目的 了解完全管理模式在肺结核防治中的应用.方法 102例肺结核患者随机分为对照组和观察组,每组51例.对照组采用常规防治措施干预,观察组在对照组的基础上采用完全管理模式干预.评估两组肺结核控制效果、并发症和疾病控制时间.结果 观察组患者肺结核控制率为100.0％,高于对照组的76.5％(P<0.01);观察组并发症发生率为9.8％,低于对照组的27.5％(P<0.05);观察组疾病控制时间明显短于对照组[(34.06±2.17)d vs(45.94±2.75)d,P<0.01].结论 完全管理模式在肺结核防治中效果显著,可降低并发症发生率,缩短肺结核控制时间.

目的 分析烟雾暴露对卵白蛋白致敏的急性支气管哮喘大鼠模型肺组织激活素A mRNA和蛋白表达的影响.方法 取28只健康成年雄性SD大鼠,按照随机分配原则,分为空白对照组(正常大鼠,不采取任何处理)、阴性对照组(正常大鼠+烟雾暴露)、模型组(制备卵白蛋白致敏的急性支气管哮喘大鼠模型)、实验组(急性支气管哮喘大鼠+烟雾暴露),每组各7只.行苏木精-伊红染色,观察各组大鼠肺组织病理学改变;采用免疫印迹法检测大鼠肺组织中激活素A蛋白表达水平;根据实时荧光定量聚合酶链反应检测大鼠肺组织中激活素A mRNA相对表达量.结果 经病理学染色结果 可知,空白对照组肺组织病理学未见异常,而阴性对照组、模型组及实验组肺组织出现不同程度的病理学改变,且实验组更加明显.经免疫印迹法检测可知,阴性对照组、模型组及实验组肺组织中激活素A蛋白表达水平较空白对照组均明显升高(P<0.05);模型组肺组织中激活素A蛋白表达水平较阴性对照组明显升高(P<0.05);实验组肺组织中激活素A蛋白表达水平较阴性对照组和模型组明显升高(P<0.05).经实时荧光定量聚合酶链反应检测可知,相比空白对照组,阴性对照组、模型组及实验组肺组织中激活素A mRNA相对表达量均明显上调(P<0.05);相比阴性对照组,模型组肺组织中激活素A mRNA相对表达量明显上调(P<0.05);相比阴性对照组和模型组,实验组肺组织中激活素A mRNA相对表达量明显上调(P<0.05).结论 在卵白蛋白致敏的急性支气管哮喘大鼠模型中,经烟雾暴露可促进大鼠肺组织激活素A蛋白表达,提高激活素A mRNA表达量,并进一步导致气道炎症加重.

OBJECTIVE To analyze the karyotype stability in hematological malignancies patients before and after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and its prognostic significance of monitoring. METHODS The karyotypes and clinical data of 21 patients with hematological malignancies at the initial diagnosis and at relapse after allo-HSCT were retrospectively reviewed. Chromosome analysis was performed by standard 24 h-cultured method and R banding. RESULTS Karyotypes at the initial diagnosis and at relapse after allo-HSCT were different in 11 patients (52.38%), including chromosome 1, 3, 6, 12, 17, 21. Numberical abnormalities and structural chromosomal abnormalities always occurs together. The median survival time of relapse of the patients with karyotype changes was significantly shorter than that of patients without a karyotype change (79 d vs 522 d, P = 0.027), and that of the patients with trisomy 6 was also significantly shorter than that of the patients without trisomy 6 (9 d vs 275 d, P = 0.005). CONCLUSION Karyotype changes after relapse are associated with the prognosis of allo-HSCT.

