肺脏具有丰富的结缔组织和微血管循环,故易受到高血糖的影响.目前,肺功能降低与糖尿病的关系尚未完全明确.笔者分析国内外相关文献发现,糖尿病致肺损伤的可能病理生理机制包括胰岛素抵抗、低级别炎症、微血管病变、累及呼吸肌的神经病变及蛋白质非酶糖基化;此外,除胰岛素之外的大多数降糖药被证实可以通过减轻炎症、降低气道高反应性、促进癌细胞凋亡等机制而对肺疾病产生积极影响,而胰岛素可能对肺疾病产生消极影响,这对糖尿病合并肺疾病患者的治疗具有一定参考价值.

现阶段肺癌依旧是全球发病率和死亡率排名第一的恶性肿瘤.早期诊断及治疗是提高肺癌患者生存率和预后的关键,全面地认识和掌握肺癌各种形式的临床表现是早期诊断的重要环节,尤其是以肺外症状首发的病例.本文深入分析了与肺癌相关的多种非转移性肺外表现,分别对表现于内分泌系统、神经系统、皮肤、免疫系统、眼部等的临床特征以及治疗进展等做一综述,从而减少临床漏诊、误诊率,提高临床表现不典型肺癌的早期诊断率.

慢性阻塞性肺疾病(COPD)是一种呼吸系统的常见病,常表现为持续存在的呼吸系统症状和气流受限,具体发病机制目前尚不完全清楚.瘦素是由肥胖基因编码的蛋白质类激素,不仅发挥调节食欲、维持能量平衡的作用,还与多种呼吸系统疾病存在较大关联,与COPD关系更是密不可分.瘦素可能通过炎症反应、氧化应激、营养不良、蛋白酶-抗蛋白酶失衡等机制在COPD的发生与进展中发挥重要的作用.进一步探索瘦素与COPD之间的关系,可能为COPD诊治及预后提供新策略.

Chronic obstructive pulmonary disease (COPD) is a very common, preventable and treatable disease of the respiratory system.Its main characteristics are persistent respiratory symptoms and airflow limitation.COPD is a systemic disease, often accompanied by a variety of complications, including malnutrition, osteoporosis, metabolic syndrome, etc.And there are many prognostic factors, including age, body mass index, severity of inflammation, and comorbidities.Recent many studies find that uric acid plays an important role in the development and prognosis of COPD.Serum uric acid is the end product of purine metabolism and is closely related to COPD.It is involved in a variety of pathophysiological processes, such as oxidation-antioxidation, inflammation, and malnutrition, osteoporosis, etc.These diseases include various systems, such as kidney disease, liver disease, diabetes, cardiovascular and cerebrovascular diseases, etc.The respiratory system diseases mainly include COPD, asthma, pulmonary fibrosis, obstructive sleep apnea, hypopnea syndrome, lung infection, lung cancer, etc.This article mainly elaborates the correlation between uric acid and the prognostic factors of COPD.

慢性阻塞性肺疾病(COPD)被认为是以中性粒细胞为主的气道炎症,但近年的研究发现部分COPD患者存在嗜酸性粒细胞增多的现象,这类患者具有其特殊的临床特征,即具有部分支气管哮喘样症状,这提示了嗜酸性粒细胞参与了部分COPD患者的发病环节.大量研究发现,嗜酸性粒细胞可作为生物标志物预测COPD急性加重并指导临床治疗.鉴于嗜酸性粒细胞在COPD气道炎症中发病的重要性,现对嗜酸性粒细胞的特点与调控因素、嗜酸性表型COPD的发生机制及嗜酸性粒细胞作为生物标志物在COPD中的应用价值、存在问题及靶向治疗的研究进展做一综述.

激素抵抗性哮喘(SRA)是一种相对少见的哮喘临床类型,因常规的治疗难以使症状得到良好控制,因此给患者带来了沉重的经济负担和社会负担,严重影响患者的生活质量.导致激素抵抗的原因错综复杂,有多种细胞及细胞因子参与其中,通过不同的信号通路影响糖皮质激素的抗炎效应.同时,糖皮质激素受体的结构改变也是激素不敏感哮喘的重要发病机制.不同的辅助性T细胞在SRA的发病机制中也发挥了重要作用.此外,感染及脂质代谢也与激素的效用密切相关.

