特发性肺纤维化(IPF)是一种预后较差的慢性进行性纤维化性肺疾病.近年来,两种抗肺纤维化药物吡非尼酮和尼达尼布已被证实可有效延缓IPF患者肺功能的下降和疾病进展.本文概述了吡非尼酮在特发性肺纤维化的临床应用的近期进展,包括特发性纤维化临床特征,吡非尼酮药理、作用机制、疗效评估及安全性,单独治疗和联合治疗特发性纤维化的临床现状等,以此较为全面了解吡非尼酮在特发性肺纤维化的理论基础及临床应用.

我国国民吸烟率长期处于较高水平且随着电子烟在青年人群中的流行,由于肺鳞状细胞癌(SQCC)与吸烟关系密切,吸烟是肺SQCC最重要的危险因素之一,故而在我国肺癌人群中肺SQCC将占据着举足轻重的地位.本文通过分析近年来PubMed及Wiley等数据库关于肺上皮细胞鳞状化生及癌变的相关异常表达的基因及分子信号通路研究,阐述了多条与肺SQCC发生相关的分子通路机制,梳理了近年来新且较为有价值的肺SQCC发生相关的分子通路实验研究及相应通路靶点药物的进展,旨在介绍当前肺SQCC发生机制及靶向治疗的一些新进展及可能的药物研究方向.

结节病是一种少见的、病因不清的肉芽肿性炎症,身体任何器官均能受累,其中肺部最常见.因其自限特性,肺结节病症状常能自行缓解,但当出现肺功能严重受损或不可逆转损害时,患者应积极接受治疗.临床实践以糖皮质激素为首选用药.本文对肺结节病治疗的最新进展作一综述,以提升医师对该病的诊治水平.

与其它恶性肿瘤相比,肺癌不仅有着第一的发病率,在死亡率上也是位居榜首,给人类的生命健康带来了极大的威胁.近年来随着医学研究的不断发展,在针对肺癌的治疗中逐渐出现了靶向治疗和免疫治疗两种新的方法.本文主要回顾和总结了肺癌的靶向治疗及免疫治疗进展相关研究成果.

目的 分析广泛期小细胞肺癌临床预后因素,为个体化治疗提供指导.方法 采用回顾性分析,2012年1月～2016年8月,医院收治的广泛期小细胞肺癌患者94例,收集患者的临床资料,按照中位生存时间进行分组,其中生存期≥中位生存期的对象纳入观察者,<中位生存期对象纳入对照组,进行因素分析.结果 中位生存期11个月,95％置信区间为6.3～14.8个月,截止2018年9月,仅2例存活,其余全部死亡.观察者与对照组年龄≥65岁、KPS评分<80分、TYF-1表达阳性、CEA阳性、NSE阳性、低钠血症、营养不良、胸腔积液、放疗、靶向药物的比重差异有统计学意义(P<0.05).多因素Logistic回归分析,结果显示KPS评分≤80分、TYF-1表达、营养不良、胸腔积液、靶向药物成为独立影响因素(P<0.05).结论 对于预计生存期较短的对象,避免滥用放化疗,以提升生活质量;重视改善患者的营养状况,规范胸腔引流;提高靶向治疗水平.

特发性肺纤维化(idiopathic pulmonary fibrosis,IPF)是一种病因未明的间质性肺疾病,其自然病程呈缓慢渐进性,少部分患者经历一次或几次急性加重,可发展为呼吸衰竭或死亡.肺移植作为IPF患者的治疗方式,仍存在供应有限、感染和免疫排斥等问题.而IPF传统药物治疗疗效欠佳.近年来对IPF致病机制进行了深入研究,使针对新靶点的治疗药物和治疗方案的研制有了新的研究进展.

纤维支气管镜(可弯曲支气管镜)对于支气管、肺疾病的研究、术后检查等是一种良好的精密仪器,其不仅在诊断上有很大进展,而且在治疗上也愈加重要.该文将从冷冻治疗、热成形术、球囊扩张、高频电圈套等四个方面对纤支镜的治疗进展予以综述,使人们对气管镜镜下治疗有全面的认识.

