气管内脂肪瘤（Endobronchial lipomas）是一种罕见的气道内良性肿瘤，因内含成熟的脂肪组织在胸部CT表现为均匀一致的低密度影。本文通过报道了 1例在胸部CT上表现为典型低密度影的气管内脂肪瘤，介绍了该病的发病机制、影像特征、内镜表现及治疗方法，分析并总结了以气道内低密度影为表现的疾病的鉴别诊断思路，为临床医生早期诊断该病提供参考。

报道1例支气管结石合并曲霉感染的病例，因支气管结石阻塞管腔后继发曲霉感染，并引起咯血，最终经取石治疗后好转。本文介绍了该病的发病机制、诊断、鉴别诊断及治疗方法，以提高临床医生对该病的认识。

结节性脂膜炎是原发于脂肪小叶的非化脓性炎症,根据受累部位,可分为皮肤型和系统型,系统型脂膜炎可累及多个内脏器官。近年虽见有结节性脂膜炎肺部受累的病例报告[1-5],但多为先出现皮肤损害,后出现肺部受累,或同时出现皮肤损害和肺部受累,少有以肺部受累为首发表现的病例报告。现将我院收治的1例以机化性肺炎为首发表现的结节性脂膜炎的病例诊治经过和相关文献的学习,报道如下:

1 临床资料 患者,男,70 岁,无明显诱因出现间断咳嗽,抗感染治疗后仍有咳嗽,胸部 CT 示右肺内见弥漫性条索影、条片样及斑片状高密度影.既往高血压病史 2 年,停用降压药物 1 年.查体:右肺呼吸音消失,左肺呼吸音弱.了解患者一般状态、血压和心电图,无行纤维支气管镜(简称纤支镜)检查禁忌症,镜下见气管通畅,隆突锐利,右上叶尖段、前段粘膜肿胀,管腔狭窄.于右上叶后段行 TBLB 术和右上叶灌洗查抗酸杆菌.检查结束后起身时突然咯一口鲜血,量约 10 ml 左右,随即出现意识不清,呼叫无应答,左侧肢体活动障碍,查体口角歪斜,左侧鼻唇沟较右侧浅,左侧肢体肌力 0 级,肌张力消失.

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气管内原发性肿瘤在临床中较少见,多为恶性肿瘤,以鳞癌和腺样囊性癌为主.据报道,气管内良性肿瘤约占气管内肿瘤的0.5%[1],而气管内神经鞘瘤更为罕见,现将本科收治的3例患者报告如下: 1 临床资料 例1:代某,男性,65岁,感冒后出现咳嗽,咳黄痰,伴呼吸困难,抗感染治疗后咳嗽、咳痰症状好转,但呼吸困难无明显缓解,遂行胸部CT检查,提示主气道占位.

Objective:Examined the impairment of regulatory T cells in cord blood from offspring of allergic asthmatic mothers. Methods:Cord blood mononuclear cells from 62 healthy neonates(40 healthy mothers and 22 allergic asthmatic mothers) were isolated,and cultured with stimuli: lipid A(TLR4 ligands),peptidoglycan(Ppg-TLR2 ligands),mitogen(PHA,phytohemagglutinin) and Dermatophagoides pteronyssinus1.And then the amount of CD4+CD25+Foxp3+T cells was acounted with flow cytometry;cytokine concentrations were measured in supernatants by LUMINEX technology;the suppressive function of regulatory T cells were examinated by isolating and culturing of CD4+CD25+T cells and CD4+CD25-T cells in vitro. Results:Cord blood from offspring of allergic asthmatic mothers showed Ppg-induced fewer regulatory T cells(CD4+CD25+Foxp3+T,P=0.03) and lower IL-10 secretion(P=0.03).Furthermore,the suppressive capacity of regulatory T cells was impaired in PHA-induced division and proliferation of T effector cells in cord blood of offspring from allergic asthmatic mothers(P=0.05).Meanwhile,the suppressive capacity of regulatory T cells to IL-13 production by effector cells was partially impared(P=0.07). Conclusion:In offspring of allergic asthmatic mothers,regulatory T cells amount,and suppressive function were impaired at birth,which maybe potentially contribute to the the susceptibility to allergic diseases.

Accumulating evidence shows that periostin, a matricellular protein, is involved in many fundamental biological processes such as cell proliferation, cell invasion, and angiogenesis. Changes in periostin expression are commonly detected in various cancers and pre-cancerous conditions, and periostin may be involved in regulating a diverse set of cancer cell activities that contribute to tumorigenesis, cancer progression, and metastasis. Periostin has also been shown to be involved in many aspects of allergic inflammation, such as eosinophil recruitment, airway remodeling, development of a Th2 phenotype, and increased expression of inflammatory mediators. In an in vivo model, bronchoalveolar lavage (BAL) fluid obtained from ovalbumin-challenged mice was found to contain significantly higher levels of periostin compared to BAL samples from control mice. To date, the molecular mechanisms involving periostin in relation to asthma in humans have not been fully elucidated. This review will focus on what is known about periostin and its role in the pathophysiological mechanisms that mediate asthma in order to evaluate the potential for periostin to serve as a biomarker and therapeutic target for the detection and treatment of asthma, respectively.

