Objective:To observe the role of Huaiqihuang Granules (HQ) in the long-term management of bronchial asthma in young children, and the effective effect on concomitant rhinitis.Methods:A prospective real-world multicenter study was conducted in children aged 2-5 years with asthma diagnosed in the outpatient department (from April 2016 to March 2019)who received either inhaled corticosteroid (ICS)/leukotriene receptor antagonist (LTRA)(control group); inhaled ICS/LTRA plus HQ(combination group), or HQ alone(HQ group). All patients were followed up at week 4, 8, 12 after treatment. The number of days with asthma symptoms, the frequency of severe asthma attacks, the level of asthma control, and the days with rhinitis symptoms in the last 4 weeks were recorded. Differences before and after treatment, and those among groups after treatment were compared using Kruskal- Wallis H test or Wilcoxon rank-sum test. Results:A total of 2 234 eligible patients were recruited, and 2 147 cases completed followed-up visits, including 477, 1 374 and 296 cases in the control group, combination group, and HQ group, respectively. After the treatment, all 3 groups showed significant declines in the days with asthma symptoms, frequency of severe asthma attack and the days with rhinitis symptoms (all P<0.01), and the rate of well-controlled asthma increased significantly ( P<0.01). It lasted until the end of follow-up. Among groups, patients in the combination group showed significantly less days of asthma symptoms than those of the other 2 group at week 8 and 12[0(0, 0.9) d vs.0(0, 0.3) d, P<0.05; 0(0, 0.1) d vs. 0(0, 1.0) d, P<0.01]. Patients in the combination group and HQ group showed a significantly lower rate of severe asthma attacks than that of the control group at week 12 [0(0, 1), 0(0, 1), 0(0, 2), all P<0.05]. The well-controlled rate of asthma in the combination group was significantly higher than that of the control group and HQ group at week 8 and 12 (89.6% vs. 85.9% vs.82.1%, H=15.28; 90.9% vs. 84.1% vs. 81.8%, χ2=29.32, all P<0.01). Conclusions:HQ can significantly alleviate symptoms of asthma and rhinitis, severe attack of asthma, and increase the control rate of asthma when used as an additional treatment or used alone.

目的:评价动态胸X线片膈肌运动在慢性阻塞性肺疾病(COPD)呼吸功能评估中的意义.方法:选取我院就诊的96例稳定期COPD患者和50例健康受试者,完成肺功能检查及动态胸片检查.获得肺通气功能及动态胸X线片横膈移动幅度、速度及时间等参数.分析并对比两组间肺功能和动态胸片各参数的差异,评估动态胸片各参数在COPD呼吸功能评估中的价值.结果:COPD组FEV1、FEV1％pre以及FEV1/FVC均低于健康受试组,且差异均有统计学意义(P＜0.01).平静呼吸时,COPD组双侧膈肌运动幅度、双侧膈肌上升速度和双侧膈肌下降速度均高于健康受试组,且均差异有统计学意义(P＜0.05).用力呼吸时,COPD患者吸气时间和呼气时间以及双侧膈肌运动幅度均小于健康受试者,且均差异有统计学意义(P＜0.05).用力呼吸时,双侧膈肌运动幅度与肺功能各项指标均成正相关.对动态胸X线片参数做K-均值聚类分析,各变量对聚类结果的重要程度前五位分别为:用力呼吸左侧膈肌运动幅度(F=86.88),用力呼气左侧膈肌运动速度(F=79.37),用力吸气左侧膈肌运动速度(F=77.41),用力吸气右侧膈肌运动速度(F=72.28),用力呼吸右侧膈肌运动幅度(F=54.46).结论:动态胸X线片可以精准评估双侧横膈的运动状态,与肺功能参数一致性好,可以作为COPD的肺功能评估的补充工具.

