目的 观察布地格福气雾吸入剂治疗慢性阻塞性肺疾病合并支气管哮喘患者的临床效果及安全性.方法 分析首都医科大学石景山教学医院呼吸科于2020年3月-2021年3月期间接受布地格福气雾吸入剂治疗的50例慢性阻塞性肺疾病合并支气管哮喘患者的临床特征,治疗疗程为3个月,比较治疗前及治疗后患者的慢性阻塞性肺疾病症状控制评分(CAT)、哮喘控制评分(ACT)、圣乔治呼吸问卷(SGRQ)评分、FEV1、FEV1占预值％(FEV1％pred)、第1秒用力呼气容积与用力肺活量的比值(FEV1/FVC％)、PEF占预计值％(PEF％pred);呼出气一氧化氮(FeNO)、急性发作次数变化.结果 经过3个月治疗后,慢性阻塞性肺疾病合并支气管哮喘患者CAT评分从(22.75±1.66)分降至(16.63±2.72)分,ACT评分从(16.33±0.65)分升至(22.35±0.53)分,SGRQ评分从(46.03±6.04)分降至(36.59±4.56)分,差异均有统计学意义(P<0.05),FEV1由(1.40±0.42)L升至(1.80±0.40)L、FEV1％pred由(48.33±6.72)％升至(74.30±7.71)％、FEV1/FVC％由(56.43±8.01)％升至(68.52±8.03)％、PEF％pred由(68.73±3.61)％升至(83.58±3.75)％,差异均有统计学意义(P<0.05);FeNO从(52.53±5.62)ppb降至(25.65±4.81)ppb,差异具有统计学意义(P<0.001);急性发作次数从(2.01±0.22)次/3个月减至(0.52±0.17)次/3个月(P<0.001).治疗期间有1例患者出现咽喉部不适,1例患者出现声音嘶哑,不良反应发生率为4％.结论 布地格福气雾吸入剂治疗慢性阻塞性肺疾病合并支气管哮喘患者可以改善症状、提升肺功能、降低FeNO、减少急性发作次数,效果明确且安全性高.

目的:分析针对哮喘-慢性阻塞性肺疾病重叠综合征(ACOS)急性发作期应用布地奈德福莫特罗联合噻托溴铵的临床疗效及安全性.方法:选择2020年3月-2021年9月首都医科大学石景山教学医院收治的74例ACOS急性发作期患者,按抽签法分为常规组和研究组,每组37例.常规组给予布地奈德福莫特罗治疗,研究组则在常规组的基础上联合噻托溴铵进行治疗,观察两组的临床疗效和安全性.结果:研究组治疗后总有效率、肺功能指标水平、哮喘控制测试(ACT)评分均高于常规组(P<0.05),慢性阻塞性肺疾病评估测试(CAT)评分低于常规组(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05).结论:在针对ACOS急性发作期患者的治疗中,与常规单一药物治疗相比,布地奈德福莫特罗联合噻托溴铵效果良好,可有效缓解患者不良症状,恢复患者肺功能,安全性良好,值得推广应用.

目的:研究重症社区获得性肺炎利用哌拉西林钠他唑巴坦钠联合左氧氟沙星氯化钠治疗的临床疗效.方法:患者就诊时间为2019年10月-2020年10月,选取收治的100例重症社区获得性肺炎患者作为研究对象,按照平均分组原则,将其分为两个组别,其中接受单药哌拉西林钠他唑巴坦钠治疗的50例患者作为对照组,将另外接受哌拉西林钠他唑巴坦钠联合左氧氟沙星氯化钠治疗的50例患者作为观察组,对比两组临床症状改善时间以及临床治疗有效率.结果:观察组肺炎患者的发热、肺啰音、喘息等症状消失时间、痰液状态恢复正常时间均短于对照组,观察组治疗有效率为94％,对照组治疗有效率为72％.结论:重症社区获得性肺炎患者接受哌拉西林钠他唑巴坦钠联合左氧氟沙星氯化钠治疗后,临床疗效明显提升.

目的:分析用经鼻高流量湿化氧疗联合布地奈德治疗慢性阻塞性肺疾病(COPD)合并呼吸衰竭的效果.方法:选择首都医科大学石景山教学医院收治的260例COPD合并呼吸衰竭患者作为研究对象.将其中采用经鼻高流量湿化氧疗联合布地奈德进行治疗的130例患者作为HFNC组,将其中采用无创正压通气联合布地奈德进行治疗的130例患者作为NPPV组.比较两组患者的肺功能指标及血气分析指标.结果:治疗2周后,两组患者的一秒钟用力呼气容积(FEV1)和用力肺活量(FVC)均高于治疗前,且HFNC组患者的FEV1和FVC均高于NPPV组患者,P<0.05.治疗2周后,两组患者的血氧饱和度(SaO2)和动脉血氧分压(PaO2)均高于治疗前,其动脉血二氧化碳分压(PaCO2)均低于治疗前,且HFNC组患者的SaO2和PaO2均高于NPPV组患者,其PaCO2低于NPPV组患者,P<0.05.结论:用经鼻高流量湿化氧疗联合布地奈德治疗COPD合并呼吸衰竭的效果显著,能有效地改善患者的肺功能及血气水平.

