential. The median OS after brain metastasis in NSCLC and SCLC was 21.3 and 10.5 months, respectively, while liver or bone metastases were notably linked to poorer survival. The factors influencing OS in NSCLC brain metastasis included age, EGFR mutations, and stereotactic radiosurgery. For SCLC brain metastasis, OS was notably impacted by gender, smoking status, the number of brain metastases, and radiotherapy.

Conclusion

This study provided insights into lung cancer metastasis. The results revealed the metastatic rates, risk factors, and OS to assist clinical decision-making.

目的肺癌转移是影响疾病进展和患者预后的重要因素。阐明肺癌转移的复杂格局，提供对部位、发生率、危险因素和生存影响的全面评估是必要的。方法对肺癌转移的发生率、危险因素、转移后总生存期（OS）及发生OS的危险因素进行研究。两名独立的审稿人使用了标准化的数据提取和质量评估表格。使用随机效应或固定效应模型计算风险比和置信区间。结果本系统荟萃分析包括115项临床试验。非小细胞肺癌（NSCLC）的常见转移部位包括脑（29%）、骨（25%）、肾上腺（15%）、肝脏（13%）和皮肤（3%）。然而，小细胞肺癌（SCLC）主要转移到肝脏（33%）、脑（30%）、骨（27%）、肾上腺（10%）和心包膜（3%）。NSCLC脑转移的危险因素包括肺腺癌、EGFR突变和预防性颅脑照射（PCI）；年龄和PCI是影响SCLC脑转移的因素。NSCLC和SCLC脑转移后的中位生存期分别为21.3个月和10.5个月，而肝或骨转移与较差的生存期明显相关。影响NSCLC脑转移OS的因素包括年龄、EGFR突变和立体定向放射手术。对于SCLC脑转移，OS明显受性别、吸烟状况、脑转移数量和放疗的影响。结论本研究为肺癌转移研究提供了新的思路。结果揭示了转移率、危险因素和OS，以辅助临床决策。

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引用次数: 0

Role of Immune Cells in Mediating the Effect of Hypothyroidism on Idiopathic Pulmonary Fibrosis 免疫细胞介导甲状腺功能减退对特发性肺纤维化的影响

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2025-07-10 DOI: 10.1111/crj.70111

Zhengling Liu, Chengkun Kou, Xiaobo Chen, Jing Yang, Huan Zhu, Yongning Jiao, Dongyan Zhang, Wencui Zhang, Liang Li

Introduction

Idiopathic pulmonary fibrosis (IPF) leads to irreversible scarring of lung tissue, resulting in deteriorating respiratory function, particularly in older adults. We aimed to explore the causative link between hypothyroidism and IPF, particularly focusing on immune cell phenotypes as mediating factors.

Methods

A two-sample Mendelian randomization (MR) approach was utilized to investigate the influence of hypothyroidism on IPF and the role of 731 distinct immune cell phenotypes as mediators. The mediating effects were quantified using the coefficient product method. Various sensitivity analyses, including Cochran's Q test for heterogeneity, MR–Egger for pleiotropy, and the “leave-one-out” method, were conducted to verify the robustness of single-nucleotide polymorphism–derived casual estimates. Statistical analyses were carried out using the R software (Version 4.3.1).

Results

Hypothyroidism was significantly associated with increased IPF risk (odds ratio [OR] = 1.13, 95% confidence interval [CI] = 1.06–1.21, p = 1.34 × 10⁻⁴). Of the 36 immune cell phenotypes associated with IPF, those related to the mean fluorescence intensity of B cells were the most prevalent. Mediation analysis showed that CD19 on IgD− CD27− accounted for approximately 3.68% of the effect of hypothyroidism on IPF, whereas herpesvirus entry mediator (HVEM) on T cells accounted for approximately 3.83% of this effect.

Conclusion

We identified a marked association between hypothyroidism and IPF. Specific immune cell phenotypes may partially mediate this relationship, although the observed effect sizes were modest. Further research is needed to validate these results in diverse populations and larger clinical trials.

特发性肺纤维化（IPF）导致肺组织不可逆的瘢痕形成，导致呼吸功能恶化，特别是在老年人中。我们的目的是探讨甲状腺功能减退和IPF之间的因果关系，特别关注免疫细胞表型作为中介因素。方法采用双样本孟德尔随机化（MR）方法研究甲状腺功能减退症对IPF的影响以及731种不同免疫细胞表型作为介质的作用。采用系数积法对中介效应进行量化。进行了各种敏感性分析，包括Cochran's Q检验异质性，MR-Egger检验多效性和“留一”方法，以验证单核苷酸多态性衍生的随机估计的稳健性。采用R软件（4.3.1版）进行统计分析。结果甲状腺功能减退与IPF风险增加显著相关（优势比[OR] = 1.13, 95%可信区间[CI] = 1.06-1.21, p = 1.34 × 10−4）。在与IPF相关的36种免疫细胞表型中，与B细胞平均荧光强度相关的表型最为普遍。中介分析显示，IgD - CD27 -上的CD19约占甲状腺功能低下对IPF影响的3.68%，而T细胞上的疱疹病毒进入介质（HVEM）约占这种影响的3.83%。结论甲状腺功能减退与IPF之间存在显著的相关性。特异性免疫细胞表型可能部分介导这种关系，尽管观察到的效应大小是适度的。需要进一步的研究在不同的人群和更大规模的临床试验中验证这些结果。

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引用次数: 0

Correction to “SIRT3 Inhibits Cell Proliferation of Nonsmall Cell Lung Carcinoma by Inducing ROS Production” 对“SIRT3通过诱导ROS产生抑制非小细胞肺癌细胞增殖”的更正

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2025-07-09 DOI: 10.1111/crj.70106

Z. Yu, H. Liao, G. Wu, Y. Liu, G. Zhang, L. Xiao, S. Yang, J. Liu, G. Yang, “ SIRT3 Inhibits Cell Proliferation of Nonsmall Cell Lung Carcinoma by Inducing ROS Production,” Clinical Respiratory Journal 18, no. 11 (2024), https://doi.org/10.1111/crj.70033.

