慢性阻塞性肺疾病合并侵袭性肺曲霉病的病理生理特点及其诊断策略

近年来,慢性阻塞性肺疾病患者侵袭性肺曲霉病的发病率不断上升,早期诊断对改善临床预后极为重要。慢性阻塞性肺疾病患者支气管-肺功能和结构损害,并经常接受激素治疗等特点导致患者合并侵袭性肺曲霉病时临床和CT表现不典型,有关侵袭性肺曲霉病的实验室诊断敏感性和(或)特异性降低,给诊断带来了困难。本文试从慢性阻塞性肺疾病合并侵袭性肺曲霉病的病理生理特点入手探讨其诊断上的一些问题。     

肺部微生物调控免疫与肺移植稳态

肺部微生物作为影响机体病理生理过程的复杂微生态系统,调控多种肺疾病的致病机制。肺部微生物不仅参与代谢、炎症和免疫稳态等多种生物学过程,而且影响肺移植术后慢性肺同种异体移植物功能障碍(chronic lung allograft dysfunction,CLAD)的发生发展。肺移植作为终末期肺疾病的主要治疗手段,其术后并发症一直是亟待解决的问题。本文主要介绍了机体健康和疾病状态下肺部微生物的组成,重点探讨了肺部微生物与免疫及肺移植稳态之间的联系,以期为肺部微生态环境的临床调控提供理论依据。     

炎症细胞因子与慢性阻塞性肺疾病

慢性阻塞性肺疾病（chronic obstructive pulmonary dis-ease,COPD）不可否认是一个重要的世界卫生问题。对于它的发病机制目前尚未明了,普遍认同的观点有：（1）感染假说;（2）免疫失衡及炎症假说;（3）氧化损伤假说;（4）蛋白酶和抗蛋白酶失衡[1]。     

中性粒细胞胞外诱捕网与肺部炎症性疾病的关系

中性粒细胞募集/浸润是肺部炎症性疾病的特征性表现,是肺部抵抗病原微生物入侵的第一道防线,主要通过吞噬作用杀灭病原微生物.然而,新近的研究发现,中性粒细胞被刺激后可形成一种以DNA为骨架并镶嵌有大量活性蛋白质的网状物质——中性粒细胞胞外诱捕网(neutrophil extracellular traps,NETs),这种特殊形式的生物结构能捕获并杀灭病原微生物.尽管就NETs的生物学功能而言,其对肺部炎症性疾病应该是有益的,但是越来越多的研究表明,NETs对肺上皮细胞和内皮细胞均具有直接的细胞毒性作用,并可能促进肺部炎症性疾病的发生发展.为了系统地了解NETs与肺部相关炎症性疾病的关系,本综述首先简述了NETs的结构、功能和形成过程,然后分别叙述了NETs与哮喘、慢性阻塞性肺病、细菌性肺炎、肺结核、肺囊性纤维化、间质性肺疾病、流感病毒感染和急性肺损伤的关系.最后总结、展望了NETs在肺部炎症性疾病中的潜在研究方向和针对性治疗策略.     

非粒细胞减少患者肺曲霉病22例回顾性分析

目的提高对非粒细胞减少患者肺曲霉病的认识及诊疗水平。方法回顾性分析22例非粒细胞减少患者肺曲霉病的临床、影像学及实验室资料,随诊其转归。结果22例肺曲霉病（PA）患者,男性12例,女性10例,平均年龄（56．3±21．4）岁。确诊、临床诊断各8例,拟诊6例。侵袭性肺曲霉病（IPA）11例,单纯性曲霉球6例,慢性坏死性肺曲霉病（CNPA）5例。常见基础疾病为继发型肺结核（8／22）、糖尿病或类固醇性糖尿病（6／22）、高血压病（5／22）、慢性阻塞性肺疾病（5／22）,4例系原发社区感染。常见临床症状咳嗽咳痰（18／22）、咯血（11／22）、气促（7／22）。影像学表现为肺部渗出或实变病灶9例、空洞改变及典型曲霉球12例,结节或肿块1例。首选药物治疗依次为伏立康唑（10／22）、卡泊芬净（4／22）、伊曲康唑（3／22）。结论非粒细胞减少伴IPA好发于糖尿病、慢性阻塞性肺疾病,亦可发生在免疫功能正常患者。单纯曲霉球多继发或并发于肺结核。应注意鉴别CNPA与单纯曲霉球。IPA临床表现缺乏特征性。影像改变未见典型晕征及空气半月征,肺外播散少见,药物治疗首选伏立康唑。     

