目的 探讨社区获得性肺炎患者预后不良的危险因素,为临床改善肺炎患者预后情况提供参考.方法 回顾性分析东莞市滨海湾中心医院2017年7月至2021年3月收治的220例社区获得性肺炎患者的临床资料,根据患者预后情况将其分为死亡组(30例)与生存组(190例),统计两组患者一般资料并进行单因素分析,采用多因素Logistic回归分析筛选社区获得性肺炎患者预后不良的独立危险因素.结果 单因素分析结果显示,死亡组患者的年龄、器官功能障碍数目≥4个的患者占比、血乳酸值、pH值、血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)、降钙素原(PCT)的水平均高于死亡组,氧合指数、血浆白蛋白、总T细胞计数、CD4+T细胞计数、CD8+T细胞计数均低于死亡组(均P<0.05);多因素Logistic回归分析结果显示,高龄、器官功能障碍数目≥?4个、血乳酸值高、氧合指数低、血清PCT、IL-6、CRP水平高、血浆白蛋白水平低、总T细胞、CD4+T细胞、CD8+T细胞计数少均为社区获得性肺炎患者预后不良的危险因素(OR=3.755、2.680、3.865、3.367、2.433、2.010、2.627、2.328、2.113、2.527、2.004,均P<0.05).结论 高龄、器官功能障碍数目≥?4个、血乳酸值高、氧合指数低、血清PCT、IL-6、CRP水平高、血浆白蛋白水平低、总T细胞、CD4+T细胞、CD8+T细胞计数少均为社区获得性肺炎患者预后不良的危险因素,临床上可通过加强对以上因素的筛查与干预,减轻患者病情严重程度,改善患者预后.

目的 探讨支气管肺泡灌洗治疗支气管扩张合并感染对患者第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、超敏?-C反应蛋白(hs-CRP)、肿瘤坏死因子?-α?(TNF-α)及白细胞介素?-8?(IL-8)水平的影响,为提高支气管扩张合并感染的临床治疗效果提供依据.方法 按照随机数字表法将2019年1月至2020年12月东莞市滨海湾中心医院收治的80例支气管扩张合并感染患者分为对照组和试验组,各40例.对照组患者采用常规治疗,试验组患者在对照组治疗的基础上采用支气管肺泡灌洗治疗,两组患者均持续进行6?d的治疗.比较治疗后两组患者湿啰音消失时间、感染控制时间、每日排痰量,治疗前后FEV1、FVC、hs-CRP、TNF-α、IL-8水平.结果 治疗后试验组患者湿啰音消失时间、感染控制时间均短于对照组,每日排痰量少于对照组;治疗后两组患者FEV1、FVC水平均高于治疗前,且试验组高于对照组,而血清TNF-α、hs-CRP、IL-8水平均低于治疗前,且试验组低于对照组(均P<0.05).结论 支气管肺泡灌洗治疗支气管扩张合并感染可有效缓解患者临床症状,改善肺功能,减轻炎症反应.

目的 研究老年重症肺炎患者血清活化蛋白C(APC)、脑钠钛(BNP)水平、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分变化及预后影响因素.方法 回顾性分析东莞市滨海湾中心医院2018年7月至2020年6月收治的116例老年重症肺炎患者的临床资料,根据所有患者28 d内生存情况分为生存组(72例)与死亡组(44例).比较两组患者入院后第1、3、5天血清APC、BNP水平及APACHEⅡ评分,统计两组患者临床资料进行单因素分析,对单因素中差异有统计学意义的因素进行多因素Logistic回归分析.结果 与入院后第1天比,生存组患者入院后第3～5天血清APC水平均呈递增趋势,血清BNP水平及APACHEⅡ评分均呈递减趋势;死亡组患者入院后第3～5天血清APC水平均呈递减趋势,血清BNP水平及APACHEⅡ评分均呈递增趋势;入院后第1～5天生存组患者血清APC水平均高于死亡组,而血清BNP水平及APACHEⅡ评分均低于死亡组;生存组中无吸烟史、未行机械通气的患者占比高于死亡组(均P<0.05);经多因素Logistic回归分析显示,影响老年重症肺炎患者预后的危险因素为机械通气、血清APC水平、血清BNP水平、APACHEⅡ评分(OR=2.818、2.008、1.809、3.445,均P<0.05).结论 机械通气、血清APC、BNP水平及APACHEⅡ评分为影响老年重症肺炎患者预后的相关因素,可通过密切监测患者血清APC、BNP水平并及时采取相应措施进行改善,同时在治疗过程中应在采取适当保护措施前提下行机械通气,并注意机械通气时间,提高患者健康状况,进而降低死亡率.

