Objective To investigate the correlation between the expression levels of interleukin（IL）-33 and soluble growth stimulating expression gene 2 protein（sST2） in pleural effusion and inflammatory response. Methods A total of 108 patients with pleural effusion admitted to Hebei Provincial Chest Hospital from March 2019 to March 2022 were included in the study retrospectively. Patients with tuberculous pleural effusion（TPE） were included in the TPE group（n=45）, and patients with malignant pleural effusion（MPE） were included in the MPE group（n=60）. In the same period, 50 healthy adults who underwent physical examination in our hospital were selected as the control group（n=50）. The levels of IL-33 and sST2 in pleural fluid and serum IL-33, sST2, IL-6, C-reactive protein（CRP） and tumor necrosis factor-α（TNF-α） were detected. The correlation between pleural effusion, serum IL-33 and sST2 and serum inflammatory factors in patients with TPE and MPE was analyzed by Pearson correlation coefficient. The diagnostic value of pleural effusion and serum IL-33 and sST2 in TPE was analyzed by receiver operating characteristic（ROC） curve. Results The levels of IL-33 and sST2 in pleural effusion were（83.52±21.09）,（1 108.37±236.15） ng/L, respectively, which were higher in TPE group than those in MPE group [（53.16±11.24）,（726.49±151.28） ng/L], the differences were statistically significant（P＜0.05）. The serum levels of IL-33 and sST2 in TPE group and MPE group were higher than those in control group, and TPE group was（74.13±18.49）,（1 454.07±477.19） ng/L, respectively, which was higher than that in MPE group[（58.46±16.52）,（1 228.65±374.64） ng/L], the differences were statistically significant（P＜0.05）. The levels of serum IL-6, CRP and TNF-α in TPE group and MPE group were higher than those in control group, and TPE group was higher than MPE group, the differences were statistically significant（P＜0.05）. Pleural effusion and serum IL-33 and sST2 were positively correlated with serum IL-6, CRP and TNF-α levels in TPE patients（P＜0.05）. The pleural effusion and serum IL-33 and sST2 were positively correlated with serum IL-6, CRP and TNF-α levels in MPE patients（P＜0.05）. ROC analysis showed that IL-33≥69.142 ng/L in pleural effusion, sST2≤943.715 ng/L in pleural effusion, IL-33≥65.172 ng/L in serum, and sST2≥1308.664 ng/L in serum were the best cut-off values for TPE（P＜0.05）. Conclusion Pleural effusion and serum IL-33 and sST2 are closely related to the occurrence and development of TPE and MPE, and are positively correlated with the levels of inflammatory factors such as IL-6, CRP, TNF-α. In clinical practice, TPE and MPE can be identified by detecting pleural effusion and serum IL-33 and sST2.

目的 分析耐药肺结核高危人群左氧氟沙星耐药情况及左氧氟沙星耐药的影响因素,为耐药结核病防控提供参考.方法 选取2018年1月-2020年12月在河北省胸科医院就诊的182例耐药肺结核高危患者为研究对象,统计左氧氟沙星耐药率,并通过单因素、多因素分析左氧氟沙星耐药的影响因素.结果 182例耐药肺结核高危患者中40例出现左氧氟沙星耐药,占比21.98％,其中耐多药25例(62.50％),多耐药9例(22.50％),一线药物均敏感5例(12.50％),一线药物单耐药1例(2.50％);左氧氟沙星耐药患者病程、左氧氟沙星应用时间长于非左氧氟沙星耐药患者,空洞及复治占比、双肺受累野数多于非左氧氟沙星耐药患者,差异均有统计学意义(P<0.05);经多因素Logistic回归模型分析发现,空洞、治疗情况、左氧氟沙星应用时间、双肺受累野数、左氧氟沙星剂量是左氧氟沙星耐药的影响因素(P<0.05).结论 耐药肺结核高危人群左氧氟沙星耐药率较高,主要受空洞、治疗情况、左氧氟沙星应用时间、双肺受累野数等因素影响,临床可据此加强耐药结核病防控.