肠道菌群对慢性阻塞性肺疾病的影响研究

慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是肺部常见疾病,肺部炎症作为COPD的一贯特征,其炎症反应多为中性粒细胞型。近年的流行病学调查表明,COPD在我国的防治现状并不理想,表现出高致死率、致残率及高隐匿性的特点。目前COPD的有效治疗措施匮乏,寻找新的治疗突破口迫在眉睫。现有的研究显示,肠道菌群及其代谢产物与多种疾病的发生发展有着密切关联,其与肺系疾病的联系称为“肺—肠轴”。在COPD中,这可能是通过改变肠道屏障完整性、产生抗炎性代谢产物和调节骨髓造血免疫功能来实现的。但现有的研究尚不能明确特定的肠道菌群对COPD的作用机制,这也是未来研究的方向及COPD治疗可能的突破口。     

纳洛酮联合呼吸兴奋合剂治疗慢性阻塞性肺疾病并肺性脑病临床观察

目的观察盐酸纳洛酮联合呼吸兴奋合剂(氨茶碱+洛贝林+尼可刹米+地塞米松)治疗慢性阻塞性肺疾病并肺性脑病的临床疗效。方法将我院2008年12月～2012年10月收住ICU的慢性阻塞性肺疾病并肺性脑病患者70例,随机分为观察组和对照组,两组均给予吸氧、应用呼吸兴奋合剂、抗感染、维持酸碱平衡及纠正电解质紊乱、营养支持等常规治疗,观察组在上述治疗的基础上加用盐酸纳洛酮,并观察两组病人的精神状态、血气分析、生命体征等变化。结果治疗组有效率为86%,明显优于对照组的61.8%(P<0.01)。结论盐酸纳洛酮对慢性阻塞性肺疾病并肺性脑病的治疗作用肯定,值得推广。     

硫氧还蛋白系统在COPD抗氧化中的作用研究进展

硫氧还蛋白系统是由硫氧还蛋白(thioredoxin,Trx)、硫氧还蛋白还原酶(thioredoxin reductase,TrxR)和还原型辅酶Ⅱ(NADPH)组成的多功能小分子蛋白系统,广泛表达的硫氧还蛋白作为蛋白质二硫键的还原酶,它参与很多生理过程,并发挥重要生物学功能,包括调节机体的氧化还原反应、抑制细胞凋亡、调节转录因子DNA结合活性以及免疫应答等,其中一重要作用是参与调节细胞氧化还原状态以对抗氧化应激。因此在一些炎症性疾病如慢性阻塞性肺疾病、急性呼吸窘迫综合征、肺间质疾病、哮喘、肺结节病等的发生发展中扮演重要角色,本文对硫氧还蛋白系统在慢性阻塞性肺疾病中的抗氧化作用作一综述。     

GDF15在气道慢性炎症性疾病中的研究进展

气道慢性炎症性疾病是指炎症累及上和(或)下气道的慢性疾病。近年来,由于环境变化和社会经济发展,流行病学显示气道慢性炎症性疾病的患病人数不断上升,严重影响患者的生活质量和期望寿命。生长分化因子15(growth differentiation factor 15,GDF15)是一种应激反应性细胞因子,属于转录生长因子-β超家族。越来越多的研究发现,GDF15水平与气道炎症程度密切相关,并影响气道黏液高分泌,与气道慢性炎症性疾病的发生、进展及预后密切相关,是具有潜力的血清检测标志物。本文主要阐述GDF15的活化机制及其与炎症的关系,以慢性鼻-鼻窦炎、慢性阻塞性肺疾病、支气管哮喘等常见疾病为例,总结了GDF15在气道慢性炎症性疾病发生发展过程中的表达水平变化,以及对疾病生理病理过程和病情转归预后的影响,以期为临床气道慢性炎症性疾病的诊断和治疗提供理论依据和参考。     

运动介导腺苷酸活化蛋白激酶防治慢性阻塞性肺疾病的作用机制

慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)是一种以持续存在的呼吸道症状和气流受限为主要特征的、常见的、可预防和治疗的慢性气道疾病。目前，我国COPD的患病率仍呈不断增长的趋势，已成为仅次于高血压、糖尿病的中国第三大常见慢性病，给患者家庭和国家卫生系统带来巨大的负担。研究证实，肺部炎症、肺细胞衰老、肺线粒体功能障碍和肺代谢失调是COPD发生与发展的主要病理原因，腺苷酸活化蛋白激酶(AMP-activated protein kinase, AMPK)可以改善肺部炎症反应、延缓肺细胞衰老、纠正肺线粒体功能障碍及调节肺细胞代谢紊乱。但就目前而言，通过运动手段上调AMPK的表达防治COPD的潜在机制仍不清楚。因此，通过中国知网(CNKI)、PubMed、Web of Science、WHO等官网与数据库，检索并梳理相关文献资料，综述COPD的发病机制、运动对AMPK表达的影响及运动介导AMPK防治COPD的可能机制，以期为COPD提供新的治疗靶点。     