静脉血栓栓塞症包括肺血栓栓塞症(pulmonary thromboembolism,PTE)和下肢深静脉血栓形成(deep venous thrombosis,DVT),是同一疾病,不同发病阶段的不同表现.由于妊娠特殊性,妊娠发生静脉血栓栓塞症的危险性是非妊娠者5～10倍,发生率约0.6‰～2‰,死亡率约0.79‰[1-2].PTE是其中特殊且危重静脉血栓栓塞症类型.随着社会经济发展及营养生活水平提高,妊娠并PTE发生率呈上升趋势,约0.09‰～0.7‰,病死率达20％～30％,有回顾分析发现,约20％ PTE合并DVT或者DVT合并PTE,严重危及孕产妇及胎儿生命安全[3-4].因受到社会伦理学、孕妇及家庭等多种因素影响,妊娠并PTE早期诊断及治疗有一定困难,各种检查,尤其创伤检查及抗凝治疗等限制因素多、风险性较高.现对妊娠并PTE有关研究进展进行分析总结,以此为临床提供指导价值.

1 病例资料 患者,男,72岁,因"咳嗽、咳痰50 +年,气短4 +年,加重2 个月"入院. 患者50 +年前出现反复咳嗽、咳痰,每年冬季因天气寒冷或感冒后病情加重,平常轻度活动无明显气喘加重,近4 +年活动时气短明显,症状逐渐加重,近期平地步行时即感胸闷、气短明显,休息可减轻. 2个月前上述症状较前加重,咳嗽,咳多量灰白色粘痰,不易咳出,无痰中带血,无发热,气喘明显,夜间尚可平卧入睡,无心悸、无恶心、呕吐,无腹痛、腹泻. 既往否认家族遗传病史.患者自诉自幼体格较弱,经常咳嗽咳痰,症状时轻时重,迁延不愈. 成年后在外院诊断为"左下肺支气管扩张",经治疗后症状可缓解. 此次门诊以"慢性阻塞性肺疾病急性加重,支气管扩张"收入呼吸内科.

药物不良反应在抗结核治疗过程中比较常见.大多数不良反应发生于服药后2个月以内.抗结核药物不良反应影响因素包括年龄、种族、低蛋白血症、肝炎病史、嗜酒、吸烟、糖尿病、HIV感染等.常见抗结核药物不良反应种类主要有肝脏损害、肾脏损害、过敏反应、神经肌肉系统损害、血液系统损害、免疫相关损害、胃肠道反应,涉及药物包括异烟肼、利福平、吡嗪酰胺、链霉素、乙胺丁醇等.重视健康宣教、规范治疗、定时监测、加强护理措施有助于预防药物不良反应.早期发现不良反应,应及时、对症处理.

目的 观察吸烟对慢性阻塞性肺疾病(COPD)稳定期患者外周血及支气管肺泡灌洗液中CD8+T细胞含量的影响.方法 选取自2014年5月至2018年1月在我院收治的COPD缓解期患者,按照吸烟情况将其纳入非吸烟COPD组、吸烟COPD组、戒烟COPD组,每组均为50例,另选取50例健康体检者纳入健康组.4组均于入院首日抽取外周静脉血5 mL,检测其中CD3+、CD4+及CD8+T细胞水平;采血完成后,采用纤维支气管镜行肺泡灌洗术取4组患者的支气管肺泡灌洗液,检测其中CD3+、CD4+及CD8+T细胞水平.结果 非吸烟COPD组、吸烟COPD组及戒烟COPD组的肺功能预测值(FEV1)、病程、疾病程度及合并症均基本一致(P>0.05).与健康组比较,非吸烟COPD组、吸烟COPD组及戒烟COPD组患者血清及支气管肺泡灌洗液中CD3+、CD4+T细胞及CD4+/CD8+比值均明显降低(P<0.05),而CD8+T细胞均明显增高(P<0.05).与吸烟COPD组比较,健康组、非吸烟COPD组及戒烟COPD组患者血清及支气管肺泡灌洗液中CD3+、CD4+T细胞及CD4+/CD8+比值均明显增高(P<0.05),而CD8+T细胞均明显降低(P<0.05).结论 吸烟的COPD缓解期患者肺部及全身均存在CD8+等T淋巴细胞异常变化,而戒烟可有效改善COPD患者肺部及全身CD8+T淋巴细胞功能紊乱.