目的:研究姜黄素对哮喘小鼠气道重构及肺组织转化生长因子β1mRNA表达的影响.方法:将48只雄性小鼠随机分成正常对照组(A组)、哮喘组(B组)、地塞米松1 mg/kg治疗组(C组)、姜黄素治疗组(D组),用卵清蛋白(OVA)进行致敏和激发,建立哮喘模型.收集小鼠支气管肺泡灌洗液(BALF)行白细胞和嗜酸粒细胞(EOS)计数,观察并计算离体支气管壁厚度、支气管平滑肌厚度、支气管平滑肌细胞核数量和肺组织形态学改变,采用医学图像分析软件测定支气管各项指标;采用逆转录-聚合酶链反应(RT-PCR)检测肺组织转化生长因子β1mR-NA和免疫组织化学方法测定转化生长因子β1的蛋白表达水平.结果:正常对照组、哮喘组、地塞米松治疗组、姜黄素治疗组的EOS分别是(0.51±0.17)×108/L,(7.42±0.33)×108/L,(4.89±0.75)×108/L,(3.14±0.24)×108/L,哮喘组明显比正常对照组增高,两组比较有统计学意义(P＜0.01).哮喘组小鼠具有明显的气道炎症,出现上皮细胞增生、平滑肌肌层增厚、结缔组织增生、黏液分泌旺盛并伴小气道栓塞,支气管黏膜下、血管壁及周围、肺间质均有大量胶原纤维沉积,姜黄素治疗组小鼠炎症明显改善,黏液产生减少,上皮增生、平滑肌层增厚不明显,气道周围胶原纤维及黏液颗粒均减少.免疫组化法TGFβ1的表达中,正常对照组阳性率为8.3%(1/12),哮喘组达66.7%(8/12),地塞米松治疗组为41.7%(5/12),姜黄素治疗组为25.0%(3/12),两两比较差异有统计学意义(P＜0.01).结论:姜黄素不仅可明显抑制哮喘小鼠的气道炎症反应,还可明显减轻气道重构的程度,这种作用可能是通过抑制TGF-β1mRNA表达来实现的.

目的 探讨应用纤维支气管镜(纤支镜)经鼻气管插管抢救重症哮喘的临床价值.方法 选择符合重症哮喘诊断标准患者65例随机分为两组,32例于喉镜引导下经鼻盲法行气管插管术(对照组),33例于纤支镜引导下行经鼻气管插管术(观察组).结果 观察组插管时间[(3.7±1.9)min]明显短于对照组[(5.5±2.9)min](P<0.05),一次性成功率(97%)高于对照组(50%)(P<0.01),损伤性出血率(3%)低于对照组(19%)(P<0.05),两组在改善重症哮喘疗效方面无统计学差异.结论 纤维支气管镜经鼻气管内插管是抢救重症哮喘快速、安全、有效的方法 。

Objective To explore the relationship of interleukin 13(IL-13)mRNA expression of peripheral blood mononuclear cells(PBMCs)with clinical feature in patients with asthma and the effect of glucocorticoid on it.Methods Thirty four cases of asthmatic patients with acute asthma attack(in which,24 cases took prednisone orally for one week),18 cases of asthmatic patients in remission stage,and 30 cases of healthy volunteers were enrolled.The PBMCs were obtained and the expression of IL-13 mRNA was detected by reverse transcription polymerase chain reaction(RT-PCR).Results The IL-13 mRNA level in patients with asthma and healthy volunteers were 16.72±1.12 and 8.25±1.15 respectively,and they had significant difference(P0.05).The IL-13 mRNA level in asthma attack group and asthma remission group were 20.72±1.02 and 13.67±3.15 respectively,and they had significant difference(P0.05).The IL-13 mRNA level in mild asthma group,moderate asthma group,and severe asthma group were 16.35±2.38,19.12±2.16 and 23.57±2.43 respectively,and they had significant difference(P0.05).After prednisone treatment,the IL-13 mRNA level of PBMCs decreased significantly in steroid-sensitive asthma group(P0.05),while it didn′t found in steroid-resistant asthma group.Conclusion The IL-13 may take part in the pathological and physiological process and regulate action of glucocorticoid in patients with asthmat.The IL-13 mRNA level of PBMCs may act as an index in judging asthma severity.