目的 总结爱泼斯坦-巴尔病毒(Epstein-Barr virus,EBV)感染所致肺部感染的胸部高分辨CT(high resolution CT,HRCT)特征,并探讨其临床诊断价值.方法 回顾性分析2017年11月至2020年2月首都医科大学附属北京友谊医院收治的16例EBV感染所致肺部感染患者的临床资料,包括性别、年龄、临床诊断、症状、体征、实验室检查、EBV-DNA拷贝数、EBV抗体及胸部HRCT表现等.结果 16例患者中男10例,女6例,年龄11-62岁;临床诊断包括嗜血细胞综合征12例(75.0％)、慢性活动性EBV感染1例(6.2％),EBV感染2例(12.5％)及乳腺癌术后维持化疗1例(6.2％).患者外周血EBV-DNA均阳性,拷贝数＞5.0×102拷贝/ml,7例EBV相关抗体阳性,提示EBV急性感染或机体存在EBV复制.胸部HRCT主要表现为磨玻璃密度斑片影(87.5％)、淋巴管周围结节(81.2％)、小叶间隔不规则增厚(68.8％)、支气管血管束旁结节(56.2％)、胸膜下结节影(50.0％)、支气管血管束增粗(43.8％)和小叶内间隔增厚(37.5％),其他表现有胸腔积液(25.0％)和纵隔/肺门淋巴结肿大(6.2％).结论 EBV感染所致肺部感染主要表现为间质性肺炎,病变沿肺内淋巴管走行分布,以多种形态混合多见.胸部HRCT表现具有一定特征,可为临床诊断提供一定参考.

目的 探讨巨噬细胞抑制因子-1(MIC-1)、鳞状细胞癌抗原(SCC)、细胞角蛋白19片段抗原21-1(CYFRA21-1)水平对早期非小细胞肺癌诊断、预后的价值.方法 以93例非小细胞肺癌患者为研究组,同期70例健康体检者为对照组,对比两组MIC-1、SCC、CYFRA21-1水平;分析MIC-1、SCC、CYFRA21-1水平对早期非小细胞肺癌的诊断价值;分析影响早期非小细胞肺癌患者治疗预后的独立危险因素.结果 研究组MIC-1、SCC、CYFRA21-1水平均高于对照组(P＜0.05);MIC-1、SCC、CYFRA21-1三者联合检测的AUC最大(0.992);死亡组与生存组肿瘤类型、肿瘤直径及SCC、MIC-1、CYFRA21-1水平比较,差异有统计学意义(P＜0.05);肿瘤直径＞4cm、肿瘤类型(腺癌)、MIC-1＞1000 pg/ml、SCC＞3.3 mg/L、CYFRA21-1＞2.5 μg/L是影响非小细胞肺癌患者预后的独立危险因素(P＜0.05).结论 相较于健康人群,早期非小细胞肺癌患者体内的MIC-1、SCC、CYFRA21-1水平均异常升高;三者联合检测有助于早期非小细胞的诊断.而肿瘤直径、肿瘤类型、MIC-1、SCC、CYFRA21-1 是影响非小细胞肺癌患者预后的独立危险因素.

目的 探讨肺癌患者血清淋巴细胞-单核细胞比值(LMR)、中性粒细胞-淋巴细胞比值(NLR)、血小板-淋巴细胞比值(PLR)变化及对预后的预测价值.方法 选取2015年1月至2018年5月我院诊治的肺癌患者90例(肺癌组),选取同期健康体检者90例(对照组),检测两组血清中的LMR、NLR、PLR变化,根据预后将肺癌组分为生存组和死亡组,比较两组血清LMR、NLR、PLR水平.分析对预后的预测价值及影响因素.结果 肺癌组LMR、NLR、PLR水平高于对照组(P<0.05);生存组LMR、NLR、PLR水平低于死亡组(P<0.05);LMR、NLR、PLR的最佳诊断截点分别为5.93、3.28、139.38;LMR、NLR、PLR联合预测的AUC高于LMR、NLR和PLR(P<0.05);生存组和死亡组在病理类型、TNM分期、淋巴结转移、远处转移、LMR水平、NLR水平、PLR水平方面比较差异有统计学意义(P<0.05);病理类型、远处转移、NLR水平、PLR水平为影响肺癌患者预后的独立危险因素(P<0.05).结论 肺癌患者血清LMR、NLR、PLR水平升高,可用于预测在常规临床实践中肺癌患者的预后.