目的 探讨肝激酶(LK)B1基因表达水平与非小细胞肺癌(NSCLC)患者的临床病理特征及与预后的相关性.方法 应用实时荧光定量-聚合酶链式反应(RT-PCR)和Western印迹法检测LKB1基因mRNA和蛋白表达,并结合23例NSCLC临床资料进行分析.结果 LKB1基因在癌组织和癌旁正常组织均有表达,癌组织表达明显低于癌旁正常组织(P<0.05).LKB1基因在鳞癌和腺癌表达无统计学差异(P>0.05).LKB1表达水平与分化程度相关(P<0.05),与患者年龄、临床分期、肿瘤大小不相关(P>0.05).LKB1基因mRNA低表达组中位无进展生存期(PFS)〔8.20(95％CI:6.29～10.11)个月〕显著低于高表达组〔16.57(95％CI:11.20～21.94)个月〕(P<0.05).LKB1基因蛋白低表达组PFS〔9.07(95％CI:5.80～12.34)个月〕显著低于高表达组〔15.36(95％CI:12.52～18.20)个月〕(P<0.05).结论 LKB1基因表达水平与NSCLC组织分化程度相关,且LKB1低表达可能提示预后不良.

Objective: To observe the effects of simvastatin on transforming growth factor-β1 (TGF-β1) expression in the lung tissue of asthmatic mice with airway remodeling. Methods: A total of 60 SPF grade female BALB/C mice were randomized into groups of asthma, simvastatin administration, and control (n = 20 for each group). Pathological changes of the lung tissues and airways were observed and compared among groups of mice. Image analysis software was used to measure the internal wall area (WAi), smooth muscle area (WAm) and the perimeter of basement membrane (Pbm) in bronchial lung tissues, and real time PCR and Western blot were used to determine the expression levels of TGF-β1mRNA and protein in the lung tissues. Results: Pathological change was the severest in mice in asthma group. Although mice in the simvastatin administration group had severer pathological change than the controls, yet the change was minor compared to mice in the asthma group. Mice in the asthma group had thicker bronchial wall and smooth muscle layer as well as higher TGF-β1mRNA expression and protein level in the lung tissues than those in control group. The difference was statistically significant. Conclusion: Simvastatin may inhibit airway remodeling through reducing TGF-β1 expression in the lung tissues.

目的 探讨新辅助化疗联合肺癌根治术在肺癌治疗中的应用效果.方法 选取我院收治的肺癌患者82例作为研究对象.将入选的患者随机分为对照组与研究组,每组各41例.对照组患者直接采用肺癌根治术治疗,研究组患者采用新辅助化疗联合肺癌根治术治疗.结果 研究组及对照组患者缓解率分别为80.49%、31.71%,两组比较,差异具有统计学意义(P<0.05).研究组患者术后并发症发生率低于对照组,差异具有统计学意义(P<0.05).结论 新辅助化疗联合肺癌根治术可有效减少并发症,疗效安全可靠,在肺癌的治疗中具有重要的临床意义.

目的:分析重组人血管内皮抑制素联合顺铂化疗方案治疗老年晚期非小细胞肺癌的效果.方法:将2016年2月-2016年12月80例老年晚期非小细胞肺癌患者作为研究对象并根据随机数字表分组,分别40例.化疗组采取吉西他滨联合顺铂化疗方案治疗,联合组在化疗组基础上给予重组人血管内皮抑制素.比较两组晚期非小细胞肺癌治疗总有效率;中位生存期、无进展生存期;干预前后患者生存质量.结果:联合组晚期非小细胞肺癌治疗总有效率高于化疗组,P＜ 0.05;联合组中位生存期、无进展生存期长于化疗组,P＜ 0.05;干预前两组生存质量相近,P＞ 0.05;干预后联合组生存质量优于化疗组,P＜0.05.结论:重组人血管内皮抑制素联合顺铂化疗方案治疗老年晚期非小细胞肺癌效果肯定,可有效延长中位生存期、无进展生存期,改善患者生存质量,值得推广.