Objective:To discuss the relationship of clinical feature,hormone inhalation and plasma level of interleukin 13(IL-13)of chronic obstructive pulmonary disease(CODP)patients.Methods:Selected 64 COPD cases at acute exacerbation,including 30 cases treated with inhalation of salmeterol fluticasone propionate at 50/250 μg for a month,42 cases at stable stage including 20 cases treated with inhalation of salmeterol fluticasone propionate,and 36 healthy cases.Tested the concentration of IL-13 in plasm.Results:The IL-13 concentration in plasma of 106 COPD cases(58.35±3.28)(pg/mL)had significant difference from 36 healthy cases(25.03±3.22)(pg/mL)(P0.05).The concentration of 64 COPD cases at acute exacerbation(67.13±3.12)(pg/mL)had significant difference from 42 cases at stable stage(39.27±4.02 pg/mL)(P0.05).The concentrations of light patients(51.25±2.38 pg/mL),of middle patients(61.03±2.36 pg/mL),severe patients(69.37±2.16 pg/mL)extreme severe patients(75.67±2.15 pg/mL)were significantly different(P0.05).With 1 month therapy with inhalation of salmeterol fluticasone propionate,IL-13 concentration significantly decreased compared with the level before treatment in both acute exacerbation group[(66.33±3.22pg/mL)vs(29.35±3.24 pg/mL)] and stable group[(38.97±1.02pg/mL)vs(26.08±1.25 pg/mL)] Conclusion:IL-13 participates in pathological and physiological process of COPD,and is valuable index for judging severity of disease and therapeutic effect.

目的探讨支气管哮喘并发肺气肿的可逆性情况,为哮喘临床诊治及预后估计提供理论依据。方法对RV/TLC(残气占肺总量百分比)40%者进行支气管舒张试验,并分别计算RV、RV/TLC的改善率。结果25%的患者肺气肿转为正常;60%肺气肿程度转轻;15%改变不明显,总体改善率达85%。结论支气管哮喘并发肺气肿的可逆性是确切存在的,只是依病情的差异可逆的程度不同,并且它完全不同于慢性阻塞性肺疾患所致的肺气肿。

目的:探讨小儿肺炎两种雾化吸入治疗的优缺点。方法:将65例肺炎患儿随机分为三组,C组采用常规治疗,A组在常规治疗的基础上加用肝素钙超声雾化,B组在常规治疗基础上加用普米克令舒空气泵雾化。结果:A、B组各临床症状消失的时间均较C组短(P<0.05),A组与B组干啰音消失时间差异无显著性(P=0.901),但治愈时间A组较B组短(P<0.05)。结论:吸入治疗对小儿肺炎的治疗是有帮助的。另对肺炎因痰多所致气促、气喘,肝素雾化吸入疗效较好。

目的评价急性生理学与慢性健康状况评分Ⅲ(APACHEⅢ)对COPD急性加重期并呼吸衰竭患者病性评估的价值。方法对77例慢性阻塞性病急性加重期(AECOPD)并发呼吸衰竭患者进步APACHEⅢ评分,所有指标均取确诊呼吸衰竭后最初24h内的最差值,比较存活组与死亡组患者之间的差异,对不同分值段的并发症、死亡率进行比较分析。结果77例患者APACHEⅢ评分范围在25~125分,平均(52·34±22·41)分,存活组53例评分(41·02±10·16)分,死亡组24例评分(77·21±21·93)分。二者差异有统计学意义(P<0·01),随着APACHE评分可用于AECOPD合并呼吸衰竭患者的病性评估,有利于指导治疗及预测预后。

目的总结纤维支气管镜在支气管异物中的诊治价值。方法对纤维支气管镜诊治成人支气管异物17例的临床资料进行回顾性分析。结果本组17例均治愈,成功率为100%,其中15例均1次取出,2例第2次取出;钳取异物时间:最短10min,最长50min。结论纤维支气管镜是目前诊治支气管异物的最有效方法。

Objective To comprehend the diagnostic value of bronchofiberoscope examination on heamoptysis in the middle-aged and aged patients.Methods An retrospective analysis was made on bronchofiberoscope examination on heamoptysis with the pliers and brush.Results The final causes of 256 cases with heamoptysis in the middle-aged and aged patients were inflammation in 52.73%,tumor in 25.78%,bronchiectasises in 7.03%,bronchial tuberculosis in 5.47%.Conclusion Bronchofiberoscope examination is clinical utility value to diagnose the reasons of heamoptysis in the middle-aged and aged patients.We must especially watch out for lung cancer.