Accumulating evidence shows that periostin, a matricellular protein, is involved in many fundamental biological processes such as cell proliferation, cell invasion, and angiogenesis. Changes in periostin expression are commonly detected in various cancers and pre-cancerous conditions, and periostin may be involved in regulating a diverse set of cancer cell activities that contribute to tumorigenesis, cancer progression, and metastasis. Periostin has also been shown to be involved in many aspects of allergic inflammation, such as eosinophil recruitment, airway remodeling, development of a Th2 phenotype, and increased expression of inflammatory mediators. In an in vivo model, bronchoalveolar lavage (BAL) fluid obtained from ovalbumin-challenged mice was found to contain significantly higher levels of periostin compared to BAL samples from control mice. To date, the molecular mechanisms involving periostin in relation to asthma in humans have not been fully elucidated. This review will focus on what is known about periostin and its role in the pathophysiological mechanisms that mediate asthma in order to evaluate the potential for periostin to serve as a biomarker and therapeutic target for the detection and treatment of asthma, respectively.

原发气管黏膜相关淋巴组织淋巴瘤（ MALT淋巴瘤）临床较为罕见，现将1例以刺激性干咳为主要症状的纤支镜组织病理学诊断为原发气管MALT淋巴瘤的病例报道如下。

纵隔囊肿是原发性纵隔肿瘤类型之一,为良性肿瘤,大多数因先天性因素引起.由于生物学特性,纵隔囊肿患者多无明显症状及阳性体征.本文对8例老年纵隔囊肿病例进行回顾性分析,结合文献材料,研究经纤维支气管镜针吸微创方法对老年纵隔囊肿诊治的临床应用. 1对象与方法 1.1研究对象选择2003年6月至2012年8月吉林大学第二医院呼吸内科收治的8例纵隔囊肿患者,年龄60 ～ 78岁,男6例,女2例.临床表现:有症状3例,表现为胸闷、气短,经治疗后症状消失;无症状5例,在体检时发现病变;均为胸部CT检查提示纵隔囊肿.

患者女,30岁.因“咳嗽、痰中带血、呼吸困难及胸痛半个月,加重3d”于2012年11月3日就诊吉林大学第二医院呼吸内科.患者半个月前无明显诱因出现咳嗽,咳少量白色黏痰,偶有痰中带血,伴有气短、活动后呼吸困难,静息缓解,偶有胸痛,呈阵发性钝痛,无明显诱因及缓解方式,与呼吸、咳嗽及劳累无关,伴有畏寒及双下肢轻度胀痛,曾使用抗生素治疗(具体用药不详)数日后,上述症状逐渐加重,3d前呼吸困难症状加重.门诊行CT肺动脉造影示双肺动、静脉栓塞,门诊以“肺栓塞”收入院,病程中伴有双下肢轻度胀痛,逐渐出现双下肢可凹性水肿.既往史:2006年曾诊断“特发性血小板减少症”(具体不详),胆囊切除手术史,无烟酒嗜好.入院体检:患者一般状态尚可,血压130/80 mm Hg(1 mm Hg =0.133 kPa),无明显发绀,叩诊双肺呈清音,听诊双肺呼吸音清晰,未闻及干湿啰音.双下肢轻度可凹性水肿.其余检查未见明显异常.辅助检查:D-二聚体902 μg/L.血常规:血小板58×109/L,白细胞计数、中性粒细胞分类和血红蛋白均无明显异常.尿常规、血生化无明显异常.凝血常规:APTT 71.6 s,呈2倍延长,国际标准化比值(INR)正常.双下肢血管彩色多普勒超声:左侧股浅静脉血栓,右侧腘静脉血栓.

<正>脉冲振荡法(IOS)测定呼吸阻抗是近十几年来应用于临床的新型肺功能检测方法,因其方法简单,易于操作,受试者配合程度小,测定结果准确,重复性好,并可用图解方式显示诸如中央气道阻力、外周气道阻力和顺应性等指标,形象、直观,特别适用于老年人、儿童及病情较重者而得到大力推广。本文采用

目的 分析变应性哮喘患者过敏原特异性抗体谱,以指导临床诊断及脱敏治疗.方法 应用ELISA法检测174例变应性哮喘患者(哮喘组)、141例体检健康者(对照组)血清过敏原特异性抗体,比较2组检测结果,分析特异性抗体阳性与变应性哮喘相关性.结果 哮喘组多种过敏原特异性IgE,IgM,IgG抗体阳性率高于对照组(P＜0.05)；12种过敏原特异性IgE抗体阳性是变应性哮喘的危险因素(OR＞2),其中危险度较高的前3种过敏原依次为淡水鱼(OR=13.32)、春季花粉(OR=7.36)、蒿草花粉(OR=7.15)；13种过敏原特异性IgM抗体阳性和11种过敏原特异性IgG抗体阳性可作为变应性哮喘的危险因素(OR＞2).结论 淡水鱼等多种过敏原是变应性哮喘发病危险因素.