目的 观察降钙素原(PCT)、脑钠肽(BNP)联合急性生理与慢性健康Ⅱ(APACHEⅡ)评分对呼吸重症监护患者预后的评估价值.方法 选取呼吸重症监护病房(RICU)290例呼吸重症患者进行回顾性分析,根据28天内生存情况,将其分为存活组与死亡组,比较两组入院第1天、3天、5天APACHEⅡ评分、PCT和BNP表达水平,分析患者预后影响因素及PCT、BNP联合APACHEⅡ评分对预后的预测价值.结果 28天内290例患者死亡72例(24.83％),存活218例(75.17％).存活组入院第1天、3天、5天APACHEⅡ评分、PCT和BNP表达水平均明显低于死亡组(P<0.05).存活组与死亡组C反应蛋白(CRP)、PCT、BNP、APACHEⅡ评分差异有统计学意义(P<0.05).Logistic回归分析显示,PCT、BNP、APACHEⅡ评分为RICU呼吸重症患者死亡独立危险因素(P<0.05).受试者工作特征(ROC)曲线分析显示,PCT预后评估灵敏度为79.5％,特异度为77.3％;BNP灵敏度为70.2％,特异度为78.2％;APACHEⅡ评分灵敏度为84.2％,特异度为71.5％;三者联合预测灵敏度为92.6％,特异度为90.1％.结论 PCT、BNP联合APACHEⅡ评分能更好地评估呼吸重症监护患者的预后.

目的 探讨铜绿假单胞菌感染对支气管扩张发病的作用机制,为该病的临床治疗提供理论依据.方法 将30只SD大鼠按随机数字表法分为正常对照组、假手术组和支气管扩张模型组(模型组),每组10只,对大鼠气管注射铜绿假单胞菌,把支气管扩张模型建立起来;假手术组只做气管切开后缝合,正常对照组不予任何处理.术后第14天测定3组大鼠一般情况,苏木素-伊红(HE)染色观察肺组织病理学改变,流式细胞术测定外周血辅助性T细胞17(T helper cell 17,Th17)和调节性T细胞(T regulatory cell,Treg)的表达,酶联免疫吸附试验(ELISA)检测血清白细胞介素(IL)-17、IL-6、IL-10、转化生长因子(TGF)-β的表达.结果 与正常对照组和假手术组比较,模型组用力肺活量(FVC)、0.3 s用力呼吸容积(FEV0.3)、用力呼气峰值流速(PEF)明显下降,而FEV0.3/FVC比值升高(P<0.05).光镜下观察,模型组大鼠支气管扩张明显,有明显的炎症病理性改变.模型组与正常对照组、假手术组分别比较,血清IL-17明显升高(P<0.01)、IL-6明显升高(P<0.01)、IL-10明显降低(P<0.01)、TGF-β明显降低(P<0.01)、Th17表达显著升高(P<0.01)、Treg表达明显降低(P<0.01)、Th17/Treg比值升高(P<0.01).结论 铜绿假单胞菌介导的支气管扩张大鼠炎症反应升高,与Th17/Treg表达失衡有关,导致肺功能下降.

目的 研究乙酰半胱氨酸雾化吸入对支气管扩张症患者的临床治疗效果.方法 75例支气管扩张症患者,随机分为对照组(37例)和观察组(38例).对照组采用生理盐水雾化吸入治疗,观察组采用乙酰半胱氨酸雾化吸入治疗.比较两组患者的疗效,肺功能指标[第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、呼气峰值流速(PEF)],咳痰量、咳嗽次数评分,生活质量评分.结果 观察组总有效率为92.11％(35/38),高于对照组的72.97％(27/37),差异具有统计学意义(P<0.05).观察组患者的FEV1、FVC、PEF均高于对照组,差异均具有统计学意义(P<0.05).观察组患者的咳痰量评分(1.62±0.73)分、咳嗽次数评分(1.20±0.63)分均低于对照组的(2.71±0.98)、(1.57±0.86)分,差异均具有统计学意义(P<0.05).观察组患者的生活质量评分(33.49±5.37)分低于对照组的(40.53±6.54)分,差异具有统计学意义(P<0.05).结论 乙酰半胱氨酸雾化吸入对支气管扩张症患者的治疗效果较好,明显地改善了患者的肺功能,减少咳痰量和咳嗽次数,提高患者的生活质量.

