布地奈德联合特布他林雾化吸入治疗对毛细支气管炎患儿潮气呼吸肺功能、T细胞亚群及血清炎性因子的影响

摘要 目的：探讨布地奈德联合特布他林雾化吸入治疗对毛细支气管炎患儿潮气呼吸肺功能、T细胞亚群及血清炎性因子的影响。方法：选取2019年1月~2019年12月期间我院收治的毛细支气管炎患儿98例,采用随机数字表法分为对照组（常规方案治疗）和观察组（对照组基础上加用布地奈德联合特布他林雾化吸入治疗）,各49例。记录两组治疗1周后总有效率。对比两组治疗前、治疗1周后的潮气呼吸肺功能指标[吸气/呼气时间比（Ti/Te）、达峰时间比（TPTEF/TE）、达峰容积比（VPEF/VE）、每千克潮气量（Vt/kg）]、T细胞亚群[CD3⁺、CD4⁺、CD8⁺及CD4⁺/CD8⁺]、血清炎性因子[降钙素原（PCT）、C反应蛋白（CRP）]。比较两组不良反应发生率。结果：+、CD4⁺、CD4⁺/CD8⁺均高于治疗前,且观察组高于对照组（P<0.05）,PCT、CRP、CD8+均低于治疗前,且观察组低于对照组（P<0.05）。两组患儿不良反应发生率对比无统计学差异（P>0.05）。结论：雾化吸入特布他林联合布地奈德治疗毛细支气管炎患儿疗效显著,可有效改善患儿T细胞亚群、潮气呼吸肺功能,减轻患儿炎性反应,且安全性好。     

Association of 25-Hydroxyvitamin D status and genetic variation in the vitamin D metabolic pathway with FEV1 in the Framingham Heart Study

Background

Vitamin D is associated with lung function in cross-sectional studies, and vitamin D inadequacy is hypothesized to play a role in the pathogenesis of chronic obstructive pulmonary disease. Further data are needed to clarify the relation between vitamin D status, genetic variation in vitamin D metabolic genes, and cross-sectional and longitudinal changes in lung function in healthy adults.

Methods

We estimated the association between serum 25-hydroxyvitamin D [25(OH)D] and cross-sectional forced expiratory volume in the first second (FEV₁) in Framingham Heart Study (FHS) Offspring and Third Generation participants and the association between serum 25(OH)D and longitudinal change in FEV₁ in Third Generation participants using linear mixed-effects models. Using a gene-based approach, we investigated the association between 241 SNPs in 6 select vitamin D metabolic genes in relation to longitudinal change in FEV₁ in Offspring participants and pursued replication of these findings in a meta-analyzed set of 4 independent cohorts.

Results

We found a positive cross-sectional association between 25(OH)D and FEV₁ in FHS Offspring and Third Generation participants (P = 0.004). There was little or no association between 25(OH)D and longitudinal change in FEV₁ in Third Generation participants (P = 0.97). In Offspring participants, the CYP2R1 gene, hypothesized to influence usual serum 25(OH)D status, was associated with longitudinal change in FEV₁ (gene-based P < 0.05). The most significantly associated SNP from CYP2R1 had a consistent direction of association with FEV₁ in the meta-analyzed set of replication cohorts, but the association did not reach statistical significance thresholds (P = 0.09).

Conclusions

Serum 25(OH)D status was associated with cross-sectional FEV₁, but not longitudinal change in FEV₁. The inconsistent associations may be driven by differences in the groups studied. CYP2R1 demonstrated a gene-based association with longitudinal change in FEV₁ and is a promising candidate gene for further studies.

Electronic supplementary material

The online version of this article (doi:10.1186/s12931-015-0238-y) contains supplementary material, which is available to authorized users.     

孟鲁司特联合舒利迭对哮喘急性发作期患者疗效及免疫功能的影响

目的探讨孟鲁司特联合舒利迭对哮喘急性发作期患者疗效及免疫功能的影响。方法 2012年1月至2014年1月选取在本院收治的120例哮喘急性发作期患者为研究对象,根据随机数字表将患者分为观察组及对照组各60例,对照组给予舒利迭雾化吸入治疗,50 mg/250 mg,2次/d,观察组在对照组基础上口服孟鲁司特,10 mg/次,1次/d,疗程为2周。对比分析两组患者治疗效果及治疗前后肺功能及免疫功能的变化。结果观察组总有效率为96.67%,对照组总有效率为76.67%,差异有统计学意义(P0.05)。观察组患者治疗后第1秒呼吸气体的容积(FEV1)、用力呼吸的肺活量(FVC)及FVC占预计值百分比(FVC%)改善优于对照组(P0.05)。观察组治疗后白细胞介素4(IL-4)、免疫球蛋白(Ig E)水平、IL-4/INF-γ显著低于对照组,而干扰素(IFN-γ)与对照组相比差异无统计学意义。结论孟鲁司特联合舒利迭能有效改善哮喘急性发作期患者肺功能及免疫功能,提高哮喘患者治疗效果。     