目的通过对8例病例的学习,探讨TBNA在无症状性上纵隔囊肿诊治中的应用价值。方法采用日本OLYMPUSBF260型电子纤维支气管镜和日本OLYMPUSBFN1C穿刺针对胸部CT提示为上纵隔囊肿的8例成年患者进行穿刺诊断和穿刺排液治疗,并进行随访观察疗效。结果 8例患者病理证实均为良性上纵膈囊肿,对其进行穿刺排液,经随访3～6个月无1例复发。结论针对高龄、复发性、无症状性上纵隔囊肿首选TBNA术,可以鉴别囊肿良恶性,同时可对囊肿进行穿刺排液,在部分患者中疗效良好。

患者 女,72岁,因“咳嗽、痰中带血伴活动后呼吸困难4个月,加重伴胸痛2 d”于 2011年8月2 日入院.患者4个月前无明显诱因开始出现阵发性咳嗽,咳白色黏液痰,痰中带血丝,伴活动后呼吸困难,体力活动轻度受限;2 d前开始出现左侧胸痛,呈持续性钝痛,咳嗽时加重,无心悸、大汗,未系统诊治.吸烟指数37.5包年.否认特殊用药史及职业接触史.入院体检:一般状态欠佳,生命体征平稳,听诊左肺呼吸音减弱,右下肺可闻及呼气未干啰音,双下肢轻度水肿,余未见异常体征.外院2011年8月1日胸部CT示:双肺见弥漫性磨玻璃影,密度小均匀,左上肺为善,左肺门影增大,部分左上肺肺与胸膜有黏连(图1～4).

目的 研究抗中性粒细胞胞浆抗体(ANCA)相关性血管炎(AASV)在肺部疾病的临床表现及特点.方法 回顾性分析2007年1月至2011年4月于吉林大学第二医院确诊为AASV的30例住院患者肺部病变的临床资料.结果 30例AASV患者发病年龄24～77岁,其中女18例,男12例.30例AASV患者中Wegener肉芽肿(WG)8例,显微镜下多血管炎(MPA) 22例,无变应性肉芽肿血管炎(CSS).结论 所有年龄段均有可能患AASV,MPA的发病率大约是WG的3倍,MPA患病率较多,可能是我国AASV的特点之一.WG患者较MPA患者更易出现呼吸系统症状,MPA患者较WG患者更易累及肾脏,出现肾功改变.影像学表现无特异性改变,但常重于临床表现.AASV肺部病理可表现为特发型肺间质纤维化.随着检验手段的提高,AASV的发病率逐渐增高,其临床表现多变,病变部位广泛,肾脏和肺脏是AASV最易受累的器官.对于长期发热及多器官受损的患者应尽早进行ANCA检查,及时治疗,改善预后.

吉林大学附属第二医院2008年至2010年收治2例肺毛霉病病例,均合并社区获得性肺炎及糖尿病,现报道如下. 例1女,63岁,因"干咳20 d"于2008年1月26日入院.患者于20 d前开始出现刺激性干咳,不伴发热,在外院行胸部X线透视后考虑为右肺肺炎,给予"莫西沙星"治疗2周,咳嗽无好转,胸部CT检查示右肺中下叶片状密度增高影,右肺中叶实变,为明确病因而转入我院.既往有2型糖尿病病史20余年,平日血糖水平控制不理想.患者于发病初期曾有过右侧胸痛,但近1周胸痛缓解.入院体检:右下肺可闻及散在的中小水泡音.

目的:探讨妊娠期高血压疾病的发病因素以及对孕妇及围产儿预后的影响.方法:对97例妊娠期高血压疾病患者的临床资料进行回顾性分析.结果:①妊娠期高血压疾病社会因素主要为居住地,城市孕妇患病率明显低于农村(P<0.05);②产科因素主要为产次,初产妇与经产妇患子痫的比例有统计学差异(P<0.05);③妊娠期高血压疾病并发低蛋白血症组孕妇终止妊娠孕周为(34.8439±4.9160)周与非低蛋白血症组孕妇终止妊娠孕周(36.2387±3.0930)周比较,差异有统计学意义(P<0.05),低蛋白血症组围生儿体重(2146.0382±827.3002)g与非低蛋白血症组围生儿体重(2464.5455±807.1133)g比较,差异有统计学意义(P<0.05).结论:对妊娠期高血压疾病的高危人群应加强孕期监测,对已经发生低蛋白血症的患者,应在严格掌握禁忌证下适量补充白蛋白以缓解病情、延长孕周,改善围生儿结局.