BACKGROUND The prevalence of bronchiectasis with comorbid chronic obstructive pulmonary disease (COPD) is rising, which causes extremely high risk of exacerbation and mortality. We aimed to evaluate the differences in clinicopathological manifestations, immune function, and inflammation in bronchiectasis patients with comorbid COPD vs. patients who only have COPD. MATERIAL AND METHODS Clinicopathological characteristics, including common potentially pathogenic microorganisms, lung function, immune function, and inflammation were assessed in bronchiectasis patients with comorbid COPD and in patients who only had COPD. RESULTS Compared to patients who only had COPD, patients with bronchiectasis with comorbid COPD had a higher positive rate of sputum bacteria (45.27% vs. 28.03%, P<0.01). Among them, Pseudomonas aeruginosa (P. aeruginosa) accounted for 25.19% in COPD (4.37%) (P<0.01). Likewise, patients with bronchiectasis with comorbid COPD had worse lung function, worse COPD assessment test scores, and worse Modified Medical Research Council scores. Moreover, compared with COPD only cases, patients with bronchiectasis with comorbid COPD had higher levels of white blood cells (WBC), neutrophils, C-reactive protein (CRP), and procalcitonin (PCT) (all P<0.05). Interestingly, the expression levels of Treg in patients with bronchiectasis with comorbid COPD were lower than in patients with COPD only (P<0.05). Th17 and Th17/Treg levels were higher (P<0.05). Furthermore, remarkable increased level of IL17 and IL-6 and decreased level of IL-10 and TGF-ß were observed in the bronchiectasis combined COPD than in pure COPD (All P<0.05). CONCLUSIONS Our findings suggest that P. aeruginosa is the main pathogen of bacterial infection in bronchiectasis patients with comorbid COPD. These patients have more serious clinical manifestations and immune imbalance, which should be considered when providing clinical treatment.

目的 探讨细菌溶解产物对慢性阻塞性肺疾病(COPD)急性加重期(AECOPD)患者免疫功能、临床疗效及肺功能的影响.方法 192例AECOPD患者随机分为观察组与对照组各96例,观察组在常规治疗的基础上给予细菌溶解产物胶囊(泛福舒胶囊)治疗.3个疗程结束后,对两组外周血T淋巴细胞亚群、免疫球蛋白(Ig)、补体、Th17细胞、Treg细胞比例进行检测分析,记录并比较两组治疗过程中急性发作次数、急性发作时间及发作期间抗生素应用时间;对比两组治疗后肺功能改善情况.结果 观察组治疗后CD3+细胞、CD4+细胞、CD4+/ CD8+细胞比例、免疫球蛋白(Ig)A、IgG、补体C3、C4水平均高于对照组,CD8+细胞低于对照组(P<0.05);观察组治疗后Th17细胞占CD4+T细胞比例高于对照组,Th17/Treg细胞比例高于对照组(P<0.05).观察组治疗后急性发作次数、急性发作时间及抗生素应用时间均少于对照组(P<0.05).观察组治疗12、24 w中发作及反复发作者比例低于对照组(P<0.05).观察组治疗后肺功能改变情况优于对照组(P<0.05).结论 细菌溶解产物能提高AECOPD患者的体液免疫及细胞免疫功能,增强机体的抗感染能力,降低COPD急性发作及反复发作次数,改善COPD患者的肺功能状态.

Objective To study infection of the lung tissue by bronchoalveolar lavage for BALF and explore whether GM can help improve the he diagnosis efficiency in patients without granulocyte deficiency with IPA, and find the threshold of GM values. Methods Between January 2011 and December 2011, 173 cases of patients were considered possible invasive pulmonary aspergillosis in parallel BALF GM detection in the center of the respiratory endoscopic examination.. According to the diagnostic criteria at home and abroad, all the cases were divided into four groups, including group of IPA, group of tuberculosis, group of bacterial pneumonia and group of non-infection. Using ELISA method for determination of serum and BALF GM. The diagnostic value was made by statistical methods in BALF GM detection without patients of granulocyte deficiency with IPA. Results There were 11 cases in the group of IPA, 23 cases in the group of tuberculosis, 90 cases in the group of bacterial pneumonia and 49 cases in the group of non-infection. In patients without granulocyte deficiency with IPA,BALF GM value was higher comparing with the patients without IPA. There were significant difference between the two groups; Comparing the GM value in the serum, the detection of BALF GM was higher in IPA. ROC curve analysis found that when the BALF GM test value was 0.95 or higher, there was highest possible with IPA. Conclusion BALF GM testing is beneficial to patients of invasive pulmonary aspergillosis without granulocyte deficiency in early identification with IPA. This study found that BALF GM best value is 0.95 or higher.