加味射干麻黄汤对重度支气管哮喘患者血清ECP、LPO、FeNO及肺功能的影响

目的:探讨加味射干麻黄汤对重度支气管哮喘患者血清嗜酸性粒细胞阳离子蛋白(ECP)、脂质过氧化物(LPO)、呼出气一氧化氮(FeNO)及肺功能的影响。方法:选择2015年9月至2017年9月我院接诊的96例重度支气管哮喘患者进行研究,通过随机数表法分为观察组(n=48)和对照组(n=48),在常规治疗基础上,对照组给予异丙托溴铵溶液、甲泼尼龙琥珀酸钠治疗,观察组联合加味射干麻黄汤治疗,均连续治疗4周。比较两组临床疗效、治疗前后中医证候积分、肺功能、血清ECP、LPO及FeNO的变化和不良反应。结果:治疗后,观察组临床疗效总有效率为91.67%(44/48),明显高于对照组的72.92%(35/48)(P0.05);治疗后,两组各中医证候积分、肺功能、血清ECP、LPO及FeNO较治疗前均显著改善(P0.05);中医证候积分中,观察组治疗后喘息、咳嗽、咳痰、胸闷、哮鸣音积分均明显低于对照组,肺功能中,观察组第1秒用力呼出量(FEV1)、FEV1/用力肺活量(FEV1/FVC)均明显高于对照组,呼气峰值流速(PEF)昼夜变异率明显低于对照组,且观察组血清ECP、LPO及FeNO明显比低于对照组,差异均具有统计学意义(P0.05);两组治疗期间不良反应比较无显著差异(P0.05)。结论:在重度支气管哮喘患者中应用加味射干麻黄汤效果显著,可有效改善肺功能及临床症状,其内在机制可能和调节气道慢性炎症反应、氧化应激反应,降低血清ECP、LOP及FeNO的表达相关,且用药安全性高,值得应用推广。     

小鼠腹腔注射硫酸铍的病理形态学观察

目的研究腹腔注射硫酸铍（BeSO4.4H2O）对小鼠主要脏器的损害作用。方法将30只6周龄昆明（KM）雄性小鼠随机分为三组,分别予以不同剂量硫酸铍生理盐水溶液腹腔注射染毒,隔日一次,染毒两周。观察主要脏器的病理组织学变化并测定脏器系数。结果与对照组比较,染毒组心、脾、肾、睾丸脏器系数无显著差异,肝、肺脏器系数差异有统计学意义（P〈0.05）;对照组肺、肝病理学组织检查未见异常,低剂量组小鼠肺组织可见淤血、出血、支气管扩张出血,肺泡腔内有少量炎性渗出物、支气管周围炎、间质性肺炎、小叶性肺炎等;高剂量组小鼠肺组织可见支气管扩张出血,支气管腔内有大量炎性渗出物,支气管周围肺泡扩张,间质性肺炎、小叶性肺炎、融合性小叶性肺炎;低剂量组肝细胞水肿,可见点状坏死和小灶性坏死;高剂量组小鼠肝组织损伤严重,肝细胞排列紊乱,多数肝细胞呈细胞水肿,肝细胞胞质成空泡状,可见明显的点状坏死和小灶性坏死,并伴有炎细胞浸润,坏死区周围肝细胞细胞质呈嗜酸性变,轻度核固缩,并且肝细胞呈不同程度的胞质疏松,肝窦以及肝中央静脉扩张有广泛变性、坏死等病理改变。睾丸、心、脾、肾未见明显异常。结论小鼠腹腔注射本试验剂量的硫酸铍后主要引起肺组织和肝脏损伤,其它脏器未见明显异常。     

Analysis of exposure-time-response relationships using a spline weight function

To examine the time-dependent effects of exposure histories on disease, we estimate a weight function within a generalized linear model. The shape of the weight function, which is modeled as a cubic B-spline, gives information about the impact of exposure increments at different times on disease risk. The method is evaluated in a simulation study and is applied to data on smoking histories and lung cancer from a recent case-control study in Germany.     