目的 评估预后营养指数(prognostic nutritional index,PNI)变化对接受新辅助化疗(neoadjuvant chemotherapy,NAC)乳腺癌患者预后的影响.方法 本研究为一项单中心、回顾性队列研究.选2008年1月至2017年12月在本院接受NAC和手术切除的乳腺癌患者为研究对象,随访截至2020年12月.主要研究终点为无病生存期.采用时间依赖的ROC曲线计算NAC前PNI(pre?PNI)、NAC后PNI(post?PNI)以及NAC前后PNI(ΔPNI)的截断值,采用Cox比例风险回归分析PNI与无病生存期的关联性.结果 共131例患者符合标准纳入研究.NAC后PNI较NAC前降低(46.4±4.5 vs 52.5±4.2,P<0.001).ΔPNI的截断值为5.26.高ΔPNI组的无病生存率明显低于低 ΔPNI组(P<0.001).多因素Cox比例风险回归显示,ΔPNI、NAC前的临床分期、HER?2均是无病生存期的独立影响因素(均P<0.05).结论 NAC期间PNI降低提示预后不良.在NAC期间保持良好营养状态可能会为乳腺癌患者带来更好的治疗结果.

目的 分析血清癌胚抗原(CEA)、甲胎蛋白(AFP)、细胞角蛋白19片段(CYFRA21-1)在非小细胞肺癌(NSCLC)患者中的表达及与病理特征和预后的关系.方法 收集2018年9月至2020年9月首都医科大学附属北京世纪坛医院收治的92例NSCLC患者(NSCLC组),另选取同期89例健康体检志愿者(对照组).收集患者一般资料,比较两组血清CEA、AFP、CYFRA21-1表达水平,分析CEA、AFP、CYFRA21-1与NSCLC病理特征和预后的关系.结果 NSCLC组患者血清中CEA、AFP、CYFRA21-1表达水平均明显高于对照组,差异有统计学意义(P<0.05).Ⅲ～Ⅳ期、低分化、淋巴结转移者CEA、AFP、CY-FRA21-1阳性率明显高于I-II期、中高分化、无淋巴结转移者,差异有统计学意义(P<0.05),在不同年龄、性别、病理类型之间CEA、AFP、CYFRA21-1阳性率比较差异无统计学意义(P>0.05).92例患者根据预后情况分为预后良好组71例,预后不良组21例.TNM分期、组织分化、CEA、AFP、CYFRA21-1为影响NSCLC患者预后的单因素(P<0.05).经多元Logistic回归分析可知,TNM分期、组织分化、CEA、AFP、CYFRA21-1为影响NSCLC患者预后不良的独立危险因素(P<0.05).结论 血清CEA、AFP、CYFRA21-1在NSCLC患者中的表达均上调,与患者病理特征和预后密切相关,可能可作为预后评估的有效指标.

目的 探讨红细胞体积分布宽度(RDW)、白细胞介素6(IL-6)水平对急性呼吸窘迫综合征(ARDS)患者预后的评估价值.方法 收集2018年1月至2020年1月于首都医科大学附属北京友谊医院就诊的96例ARDS患者的临床资料,根据预后情况分为存活组(46例)和死亡组(50例).比较2组患者RDW、IL-6及一般临床资料的差异,探讨ARDS患者死亡的影响因素,分析RDW、IL-6对ARDS患者死亡的诊断效能.结果 死亡组患者的年龄、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、白细胞计数、C反应蛋白水平明显高于存活组,而氧合指数明显低于存活组,差异均有统计学意义(均P<0.05).死亡组患者的RDW、IL-6明显高于存活组[(17±4)％比(13±3)％、(215±38)ng/L比(80±22)ng/L],差异均有统计学意义(均P<0.001).Logistic多因素回归分析显示年龄(比值比=1.876)、RDW(比值比=2.133)、IL-6(比值比=1.978)及APACHEⅡ评分(比值比=1.655)均是ARDS患者死亡的影响因素(均P<0.05).RDW、IL-6诊断ARDS患者死亡的受试者工作特征曲线下面积分别为0.826、0.877,最佳截断值分别为14.32％、178.47 ng/L,二者联合诊断的曲线下面积为0.951,高于任一单项指标(均P<0.001).结论 RDW、IL-6对ARDS患者预后均具有较好的预测价值,二者联合检测有助于早期评估患者病情以改善预后.