目的 探讨富含ω-3脂肪酸的肠内营养支持联合乙酰半胱氨酸治疗急性加重期慢性阻塞性肺疾病(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)的临床疗效.方法 选取2018年10月至2019年12月河北省胸科医院收治的172例AECOPD患者为研究对象,采用随机数字表法分为A组、B组、C组和D组,每组各43例.A组给予基础治疗,B组给予基础治疗+富含ω-3脂肪酸的肠内营养支持治疗,C组给予基础治疗+乙酰半胱氨酸治疗,D组给予基础治疗+富含ω-3脂肪酸的肠内营养支持治疗+乙酰半胱氨酸治疗,四组患者均连续治疗14d.比较分析四组患者治疗14d后的临床疗效,治疗前后的体重、气流阻塞、呼吸困难和运动能力(body mass,airflow obstruction,dyspnea and exercise capacity,BODE)指数,治疗前后的CD4+、CD8+、CD4+/CD8+、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素-8(interleukin-8,IL-8)和脂联素(adiponectin,APN)水平,住院时间、住院费用以及住院期间的不良反应发生情况.结果 治疗后,B组、C组和D组患者的总有效率均显著高于A组(P<0.05);D组患者的总有效率均显著高于B组和C组(P<0.05).与治疗前比较,四组患者治疗后的BODE指数均显著降低(P<0.05).治疗后,B组、C组和D组患者的BODE指数均显著低于A组(P<0.05);D组患者的BODE指数均显著低于B组和C组(P<0.05).与治疗前比较,四组患者治疗后的CD4+、CD4+/CD8+、APN水平均显著升高(P<0.05),CD8+、TNF-α、IL-8水平均显著降低(P<0.05).治疗后,B组、C组、D组患者的CD4+、CD4+/CD8+、APN水平均显著高于A组(P<0.05),CD8+、TNF-α、IL-8水平均显著低于A组(P<0.05);D组患者的CD4+、CD4+/CD8+、APN水平均显著高于B组和C组(P<0.05),CD8+、TNF-α、IL-8水平均显著低于B组和C组(P<0.05).B组、C组和D组患者的住院时间和住院费用均显著短于或少于A组(P<0.05);D组患者的住院时间和住院费用均显著短于或少于B组和C组(P<0.05).四组患者的不良反应发生率比较差异均无显著性(P=0.576).结论 富含ω-3脂肪酸的肠内营养支持联合乙酰半胱氨酸治疗AECOPD能够提高临床疗效,改善患者的营养状态和肺功能,增强运动能力,改善免疫功能,减轻炎症反应,缩短住院时间,减少住院费用,且安全性较高,值得临床应用.

Objective To discuss the application of modified Nikaidoh in Taussig-Bing anomaly with pulmonary stenosis.Methods The modified Nikaidoh procedure was employed to exchange and transplant the aortic and pulmonary roots and rebuild the left and right ventricular outflow tracts.The changes in structure of heart tissues,the post-operative recovery and growth and development of the patients were observed.Results After the modified Nikaidoh procedure,the relationship between the ventricle and artery was recovered to be normal,without the serious progressive aortic valve insufficiency,and medium or above pulmonic valve regurgitation,and left and right ventricular outflow tract obstruction.5 cases survived after the operation and 1 case died of serious heart failure and multiple organ dysfunction syndrome.According to the follow-up of 4 months to 7 years,the growth and development of patients were improved,with the significant increase in the oxygen saturation and the disappearance of cyanosis.Conclusion The application of modified Nikaidoh in Taussig-Bing anomaly with pulmonary stenosis can achieve the anatomical radical cure and obtain the good surgical effect.

目的 探讨心肌梗死患者自体外周血干细胞(autologous peripheral blood stem cell,APBSC)动员、采集的效率,以及自体外周血干细胞移植(autologous peripheral blood stem cell transplantation,APBSCT)治疗心肌梗死的安全性和可行性.方法 46例心肌梗死患者在常规药物治疗基础上,冠状动脉旁路移植术(coronary artery bypass grafting,CABG)前5d,根据患者体质量,给予重组人粒细胞集落刺激因子(recombinant human granulocyte colony stimulating factor,rhG-CSF)450 μg/d(≤65 kg)或600 μg/d(＞65 kg)皮下注射,进行APBSC动员及扩增.CABG前24 h进行APBSC采集.46例患者均在非体外循环下行CABG,在完成血管桥吻合后,经桥血管及心外膜下注入采集的APBSC.在APBSC动员、采集前后检测外周血和采集产品中单个核细胞(mononuclear cells, MNC)及CD34+细胞数量.检测APBSC采集前后血压、心率、呼吸、白细胞(white blood cell,WBC)、红细胞(red blood cell,RBC)、血红蛋白(hemoglobin,Hb)、血细胞比容(hematocrit,Hct)、血小板(platelet,Plt)和血清Ca2+的变化.观察APBSC动员、采集、移植过程中有无不良反应.结果 APBSC动员后外周血中WBC、MNC、CD34+细胞数量较动员前显著升高(P＜0.01).APBSC采集后外周血中MNC、CD34+细胞数量较采集前显著升高(P＜0.01),APBSC采集前后血压、心率、呼吸、WBC、RBC、Hb、Hct及血清Ca2+变化差异无统计学意义(P＞0.05),Plt计数采集后较采集前明显降低(P＜0.01).APBSC动员、采集、移植过程中发生不良反应20例,其中APBSC动员过程中的不良反应占17.4％(8/46),APBSC采集过程中的不良反应占10.9％(5/46),APBSC移植过程中的不良反应占15.2％(7/46).结论 心肌梗死患者APBSC经过动员、采集后可获得较高的MNC和CD34+细胞产量;APBSCH治疗心肌梗死安全可行.