目的 探讨吸入性激素的不同给药方式治疗过敏性鼻炎哮喘综合征(CARAS)的临床效果.方法 120例过敏性鼻炎哮喘综合征患者为研究对象,随机将其分为A、B、C三组,各40例.A组使用布地奈德鼻喷雾剂治疗,B组经口吸入布地奈德粉吸入剂治疗,C组鼻喷加口吸联合用药治疗.比较三组患者治疗前和治疗后12周血清免疫球蛋白E(IgE)、白介素-4(IL-4)、外周血嗜酸粒细胞百分比(Eos％)、肺功能情况、临床症状评分.结果 治疗后,三组患者血清IgE、IL-4、Eos％水平均低于治疗前,且C组患者血清IgE、IL-4、Eos％分别为(133.4±55.4)IU/ml、(13.9±4.8)ng/L、(4.13±1.46)％,均低于A组的(186.3±102.7)IU/ml、(19.8±6.7)ng/L、(5.89±1.57)％和B组的(164.8±65.9)IU/ml、(17.5±5.7)ng/L、(5.67±1.57)％,差异均具有统计学意义(P<0.05).治疗后,三组患者第1秒用力呼气容积(FEV1)、第1秒用力呼气容积占用力肺活量百分比(FEV1/FVC)均高于治疗前,且C组FEV1、FEV1/FVC高于A组和B组,差异均具有统计学意义(P<0.05).治疗后,C组的临床症状评分(0.03±0.17)分明显低于A组的(0.10±0.32)分和B组的(0.24±0.37)分,差异均具有统计学意义(P<0.05).结论 在过敏性鼻炎哮喘综合征患者的临床治疗中,不同的给药方式治疗效果不同,其中口鼻联合吸入激素治疗效果最好,可以有效的改善临床症状,提高患者的生存质量.

目的:研究急性胰腺炎大鼠模型白介素-6(IL-6)、转化生长因子-β(TGF-β)、白介素-32(IL-32)及肿瘤坏死因子-α(TNF-α)的表达及联合检测的意义.方法:选取50只健康大鼠随机分为正常组和模型组,各25只.光学镜下检测大鼠小肠粘膜厚度、绒毛高度和上皮损伤,ELISA法检测IL-6、IL-32表达,免疫透射比浊法检测TGF-β、TNF-α表达,对白介素-6、TGF-β、IL-32及TNF-α进行单独检测和联合检测,分析联合检测的意义.结果:模型组大鼠小肠粘膜厚度显著低于正常组,绒毛厚度显著低于正常组;模型组上皮损伤指数显著高于正常组.模型组大鼠IL-6、IL-32、TGF-β、TNF-α表达显著高于正常组.IL-6、IL-32、TGF-β及TNF-α敏感度、特异度、准确度存在差异,TNF-α单独检测敏感度显著高于其他三项,TGF-β单独检测特异度显著高于其他三项;IL-6、IL-32、TGF-β及TNF-α四项联合检测敏感度、特异度、准确度显著高于单项检测.结论:在急性胰腺炎大鼠模型中,白介素-6、TGF-β、IL-32及TNF-α水平显示高表达,在对急性胰腺炎诊断中具有重要意义,四项联合检测可以提高诊断效率,对急性胰腺炎的治疗与预后提供重要的参考价值.

目的:检测肺结核患者血浆中微小RNA-155(miR-155)和细胞因子信号转导抑制物1(SOCS1)的表达水平,探讨二者在肺结核发病中的关系及意义.方法:选取30例活动性肺结核患者作为活动性结核组,30例完成结核治疗患者作为治疗完成组,30例结核潜伏感染者为潜伏感染组,40例健康体检人群作为对照组;活动性结核组、潜伏感染组于入院时,治疗完成组于治疗结束时,对照组于体检当日,采集空腹静脉血,采用实时荧光定量PCR(RT-qPCR)法检测血浆中miR-155水平,采用酶联免疫吸附(ELISA)法检测血浆SOCS1表达水平;利用受试者工作特征曲线(ROC)下面积(AUC)评价miR-155与SOCS1对肺结核的诊断价值,采用Pearson法分析miR-155与SOCS1在肺结核患者血浆中表达的相关性.结果:与对照组比较,治疗完成组、潜伏感染组、活动性结核组患者血浆中miR-155水平逐渐升高,SOCS1水平逐渐降低,差异有统计学意义(P<0.05);ROC曲线分析显示,血浆miR-155、SOCS1诊断肺结核的AUC分别为0.938、0.808,对应的灵敏度分别为83.33％、93.33％,特异度分别为92.56％、65.00％;Pearson分析结果显示,肺结核患者血浆miR-155、SOCS1水平呈负相关(r=-0.455,P<0.05).结论:肺结核患者血浆中miR-155呈现高表达、SOCS1呈低表达,二者为负相关关系,对肺结核有一定诊断价值.