Therapeutic modulation of V Set and Ig domain-containing 4 (VSIG4) signaling in immune and inflammatory diseases

Inflammation is the result of acute and chronic stresses, caused by emotional or physical trauma, or nutritional or environmental pollutants, and brings serious harm to human life and health. As an important cellular component of the innate immune barrier, the macrophage plays a key role in maintaining tissue homeostasis and promoting tissue repair by controlling infection and resolving inflammation. Several studies suggest that V Set and Ig domain-containing 4 is specifically expressed in tissue macrophages and is associated with a variety of inflammatory diseases. In this paper, we mainly summarize the recent research on V Set and Ig domain-containing 4 structures, functions, function and roles in acute and chronic inflammatory diseases, and provide a novel therapeutic avenue for the treatment of inflammatory diseases, including nervous system, urinary, respiratory and metabolic diseases.     

The role of osteopontin in inflammatory processes

Osteopontin (OPN) is a matricellular protein that mediates diverse biological functions. OPN is involved in normal physiological processes and is implicated in the pathogenesis of a variety of disease states, including atherosclerosis, glomerulonephritis, cancer, and several chronic inflammatory diseases. Through interactions with several integrins, OPN mediates cell migration, adhesion, and survival in many cell types. OPN also functions as a Th1 cytokine, promotes cell-mediated immune responses, and plays a role in chronic inflammatory and autoimmune diseases. Besides its function in inflammation, OPN is also a regulator of biomineralization and a potent inhibitor of vascular calcification.     

Long non‐coding RNA expressed in macrophage co‐varies with the inflammatory phenotype during macrophage development and polarization

Advances in microarray, RNA‐seq and omics techniques, thousands of long non‐coding RNAs (lncRNAs) with unknown functions have been discovered. LncRNAs have presented a diverse perspective on gene regulation in diverse biological processes, especially in human immune response. Macrophages participate in the whole phase of immune inflammatory response. They are able to shape their phenotype and arouse extensive functional activation after receiving physiological and pathological stimuli. Emerging studies indicated that lncRNAs participated in the gene regulatory network during complex biological processes of macrophage, including macrophage‐induced inflammatory responses. Here, we reviewed the existing knowledges of lncRNAs in the processes of macrophage development and polarization, and their roles in several different inflammatory diseases. Specifically, we focused on how lncRNAs function in macrophage, which might help to discover some potential therapeutic targets and diagnostic biomarkers.     

MicroRNAs in inflammatory lung disease - master regulators or target practice?

MicroRNAs (miRNAs) have emerged as a class of regulatory RNAs with immense significance in numerous biological processes. When aberrantly expressed miRNAs have been shown to play a role in the pathogenesis of several disease states. Extensive research has explored miRNA involvement in the development and fate of immune cells and in both the innate and adaptive immune responses whereby strong evidence links miRNA expression to signalling pathways and receptors with critical roles in the inflammatory response such as NF-κB and the toll-like receptors, respectively. Recent studies have revealed that unique miRNA expression profiles exist in inflammatory lung diseases such as cystic fibrosis, chronic obstructive pulmonary disease, asthma, idiopathic pulmonary fibrosis and lung cancer. Evaluation of the global expression of miRNAs provides a unique opportunity to identify important target gene sets regulating susceptibility and response to infection and treatment, and control of inflammation in chronic airway disorders. Over 800 human miRNAs have been discovered to date, however the biological function of the majority remains to be uncovered. Understanding the role that miRNAs play in the modulation of gene expression leading to sustained chronic pulmonary inflammation is important for the development of new therapies which focus on prevention of disease progression rather than symptom relief. Here we discuss the current understanding of miRNA involvement in innate immunity, specifically in LPS/TLR4 signalling and in the progression of the chronic inflammatory lung diseases cystic fibrosis, COPD and asthma. miRNA in lung cancer and IPF are also reviewed.     