We apologize for this error.

11 (2024), https://doi.org/10.1111/crj.70033。我们为这个错误道歉。

引用次数: 0

Association Between Albumin Corrected Anion Gap and 28-Day All-Cause Mortality in Patients With Acute Respiratory Failure in ICU: A Retrospective Study Based on the MIMIC-IV Database 白蛋白纠正阴离子间隙与ICU急性呼吸衰竭患者28天全因死亡率的关系：基于MIMIC-IV数据库的回顾性研究

IF 1.9 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal

Pub Date : 2025-07-09 DOI: 10.1111/crj.70100

Jianmin Qu, Xiahong Tang, Yi Cheng, Wei Xiong, Yunfeng Zhao

Background

For critically ill patients in the intensive care unit (ICU), acute respiratory failure (ARF) stands as a prominent cause of mortality. Anion gap (AG) denotes the disparity between unmeasured cations and anions. Adjusting AG for albumin levels results in the albumin corrected anion gap (ACAG), which provides a more accurate representation of the body's acid–base status. Elevated ACAG may arise from ARF-induced cellular hypoxia and metabolic acidosis. However, limited research has investigated the association between ACAG and the 28-day all-cause mortality of ARF patients in critical care.

Methods

Using the Medical Information Mart for Intensive Care (MIMIC-IV 2.2) database, a retrospective data analysis was conducted, specifically targeting critically ill patients diagnosed with ARF. Serum ACAG was collected within 24 hours of the patient's admission to the ICU. The association between ACAG levels and 28-day all-cause mortality was investigated using smooth curve fitting, a multivariate Cox proportional hazard regression model, and Kaplan–Meier survival curve analysis. Furthermore, the consistency of these relationships was assessed through interaction and subgroup analyses.

Results

The study involved the enrollment of 3888 eligible participants in total. After adjusting for confounding variables in the multivariable Cox regression analysis model, we noticed a positive linear relationship between the ACAG value and the ICU's 28-day all-cause mortality rate. When ACAG was used as a continuous variable, a 3.1% increase in 28-day all-cause mortality was associated with a 1.0-mmol/L increase in ACAG (adjusted HR = 1.037, 95% CI: 1.025–1.048, p < 0.001). In the 28-day all-cause mortality, the highest and intermediate ACAG groups (adjusted HR 1.483, 95% CI: 1.244–1.768 and adjusted HR 1.244, 95% CI: 1.062–1.457, respectively) were notably higher than the lowest ACAG group when ACAG was utilized as a tertiles categorical variable. The substantial association between ACAG and 28-day all-cause mortality in the ICU was consistently demonstrated through subgroup analysis.

Conclusions

Among ICU patients with ARF, an elevated ACAG is linked to an elevated risk of 28-day all-cause mortality. There exists a linearly positive relationship between the 28-day all-cause mortality and ACAG.

背景对于重症监护病房（ICU）的危重患者，急性呼吸衰竭（ARF）是导致死亡的主要原因。阴离子间隙（AG）表示未测阳离子和阴离子之间的差异。根据白蛋白水平调整AG会产生白蛋白校正阴离子间隙（ACAG），这能更准确地反映机体的酸碱状态。ACAG升高可能由arf诱导的细胞缺氧和代谢性酸中毒引起。然而，有限的研究调查了ACAG与危重重症ARF患者28天全因死亡率之间的关系。方法利用重症医学信息集市（MIMIC-IV 2.2）数据库，对诊断为ARF的危重患者进行回顾性数据分析。患者入ICU后24小时内采集血清ACAG。采用光滑曲线拟合、多变量Cox比例风险回归模型和Kaplan-Meier生存曲线分析，研究ACAG水平与28天全因死亡率之间的关系。此外，通过相互作用和亚组分析来评估这些关系的一致性。结果本研究共纳入3888名符合条件的受试者。在多变量Cox回归分析模型中调整混杂变量后，我们注意到ACAG值与ICU 28天全因死亡率之间存在正线性关系。当ACAG作为一个连续变量时，28天全因死亡率增加3.1%与ACAG增加1.0 mmol/L相关（校正HR = 1.037, 95% CI: 1.025-1.048, p < 0.001）。在28天全因死亡率中，当ACAG作为分类变量时，最高和中级ACAG组（校正后的HR分别为1.483,95% CI为1.244 - 1.768，校正后的HR为1.244,95% CI为1.062-1.457）显著高于最低ACAG组。通过亚组分析，ACAG与ICU 28天全因死亡率之间存在实质性关联。结论：在ARF ICU患者中，ACAG升高与28天全因死亡率升高相关。28天全因死亡率与ACAG呈线性正相关。

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引用次数: 0