Objective Studies show that the ERCC1 gene may be involved in secondary cisplatin resistance.This article aims to investigate the effects of shRNA targeting silencing excision repair cross-complementation group 1 (ERCC1-shRNA) on the proliferation and apoptosis of lung cancer A549/DDP cells treated with different concentrations of cisplatin.Methods Lung cancer A549/DDP cells were divided into a negative control, a blank control, an ERCC1-shRNA1, and an ERCC1-shRNA2 group.Human interfering RNA (RNAi) targeting the human ERCC1 gene was constructed and transfected into the A549/DDP cells using Lipofectamine 2000.The mRNA and protein expressions of ERCC1 in the A549/DDP cells were detected by real-time PCR and Western blot respectively, the proliferation-inhibition rate was assessed by MTT, and their cell cycle and apoptosis were determined by flow cytometry.Results ERCC1-shRNA was successfully constructed and transfected into the A549/DDP cells.Both the mRNA and protein expressions of ERCC1 were significantly lower in the ERCC1-shRNA1 (0.20±0.04 and 0.24±0.10) and ERCC1-shRNA2 (0.47±0.28 and 0.37±0.11) than in the negative control (0.96±0.12 and 1.32±0.13) and blank control groups (0.84±0.07 and 1.45±0.23) (P<0.01).Compared with the negative and blank control groups, the ERCC1-shRNA1 group showed a significantly decreased IC50 value (16.71±2.33 and 16.69±1.69 vs 7.78±0.54, P<0.01) and an increased proportion of G0/G1 phase cells ([72.87±3.23] and [71.75±4.56] vs [82.99±4.23]%, P<0.05), with the cell cycle arrested in the G0/G1 phase.The apoptosis rate of the cells in the ERCC1-shRNA1 group was remarkably lower after treated with cisplatin at the concentrations of 6.25 and 12.5 μg/mL than at 0 μg/mL ([8.17±0.65] and [11.91±1.41] vs [29.97±3.14]%, P<0.05).Conclusion ERCC1-shRNA can inhibit the proliferation and enhance the apoptosis of A549/DDP cells by silencing the expression of the ERCC1 gene.

目的 比较洛铂或者顺铂联合培美曲塞二钠治疗晚期肺腺癌的近期疗效及不良反应.方法 选择本院2013年3月至2016年11月期间收治的48例晚期肺腺癌患者,随机分为治疗组(洛铂联合培美曲塞)23例,对照组(顺铂联合培美曲塞)25例.治疗组:培美曲塞二钠500 mg/m2 D1,洛铂30 mg/m2,D2,21天为1周期;对照组:培美曲塞二钠500 mg/m2,D1,注顺铂25 mg/m2,D 1~3天,21天为1周期.两个周期后评价近期疗效和毒副反应.结果 两组近期客观有效率比较,差异无统计学意义(P>0.05).治疗组、对照组恶心呕吐发生率分别为17.4%、48.0%,差异有统计学意义(P<0.05).结论 洛铂联合培美曲塞治疗晚期肺腺癌的近期疗效相近,但不良反应发生概率较低.

Objective To investigate the clinical value of ultrasound -guided and CT -guided percutaneously transthoracic lung biopsy for peripheral lung cancer. Methods The clinical characteristics and data of 331 patients with suspected peripheral lung cancer who received ultrasound-guided or CT-guided percutaneously transthoracic lung biopsy were retrospectively analyzed. These patients were divided into ultrasound-guided group(42 cases) and CT-guided group(289 cases). The accuracy of diagnosis and the incidences of complications were comparatively analyzed. Results The accuracy of diagnosis was 85.71% for ultrasound-guided group,and 94.12% for CT-guided group, there was no significance difference between two groups(χ2=4.005,P=0.056). The incidences of pneumothorax and hemopytsis were 7.14% and 9.52% in ultrasound-guided group, respectively. The incidences of pneumothorax and hemopytsis were 4.84%and 3.81%in CT-guided group, respectively, there was no significance difference between two groups(χ2=2.698,P=0.156). Conclusion Both ultrasound-guided and CT-guided percutaneously transthoracic lung biopsies are minimally invasive,safe and accurate diagnostic procedure for peripheral lung cancer.

Lung cancer has become the leading cause of cancer death.In recent years, it has been found that the mutation rate of LKB1 in non small cell lung cancer cells is only second to p53, K-ras mutation rate, especially in NSCLC, which is even as high as 15%~35%.LKB1 anticancer mechanism is to induce cell cycle arrest in G0/G1 phase, inhibit or delay the synthesis of DNA cells, and inhibit cell growth.The researchers found that the deletion mutation of LKB1 plays an important role in promoting the differentia-tion and metastasis of lung cancer tissue.Therefore, the dynamic testing of LKB1 anomalies can be used to diagnose the occurrence, development and prognosis of lung cancer and it may become the malignant degree index and prognostic factor of lung cancer.In this paper, the research progress of LKB1 in the field of lung cancer in recent years is reviewed.

