目的 探讨趋化因子配体13蛋白(CXCL13)水平与支气管哮喘中免疫球蛋白E(IgE)、嗜酸性粒细胞(EOS)及肺功能的相关性.方法 选取2019年3月至2021年3月大连大学附属新华医院收治的100例支气管哮喘患者为研究对象,其中急性发作期60例(急性发作组)、慢性持续期40例(慢性持续组),另选取同期体检中心体检的40例健康志愿者作为健康对照组.所有研究对象均通过ELISA法及常规血生化检测血清CXCL13、IgE、EOS的表达水平,住院时间72 h内完善肺功能检查.根据CXCL13在急性发作期的表达水平,多元线性回归分析CXCL13与IgE、EOS和肺功能的相关性.受试者工作特征(ROC)曲线分析CXCL13、IgE、EOS对急性发作的预测效能.结果 急性发作组CXCL13、IgE、EOS水平高于慢性持续组和健康对照组,且慢性持续组高于健康对照组,差异有统计学意义(P＜0.05).急性发作组第1秒用力呼气容积(FEV1)、第1秒用力呼气容积与用力肺活量比值(FEV1/FVC)、第1秒用力呼气容积占预计值百分数(FEV1％pred)低于慢性持续组和健康对照组,且慢性持续组低于健康对照组,差异有统计学意义(P＜0.05).多元线性回归分析结果显示血清CXCL13与IgE、EOS呈正相关,与FEV1、FEV1/FVC、FEV1％pred呈负相关(P＜0.05).ROC曲线显示,CXCL13对预测急性发作的效能高于IgE、EOS.结论 CXCL13可作为预测支气管哮喘急性发作的临床指标.

Objective:To analyze the changes of Th1/Th2 imbalance and cytokines in acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to explore its role in AECOPD.Methods:This was a case-control study.A total of 150 AECOPD patients in Zhongshan Hospital affiliated to Dalian University from March 2021 to December 2021 were selected as the study group by non-random sampling method.Meanwhile, 40 patients with stable COPD (SCOPD) were selected as SCOPD group, and 22 cases in healthy group were selected.The AECOPD group was divided into AECOPD group Ⅰ ( n=48), group Ⅱ ( n=55), and group Ⅲ ( n=47) according to the clinical grading standards of AECOPD in guidelines for the Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease (revised edition 2021).IFN-γ, interleukin-4 (IL-4), IL-17, and IL-10 were detected by flow cytometry, and the ratio of IFN-γ/IL-4 was used as Th1/Th2.One-way ANOVA was performed.The changes of the above indicators in AECOPD and their correlation with inflammatory indicators, lung function parameters, and clinical grade of AECOPD were analyzed. Results:(1) In the AECOPD group, forced expiratory volume in the first second in percent predicted values (FEV 1%pred) and FEV 1/forced vital capacity (FVC) were lower than those in SCOPD group and healthy group, neutrophil to lymphocyte ratio (NLR) and C-reactive protein (CRP) were higher than those in SCOPD group and healthy group (all P<0.05).(2) Th1/Th2 in AECOPD group was lower than that in SCOPD group and healthy group (all P<0.05), while IFN-γ, IL-4, IL-10 and IL-17 were higher than those in SCOPD group and healthy group (all P<0.05).(3) The order of NLR and CRP in AECOPD subgroups from low to high was AECOPD ⅠAECOPD Ⅱ>AECOPD Ⅲ (all P<0.05).(4) The order of Th1/Th2 and IL-10 in AECOPD subgroups from high to low was AECOPD Ⅰ>AECOPD Ⅱ>AECOPD Ⅲ(all P<0.05).The order of IL-17 from low to high was AECOPD Ⅰ