MicroRNA (MiRNA) are a class of short non-coding small RNA that hold back from blocking the translation of miRNA or inhibiting the protein aggregation in the late stage of translation.By these activities,miRNA can control post-transcriptional gene regulation.Recent studies have found new evidence that miR-155 plays an indispensible role in chronic diseases,such as allergic asthma.The present review would summarize the progress of miR-155 in bronchial asthma.

The expression of proto-oncogene c-Kit has been found in non-embryonic cells,including vascular endothelial cell,interstitial cells of Cajal and so on.Recent studies have found that SCF/c-Kit receptor complexes are involved in various aspects of respiratory diseases.The article summarizes the latest research progress of SCF/c-Kit in allergic rhinitis,bronchial asthma,chronic obstructive pulmonary disease and interstitial lung disease and so on.

Objective To investigate the order of severity and prognostic value of plasma ID-dimer (D-D) levels in patients with severe community acquired pneumonia (SCAP) and to provide the basis for treatment and prognosis of SCAP.Methods As the prognosis,patients were divided into a survival group or a death group.All patients were extracted peripheral blood serum 5 ml in early morning hollow of Day 1,Day 5 and the clinical endpoint (the final measurement before hospital discharge or death),and measured in the clinical laboratory immediately.Results I-D measurements on Day 5 and at the clinical endpoint showed significantly different (P ＜0.01),D-D levels of the death group were significantly higher than the survival group (P ＜0.01),D-D measurements within the same group were significantly different at different time points (P ＜0.01).In the survival group,D-D levels decreased.In the death group,D-D levels increased.Conclasions Increasing plasma D-D levels are indicators of a poor outcome for patients with SCAP.

癌症是人群健康和生命威胁最大的恶性肿瘤之一 ,随着人口的增长和老龄化 ,癌症的发生率不断增加 ,肺癌的发病率和病死率增长最快 ,已经成为发展中国家及发达国家沉重的经济负担.

Resolvins are novel anti-inflammatory lipid mediators derived from the omega-3 polyunsaturated fatty acid and categorized into D series,E series.It has been recently shown that resolvins E play important roles in chronic inflammation,as bronchial asthma.The present review would summarize the mechanism of resolvins E1 in bronchial asthma.

Objective To investigate the changes of the levels of interleukin 6(IL-6)and interleukin 8(IL-8)in the pathogenetic process of acute respiratory distress syndrome(ARDS). Methods We enrolled 50 ARDS patients who were admitted into the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xi'an Medical University from December 2010 to February 2013. The patients were divided into cure group(30 patients)and a non - survival group(20 patients). The levels of serum IL-6 and IL-8 were measured on day 1 after admission and right before discharge for cure group and were also measured right before death for non - survival group. We also enrolled 50 healthy subjects as control group,and the levels of serum IL-6 and IL-8 were detected. SPSS 19. 0 statistical software was employed to conduct statistical treatment. Results ARDS group was higher(P ﹤ 0. 01)than control group in the levels of serum IL-6〔(2. 1 ± 1. 8)ng/ L vs. (1. 1 ± 0. 2)ng/L〕and IL-8〔(639. 6 ± 98. 3)ng/ L vs. (415. 9 ± 56. 8) ng/ L〕. Non - survival group was higher(P ﹤ 0. 01)than cure group in the levels of serum IL-6〔(3. 8 ± 0. 2)ng/ L vs. (1. 8 ± 0. 4)ng/ L〕and IL-8〔(687. 8 ± 70. 2)ng/ L vs. (493. 9 ± 71. 7)ng/ L〕,and cure group and non - survival group were all higher(P ﹤ 0. 01) than control group in the two levels. Conclusion The levels of serum IL-6 and IL-8 play an important role in the development of ARDS,and the non - survival group is significantly higher in the level of serum IL-6 and IL-8.