目前非小细胞肺癌(NSCLC)是造成死亡最多的恶性肿瘤之一,大部分患者一经发现已是晚期且预后很差,但近十年来以化疗为主的治疗手段并未使非小细胞肺癌的疗效获得突破性进展.因此非小细胞肺癌分子靶向治疗成为研究的热点,分子靶向治疗药物包括:EGFR抑制剂、间变淋巴瘤激酶(ALK)抑制剂、抗血管生成药物、哺乳动物雷帕霉素靶蛋白(mTOR)抑制剂等,为非小细胞肺癌患者临床用药和非小细胞肺癌靶向治疗药物开发提供参考.本文将从这几类药物的作用机制、适用范围、药物疗效等作一综述.

目的:观察埃克替尼—线治疗晚期非小细胞肺癌表皮生长因子受体(EGFR)敏感性突变患者的疗效及毒副反应.方法:22例接受盐酸埃克替尼治疗的EGFR敏感性突变的NSCLC患者,口服埃克替尼125 mg,3次/d,持续至疾病进展或不良反应无法耐受,评价近期疗效及毒副反应.结果:22例患者中19外显子缺失突变9例,21外显子L858R点突变13例,客观缓解率59.1％,疾病控制率72.7％,中位无进展生存期7.77个月;主要不良反应为皮疹和腹泻,多为Ⅰ～Ⅱ级.结论:盐酸埃克替尼—线治疗EGFR敏感性突变的NSCLC患者疗效较好,不良反应轻.

Objective:To analyze the potential risks inducing psychotic-like symptoms in patients associated with use of voriconazole .Methods:Exclusion criteria were cases without existed neurological disorder or metabolic encephalopathy,and finally 113 were included from January to November of 2014.All patients were given intravenous infusion ( once every 12 h) of voriconazole by double dosage at day one on dose of 200 mg basis,and allocated to group with side effects( psychotic-like symptoms) or controls in compliance with presence of psychotic-like symptoms.Then the basic data,including types of bacterial infection and laboratory findings,in the two groups were compared and analyzed regarding the incidence of psychotic-like symptoms and potential risks as-sociated with voriconazole by Logistic regression models.Results:Eleven in 113 patients were complicated with psychotic-like symptoms.Patients with ad-verse events had higher level of alanine aminotransferase(ALT) and aspartate aminotransferase(AST) than those of the controls[(115 ±10.45)U/L and (65.82 ±6.01U/L)vs.(25.86 ±8.86)U/L and (24.4 ±8.68)U/L],and the difference was significant,yet the remaining indicators were not.Logistic regression analysis indicated that the risks inducing psychotic-like symptoms in use of voriconazole were associated with ALT and AST levels in patients (ORALT =1.54;ORAsT =1.052).Conclusion:Patients with abnormal ALT and AST levels may be higher potential incidence of psychotic-like symptoms in use of voriconazole.

To evaluate the relationship between microRNAs and lung cancer. MicroRNA ( miRNAs) is a kind of small single-stranded RNA with 18 to 22 nucleotides. They can regulate the gene transcription through mRNA. MiRNAs have been implicated to play important roles such series of physiological processes as the development, differentiation, proliferation and apoptosis within the body. Lung cancer, as one of the malignant tumors, which does harm to human body, is difficult to detect and diagnose in early peri-od. Furthermore, because of the drug resistance, many patients have been poorly recovered. This article summarizes the miRNAs’ participation mechanism in the pathogenesis and progress of lung cancer, in order to guide the clinical diagnosis and treatment.

Objective:To observe the curative effects of sublingual administration of dust mite drops on bronchial asthma .Methods:207 adult patients of bronchial asthma allergic to dust mites were included and assigned randomly to treatment group(n=100,treated with sublingual dust mite drops plus inha-lation of salmeterol/flutieasone propionate) and control group(n=107,managed with simple inhalation of salmeterol/flutieasone propionate).The indica-tors,including asthma symptoms scores,asthma control test and pulmonary function,were evaluated for the two groups.Results:The patients in the treat-ment group were improved a lot regarding the asthma symptoms scores,asthma control test and lung function(P<0.05).Conclusion:Sublingual adminis-tration of dust mite drops can be efficacious and safe for bronchial asthma ,and is worthy of wider clinical recommendation .