Objective:To investigate the significance and level of serum GRP78 and GRP94 in the early stage ofacute pulmonary embolism.Methods:Ninety APE patients (APE group) and forty healthy controls (control group) in Affiliated Zhongshan Hospital of Dalian University from January 2018 to March 2020 were recruited. The level of serum D-Dimer, GRP78 and GRP94 were compared between the two groups. The pulmonary embolism group was divided into three groups according to guidelines for the diagnosis and treatment of pulmonary embolism in ESC in 2019: low risk, medium risk, high risk, The level of serum D-Dimer, GRP78, GRP94, blood gas, pulmonary arterial pressure, PESI mark of three groups were compared.Results:Two groups had no significant difference in sex, age, body mass index ( P>0.05), but the level of serum D-Dimer, GRP78 and GRP94 in control group and APE group were higher than those in the control group: (3.86 ± 1.82) mg/L vs. (0.31 ± 0.15) mg/L, (2.68 ± 0.71) μg/L vs. (1.64 ± 0.38) μg/L, (1.31 ± 0.29) μg/L vs. (0.98 ± 0.13) μg/L ( P<0.05). The levels of serum D-Dimer, GRP78, GRP94, pulmonary arterial pressure, PO2, PESI score of different degree group (low risk, medium risk, high risk) were higher than those of low risk group and medium risk group: (5.63 ± 1.75) mg/L vs. (2.29 ± 0.51) and (3.64 ± 1.02) mg/L, (3.24 ± 0.76) μg/L vs. (2.17 ± 0.41) μg/L and (2.64 ± 0.47) μg/L, (1.57 ± 0.33) μg/L vs. (1.12 ± 0.13) and (1.26 ± 0.14) μg/L, (47.75 ± 6.98) mmHg (1 mmHg = 0.133 kPa) vs. (26.15 ± 4.63) and (35.21 ± 5.85) mmHg, (123.5 ± 20.59) scores vs. (85.5 ± 14.31) and (102.5 ± 13.32) scores ( P<0.05), and that of medium risk group were higher than those of low risk group ( P<0.05). But PO 2 of high risk group was lower than that of low risk group and medium risk group ( P<0.05), and PO 2 of medium risk group was lower than that of low risk group ( P< 0.05). pH of three group had no significant difference ( P>0.05). PCO 2 of high risk group was lower than that of low risk group and medium risk group ( P<0.05), and PCO 2 of medium risk group and low risk group had no significant difference ( P>0.05). The level of serum D-Dimer, GRP78, GRP94 were positively correlated withPESI score ( r = 0.610, 0.622, 0.627, P<0.01). After treatment, the levels of D-Dimer, GRP78 and GRP94 were significantly decreased ( P<0.05). Conclusions:The level of serum GRP78 and GRP94 are connected with acute pulmonary embolism, and it can reflect the severity of the disease.

目的 评价血清AQP5诊断ACO的临床价值.方法 选取2017年3月至2020年7月在大连大学附属中山医院就诊的ACO患者30例、哮喘患者40例、COPD患者50例及未吸烟的健康者30例.ELISA检测受试者血清AQP5表达水平.单因素方差分析统计AQP5在对照组、哮喘组、COPD组、ACO组中表达水平与各因素之间的相关性.ROC曲线评价AQP5对ACOS的诊断价值.结果 各组间年龄、肺功能存在统计学差异(P<0.05).ACO组肺功能FEV1、FVC、FEV1/FVC值低于对照组、哮喘组、COPD组,但与COPD组无统计学差异(P>0.05);ACO组支气管舒张试验前后ΔFEV1低于哮喘组,高于对照组和COPD组,两两比较有统计学差异(P<0.05).ACO组AQP5表达水平(50.80±21.95)ng/mL,COPD组(81.44±17.69)ng/mL、哮喘组(107.00±17.33)ng/mL和对照组(183.8.±13.97)ng/mL,两两比较有统计学差异(P<0.001).AQP5表达水平与肺功能正相关(P<0.05),与年龄和吸烟指数负相关(P<0.05).回归分析显示吸烟指数、FEV1、ΔFEV1对AQP5表达有影响(P=0.001,P=0.000,P=0.001).血清AQP5水平AUC为0.774(P<0.001).结论 AQP5对鉴别哮喘、COPD和ACO有重要意义.

