慢性阻塞性肺疾病( COPD) 被定義為一種慢性肺部“炎癥”性疾病。COPD 的炎癥反應由吸煙、大氣污染等有害顆粒或氣體所誘發, 主要累及小氣道和肺實質, 導致慢性支氣管炎和氣道阻塞; 同時還導致肺實質的破壞, 引起肺氣腫, 最終形成不能完全可逆的氣流受限。吸煙是COPD 發病的主要危險因素。雖然, 戒煙可以改變COPD 的自然病程, 減緩肺功能的下降速率。但是, 戒煙后COPD炎癥并不能完全消除, COPD疾病進程也不會因此而“止步”。近年的研究發現部分COPD 患者停止吸煙后, 炎癥反應仍在相當長的時間內持續存在[1] 。這些現象提示COPD 炎癥過程一旦啟動, 似乎就難以終止。COPD 炎癥發生發展的機制還遠未闡明。
慢性阻塞性肺疾病(COPD)的發病率和病死率在全球范圍內仍呈升高趨勢。吸煙是COPD最重要的發病危險因素。由于我國的吸煙人群高達3.5億，而且缺乏有效的控煙措施，所以可以預計在未來相當長的時間內，我國的COPD發病率和病死率仍會持續升高，繼續成為一個嚴重的公共衛生問題。近年來的多項臨床試驗證實噻托溴銨、沙美特羅／氟替卡松等藥物的應用可以改善COPD患者的癥狀及生活質量，甚至短期內改善一些肺功能指標。2006年新版的“慢性阻塞性肺疾病全球創議”(GOLD)將COPD定義為“可治療”的疾病，比過去GOLD 的定義增加了“樂觀”的成分。但是目前的這些藥物還不能改變COPD的自然病程，能否降低COPD的病死率也沒有明確的答案。因此，葛蘭素史克(GSK)公司發起了全球性的多中心臨床試驗——“邁向COPD患者健康的變革(TORCH)”研究[1]，研究的目的是驗證這樣的假設，即通過沙美特羅／氟替卡松3年的治療能降低所有原因導致的COPD死亡率，包括作者單位在內的44個國家444個醫學臨床研究中心參加了該研究。
變應原特異性免疫治療(SIT)是目前已知的唯一能改變變態反應性疾病患者對變應原免疫的類型，并有可能治愈變態反應性疾病的方法。通常是通過反復多次皮下注射，即皮下免疫治療(SCIT)，誘導患者對變應原的耐受，但因其不良反應較大，并有可能引起過敏性休克等原因而使其應用受到限制。近來通過舌下含服的方法進行免疫治療，即舌下免疫治療(SLIT)，引起了臨床上廣泛的興趣。與SCIT相比，SLIT完全由患者自己使用藥物，因此更方便，臨床研究也證實這種方法更安全，也更有效。而且與藥物治療相比，SLIT可以顯著降低臨床費用，減輕患者和社會的負擔。但是SLIT誘導免疫耐受的確切機制目前仍不清楚。
Objective To investigate the effect of aerosolized perfluorocarbon (PFC) (FC77) on gas exchange，histopathological changes of lung in acute lung injury and pulmonary expression of tumor necrosis factor-α (TNF-α) mRNA.Methods After acute lung injury (ALI) was induced by oleic acid (OA)，16 rabbits were assigned randomly into 2 groups,ie.aerosolized perfluorocarbon group (PFC group) and conventional mechanical ventilation group (CMV group).Gas exchange parameters were measured before and after ALI，at 1，2，3，4 h after treatment.Histological sections taken from 6 different parts of lung were stained by hematoxylin and eosion.The express of TNF-α mRNA in the 2 different parts of lung were detected by in situ hybridization (ISH).Results Compared with CMV group，the PaO2 and static lung compliance (CLst) were significantly increased (Plt;0.05)，the histopathological lesions of lung were attenuated，and the TNF-α mRNA expression was decreased significantly in PFC group (all Plt;0.05).There was more expression of TNF-α mRNA in backside than that in foreside of lung in two groups (Plt;0.05).Conclusion Aerosolized perfluorocarbon (PFC) can decrease expression of tumor necrosis factor-α mRNA in the lung，and improve the CLst and oxygenation during acute lung injury.
Objective To analyze the clinical symptoms, imaging, laboratory tests, efficacy and other indicators of patients diagnosed as diffuse parenchymal lung disease ( DPLD) , in order to provide a reference for differential diagnosis of secondary DPLD and idiopathic interstitial pneumonia ( IIP) .Methods Sixtytwo patients diagnosed as DPLD were retrospectively analyzed. Results In 62 patients with DPLD, 19 patients ( 30. 6% ) were diagnosed as secondary DPLD, 42 cases ( 67. 7% ) as IIP, 1 case ( 1. 6% ) as Langerhans cell histiocytosis. The smoking rate of the DPLD patient was 33. 8% , which was higher than general population ( 29. 7% ) . 94. 7% of the secondary DPLD patients had cough, which was higher than the IIP patients ( 71. 4%) . The average age of onset of the secondary DPLD and IIP was ( 45. 9 ±16. 8) years and ( 60. 5 ±7. 7) years respectively, without significant difference ( P gt; 0. 05) . Etiological factors of secondary DPLD were dust, pets, drugs, pesticides, decoration material, etc. The secondary DPLD patients had higher response rate to steroid therapy, but had no statistical difference compared with the IIP patients ( 46. 2% vs. 37. 5% , P gt;0. 05) . Conclusions As a group of diseases of known causes, history taking is very important for DPLD diagnosis and differential diagnosis. Clinical symptoms, imaging, and laboratory tests may provide reference for differential diagnosis of secondary DPLD and IIP.