Objective To explore the clinical significance of detection of the expression of serine/threo-nine protein kinase 11(STK11),Bcl-2 interacting mediator of cell death(BIM) in non-small cell lung cancer (NSCLC).Methods Total of 65 NSCLC patients in Hebei Provinical Chest Hospital from Mar.2014 to Mar.2015 were included in the study,the dissected cancerous tissue sample and the paracancerous tissue were collected.Immunohistochemical techniques was used to study the expression of STK11,BIM in the pro-tein samples.Results STK11 positive expression rate of the cancer tissue was lower than the paracancerous tissue[63.08%(41/65) vs 92.31% (60/65)](χ2 =16.022,P<0.05),the BIM positive expression rate of the cancerous tissue was higher than the paracancerous tissue[61.54%(40/65) vs 21.54%(14/65)] (χ2 =21.413,P<0.05).Tissues STK11 positive expression rate in in patients with lymph node metastasis was significantly lower than patients without lymph nodes metastasis [ 41.38%( 12/29 ) vs 80.56%( 29/36)] (P<0.05); STK11 positive rate in stageⅠ-Ⅱpatients was significantly higher than that of stage Ⅲ-Ⅳ patients[72.55%(37/51) vs 28.57%(4/14)] (P<0.05);STK11 positive expression rate of patients of higher differentiation was significantly higher than patients with medium and low differentiation [89.47%(17/19) vs 51.61%(16/31),53.33%(8/15)] (P<0.05).STK11 in patients with adenocarcinoma was significantly higher than patients with squamous cell carcinomas[78.13%(25/32) vs 48.48%(16/33)] (P<0.05).BIM positive expression rate of stage Ⅰ-Ⅱ patients was significantly higher than that of Ⅲ-Ⅳ[70.59%(36/51) vs 28.27%(4/14)] (P<0.05);the BIM positive expression rate of patients with high differentiation was significantly higher than patients with medium and low differentiation [ 89.47%( 17/19 ) vs 45.16% (14/31),60.00%(9/15)](P <0.05).Adenocarcinoma BIM positive rate was higher than squamous cell carcinoma[75.00%(24/32) vs 48.48%(16/33)] (P<0.05).Conclusion The STK11, BIM expression levels can be used as biological indicators for the metastasis and prognosis of NSCLC .

目的 探讨Delta样配体4(delta-like ligand4,DLL4)和Ⅱ型跨膜丝氨酸蛋白酶4(typeⅡteansmembrane serine 4,TMPRSS4)在非小细胞肺癌(non-small cell lung cancer,NSCLC)中的表达及其临床意义.方法 选取手术前未行放化疗的NSCLC患者72例癌组织标本作为观察组,另选取距离原发肿瘤5 cm以上、经病理证实无肿瘤浸润的肺组织标本作为正常对照组.通过免疫组织化学染色法,检测两组DLL4和TMPRSS4表达情况,分析观察组DLL4和TMPRSS4表达与患者临床病理特征的关系以及二者表达的相关性.结果 观察组DLL4阳性表达率为65.3％,TMPRSS4阳性表达率为79.2％,均高于正常对照组的25.0％和26.4％,差异均有统计学意义(P均＜0.01).观察组DLL4和TMPRSS4的表达与患者肿瘤临床分期、分化程度、淋巴结转移情况相关(P＜0.05或P＜0.01).Spearman相关性分析显示,观察组DLL4与TMPRSS4表达呈正相关(r=0.344,P=0.003).结论 DLL4和TMPRSS4在NSCLC的发生、发展和转移中可能起协同作用,DLL4联合TMPRSS4检测对判断NSCLC预后有一定价值.