研究人员近日在《美国呼吸与重症监护医学杂志》上发表报告称,减轻体重可改善阻塞性睡眠呼吸暂停综合征症状,其主要原因是舌头脂肪的减少.由此可见,减少舌脂对于阻塞性睡眠呼吸暂停综合征有着积极的作用.

Objective:To observe the effects of bundled pulmonary rehabilitation on static pulmonary function, cardiopulmonary exercise function and inflammatory factors in patients with moderate or severe stable chronic obstructive pulmonary disease (COPD).Methods:Sixty moderate or severe COPD patients in stable phase from December 2017 to October 2018 in Affiliated Zhongshan Hospital of Dalian University were selected. The patients were divided into control group and rehabilitation group by random digits table with 30 cases each. The patients of control group received routine medicine therapy, and the patients of rehabilitation group received bundled pulmonary rehabilitation besides routine medicine therapy. Pulmonary function, cardiopulmonary exercise function and inflammatory factors in each group were tested before treatment and 3, 6 month after treatment.Results:In control group, there were no statistical differences in the pulmonary function, including the forced expired volume in one second (FEV 1), FEV 1 as percentage of predicted (FEV 1%pred), FEV 1/forced vital capacity (FVC); cardiopulmonary exercise function, including the peak load, peak VO 2, peak VO 2 as percentage of predicted (peak VO 2% pred), peak VO 2/kg, peak VE 3 and 6 months after treatment compared with those before treatment ( P>0.05); in rehabilitation group, there were no statistical differences in the indexes 3 months after treatment compared with those before treatment ( P>0.05), the indexes 6 months after treatment were significantly improved compared with those before treatment and 3 months after treatment ( P < 0.05). In control group, the C-reactive protein (CRP) and interleukin (IL-6) before treatment and 3 months after treatment and tumor necrosis factor-α (TNF-α) before treatment and 3, 6 months after treatment had no significant difference ( P > 0.05); the CRP and IL-6 6 months after treatment were significantly lower than those before treatment and 3 months: (5.48 ± 0.91) mg/L vs. (6.26 ± 0.99) and (6.09 ± 0.97) mg/L, (9.17 ± 1.04) ng/L vs. (10.83 ± 1.79) and (10.29 ± 1.53) ng/L, P < 0.05. In rehabilitation group, the CRP, IL-6 and TNF-α 3 and 6 months after treatment were significantly lower than previous phase: (5.21 ± 0.87) and (5.67 ± 0.91) mg/L vs. (6.15 ± 0.92) mg/L, (8.56 ± 1.17) and (10.03 ± 1.61) ng/L vs. (11.06 ± 2.01) ng/L, (7.16 ± 1.33) and (8.05 ± 1.62) ng/L vs. (8.97 ± 2.05) ng/L, P < 0.05. In rehabilitation group, the CRP, IL-6 and TNF-α before and after treatment were negatively correlated with pulmonary function (FEV 1, FEV 1% pred and FEV 1/FVC) and cardiopulmonary exercise function (peak load, peak VO 2, peak VO 2% pred, peak VO 2/kg and peak VE) ( r=- 0.641 to - 0.884, P < 0.01). Conclusions:Bundled pulmonary rehabilitation in patients with moderate or severe stable COPD can improve pulmonary function and cardiopulmonary exercise function and reduce inflammatory factors.

Objective To investigate the effect of Cordyceps sinensis on immune function in patients with bronchial asthma.Methods 60 cases of bronchial asthma were randomly divided into 2 groups: treatment group patients on the basis of conventional treatment with the use of the capsule .To observe the clinical effect of patients .Results Tcell sub-sets Th1/Th2 and Th2/Treg ratio imbalance in asthma patients .The ratio of Th1/Th2 and Th2/Treg could be corrected to a certain extent , and the serum level of IgE was decreased .Conclusions Bao Bao capsule can mobilize their own im-munity, improve the clinical symptoms of asthma patients .