AIM: To study the effects of arsenolite on the leukotriene C_4 and the expression of cPLA_2 mRNA in ovalbumin challenged asthmatic mice. METHODS: 56 mice were randomly divided into 7 groups. Establishing the ovalbumin sensitized asthmatic model, RT-PCR was employed to detect the expression of cPLA_2 mRNA in the lung. The TLC_4 and PLA_2 in BALF were measured by ELISA.Expiration time/respiratory total time and expiration maximum pressure were detected. RESULTS: The expression of PLA_2 mRNA in the lung and the TLC_4, PLA_2 activity in BALF in asthmatic group were significantly higher than those in normal group. After therapy with dexamethasone and different dosage of arsenolite( 0.625, 1.25, 2.50 and 5.00 mg·kg -1),the expression of PLA_2 mRNA and the TLC_4, PLA_2 activity were significantly lower than those in asthmatic group. Expiration time/respiratory total time and expiration maximum pressure in asthmatic group were significantly increased compared with normal group. Expiration time/respiratory total time and expiration maximum pressure of groups treated with 4 doses arsenolite were significantly decreased compared with asthmatic group. CONCLUSION: PLA_2 mRNA expression increases in asthma group, and arsenolite can efficiently treat asthma. Its mechanism maybe partly relates to decreasing TLC_4 in airway and the inhibition of PLA_2 mRNA expression.

目的:探讨抗凝血酶(AT)活性测定在慢性肺源性心脏病(肺心病)的临床应用价值.方法:测定46例慢性肺源性心脏病患者血清AT活性及与PaO2、PaCO2、红细胞压积(HCT)的相关性.结果:肺心病急性加重期患者血浆中AT活性显著低于缓解期(P＜0.05),急性加重期合并Ⅱ型呼吸衰竭患者血浆中AT活性显著低于急性加重期合并Ⅰ型呼吸衰竭患者(P＜0.05);肺心病急性加重期患者血浆中AT活性与PaO2均呈正相关,与PaCO2、HCT均呈负相关;肺心病缓解期AT活性与PaO2、PaCO2和HCT无相关性.结论:血浆AT活性测定在慢性肺源性心脏病中有一定的临床应用价值.

Objective: To investigate the change of serum levels of thyroid hormone and IL-6 and the relationship between them in elderly patients with chronic pulmonary heart disease (CPHD). Methods: Serum levels of TT 3, TT 4, TSH, and IL-6 in 64 elderly patients with CPHD and 30 healthy controls were determined by RIA and ELISA, respectively, and the artery blood gas analysis was also performed. Results: Compared with those in the stable stage of CPHD and in the controls, serum levels of TT 3 and TT 4 were decreased, and IL-6 content was increased in the acute stage of CPHD (P0.01). PaO 2 in patients showed positive correlations with TT 3 and TT 4 levels (r=0.576, P0.01;r=0.598, P0.01). IL-6 level was negatively correlated with PaO 2 (r=-0.625, P0.01), and TT 3 and TT 4 levels (r=-0.301, P0.01; r=-0.374, P0.01). Conclusion: Serum levels of TT 3, TT 4 and IL-6 could reflect the severity of the elderly patients with CPHD, and the detection of these parameters is helpful in evaluating the illness state and the prognosis.

