目的 探析铜绿假单胞菌介导线粒体DNA(mtDNA)/Toll样受体 9(TLR9)信号通路在支气管扩张症免疫失衡的作用机制.方法 选取 30 只雄性SPF级Wistar大鼠,10 只大鼠作为空白组,另外 20 只建立支气管扩张症模型,将建模成功的 20 只大鼠分为假手术组和模型组,各 10 只.空白组不做特殊处理;模型组注射 0.5 ml的铜绿假单胞菌液及 0.5 ml气体;假手术组注射 0.5 ml的生理盐水及 0.5 ml气体.采用苏木素-伊红(Hematoxylin-eosin,HE)染色对大鼠肺组织中支气管情况进行病理学观察,检测大鼠0.3 s用力呼吸容积(forced expiratory volume in 0.3 second,FEV0.3)、用力肺活量(forced vital capacity,FVC)、0.3 s用力呼吸容积/用力肺活量(forced expiratory volume in 0.3 second/forced vital capacity,FEV0.3/FVC)、用力呼气峰值流速(forced peak expiratory velocity,PEF)水平;酶联免疫吸附实验法检测高迁移率族蛋白B1(high mobility group box-B1,HMGB1)、干扰素-γ(Gamma interferon,IFN-γ)、白细胞介素-6(Interleukin-6,IL-6)、转化生长因子-β(transforming growth factor-β,TGF-β)水平;流式细胞仪检测辅助性T细胞 17(T helper cells 17,Th17)、调节性T细胞(T regulatory cell,Treg)、Th17/Treg细胞因子水平.结果 病理学分析中,空白组大鼠肺组织内支气管组织正常,假手术组大鼠支气管组织受到轻微损伤,模型组大鼠支气管组织出现严重损伤.与空白组相比,假手术组、模型组FEV0.3、FVC、PEF、IFN-γ、TGF-β、Treg水平降低(P＜0.05);FEV0.3/FVC、HMGB1、IL-6、Th17、Th17/Treg水平及mtDNA、TLR9 相对表达量均升高(P＜0.05).与假手术组相比,模型组Th17 水平升高,Treg水平降低,Th17/Treg水平升高,差异具有统计学意义(P＜0.05).结论 铜绿假单胞菌介导mtDNA/TLR9 信号通路在支气管扩张症中能够造成炎症反应升高,并且影响免疫功能,造成免疫失衡.

目的 研究老年重症肺炎患者血清活化蛋白C(APC)、脑钠钛(BNP)水平、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分变化及预后影响因素.方法 回顾性分析东莞市滨海湾中心医院2018年7月至2020年6月收治的116例老年重症肺炎患者的临床资料,根据所有患者28 d内生存情况分为生存组(72例)与死亡组(44例).比较两组患者入院后第1、3、5天血清APC、BNP水平及APACHEⅡ评分,统计两组患者临床资料进行单因素分析,对单因素中差异有统计学意义的因素进行多因素Logistic回归分析.结果 与入院后第1天比,生存组患者入院后第3～5天血清APC水平均呈递增趋势,血清BNP水平及APACHEⅡ评分均呈递减趋势;死亡组患者入院后第3～5天血清APC水平均呈递减趋势,血清BNP水平及APACHEⅡ评分均呈递增趋势;入院后第1～5天生存组患者血清APC水平均高于死亡组,而血清BNP水平及APACHEⅡ评分均低于死亡组;生存组中无吸烟史、未行机械通气的患者占比高于死亡组(均P<0.05);经多因素Logistic回归分析显示,影响老年重症肺炎患者预后的危险因素为机械通气、血清APC水平、血清BNP水平、APACHEⅡ评分(OR=2.818、2.008、1.809、3.445,均P<0.05).结论 机械通气、血清APC、BNP水平及APACHEⅡ评分为影响老年重症肺炎患者预后的相关因素,可通过密切监测患者血清APC、BNP水平并及时采取相应措施进行改善,同时在治疗过程中应在采取适当保护措施前提下行机械通气,并注意机械通气时间,提高患者健康状况,进而降低死亡率.

目的 探讨沙美特罗替卡松气雾剂联合异丙托溴铵治疗哮喘-慢性阻塞性肺疾病重叠综合征(ACOS)的临床效果.方法 选取2018年10月至2020年3月我院收治的ACOS患者80例,随机分为两组各40例.对照组采用沙美特罗替卡松气雾剂治疗,观察组在对照组基础上采用异丙托溴铵治疗,比较两组的治疗效果.结果 治疗后,观察组的TNF-α、IgE、EOS水平均显著低于对照组,FEV1、TLC、PEF水平均显著高于对照组(P<0.05).两组的不良反应发生率比较,差异无统计学意义(P>0.05).结论 沙美特罗替卡松气雾剂联合异丙托溴铵治疗ACOS可有效减轻患者气道炎症,提高其肺功能,且安全性较高.