Objective:To investigate the effects of low-dose azithromycin on lung function and exhaled nitric oxide concentration in bronchial asthma.Method:58 patients with newly diagnosed asthma were selected in respiration department in 2012,they were randomly divided into the azithromycin group and the control group,29 cases in each group. The azithromycin group was treated with azithromycin combined with inhaled Salmeterol xinafoate and fluticasone propionate powder for inhalation,the control group was only treated with salmeterol xinafoate and fluticasone propionate powder, ventolin inhalation were applied when necessary,the FEV1,PEF and the level of FeNO between the two groups were observed and compared.Result:The FEV1,PEF and the level of FeNO of two groups before treatment,the differences had no statistical significance(P>0.05).FEV1 and PEF levels after treatment in the two groups were significantly higher than those before treatment,and the FEV1 and PEF levels in azithromycin group after treatment were significantly higher than those in control group,the differences were statistically significant(P<0.05).The level of FeNO after treatment in the two groups were significantly lower than the control group,and the level of FeNO in azithromycin group after treatment was significantly lower than the control group,the differences were statistically significant(P<0.05).Conclusion:Asthmatic patients treated with low-dose azithromycin combined with salmeterol xinafoate and fluticasone propionate powder have better therapeutic effects,it is worthy of clinical promotion.

Objective To evaluate Serum Bactericidal Activity(SBA)of ceftazidime administered in continuous versus intermittent infusion in vivo.Methods 30 rabbits of Klebsiella pneumoniae pneumonia model were divided into experiment group and control group randomly.The rabbits of experiment group were given ceftazidime by continuous or intermittent infusion stochastically 24 hours after infection for 4 days.Each infusion group was divided into high-dose and low-dose sub groups.The rabbits of control group were fed as usual without giving drug.Blood samples were collected at different times after the start of drug administration.Serum bactericidal activity was determined by microdilution method.Bronchoalv eolar lavage(BAL)samples were extracted and bactericidal curve was drawn.The chest X-ray and lung pathologic examination were made before and after the treatment.Results Ceftazidime showed good antimicrobial activities in both continuous and intermittent infusion regimens.However,the characteristics of them were difference.For the continuous infusion regimen,the SBS and SBA were steady and constantly.For the intermittent infusion regimen,the SBS and SBA were unstable with the tpeak and trough level fluctuating greatly.However,the SBS and SBA of high-dose groups in the two regimens were shown to be slightly stronger than that of low-dose group.Bactericidal curve indicated that the quantities of bacteria were decreased steadily in continuous infusion regimen compared with that in intermittent infusion regimen.Of the chest X-ray examination and Lung pathologic examination are both consistent with the SBS and SBA.Conclusion In comparison,for ceftazidime,continuous infusion regimen is superior to intermittent infusion regimen for its steady and constantly SBS and SBA.It will become even better if increase the dose of the drug to some extent.

目的探讨成人Still病(AOSD)的临床特征和治疗,提高对本病的认识。方法对该院1992～2006年确诊的26例成人Still病患者的临床资料进行回顾性分析。结果26例患者中发热100%,皮疹80.8%,关节肿痛84.6%,咽痛53.8%,淋巴结肿大42.3%,肝脏肿大30.8%,脾脏肿大34.6%。血白细胞总数增高100%,中性粒细胞增高88.5%,贫血61.5%,C反应蛋白升高57.7%,血清铁蛋白升高80.8%,血沉增快96.2%,肝功能异常46.2%,血清免疫球蛋白增高65.4%,血培养均阴性。治疗上应用糖皮质激素,可联用非甾体消炎药,必要时联用免疫抑制剂,88.5%的患者治疗有效。结论成人Still病临床表现复杂,发热、皮疹和关节痛是其主要临床表现,血白细胞升高、血沉增快、血培养均阴性、血清铁蛋白升高是其特征。治疗上以糖皮质激素为主。预后较好,但应加强随访。