Objective To investigate the prognostic value of serum prealbumin level in patients with severe community-acquired pneumonia ( SCAP) . Methods The clinical data of 87 patients with SCAP were retrospectively analyzed, who were admitted to the Department of Respiratory and Critical Care Medicine of the First Affiliated Hos-pital of Xi'an Medical University from August 2010 to August 2014. They were divided into the survival group (64 ca-ses) and the death group (23 patients). Serum prealbumin was measured at Day 1 and 5, and the clinical endpoint ( the final measurement before hospital discharge or death, mean ( 19. 2 ± 5. 7 ) days ) . The clinical data were analyzed by spss statistics version 19. 0. The qualitative data were analyzed byχ2 test, t test of independent samples between the two groups, and repeated analysis of variance in each group. Results There was no significant differ-ence in serum prealbumin on Day 1 between the two groups (P>0. 05). On Day 5 and at the clinical endpoint, it showed significant difference ( P<0. 01 ) . The level of serum prealbumin increased progressively from Day 1 to the clinical endpoint in the survival group, but it decreased in the death group (P<0. 01). Conclusion The low level of serum prealbumin indicates poor outcome for patients with SCAP. Dynamic observation of serum prealbumin level has prognostic value in predicting the outcome of SCAP.

目的 研究血清中白细胞介素-6(IL-6)表达水平与社区获得性肺炎严重程度及预后的相关性. 方法 选择58例PSI评分Ⅲ-Ⅴ类的社区获得性肺炎患者为入组病例,通过酶联免疫吸附试验法(ELISA)检测入组患者入院第1天清晨空腹血清中IL-6的表达水平,分析IL-6血清浓度与PSI评分的相关性,同时对死亡组和存活组IL-6血清浓度进行比较. 结果 IL-6在PSI评分Ⅴ类患者中血清含量最高,Ⅳ类次之,Ⅲ类最低,两两比较,差异均具有统计学意义(P＜0.05),并且死亡组IL-6血清浓度明显高于存活组(P＜0.05). 结论 IL-6在肺炎患者血清中的浓度升高,并随PSI评分的增高而增高,提示其与肺炎病情的严重程度及预后具有相关性.

Objective Explore the relation between pulmonary function test(PFT)and life style, environment.Methods A questionnaire survey and PFT were performed by 405 people at east and north districts in Xi′an,analyze the factors impacting PFT by stepwise regression.Results FVC,PEF and FEF25-75 in east and north districts are under predict value and difference between them was statistically significant(P <0.001).There is negative correlation between the FVC,PEF,FEF25-75 and age,gender, lung diseases(P <0.05).Conclusions FVC,PEF and FEF25-75 of PFT from some people in Xi′an is lower than predict value,this provides the basis for preventing the pulmonary diseases.

AIMTo investigate the expression and clinical significance of CEACAM1 and HBx in HBV related hepatocellular carcinoma.METHODSThe expression of CEACAM1 and HBx in 81 HBV related hepatocellular carcinoma were detected by immunohistochemistry, and the relationship with clinicopathological features was analyzed. The expression of CEACAM1 in the human normal hepatocyte cell line QZG, HepG2 and HepG2-X were detected by Western blot.RESULTSThe positive rate of CEACAM1 and HBx in 81 HBV related hepatocellular carcinoma tissues were 71.60%(58/81) and 74.07%(60/81) respectively. The expression of CEACAM1 and HBx were correlated with portal vein invasion, nodal metastasis and TNM staging. The expression of CEACAM1 was negative correlated with HBx(r(s);=-0.310, P<0.01). CEACAM1 protein was significantly down regulated in HepG2-X than in HepG2-PC and human normal hepatocyte cell line QZG.CONCLUSIONThe higher expression of HBx and lower expression of CEACAM1 are correlated with invasion and metastasis of HBV related hepatocelular carcinoma, CEACAM1 may be a effect molecule in HBV related hepatocarcinogenesis.