目的 探讨肺癌合并肺部感染患者癌基因(PIK3CA)蛋白表达、血常规指标和凝血指标水平的变化及临床意义.方法 回顾性分析2015年1月至2019年12月东莞市滨海湾中心医院收治的40例肺癌合并肺部感染患者(感染组)和40例肺癌未合并肺部感染患者(未感染组)的临床资料,比较两组患者的PIK3CA蛋白、白细胞计数(WBC)、血小板计数(PLT)、血小板体积分布宽度(PDW)、平均血小板体积(MPV)、中性粒细胞(NEU)、淋巴细胞(LYW)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)和D-二聚体(D-D)水平.结果 感染组患者的PIK3CA蛋白阳性率为47.50％,明显高于未感染组的15.00％,差异有统计学意义(P<0.05);感染组患者的WBC、PDW、MPV、NEU水平分别为(8.14±1.02)×109/L、(10.72±0.85)fL、(10.56±0.94)fL、(68.13±6.11)％,明显高于未感染组的(6.83±1.48)×109/L、(9.63±1.42)fL、(9.30±1.18)fL、(60.06±4.30)％,PLT、LYW水平分别为(183.34±26.10)×109/L、(22.04±2.74)％,明显低于未感染组的(231.15±21.84)×109/L、(26.82±3.06)％,差异均有统计学意义(P<0.05);感染组患者的APTT、PT、TT分别为(38.05±1.34)s、(15.38±1.25)s、(17.34±1.28)s,明显长于未感染组的(36.86±1.27)s、(13.02±1.06)s、(16.05±1.41)s,FIB、D-D水平分别为(6.38±0.75)g/L、(2.20±0.36)mg/L,明显高于未感染组的(4.33±0.69)g/L、(1.39±0.22)mg/L,差异均有统计学意义(P<0.05).结论 肺癌合并肺部感染患者的PIK3CA蛋白阳性表达率明显升高,血常规、凝血功能指标水平均出现异常表达,临床上应予以重视.

目的 观察降钙素原(PCT)、脑钠肽(BNP)联合急性生理与慢性健康Ⅱ(APACHEⅡ)评分对呼吸重症监护患者预后的评估价值.方法 选取呼吸重症监护病房(RICU)290例呼吸重症患者进行回顾性分析,根据28天内生存情况,将其分为存活组与死亡组,比较两组入院第1天、3天、5天APACHEⅡ评分、PCT和BNP表达水平,分析患者预后影响因素及PCT、BNP联合APACHEⅡ评分对预后的预测价值.结果 28天内290例患者死亡72例(24.83％),存活218例(75.17％).存活组入院第1天、3天、5天APACHEⅡ评分、PCT和BNP表达水平均明显低于死亡组(P<0.05).存活组与死亡组C反应蛋白(CRP)、PCT、BNP、APACHEⅡ评分差异有统计学意义(P<0.05).Logistic回归分析显示,PCT、BNP、APACHEⅡ评分为RICU呼吸重症患者死亡独立危险因素(P<0.05).受试者工作特征(ROC)曲线分析显示,PCT预后评估灵敏度为79.5％,特异度为77.3％;BNP灵敏度为70.2％,特异度为78.2％;APACHEⅡ评分灵敏度为84.2％,特异度为71.5％;三者联合预测灵敏度为92.6％,特异度为90.1％.结论 PCT、BNP联合APACHEⅡ评分能更好地评估呼吸重症监护患者的预后.

目的 探究支气管扩张合并铜绿假单细胞菌感染患者的治疗中应用比阿培南的临床效果.方法 60例支气管扩张合并铜绿假单细胞菌感染患者,随机分为研究组(35例)和对照组(25例).对照组患者静脉滴注美罗培南治疗,研究组患者静脉滴注比阿培南治疗,比较两组患者治疗前后临床症状评分、细菌清除率和不良反应发生率.结果 治疗前后,两组患者咳嗽咳痰、呼吸困难、胸痛、咯血评分比较,差异均无统计学意义(P>0.05).研究组细菌清除率为91.43％显著高于对照组的68.00％,差异具有统计学意义(P<0.05).研究组不良反应发生率8.57％与对照组的16.00％比较,差异无统计学意义(P>0.05).结论 比阿培南治疗支气管扩张合并铜绿假单细胞菌感染患者临床效果理想,在保证安全性和有效性的同时可以较好的清除铜绿假单胞菌.