Objective To investigate the effects of FasL gene-modified dendritic cell (DC) on the airway inflammation in mice sensitized/challenged by house dust mite (HDM) allergen.Methods FasL gene-modified DC (FasL-DC) and control DC (nontransfection DC) were administrated into HDM sensitized and challenged mice by intratracheal injection respectively，then HDM sensitized and challenged mice were sacreificed two days later.Total and differentiation cell counts and levels of interleukin-4（IL-4），IL-5 and interferon-γ(IFN-?) in bronchoalveolar lavage fluid (BALF) were detected and lung histological features were observed.Results After administration of FasL-DC，lung allergic inflammation was ameliorated while total cell counts，the percentage of eosinophil ,the levels of IL-4 and IL-5 in BALF decreased and the level of IFN-? in BALF increased.Conclusion Administrating FasL-DC into HDM sensitized/challenged mice can inhibit Th2 cells activation and ameliorate airway allergic inflammation.
Objective To investigate the constituent ratio and clinical features of diffuse interstitial lung disease（DILD） in Chongqing city.Methods Data was collected from all patients diagnosed as DILD in five comprehensive teaching hospitals in Chongqing from 2002 to 2006.The disease constituent ratio of DILD in the respiratory department or in the whole hospital was analysised.Meanwhile the clinical manifestation and the laboratory examination such as lung function and biopsy were also analysised.Results Mean age of DILD patients is （61.65±13.31）years with a ratio male to female of 1.83.The constituent ratio of DILD were 2.83‰ in respiratory department and 0.30‰ in hospital in 2002，and increased to 8.29‰ and 0.48‰ respectively in 2006.Graticule（62.20%）and honeycombing（24.50%） were predominant imaging manifestations.47.55% patients had restrictive lung function impairment，and 51.05% had mixed lung function impairment.Pathologic examination revealed UIP as the most common type，however，81.82% cases could not be classified to any category pathologically.Conclusions The prevalence of DILD increased progressively from 2002 to 2006.A definite diagnosis of DILD demands cooperation of physicians，radiologists and pathologists.
Objective To explore the risk factors of invasive fungal infection ( IFI) in respiratory ward. Methods A multi-center, retrospective, case-control study was carried out. Patients from five general hospitals in Chongqing city, diagnosed as fungal infection, or whose respiratory specimens were fungal positive, were retrospectively screened for IFI. Patients with respiratory infection and colonization of nonfungal cases in the same period of hospitalization were enrolled as control. Results Thirty-four patients diagnosed with IFI and 50 patients diagnosed with bacterial infection were analyzed for the risk factors of IFI. The demographic characteristics of patients including age and gender were not different( P gt; 0. 05) , but hospitalization days, carbapenem antibiotic use, chemotherapy, deep venous catheterization, total parenteralnutrition( TPN) , neutropenia, and renal disfunction were different significantly between the IFI group and the control group. Multiple logistic regression analysis showed that carbapenem antibiotic use ( OR = 6. 753) ,central venous catheterization ( OR = 5. 021) and TPN ( OR = 3. 199) were main risk factors of invasive fungal infection. Conclusion The carbapenem antibiotic use, central venous catheterization and TPN are risk factors for IFI in respiratory ward.
Objective To compare the differences of flow and volume responses in patients with mild to very severe chronic obstructive pulmonary disease（COPD） in bronchodilatation test. Methods The different changes of FEV1 and FVC in 217 patients with mild to very severe COPD（GOLD stage Ⅱ-Ⅳ） after inhaling salbutamol were analyzed retrospectively. Results FEV1 and FVC of the patients with COPD at stage Ⅱ-Ⅳ increased remarkably after inhaling β2 agonist，while there were significant differences between the changes of FEV1 and FVC. Increment of FEV1 and FVC (ΔFEV1 and ΔFVC)，representing flow and volume responses respectively，showed a normal distribution. The majority of patients fell in the range of ΔFEV1 from 0.00 to 0.04，0.05 to 0.09 and 0.10 to 0.14 liter，and ΔFVC from 0.00 to 0.09，0.10 to 0.19 and 0.20 to 0.29 liter. There was significant difference of ΔFEV1 among stage Ⅱ-Ⅳ patients with COPD （Plt;0.01），namely more severe the disease less ΔFEV1 got.In the other hand ΔFVC increased along with the progression of COPD，although no significant difference of ΔFVC among stage Ⅱ-Ⅳ patients with COPD was found. Though different changes of ΔFEV1 and ΔFVC were revealed，there was a positive correlation between ΔFEV1 and ΔFVC in patients at each GOLD stage and the correlation became more insignificant with the progression of COPD. Conclusions There are significant differences between post-bronchodilator flow and volume responses in patients with COPD.Flow response decreases remarkably along with the progression of COPD，whereas volume response increases along with the progression of COPD.