Objective To investigate the expressions and clinical significance of delta-like ligand 4( DLL4), Hypoxia inducible factor alpha(HIF-α)and Vascular endothelial growth factor( VEGF)in non-small cell lung cancer (NSCLC). Methods A total of 72 samples of NSCLC patients undergoing surgery during October 2012 and November 2015 were chosen as NSCLC group,and 72 pulmonic tissue samples more than 5 centimeters away from of the primary tumor,which were confirmed with no tumor invasion by hematoxylin and eosin stain(HE)staining,were chosen as con-trol group. The expressions of DLL4,HIF-α and VEGF were detected using immunohistochemical staining method,and were analyzed,combined with the pathological data. Results The positive expression rates of DLL4,HIF-α and VEGF in NSCLC group were significantly higher than those in control group(P ﹤ 0. 01). The expressions of DLL4,HIF-α and VEGF related to degrees of tumor differentiation,clinical stages and lymph node metastasis(P ﹤ 0. 05),but the expres-sions were not related to patients’ age,gender,pathological types and tumor diameter( P ﹥ 0. 05). The expressions of DLL4,HIF-α and VEGF showed significant positive relation between every two(r = 0. 320,0. 366,0. 335,P ﹤ 0. 01). Conclusion DLL4,HIF-α and VEGF may play a collaborative role in incidence,development and metastasis of NSCLC. It has some value for judging incidence,development and prognosis of NSCLC and studying new targeted thera-peutic drugs by detecting the expressions of DLL4,HIF-α and VEGF.

Objective To explore the efficacy and safety of large and conventional fractionated three dimensional conformal radiation therapy for non small cell lung cancer with superior vena cava compression syndrome, and to provide clinical reference for improving the prognosis of patients with non small cell lung cancer. Methods The general data of 63 patients with non small cell lung cancer complicated with superior vena cava syndrome treated in Lu'an Hospital of Traditional Chinese Medicine from January 2010 to December 2012 were analyzed retrospectively. According to the different treatment methods, the patients were divided into observation group ( n =28) and control group ( n =35) .The control group was given conventional fractionated three-dimensional conformal radiation therapy, three dimensional conformal radiation therapy was given to the observation group. The clinical efficacy, toxicity, and 1, 2 years survival rate of the two groups were compared.&nbsp;Results The complete remission rate of observation group was 96.43%, which was significantly higher than 74.29%in the control group (P<0.05) . The complete remission in the observation group was 89.29%in two weeks, which was significantly higher than 62.86%in the control group (P<0.05) . The total effective rate of observation group was 85.71%, which was significantly higher than that 62.86%in the control group (P<0.05) . The clinical benefit rate of observation group was 96.43%, and there was no significant difference between the two groups (P>0.05) . There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05) . There was no significant difference in 1, 2 year survival rate between the two groups (P>0.05) . Conclusion Three dimensional conformal radiation therapy for non small cell lung cancer patients with superior vena cava syndrome is superior to conventional treatment, and does not increase the toxic side effects, which is worthy of clinical attention.

目的:探讨基于RNA干扰CMTM7对肺腺癌A549细胞凋亡的影响.方法:选择肺腺癌A549细胞株分为siRNA组、阴性对照组与空白对照组,在对数生长的A549细胞中转染RNA干扰CMTM7载体、脂质体空载体和不进行转染,观察A549细胞的生长、凋亡与细胞周期状况.结果:MTT实验显示siRNA转染组的抑制率明显高于阴性对照组和空白对照组(P＜0.05),阴性对照组与空白对照组的对比无明显差异(P＞0.05).流式细胞术实验表明siRNA转染组的细胞凋亡率明显高于阴性对照组和空白对照组(P＜0.05),阴性对照组与空白对照组的对比无明显差异(P＞0.05).流式细胞术实验表明siRNA转染组的G0/G1期细胞数目较阴性对照组和空白对照组增多明显(P＜0.05),同时siRNA转染组的S、G2/M期细胞数目较阴性对照组和空白对照组明显减少(P＜0.05),阴性对照组和空白对照组对比差异无统计学意义(P＞0.05).结论:RNA干扰CMTM7能够促进肺腺癌A549细胞凋亡,抑制肿瘤细胞的生长,其作用机制可能通过干扰细胞周期而实现.