Objective To investigate the effect of non-invasive ventilation in patients with severe COPD complicating by pulmonary hypertension.Methods From January 2017 to December 2017,74 patients with severe COPD and pulmonary hypertension were selected and were divided into control group (n=37) and observation group (n=37).The patients in the control group were treated with routine therapy,and the patients in the observation group were treated with non-invasive ventilation.FEV1/FVC,FEV1/prediction,PASP,and adverse reaction rate were compared between the two groups.Results FEV1/FVC,FEV1/prediction,PASP in the observation group after treatment were significantly better than those of the control group (P＜0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups (P＞0.05).Conclusion The effect of noninvasive ventilation in patients with severe COPD and pulmonary hypertension is significant,which can effectively improve the pulmonary function and reduce the pulmonary systolic pressure,with the value of clinical treatment.

目的 探讨胸腺肽α1联合肺泡灌洗对铜绿假单胞菌定植的支气管扩张患者的机体免疫功能及临床效果的影响.方法 选择铜绿假单胞菌定植的支气管扩张患者116例,经过急性期治疗病情得到控制后,以自愿为原则随机双盲分为2组,对照组行单纯肺泡灌洗,观察组给予皮下注射胸腺肽α1的同时行肺泡灌洗,观察两组患者3个月后免疫指标及炎症因子的变化和6个月内临床症状及呼吸道再次感染次数.结果 胸腺肽α1联合肺泡灌洗治疗能够减轻铜绿假单胞菌定植的支气管扩张患者的临床症状,增强肺功能、降低再感染率,并可在一定程度上降低患者Th17免疫功能指标和提升Treg免疫功能指标,同时降低白细胞介素(IL)-17、IL-6炎症指标水平和提升IL-10、转化生长因子-β (TGF-β)等炎症指标水平.结论 胸腺肽α1联合肺泡灌洗可提高铜绿假单胞菌定植的支气管扩张患者的免疫功能,减少其炎症反应及临床症状,降低呼吸道再次感染发病率.且胸腺肽α1药物耐受性好,不良反应小.

BACKGROUND The prevalence of bronchiectasis with comorbid chronic obstructive pulmonary disease (COPD) is rising, which causes extremely high risk of exacerbation and mortality. We aimed to evaluate the differences in clinicopathological manifestations, immune function, and inflammation in bronchiectasis patients with comorbid COPD vs. patients who only have COPD. MATERIAL AND METHODS Clinicopathological characteristics, including common potentially pathogenic microorganisms, lung function, immune function, and inflammation were assessed in bronchiectasis patients with comorbid COPD and in patients who only had COPD. RESULTS Compared to patients who only had COPD, patients with bronchiectasis with comorbid COPD had a higher positive rate of sputum bacteria (45.27% vs. 28.03%, P<0.01). Among them, Pseudomonas aeruginosa (P. aeruginosa) accounted for 25.19% in COPD (4.37%) (P<0.01). Likewise, patients with bronchiectasis with comorbid COPD had worse lung function, worse COPD assessment test scores, and worse Modified Medical Research Council scores. Moreover, compared with COPD only cases, patients with bronchiectasis with comorbid COPD had higher levels of white blood cells (WBC), neutrophils, C-reactive protein (CRP), and procalcitonin (PCT) (all P<0.05). Interestingly, the expression levels of Treg in patients with bronchiectasis with comorbid COPD were lower than in patients with COPD only (P<0.05). Th17 and Th17/Treg levels were higher (P<0.05). Furthermore, remarkable increased level of IL17 and IL-6 and decreased level of IL-10 and TGF-ß were observed in the bronchiectasis combined COPD than in pure COPD (All P<0.05). CONCLUSIONS Our findings suggest that P. aeruginosa is the main pathogen of bacterial infection in bronchiectasis patients with comorbid COPD. These patients have more serious clinical manifestations and immune imbalance, which should be considered when providing clinical treatment.