Thrombin binding aptamer analogues containing inversion of polarity sites endowed with antiproliferative and anti-motility properties against Calu-6 cells

Background

Although the thrombin binding aptamer (TBA) is endowed with both anticoagulant and antiproliferative properties, it is possible to reduce the first and enhance the second one by suitable chemical modifications.

Twenty-four-hour variations in subcellular structures of rat type II alveolar epithelial cells

Summary Subcellular structures of type II alveolar epithelial cells in the rat lung were analyzed at six evenly spaced times over 24 h (light period: 06.00 h–18.00 h), using a morphometric technique. The cell volumes were maximal at 16.00 h and minimal at 08.00 h. The volume and surface densities of rough endoplasmic reticulum and mitochondria were low during the light period, and high during the dark period. Morphometric parameters of multivesicular bodies did not significantly fluctuate over 24 h, but they increased from 04.00 h to 08.00 h. The volume densities of lamellar bodies increased from 16.00 h to 20.00 h, and decreased from 00.00 h to 08.00 h. The change in numerical densities of lamellar bodies was inversely correlated to that in the volume densities. As shown by electron microscopy, small lamellar bodies predominated at 08.00 h, larger lamellar bodies increasing at 16.00h. Composite bodies often appeared at 08.00 h and 12.00 h. Type II cells thus appear to fluctuate, showing three phases over 24 h: formation, accumulation and secretion of lamellar bodies. In particular, it is noteworthy that the accumulation stage occurs during the resting phase of the rat, whereas the secretion stage occurs during its body-active phase.     

胸腔镜食管癌切除术后肺部感染患者肺功能和炎症因子水平的关系研究

目的:研究胸腔镜食管癌切除术后肺部感染患者肺功能和炎症因子水平的关系。方法:选取2015年3月～2018年7月我院收治的食管癌患者120例为研究对象,将其以随机数字表法分成对照组和观察组。对照组予以传统开胸手术治疗,观察组则予以胸腔镜食管切除术治疗。分别比较两组术后肺部感染发生情况、手术前后肺功能以及炎症因子水平变化情况,并分析胸腔镜食管癌切除术后肺部感染患者肺功能与炎症因子的关系。结果:观察组患者术后肺部感染发生率为13.33%(8/60),低于对照组的36.67%(22/60),差异有统计学意义(P0.05)。术后观察组用力肺活量(FVC)、第1秒用力呼气量(FEV1)、FEV1/FVC均高于对照组,差异均有统计学意义(均P0.05)。术后1 d、术后5 d观察组白细胞介素-6(IL-6)、白细胞介素-10(IL-10)以及C反应蛋白(CRP)水平均低于对照组,差异均有统计学意义(均P0.05)。经Pearson相关性分析可得:胸腔镜食管癌切除术后肺部感染患者FVC、FEV1、FEV1/FVC与IL-6、IL-10、CRP均呈负相关性(均P0.05)。结论:胸腔镜食管癌切除术可显著降低患者肺部感染发生风险,且术后肺部感染患者肺功能与炎症反应存在密切相关,降低术后肺部感染发生率的机制可能与减轻机体炎症反应有关。     

静注氟比洛芬酯预防肺叶手术中全麻患者苏醒期躁动的临床研究

目的:探讨肺叶手术中超前应用氟比洛芬酯对减轻全身麻醉苏醒期躁动发生率的影响。方法:60例肺叶切除术患者随机分为A组和B组,每组30例,两组均常规诱导全麻气管插管,术中瑞芬、丙泊酚、维库溴铵泵住维持麻醉,A组于术前给予氟比洛芬酯1 MG/KG。比较两组躁动得分、苏醒后(10 min、30 min、1 h、2 h、4 h、24 h)六个时间点疼痛评分及不良反应发生率。结果:两组出血时间、拔管时间、麻醉时间差异均无统计学意义(均P0.05);A组患者的躁动得分显著低于B组,差异有统计学意义(P0.05);两组的VAS评分差异有统计学意义(P0.05),不同时间点的VAS评分差异有统计学意义(P0.05),分组与时间之间存在交互作用(P0.05);A组患者的不良反应发生率低于B组,差异有统计学意义(P0.05)。结论:肺叶手术中超前应用氟比洛芬酯具有良好的镇痛效果,可以降低全身麻醉苏醒期躁动的发生率。