Objective To explore connective tissue growth factor(CTGF)and transforming growth factor β1(TGF-β1)detection levels in serum and bronchoalveolar lavage fluid of patients with chronic obstructive pulmonary disease(COPD)and significance.Methods Totally 65 patients with COPD treated in the hospital from March 2016 to March 2017 were selected as the subjects,the patients were divided into acute exacerba-tion group(32 cases)and stable phase group(33 cases)according to the severity of the disease.Another 35 cases of physical examination in the hospital were selected as the control group.Serum and bronchoalveolar lavage fluid CTGF and TGF-β1 levels were detected by using enzyme-linked immunosorbent assay(ELISA) method,and lung function index,such as forced vital capacity(FVC),forced expiratory volume(FEV1),and FEV1/FVC of patients with COPD were detected,and the relationship was analyzed of CTGF and TGF-β1 in serum and bronchoalveolar lavage fluid and lung function.Results CTGF and TGF-β1 levels in serum and bronchoalveolar lavage fluid in acute exacerbation group were significantly higher than those in stable group and control group(P<0.05).CTGF and TGF-β1 levels in serum and bronchoalveolar lavage fluid of the sta-ble group were significantly higher than those in the control group(P<0.05).Lung function results showed that lung function index FVC,FEV1 and FEV1/FVC value in acute exacerbation group decreased significantly when compared with those in stable group and the control group(P<0.05).FEV1 and FEV1/FVC in the sta-ble group was significantly lower than that in the control group(P<0.05).CTGF expression level was posi-tively correlated in serum and bronchoalveolar lavage fluid of acute exacerbation group,and TGF-β1 was also positively correlated.Serum CTGF and TGF-β1 levels were positively correlated,and CTGF and TGF-β1 in alveolar lavage fluid were also positively correlated.Serum CTGF and TGF-β1 levels were negatively correla-ted with FVC,FEV1,FEV1/FVC,and CTGF and TGF-β1 in alveolar lavage fluid were negatively correlated with FVC,FEV1 and FEV1/FVC respectively.Conclusion The high expression of CTGF and TGF-β1 is closely related to the occurrence and development of COPD,and it can be used as an index for monitoring the condition of COPD.

Objective To explore the role of D-dimer (D-D) level in patients with acute exacerbation of chronic obstructive disease (AECOPD) in predicting the prognosis of patients.Methods 99 patients with AECOPD in our hospital from July 2008 to December 2010 were selected as the subjects,and were divided into observation group (n=50) and control group (n=49) according to the expression of D-D in patients with positive (D-D level cutoff value of 500 g/L).The basic information and survival of the two groups of patients were investigated,and the level of serum D-D was detected by scatter turbidimetry.The receiver operating characteristic curve (ROC) was used to evaluate the predictive value of D-D on the survival of the patients.The survival time of the two groups was compared by Kaplan-Meier.Results There was no statistically significant difference in gender,age and GOLD score between the two groups (P＞0.05).The level of D-D,the time of first hospitalization,the number of re hospitalization,the first hospital mortality and re hospitalization mortality in the observation group were significantly higher than those in the control group (P＜0.05).The ROC curve showed that the truncated value of D-D was 1 171.34 g/L and 893 g/L,respectively.The average survival time of patients in the observation group was 30.37 months and the control group was 46.37 months,respectively;Kaplan-Meier study showed that the survival time of patients in the observation group was significantly lower than that in the control group (x2 =6.371,P＜0.05).Conclusion The level of D-D in patients with AECOPD is of great value in predicting the prognosis of patients,which can be used as an independent indicator of disease progression.

目的：探讨持续气道正压通气（CPAP）治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并2型糖尿病患者的临床治疗效果。方法：选择临床确诊OSAHS合并2型糖尿病的患者共52例，随机分为对照组和观察组各26例，对照组采用常规的降糖治疗，观察组在常规降糖治疗基础上应用CPAP治疗，比较两组治疗前及治疗1个月后呼吸暂停指数（AHI）、最低血氧饱和度（SpO2：Low）、空腹血糖（FBG）、餐后2h血糖（2hPBG）、糖化血红蛋白（HbA1c）等指标情况。结果：两组治疗前各指标差异均无统计学意义（P＞0.05）；观察组治疗1月后与对照组相比AHI显著显著降低，SpO2：Low明显升高（P 0.05），FBG、2hPBG、HbA1c水平均显著降低（均为P 0.05）。结论：CPAP治疗OSAHS合并2型糖尿病患者临床疗效良好，值得临床应用推广。

目的了解北京SARS发病高峰期间来我院发热门诊就诊患者的情况,分析其临床特点.方法采用回顾性分析方法,病例资料选择了在2003年4月26日～5月6日期间来石景山医院发热门诊初诊患者的病历资料.结果这期间共有560例初诊的发热患者前来就诊,平均年龄(31.17±13.63)岁,其中有19例(3.4%)被确诊为SARS患者,疑似患者19例(3.4%).结论 SARS初诊临床不典型,应全面综合考虑,防止误诊、漏诊的发生.面对新发生的疾病要避免恐慌.目前急需病原学和血清学手段来提高诊断的准确性.