目的：观察沙美特罗替卡松联合噻托溴铵吸入治疗慢性阻塞性肺疾病(COPD)合并支气管扩张的临床疗效。方法150例 COPD 合并支气管扩张患者,随机分为对照组(68例)和实验组(82例),对照组采用沙美特罗替卡松粉吸入剂治疗12周,实验组在对照组基础上联用噻托溴铵粉吸入剂治疗。对比两组临床疗效。结果治疗后,两组第一秒用力呼气容积(FEV1)/预计值、FEV1/用力肺活量(FVC)、FEV1、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)均优于治疗前,实验组优于对照组(P<0.05)。随访1年中,实验组急性发作(2.3±1.1)次,对照组为(3.6±1.8)次,实验组少于对照组(t=5.43, P<0.05)。实验组 COPD 评估测试(CAT)问卷评分(8.2±2.1)分,对照组为(10.3±2.6)分,实验组低于对照组(t=5.47, P<0.05)。结论沙美特罗替卡松联合噻托溴铵吸入治疗 COPD 合并支气管扩张的疗效显著,可显著改善患者生活质量,减少急性发作次数,值得临床推广。

Abstrac Objective:To explore clinical effective treatment approach for the analysis of bronchiectasis with asthma.Methods:In May 2012 to April 2014 I department admitted during the period of 40 patients with bronchiectasis with asthma were randomly divided into observation group and control group .Control group given conventional treatment,the observation group in the control group treated with hormone inhaling,on the basis of observation of two groups of patients get better condition and the change of lung function index.Results:Observation group after corresponding treatment of improvements and changes in lung func-tion index were superior to control group,the differences between the two groups have statistical significance (P <0.01).Conclusion:In conventional methods to join hormone inhalation in the treatment of bronchiectasis with asthma can improve the patient's clinical symptoms improve ventilation function.

Objective To investigate the clinical effect of Broncho-Vaxom combined with postural drainage in the treatment of bronchiectasis.Methods 78 cases of bronchiectasis whose acute phase condition was under control after treatment,were randomly double-blind divided into two groups.Control group received postural drainage,and treatment group received Broncho-Vaxom capsule combined with postural drainage.Compared immune indexes after 3 months and clinical symptoms including cough and expectoration,number of respiratory infection during 6 months between two groups.Results Cough and expectoration symptoms after treatment in treatment group were better than those in control group (P=0.046),the number of respiratory tract infection was lower (P=3.43× 1012).Expression levels of CD4+,CD4+/CD8+,NK after treatment improved significantly in treatment group (P＜0.01),expression level of CD8+ decreased (P＜0.01).Expression levels of CD4+,CD4+/CD8+,NK in control group before and after treatment did not change significantly.The levels of IgG and IgA after treatment in treatment group were significantly higher those in control group (P＜0.01).Conclusions Broncho-Vaxom combined with postural drainage can relieve cough and expectoration symptoms of bronchiectasis patients,reduce the incidence of respiratory tract infection,enhance body immunity.Broncho-Vaxom has a good drug tolerance,with slight side effect.

目的：对无创呼吸机治疗慢性阻塞性肺疾病急性加重期早期的疗效进行探讨。方法：选取我院收治的80例慢性阻塞性肺疾病患者为研究对象，随机分组，对照组实施常规治疗，实验组在对照组的基础上增加无创呼吸机治疗。对两组患者的临床疗效进行评估。结果：实验组的PaO2、PaCO2、心率、呼吸、pH改善情况明显优于对照组，有统计学意义（P<0.05）；实验组的住院时间比对照组短，并发症发生率比对照组少，有统计学意义（P<0.05）。结论：采用无创呼吸机对慢性阻塞性肺疾病急性加重期早期进行治疗，效果明确，安全性高，值得普及和应用。

目的:探讨B超定位针刺胸膜活检在胸膜疾病诊断中的阳性率和安全性。方法:对近4年诊断为胸膜疾病并行针刺胸膜活检、胸水脱落细胞检查的68例患者的临床资料进行回顾性分析。结果:68例胸膜活检中提示结核性胸膜炎23例(33.8%)、慢性炎症13例(19.1%)、腺癌11例(16.1%)、鳞癌5例(7.0%)、小细胞癌3例(4.4%)、不明部位的转移癌3例(4.4%)、间皮瘤1例(1.4%),活检失败得到胸膜组织病理报告为骨胳肌组织和纤维脂肪组织9例(13.2%),胸膜活检恶性阳性率33.8%,胸水脱落细胞阳性率仅为29.4%,总病理确诊率为86.7%。术后并发症主要是气胸3例(4.4%),胸膜反应2例(2.9%),出血1例(1.4%)。结论:在胸膜疾病中,B超定位针刺胸膜活检是一种有效的诊断手段,阳性率高,致命并发症极少。