目的 探讨第1秒用力呼气容积占预计值百分比(FEV1％pred)结合睡眠呼吸暂停临床评分(SACS)对慢性阻塞性肺疾病(COPD)合并阻塞性睡眠呼吸暂停(OSA)患者的初筛价值.方法 选取2020年1月至12月于航天中心医院呼吸与危重症医学科住院检查确诊为COPD的299例患者为研究对象,所有患者均完成肺功能FEV1％pred检查以及SACS,行整夜多导睡眠图(PSG)监测.根据睡眠呼吸暂停低通气指数(AHI)将患者分为单纯COPD组和COPD合并OSA(重叠综合征,OVS)组.采用SPSS 23.0软件进行统计分析.根据数据类型,组间比较分别采用独立样本t检验或 χ2检验.采用Pearson's相关系数分析FEV1％pred、SACS与AHI的相关性.采用受试者工作特征(ROC)曲线分析FEV1％pred结合SACS预测COPD患者OVS的价值.结果 OVS组FEV1％pred[(53.4±15.1)和(43.6±13.9)％;P<0.05]及SACS[(19.1±3.9)和(7.3±2.1)分;P<0.05]显著高于单纯COPD组.相关性分析显示,AHI与FEV1％pred(r=0.631,P<0.05)及SACS(r=0.689,P<0.05)呈正相关.ROC曲线显示,FEV1％pred诊断OVS的最佳截断点为48.3％,灵敏度和特异度分别为81.3％和75.4％;SACS诊断OVS的最佳截断值为16,灵敏度和特异度分别为83.2％和79.3％;将FEV1％pred≥48.3％和SACS≥16分作为联合指标诊断OVS的曲线下面积为0.812(95％CI 0.781～0.903),灵敏度和特异度分别为85.2％和79.5％.结论 FEV1％pred联合SACS评分对筛查COPD患者OVS具有良好的预测价值.

目的 回顾性分析支气管扩张症合并慢性阻塞性肺疾病急性加重(AECOPD)患者住院死亡的相关因素.方法 选取航天中心医院呼吸科2015年1月至2020年6月收治的111例支气管扩张症合并AECOPD住院患者为研究对象.根据不同预后结果将患者分为存活组与死亡组,收集2组患者的一般资料、临床表现、肺功能、实验室检查及住院时间等进行分析,筛查影响患者住院死亡风险的相关因素.采用SPSS 24.0统计软件进行数据处理.根据数据类型,分别采用t检验、χ2检验或Mann-Whitney秩和检验进行组间比较.采用logistic回归分析死亡风险因素.结果 共筛选出31个风险因素进行分析.单因素分析显示,2组患者年龄、合并基础疾病、体质量指数(BMI)、粒细胞/淋巴细胞比值(NLR)、血清白蛋白(Alb)、铜绿假单胞菌感染、最大呼气第1秒呼出气量的容积占预计值百分比(FEV1％pred)、动脉血气分析(BGA)、二氧化碳分压(PCO2)、氧合指数(OI)、胸部影像学Bhalla评分及每年症状持续时间比较,差异有统计学意义(P<0.05).多因素logistic回归分析显示,NLR、FEV1％pred及Bhalla评分是支气管扩张症合并AECOPD患者的死亡危险因素.结论 NLR升高、FEV1％pred下降及胸部影像学Bhalla评分低是支气管扩张症合并AECOPD患者死亡的独立危险因素.

Objective To discuss the clinical application of 18F fluorodeoxyglucose (18F-FDG) coincidence single photon emission computed tomography (SPECT/CT) in the diagnosis of lung nodules.Methods The CT and SPECT/CT findings of 128 cases with pulmonary nodules were collected.Semi quantitative measurement method (uptake ratio of tumor tissues to periodic soft tissue, T/N) were used.The data were statistically analyzed.The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT and SPECT/CT were calculated, and the results of SPECT/CT in the diagnosis of benign and malignant tumors were analyzed.Results The sensitivity, specificity and negative predictive value, positive predictive value and accuracy of SPECT/CT in the diagnosis of lung nodules were 96.46%, 86.67% and 76.51%, 98.13%, 95.32%, and with no significant difference with pathological results (X2=0.25,P=0.617).The sensitivity, specificity and negative forecast value, positive predictive value and accuracy of CT were 86.72% and 73.33%, 86.08%, 42.3%, 85.1% with significant difference with pathological results (X2=5.26, P=0.022).The sensitivity, specificity, negative predictive value, positive predictive value and accuracy of SPECT/CT were higher than those of CT with significant difference (P<0.05).The T/N ratio of patients with benign and malignant nodules was significantly different in <2, 2~3, >3 (u=2.87, P=0.012).The average T/N value of malignant group (2.98±0.6) was significantly higher than that of the benign group (1.23±0.2), the difference was statistically significant (P<0.05).Conclusion The specificity and sensitivity of 18F-FDG SPECT/CT imaging in the diagnosis of pulmonary nodules were high , and this examination can effectively improve the diagnostic accuracy of pulmonary nodules.

Objective To observe the pneumoconiosis patients coinfected take Tanreqing injection in the treatment of effect. Methods The patients infected with pneumoconiosis merged hospital admissions of 78 cases divided into study group 40 cases and control group 38 cases, the control group received intravenous levolfoxacin therapy, and research groups to take intravenous tanreqing treatment. Patients were observed and recorded the time symptoms and signs disappeared time, blood normal time, cure time, length of hospital stay and treatment and adverse events, and analyzed. Results The time symptoms and signs disappeared time, blood return to normal time, healing time and hospital stay are signiifcantly lower than the control group (P<0.05), there were no serious adverse reactions are (P>0.05), while the total efifciency of treatment, there was no signiifcant difference in comparison (P>0.05). Conclusion Pneumoconiosis coinfected patients to take tanreqing treatment can get relatively good results, signs and symptoms disappear quickly, blood faster recovery and a shorter hospital stay, no serious adverse reactions, it is worth learning from.