Background We performed a systematic review and meta-analysis to evaluate the risks of ophthalmic adverse events (AEs) associated with immune checkpoint inhibitors (ICIs) in patients with solid tumors.Methods Eligible studies were selected after a comprehensive search of multiple databases including phase II/III randomized controlled trials (RCTs) investigating ICIs in patients with the solid tumor. The data was analyzed by R software.Results After exclusion of ineligible studies, 21 RCTs met our strict inclusion criteria for the meta-analysis, included 11930 patients. Compared with chemotherapy, the odds ratio of all-grade ophthalmic treatment-related adverse events (trAEs) were significantly lower for PD-L1 inhibitors (OR: 0.18; 95% CI: 0.08-0.39; p<0.0001) and PD-1 inhibitors (OR 0.44, 95% CI: 0.23-0.83, p<0.050). The combination therapy of PD-1 plus CTLA-4 inhibitors significantly increased the risks of all-grade ophthalmic trAEs (OR 5.29, 95% CI: 1.59-17.57, p<0.05) and all-grade ophthalmic immune-related AEs (irAEs) ( OR: 3.67; 95%CI: 1.08-12.50; p<0.05) compared with PD-1 or CTLA-4 inhibitors monotherapy. The combination therapy of ICIs plus chemotherapy also significantly increased the risks of all-grade ophthalmic trAEs (OR, 3.44; 95%CI, 1.72-6.88; p<0.001) and all-grade ophthalmic irAEs ( OR: 3.69; 95%CI: 1.32-10.32; p<0.05) compared with chemotherapy. The risks of high-grade ophthalmic AEs had no difference in any subgroup compared with control.Conclusions Our meta-analysis demonstrated that compared with chemotherapy, PD-L1/PD-1 inhibitors had lower risks of all-grade ophthalmic trAEs and non-specific ophthalmic trAEs (NS-trAEs) but had the same risk of ophthalmic irAEs. Combination therapy of ICIs plus chemotherapy had higher risks of all-grade ophthalmic trAEs and irAEs. Compared with PD-1 or CTLA-4 inhibitors monotherapy, PD-1 plus CTLA-4 inhibitors combination therapy had significantly higher risks of all-grade ophthalmic trAEs and irAEs.

To explore the effect of the full iterative model reconstruction algorithm (IMR) on chest CT image processing and its adoption value in the clinical diagnosis of lung cancer patients, multislice spiral CT (MSCT) scans were performed on 96 patients with pulmonary nodules. Reconstruction was performed by hybrid iterative reconstruction (iDose4) and IMR2 algorithms. Then, the image contrast, spatial resolution, density resolution, image uniformity, and noise of the CT reconstructed image were recorded. The benign and malignant pulmonary nodules of patients were collected and classified into malignant pulmonary nodule group and benign pulmonary nodule group, and the differences in chest CT imaging characteristics between the two groups were compared. The subject’s receiver operating characteristic (ROC) curve was used to analyze the diagnostic sensitivity, specificity, and area under the curve (AUC) of CT for benign and malignant pulmonary nodules. It was found that the spatial resolution, density resolution, image uniformity, and contrast of the CT image reconstructed by the IMR2 algorithm were remarkably greater than those of the iDose4 algorithm, and the noise was considerably less than that of the iDose4 algorithm ( P < 0.05 ). Among 96 patients with pulmonary nodules, 65 were malignant nodules, including 15 squamous cell carcinoma, 31 adenocarcinoma, and 19 small cell carcinomas. There were 31 cases of benign nodules, including 14 cases of hamartoma, 10 cases of tuberculous granuloma, 2 cases of sclerosing hemangioma, and 5 cases of diffuse lymphocyte proliferation. The pulmonary nodule malignant group and the pulmonary nodule benign group had statistical differences in pulmonary nodule size, nodule morphology, burr sign, lobular sign, vascular sign, bronchial sign, and pleural depression sign ( P < 0.05 ). The sensitivity, specificity, and area under the curve (AUC) of IMR2 algorithm processing chest CT images for liver cancer diagnosis were 85.7%, 82.3%, and 0.815, respectively, which were significantly higher than the original CT images ( P < 0.05 ). In short, chest MSCT based on the IMR2 algorithm can greatly improve the diagnosis efficiency of lung cancer and had practical significance for the timely detection of early lung cancer.