目的:探讨慢性阻塞性肺疾病合并呼吸衰竭患者应用呼吸机不同通气模式治疗的效果.方法:选择医院治疗的68例慢性阻塞性肺疾病合并呼吸衰竭患者,随机分为对照组与观察组各34例.对照组采用无创呼吸机治疗联合ST通气模式治疗;观察组联合平均容积保证压力支持通气模式治疗,比较两组的治疗效果.结果:观察组治疗后的血氧应激反应、动脉血气指标改善程度均优于对照组,且不良反应更少,差异有统计学意义(P＜0.05).结论:慢性阻塞性肺疾病合并呼吸衰竭患者经呼吸机不同通气模式治疗后的效果显著,明显改善了患者的血氧应激反应与动脉血气指标.

目的 分析慢性阻塞性肺疾病(COPD)采用罗红霉素联合噻托溴铵治疗的临床价值.方法 随机选取该院近年来收治的COPD患者75例,根据治疗方式分为两组,治疗组38例患者采取罗红霉素联合噻托溴铵治疗,对照组37例患者以噻托溴铵治疗,对比两组患者治疗效果.结果 治疗组治疗效果总有效率94.7％,较对照组的75.7％明显提高19％,治疗组治疗后肺功能较对照组改善明显,6 min步行距离(6MWD)长于对照组,生活质量优于对照组,差异有统计学意义(P＜0.05).两组患者治疗期间未出现严重不良反应.结论 罗红霉素联合噻托溴铵治疗COPD可显著改善患者生活质量,改善肺功能,疗效显著.

Objective:To observe the targeting therapy of early stage non small cell lung cancer (NSCLC) affect the life quality and immune function of patients.Method:126 patients with early non small cell lung cancer in our hospital from June 2014 to May 2016 were selected as the objects of study,they were randomly divided into molecular targe group of 76 cases and conventional treatment group of 50 cases.The molecular targe group was given drug therapy for the treatment,the dose for Gefitinib Imatinib 250 mg/d,Erlotinib Erlotinib 150 mg/d, ALK positive detection by Eck for Nigerian 125 mg/time,3 times a day,continuous treatment for 12 months. The conventional treatment group was given adjuvant chemotherapy. of therapeutic effect, quality of life, immune function and adverse reactions of two groups were observed.Result:The total effective rate and disease control rate of two groups had no significant difference(P>0.05); there were statistically significant differences of KPS score in molecular target group before and after treatment(P<0.05),after treatment,the KPS score of two groups had statistically significant difference(P<0.05);the quality life of two groups after treatment had statistically significant difference(P<0.05),and molecular targeted group of that was better than control group, the difference was statistically significant(P<0.05).The main adverse reactions were rash, diarrhea, nausea and ulcers,but it had no effect on anti tumor therapy.Conclusion:The targeted therapy for early stage non-small cell lung cancer patients can improve the life quality and immune function of patients.

目的：观察沙美特罗替卡松联合噻托溴铵吸入治疗慢性阻塞性肺疾病(COPD)合并支气管扩张的临床疗效。方法150例 COPD 合并支气管扩张患者,随机分为对照组(68例)和实验组(82例),对照组采用沙美特罗替卡松粉吸入剂治疗12周,实验组在对照组基础上联用噻托溴铵粉吸入剂治疗。对比两组临床疗效。结果治疗后,两组第一秒用力呼气容积(FEV1)/预计值、FEV1/用力肺活量(FVC)、FEV1、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)均优于治疗前,实验组优于对照组(P<0.05)。随访1年中,实验组急性发作(2.3±1.1)次,对照组为(3.6±1.8)次,实验组少于对照组(t=5.43, P<0.05)。实验组 COPD 评估测试(CAT)问卷评分(8.2±2.1)分,对照组为(10.3±2.6)分,实验组低于对照组(t=5.47, P<0.05)。结论沙美特罗替卡松联合噻托溴铵吸入治疗 COPD 合并支气管扩张的疗效显著,可显著改善患者生活质量,减少急性发作次数,值得临床推广。

Objective To investigate the curative effect of cisplatin combined with gemcitabine and cisplatin plus pacli-taxel in the treatment of advanced non-small cell lung cancer. Methods All 100 patients with non-small cell lung can-cer in our hospital from January 2012 to January 2014 in our hospital, randomly divided into observation group (gemc-itabine+cisplatin, GP group) and control group (paclitaxel+cisplatin, TP group), each group had 50 cases, two groups of patients every 21 days for a cycle, observed curative effect after 2 cycles, toxic and adverse reaction were compared between the two groups. Results The effective rate of the observation group after treatment was 42.0%(21/50),was higher than that of the control group 40% (20/50), but there was no significant difference (P>0.05). Conclusion Cura-tive effect of cisplatin combined with gemcitabine and cisplatin plus paclitaxel in the treatment of advanced non-small cell lung cancer is similar, the poisonous side effect is different and can be tolerated, for the treatment of advanced non-small cell lung cancer treatment plan better.