目的：探讨非小细胞肺癌组织中 Delta 样配体4（DLL4）的表达及与增殖相关蛋白增殖细胞核抗原（PCNA）、细胞周期蛋白 D1（CyclinD1）、侵袭相关蛋白基质金属蛋白酶（MMP）－2、MMP －9表达的关系及临床意义。方法对68例非小细胞肺癌组织及癌旁正常肺组织石蜡标本进行免疫组化（SP）染色，检测 DLL4的表达，同时检测 PCNA、CyclinD1、MMP －2、MMP －9的表达并进行相关分析，分析 DLL4与之的关系。结果非小细胞肺癌组织中 DLL4、PCNA、CyclinD1、MMP －2、MMP －9与正常肺组织相比均明显增强（均 P ＜0．05）；DLL4蛋白表达与肿瘤分化程度、临床分期、淋巴结转移情况有关（均 P ＜0．05）。相关分析显示，DLL4与 PCNA、CyclinD1、MMP －2表达均呈正相关（均 P ＜0．05）。结论非小细胞肺癌组织中 DLL4存在过表达，且随肿瘤进展而进一步增强。DLL4参与非小细胞肺癌进展的机制在于 DLL4可能通过调节 PCNA、CyclinD1、MMP －2表达而增强肿瘤细胞的增殖侵袭能力促进非小细胞肺癌进展。

Objective To explore the effect of local anesthesia monoporate thorascopic surgery in treatment of traumatogenic hemopneumothorax. Methods A total of 180 patients with traumatogenic hemopneumothorax during June 2009 and February 2014 were divided into two groups (n = 90 each) with block randomization method. The observation group was treated with local anesthesia monoporate thoracic surgery, and the control group received traditional thoracic closed drainage. In the two groups, the postoperative drainage volume and the keeping tube time of thoracic closed drain-age were observed, and the time from admission to transference exploratory thoracotomy, complications and the average hospital stay were also recorded. Results All the patients were cured and discharged. The postoperative drainage vol-ume, the keeping tube time of thoracic closed drainage, the time from admission to transference exploratory thoracotomy, complications and the average hospital stay in observation group were superior to those in control group (P < 0. 05). The difference in number of transference exploratory thoracotomy was not statistically significant (P > 0. 05). Conclusion The local anesthesia monoporate thorascopic surgery in treatment of traumatogenic hemopneumothorax may reduce bleed-ing volume, incidence rate of complications, the keeping tube time of closed drainage of pleural cavity and average hospi-tal stay. It has better curative effect than the traditional therapy of thoracic closed drainage.

Objective To find a new therapy to treat the tuberculous pleurisy by thoracoscope.Methods 90 cases of patients with tuberculous pleurisy were randomly selected for this study.They were treated with the same chemotherapy.The experimental group accepted the extra therapy with thoracoscope besides thoracocentesis,while the control group accepted the conventional treatment of the thoracocentesis.Clinical symptoms,pleural effusion,thickness of pleura,hospital stay and the rate forming empyema after 3 months were recorded.Results The experimental group got a better results than the control group,the difference has a statistical significance.The therapy of tuberculous pleurisy by thoracoscope is an effective method.Conclution Our therapy is worthy for extending in clinic because it's safer,more convenient and could get pathological diagnosis at the same time.

PDCA循环法是由美国著名的质量管理专家戴明博士根据信息反馈原理提出的，也是护理质量管理的最基本方法之一，分为计划（Plan，P）、执行（Do，D）、检查（Check，C）和处理（Ac-tion，A）四个阶段，PDCA循环法具有“大环套小环，阶梯式的上升，科学管理方法的综合应用”的特点［1，2］。毁损肺是由于肺部长期化脓性感染或肺结核空洞形成和肺纤维化导致肺实质严重破坏的一种慢性迁延性疾病，引起毁损肺全肺切除常见原因有结核、肺囊肿、先天性肺发育不全、慢性感染。由于肺组织的广泛纤维化，患侧一叶和单侧肺功能丧失，患者均有不同程度的气促及反复出现的咳嗽、咳脓痰、咯血，内科治疗效果不好，大多需要外科治疗，手术进程创伤大，出血多，术后并发症多且严重。如何对毁损肺全肺切除患者给予良好的健康指导，提高病人的遵医行为，促进患者健康行为的形成，我院于2011年6月将PDCA循环用于毁损肺全肺切除患者及家属的健康教育中，报告如下。