目的 应用动态胸片定量分析用力呼吸下慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease,COPD)患者与健康者双侧横膈运动状态的差异.方法 前瞻性纳入96例COPD患者和50例健康者,在用力呼吸下行动态X线胸片检查.通过后处理软件自动分析获得横膈移动距离、时间及速率,进行两组间差异的比较及横膈移动距离与肺功能相关性分析.结果 用力呼吸下COPD患者横膈移动幅度小于健康者(P<0.05),左侧COPD(35.93±13.07)mm、左侧健康者(41.49±12.07)mm;右侧COPD(32.05±12.29)mm、右侧健康者(36.88±10.96)mm.COPD患者双侧横膈移动时间均小于健康者(P<0.05),吸气时间:左侧COPD2.03(1.19)s、左侧健康者(2.53±0.83)s、右侧COPD1.94(1.32)s、右侧健康者2.23(1.21)s;呼气时间:左侧COPD4.77(3.25)s、左侧健康者(6.40±2.73)s;右侧COPD4.94(3.30)s、右侧健康者(6.72±2.58)s.两组间双侧横膈峰值速率无明显差异(P>0.05).双侧横膈移动幅度与FEV1/FVC相关性中等(r=0.44).结论 用力呼吸下COPD患者双侧横膈移动幅度及时间均小于健康者.动态胸片可以辅助临床精准评估双侧横膈的运动状态.

Objective:To explore the effect of dynamic chest digital radiography (DR) on the evaluation of diaphragm motor function in patients with chronic obstructive pulmonary disease (COPD).Methods:This was a prospective study.A total of 95 COPD patients were included in Department of Respiratory Medicine, Beijing Friendship Hospital, Capital Medical University from June 2018 to June 2019.The patients were divided into two groups by pulmonary function forced expiratory volume in the first second in percent predicted values (FEV 1%pred), the mild-moderate group (GOLD 1 or 2, n=52) and the severe-very severe group (GOLD 3 or 4, n=43). Chest DR was performed in tidal breathing and forced breathing, the diaphragm movement amplitude, the peak motion speeds and the right diaphragm angle (formed by the line of right costal diaphragm point and the right diaphragm apex and the horizontal line) were compared between two groups.Correlation analysis was performed between the motionparameters of the diaphragms and pulmonary function. Results:During tidal breathing, there was no significant difference in the diaphragm movement amplitude and peak motion speed, but the diaphragm movement amplitude in severe-very severe group was significantly less than those in mild-moderate group during forced breathing (all P<0.05)(left, [28.98±10.49] mm vs [35.38±12.08] mm, right, 24.87[12.77] mm vs.36.00[16.40] mm). Peak motion speeds in inspiratory phase and expiratory phase were significantly less in severe-very severe group compared with mild-moderate group ( P<0.05). No significant difference of movement amplitude of the diaphragms could be seen between the two groups ( P>0.05). Correlation analysis showed that the diaphragm movement amplitude and maximum movement rate were positively correlated with FEV 1/FVC, and negatively correlated with residual air volume/total lung volume ( P<0.05). Conclusions:Dynamic DR is a potential and effective tool for the assessment of diaphragmatic function in patients with COPD.

目的:分析新型冠状病毒肺炎(COVID-19)患者的凝血指标情况及影响凝血功能的相关因素,为COVID-19患者抗凝治疗提供参考.方法:回顾性分析2020年2月初至3月,华中科技大学同济医学院附属协和医院西院区收治的COVID-19确诊患者123例,其中普通型组(n=39)、重型组(n=66)和危重型组(n=18).比较三组患者的一般情况、凝血指标、Padua评分,分析影响患者凝血功能和病情程度的危险因素.结果:普通型组与重型组,普通型与危重型在年龄、Padua评分上差异有统计学意义;普通型组与危重型组,重型组与危重型组在D-Dimer水平差异有统计学意义.将普通型及重型+危重型按是否D-Dimer＞ 1.00 μg/mL各分为两亚组,分析影响凝血指标因素,结果显示重型+危重型亚组患者在白蛋白、前白蛋白及谷丙转氨酶之间差异有统计学意义.结论:年龄、D-Dimer、VTE高危是COVID-19患者病情加重的危险因素,年龄越大、D-Dimer越高、VTE高危的患者病情越重,患者的凝血功能与肝功能相关.