SIRT3与细胞代谢及心血管疾病的相关性

蛋白去乙酰化酶在细胞生理过程中发挥着极为重要的作用。人蛋白去乙酰化酶包括HDACⅠ、HDACⅡ、HDACⅢ和HDACⅣ4个家族。其中第Ⅲ类即Sir2(Silent information regulator 2)家族包括7个成员——SIRT1~ SIRT7,每个成员都具有不同的细胞定位,并且发挥不同的生物学功能。作为主要定位于线粒体的组蛋白去乙酰化酶,SIRT3不仅调节细胞的能量代谢,并在细胞凋亡、肿瘤生长和一些疾病中发挥作用。文章综述了SIRT3在细胞代谢中的生物学功能以及其在心血管疾病中的研究进展。     

Human mesenchymal stem cells inhibit the differentiation and effector functions of monocytes

Although monocytes represent an essential part of the host defence system, their accumulation and prolonged stimulation could be detrimental and may aggravate chronic inflammatory diseases. The present study has explored the less-understood immunomodulatory effects of mesenchymal stem cells on monocyte functions. Isolated purified human monocytes were co-cultured with human umbilical cord-derived mesenchymal stem cells under appropriate culture conditions to assess monocytes’ vital functions. Based on the surface marker analysis, mesenchymal stem cells halted monocyte differentiation into dendritic cells and macrophages and reduced their phagocytosis functions, which rendered an inability to stimulate T-cell proliferation. The present study confers that mesenchymal stem cells exerted potent immunosuppressive activity on monocyte functions such as differentiation, phagocytosis and Ag presentation; hence, they promise a potential therapeutic role in down-regulating the unwanted monocyte-mediated immune responses in the context of chronic inflammatory diseases.     

Characterization of novel anti-IL-26 neutralizing monoclonal antibodies for the treatment of inflammatory diseases including psoriasis

ABSTRACT

Interleukin (IL)-26, known as a Th17 cytokine, acts on various cell types and has multiple biological functions. Although its precise role still remains to be elucidated, IL-26 is suggested to be associated with the pathology of diverse chronic inflammatory diseases such as psoriasis, inflammatory bowel diseases and rheumatoid arthritis. To develop novel neutralizing anti-human IL-26 monoclonal antibodies (mAbs) for therapeutic use in the clinical setting, we immunized mice with human IL-26 protein. Hybridomas producing anti-IL-26 mAbs were screened for various in vitro functional assays, STAT3 phosphorylation and antibiotic assays. Although the IL-20RA/IL-10RB heterodimer is generally believed to be the IL-26 receptor, our data strongly suggest that both IL-20RA-dependent and -independent pathways are involved in IL-26-mediated stimulation. We also investigated the potential therapeutic effect of anti-IL-26 mAbs in the imiquimod-induced psoriasis-like murine model using human IL-26 transgenic mice. These screening methods enabled us to develop novel neutralizing anti-human IL-26 mAbs. Importantly, administration of IL-26-neutralizing mAb did not have an effect on the antimicrobial activity of IL-26. Taken together, our data strongly suggest that our newly developed anti-human IL-26 mAb is a potential therapeutic agent for the treatment of diverse chronic inflammatory diseases including psoriasis.     

Emerging roles for TNIP1 in regulating post-receptor signaling

A vast number of cellular processes and signaling pathways are regulated by various receptors, ranging from transmembrane to nuclear receptors. These receptor-mediated processes are modulated by a diverse set of regulatory proteins. TNFα-induced protein 3-interacting protein 1 is such a protein that inhibits both transduction by transmembrane receptors, such as TNFα-receptor, EGF-R, and TLR, and nuclear receptors' PPAR and RAR activity. These receptors play key roles in regulating inflammation and inflammatory diseases. A growing number of references have implicated TNIP1 through GWAS and expression studies in chronic inflammatory diseases such as psoriasis and rheumatoid arthritis, although TNIP1s exact role has yet been determined. In this review, we aim to integrate the current knowledge of TNIP1s functions with the diseases in which it has been associated to potentially elucidate the role this regulator has in promoting or alleviating these inflammatory diseases.     

分泌型磷脂酶A2亚家族：结构与功能

分泌型磷脂酶A2(secretory phospholipase A2,sPLA2)是磷脂代谢酶中最大的一个亚家族,具有多种生理功能．迄今为止,在人体中总共发现11种sPLA2亚型,它们具有不同的组织分布、水解活性和底物特异性．由于其水解产物主要为花生四烯酸和溶血磷脂,sPLA2常通过影响这两个通路调节细胞功能、炎症反应、抗菌等．本文结合近几年国际上关于sPLA2的研究报道,对于sPLA2的结构、功能、组织定位及与疾病发生发展的关系做一简要概述．