Objective To investigate clinical characteristics and prognosis of lung cancer complicated with phlebothrombosis. Methods Analysis was made on general data, location of phlebothrombosis, symptoms and treatment status in 120 lung cancer complicated with phlebothrombosis patients. Occurrence of thrombus was summarized in 3, 6, 9, 12 months after diagnosis of lung cancer. Results In the pulmonary thromboembolism group, there were respectively 36, 40, 44, 45, 52 cases with thromboembolism after 3, 6, 9, 12, and over 12 months of diagnosis of lung cancer. Those numbers in the venous thromboembolism group were 51, 53, 54, 55, 68 cases. Their differences had no statistical significance (P>0.05). In the chemotherapy group, there were respectively 28, 36, 39, 39, 48 cases with thromboembolism after 3, 6, 9, 12, and over 12 months of diagnosis of lung cancer. Those numbers in the operation group were 21, 25, 25, 25, 28 cases. Their differences had no statistical significance (P>0.05). Pulmonary thromboembolism group had death cases as in 22, 30, 33, 33, 39 cases after 3, 6, 9, 12, and over 12 months of diagnosis of venous thromboembolism. Those numbers of venous thromboembolism group were 17, 24, 28, 30, 40 cases. Their differences had no statistical significance (P>0.05). Conclusion Lung cancer patients have high incidence of venous thromboembolism, which has its high-incidence period in 3~6 months after diagnosis. Those patients of lung cancer complicated with venous thromboembolism have high mortality rate, and most of them die within 1 year. Active prevention and treatment of venous thromboembolism contain important significance for prolonging life time of lung cancer patients.

Objective To investigate the clinical effect of Broncho-Vaxom combined with postural drainage in the treatment of bronchiectasis.Methods 78 cases of bronchiectasis whose acute phase condition was under control after treatment,were randomly double-blind divided into two groups.Control group received postural drainage,and treatment group received Broncho-Vaxom capsule combined with postural drainage.Compared immune indexes after 3 months and clinical symptoms including cough and expectoration,number of respiratory infection during 6 months between two groups.Results Cough and expectoration symptoms after treatment in treatment group were better than those in control group (P=0.046),the number of respiratory tract infection was lower (P=3.43× 1012).Expression levels of CD4+,CD4+/CD8+,NK after treatment improved significantly in treatment group (P＜0.01),expression level of CD8+ decreased (P＜0.01).Expression levels of CD4+,CD4+/CD8+,NK in control group before and after treatment did not change significantly.The levels of IgG and IgA after treatment in treatment group were significantly higher those in control group (P＜0.01).Conclusions Broncho-Vaxom combined with postural drainage can relieve cough and expectoration symptoms of bronchiectasis patients,reduce the incidence of respiratory tract infection,enhance body immunity.Broncho-Vaxom has a good drug tolerance,with slight side effect.

Objective To observe the long-term inhaled budesonide/formoterol combined with postural drainage in patients with bronehiectasis prevention bronchiectasis reinfection clinical curative effect and life quality evaluation.Methods Sixty-nine cases patients with bronchiectasis after exacerbation and maintained stable were randomly double-blind divided into two groups and 12 months of maintenance therapy.Control group simple postural drainage,treatment group inhaled budesonide/ formoterol,at the same time Postural drainage.Observation of patients with clinical symptoms,dyspnea scale,pulmonary function changes,acute seizure frequency and quality of life score.Results Two patients with big haemoptysis surgical treatment exit our test,one patient with respiratory failure exit our test,66 patients completed the study.The results showed that long-term position drainage can improve the clinical symptoms with bronchiectasis,whille failed to improve dyspnea in patients with symptoms,pulmonary function,the frequency of exacerbation and survival quality,inhalation budesonide/formoterol combined postural drainage can improve the clinical symptoms and dyspnea,can reduce the frequency of exacerbation in patients,and in a certain extent improve lung function index,and improve the patients quality of life.Conclusions Long term inhaled glucocorticoid/beta receptor agonist combined postural drainage to bronchiectasis had good clinical effect,can reduce the symptoms of patients and decrease the frequency of exacerbation in patients,improve lung function with bronchiectasis.It may be as an alternative to the maintenance treatment of bronchiectasis.