新冠肺炎严重威胁人类生命安全和身体健康,广大医务工作者为拯救患者生命不懈努力,而医院后勤系统为医院正常运行提供保障.面对重大疫情,首都医科大学附属北京世纪坛医院后勤系统采取网格化管理,围绕患者就诊、医护诊疗、后勤服务3条主线,健全服务评价系统,抓好重点环节管控,制定启动应急预案,有效降低医院感染风险.通过抓住后勤保障工作中疫情防控重点,创新管理举措,统筹协调、责任到人,完善了“人流、物流、信息流”的全要素管理,为提高疫情防控工作处置效率奠定了坚实基础,取得了良好成效.

目的:探讨改良眼轮匝肌缩短术联合延续性护理在下睑内翻患者中的应用效果.方法:选取44例(88眼)下睑内翻患者,根据手术方法分为治疗组(n=22,44眼,改良眼轮匝肌缩短术)与对照组(n=22,44眼,眼轮匝肌缩短术).两组患者均进行延续性护理.分别于术前及术后1个月观察两组患者下睑睑裂形态变化,评估睑板腺的脂质分泌情况、眼表症状及体征变化情况;分别于术后1周、3个月、6个月进行温哥华瘢痕量表(Vancouver scar scale,VSS)评分;评估患者的满意度.结果:术后1个月两组OSDI评分均低于术前,且治疗组低于对照组,差异有统计学意义(P<0.05).两组睑脂评分较术前降低,但组间比较差异无统计学意义(P>0.05).术后1个月两组睑裂宽度、泪阜显露率、睫毛朝向角度均显著高于术前,且治疗组高于对照组,差异有统计学意义(P<0.05).术后1周至术后6个月,两组患者的VSS评分逐渐降低,且治疗组术后3个月、6个月的VSS评分均低于对照组,差异有统计学意义(P<0.05);但术后1周两组VSS评分比较差异无统计学意义(P>0.05).治疗组满意率为95.45％显著高于对照组(72.73％),差异有统计学意义(P<0.05).结论:下睑内翻患者行改良眼轮匝肌缩短术联合延续性护理有助于提高患者下睑睑裂形态,减轻切口瘢痕程度,同时有助于缓解患者的临床症状,提高满意度,值得推广使用.

目的 观察动态X线胸片定量分析平静呼吸下慢性阻塞性肺疾病(COPD)患者横膈运动的价值.方法 对96例COPD患者(COPD组)和50名健康对照者(对照组)行平静呼吸下动态X线胸片检查,经后处理获得横膈运动幅度、速度及时间;记录2组肺功能检查结果,比较组间动态X线胸片及肺功能参数值差异,分析COPD横膈运动参数与肺功能参数的相关性.结果 平静呼吸下COPD组左、右侧横膈运动幅度[(18.63±7.45)mm、(15.64±5.98) mm]均大于对照组[(14.69±5.40)mm、(13.13±4.84)mm,P均＜0.05];吸气时和呼气时COPD组左侧横膈运动速度18.79(15.67,22.67)mm/s、16.00(12.36,21.23) mm/s,右侧为17.00(12.71,19.73) mm/s、13.75(9.50,16.83) mm/s;对照组左侧为15.33(13.96,17.71)mm/s、11.42(9.63,16.00) mm/s,右侧为(14.91±4.38) mm/s、(10.66±3.66) mm/s(P均＜0.05).2组肺功能检查结果差异均有统计学意义(P均＜0.01).COPD组肺功能参数与动态胸片检查各参数均无明显相关(P均＞0.05).结论 动态X线胸片可定量分析COPD患者横膈运动,有望为临床精准评估COPD提供新的手段.