目的:探讨肝素治疗对慢性肺源性心脏病（肺心病）患者血浆抗凝血酶（AT）活性的影响。方法:测定46例慢性肺心病患者血清活性及与PaO2、PaCO2、红细胞比容（HCT）的相关性。结果:肺心病急性加重期患者血清中AT活性显著低于缓解期;肺心病急性加重期患者予肝素治疗后AT活性增高;肺心病急性加重期患者予肝素治疗前、后血清中AT活性与PaO2呈正相关,与PaCO2、HCT呈负相关。结论:AT活性在肺心病急性加重期下降,应用小剂量肝素治疗肺心病是不可缺少的重要措施之一。

目的:观察可乐必妥静滴液治疗社区获得性肺炎的临床疗效和安全性.方法:可乐必妥静滴液组(简称可乐必妥组,n＝60)300 mg静脉滴注,每天1次;罗氏芬针剂组(简称罗氏芬组,n＝60)1 g静脉滴注,每天2次.疗程均7～14 d,结果:可乐必妥组治愈44例(73.7%),显效12例(20%),进步2例(3.3%),无效2例(6.7%);罗氏芬组治愈40例(66.7%),显效14例(23.3%),进步4例(6.6%),无效2例(3.3%).两组疗效比较差异无统计学意义(Hc＝0.676,P＞0.05).两组在细菌清除率和药物敏感性方面差异均无显著性(P＞0.05).结论:可乐必妥静滴液是一种非常有效和安全的治疗社区获得性肺炎的抗生素.

Objective To explore the influence of blood plasma level of interleukin 13 on clinical features and effects of glucocorticoid in patients with asthma.Methods The blood plasma samples were obtained from 34 acute asthmatic patients (24 cases of which took orally prednisone before and after one week),18 asthmatic patients in remission stage,and 30 healthy volunteers.The blood plasma level of IL 13 was detected by ELISA.Results Blood plasma level of IL 13 was obviously higher in patients with asthma than that in normal group ( P 0.05).Plasma level of IL 13 in acute asthma group (34 cases) was significantly higher than that in asthma remission group (18 cases)( P 0.05).Compared among mild,moderate and severe asthma,the blood plasma level of IL 13 was obviously different ( P 0.05).After prednisone treatment,the blood plasma level of IL 13 was observed a significant decrease in steroid sensitive asthma ( P 0.05),and was not associated with significant changes in steroid resistant asthma ( P 0.05).Conclusion IL 13 takes part in pathological and physiological process and regulate action of glucocorticoid in asthmatic patients.The blood plasma level of IL 13 may act as one of the indices judging asthmatic severity.

AIM: To investigate the effects and safe of low molecular weight heparins (LMWH) in the treatment of patients with chronic pulmonary heart diseases (CPHD) at hypercoagulability state. METHODS: 65 patients were randomly assigned to treatment group (n=33) and control group (n=32). All patients were given routine treatments. The patients of treatment group were hypodermically injected with 4 100～6 150 U of LMWH per day for 7 days as a course. RESULTS: After 7 days of the treatments, the patients of treatment group showed better curative effect and significantly increase in PaO_2 and AT-III and decrease in PaCO_2 and FIB in comparison with the patients in control group (P 0.05 ). CONCLUSION: LMWH is an effective agent in treatment of patients with CPHD.

目的探讨血浆内皮素-1(ET-1)、一氧化氮(NO)及降钙素基因相关肽(CGRP)在慢性阻塞性肺疾病(COPD)发生发展中的作用.方法应用生化法及非平衡法检测72例COPD患者血中ET-1、NO2-/NO3-及CGRP水平,并结合临床分级、氧合指标水平进行分析.结果Ⅱ、Ⅲ级患者ET-1水平明显高于Ⅰ级患者及对照组(P<0.05);Ⅰ级患者NO2-/NO3-水平明显高于对照组,Ⅱ、Ⅲ级患者NO2-/NO3-水平明显低于对照组(P<0.05);各级患者CGRP水平均低于对照组(P<0.05);Ⅱ、Ⅲ级患者ET-1与PaO2、SaO2呈显著负相关,NO和CGRP则相反;Ⅱ、Ⅲ级患者吸氧后,随着PaO2、SaO2显著上升(P<0.05),NO和CGRP显著上升,ET-1显著下降(P均<0.05).结论缺氧可能通过影响ET-1与NO、CGRP等之间的平衡关系而导致COPD的形成,测定三者水平变化可作为判断COPD病情及治疗效果的指标.