目的 探讨支气管肺泡灌洗液细胞分类及T细胞亚群测定对间质性肺疾病的诊断价值.方法选取我院收治的间质性肺疾病患者59例,行支气管肺泡灌洗及经支气管肺活检,测定灌洗液细胞分类及T细胞亚群CD4+/CD8+.结果59例患者最终明确诊断52例,其中结节病16例,特发性肺间质纤维化(IPF)5例,非特异性间质性肺炎(NSIP)10例,隐源性机化性肺炎(COP)11例,外源性过敏性肺炎(HP)2例,嗜酸性粒细胞肺炎(EP)2例.肺结核3例,血管炎1例.EP患者BALF嗜酸性粒细胞(EOS)大于25％;HP患者淋巴细胞比例高达70％;NSIP和结节病患者BALF中淋巴细胞比例增高,分别为34.0±19.56％和27.50±18.53％;结节病患者T细胞亚群CD4+/CD8+升高为5.64±3.90,而COP中降低为0.95±0.53.结论BALF细胞分类及T细胞亚群CD4+/CD8+测定有助于间质性肺疾病的鉴别诊断.

患者,男,81岁,因"发热1天"于2017年8月20日入院.患者2周前曾患上呼吸道感染,经抗感染治疗后呼吸道症状均已缓解,于1天前无明显诱因出现发热,最高体温39. 2℃,伴畏寒,无皮疹,无咳嗽、咳痰、胸闷、喘憋等,来我院就诊.入院体格检查:T 38. 7℃,P 112次/分,R 28次/分,Bp 150/55 mmHg.

目的 探讨支气管镜下刷检在儿童难治性肺炎支原体肺炎(RMPP)治疗方面的应用价值.方法 回顾性分析2009年5月至2018年2月因RMPP收住首都医科大学附属北京友谊医院并行支气管镜检查的52例患儿资料,根据CT检查结果将患儿分为肺不张组(15例)及肺部实变组(37例),再根据所行电子支气管镜下操作不同分为支气管镜下支气管肺泡灌洗(BAL)治疗组及支气管镜下BAL联合刷检治疗组,肺不张组患儿中4例行单纯BAL治疗,11例行BAL联合刷检治疗;肺部实变组患儿中20例行单纯BAL治疗,17例行BAL联合刷检治疗.分别比较单纯BAL治疗和BAL联合刷检治疗对肺不张和肺部实变患儿的临床价值.结果 肺不张组患儿,对比2周内肺部炎症吸收情况,BAL联合刷检治疗组优于单纯BAL治疗组[81.9% (9/11)比25% (1/4),χ2=4.261,P =0.039].肺部实变组患儿,BAL联合刷检治疗组1周内肺部炎症吸收情况优于单纯BAL治疗组[58.8% (10/17)比20% (4/20),χ2=6.514,P =0.039].结论 对于儿童RMPP,特别是伴有炎症性肺不张的患儿,早期行支气管镜下刷检治疗,能够缩短病程,减少后遗症的发生,改善预后.

目的 探讨常用肿瘤标志物对良恶性胸腔积液的鉴别诊断价值.方法 选取自2014年6月至2015年6月住院的69例渗出性胸腔积液患者,根据诊断结果分为良性组(39例)和恶性组(30例),对其临床资料进行比较,以ROC曲线、Logistic回归判断相关指标诊断恶性胸腔积液的价值.结果 2组在性别、胸痛、咯血、消瘦、白细胞计数、中性粒细胞比例、C-反应蛋白、胸水LDH、血清LDH,胸水/血清LDH、血清CA125方面差异无统计学意义,具有可比性;2组在年龄、发热、咳嗽、呼吸困难方面差异有统计学意义(P均＜ 0.05);良性组血沉、胸水ADA显著高于恶性组,恶性组胸水CEA、血清CEA、胸水/血清CEA,胸水CA25,胸水/血清CA125,胸水CA199,血清CA199,胸水/血清CA199,血NSE、血Cyfra21-1均显著高于良性组.血Cyfra21-1,胸水CA125,胸水CEA曲线下面积依次为0.871,0.858,0.853.经Logistic回归分析,发热、胸水ADA升高,胸水/血清CEA≤1倾向良性胸腔积液的诊断.结论 血Cyfra21-1,胸水CA125,胸水CEA是诊断恶性胸腔积液较好的指标,发热、胸水ADA升高,胸水/血清CEA≤1倾向良性胸腔积液的诊断.