血清维生素D、MMP-9表达水平对哮喘患儿严重程度的评估及临床意义

目的探讨血清维生素D、基质金属蛋白酶-9(MMP-9)表达水平对哮喘患儿严重程度的评估价值。 方法选择2018年8月至2019年8月成都市妇女儿童中心医院呼吸科门诊收治入院的56例哮喘急性发作期患儿作为研究对象,根据病情严重程度将患儿分为轻度组14例、中度组25例、重度组17例,选择同期在我院儿保科体检合格的34例儿童作为对照组。所有受试对象入组后24 h内抽取静脉血测定血清中维生素D及MMP-9水平,并进行肺功能检查。比较四组研究对象的一般情况、肺功能指标、血清中维生素D及MMP-9水平,对血清中维生素D、MMP-9水平与肺功能和病情严重程度进行相关性分析。 结果患儿第1 s用力呼气容积(FEV₁)、用力肺活量(FVC)、FEV₁/FVC、25%用力呼气流量(FEF₂₅)、50%用力呼气流量(FEF50)及75%用力呼气流量(FEF₇₅)明显小于对照组(P<0.05);随着病情程度加重,FEV₁、FVC、FEV₁/FVC、FEF₂₅、FEF₅₀及FEF₇₅逐渐减小(P<0.05);患儿血清中维生素D水平明显低于对照组,血清中MMP-9水平明显高于对照组(P<0.05);随着病情程度加重,血清中维生素D水平逐渐降低,血清中MMP-9水平逐渐升高(P<0.05);血清中维生素D水平与FEF₂₅、FEF₅₀及FEF₇₅呈正相关,血清中MMP-9水平与FEF₂₅、FEF₅₀及FEF₇₅呈负相关(P<0.05);血清中维生素D水平与病情严重程度呈负相关;血清中MMP-9水平与病情严重程度呈正相关。 结论哮喘患儿血清中维生素D水平随病情程度逐渐下降,MMP-9水平随病情程度逐渐上升,同时其水平与肺功能密切相关,加强对哮喘患儿血清维生素D及MMP-9的监测对病情评估具有重要的临床意义。     

支气管舒张试验阴性的哮喘患者呼出气一氧化氮与气道反应性的关系研究

目的 分析支气管舒张试验阴性的哮喘患者呼出气一氧化氮(FeNO)与气道反应性的关系。方法选取2019年3月至2022年3月延安市人民医院和延安市中医医院收治的150例支气管舒张试验阴性的疑似哮喘患者。收集患者的一般资料，测定患者FeNO及肺功能指标[包括第1秒用力呼气容积(FEV₁)占预计值百分比、用力肺活量(FVC)占预计值百分比、FEV₁/FVC比值]。所有患者进行支气管激发试验，记录FEV₁下降20%时吸入乙酰胆碱的累积剂量(PD20-FEV₁)，以PD20-FEV₁<12.8μmol为支气管激发试验阳性，提示气道高反应性，结合临床可诊断为哮喘。根据支气管激发试验结果将患者分为阳性组(n=65)和阴性组(n=85)。支气管舒张试验阴性的哮喘患者FeNO与PD20-FEV₁的相关性分析采用Pearson相关分析。结果 阳性组FeNO、气流受限者占比高于阴性组，FEV₁占预计值百分比和FEV₁/FVC比值...     

成人支气管哮喘患者血清25-羟维生素D_3水平及其与肺功能的关系

目的了解成人支气管哮喘(简称哮喘)患者血清25-羟维生素D3[25(OH)D3]水平,为哮喘的治疗提供新的策略。方法收集门诊确诊哮喘患者162例,通过电化学发光法检测患者血清25(OH)D3浓度,以德国JAEGER肺功能仪检测哮喘患者用力肺活量(FVC)、第1秒用力呼气容积(FEV1),计算第1秒用力呼气容积占预计值百分比(FEV1%pred)、FEV1/用力肺活量。根据患者FEV1情况行支气管激发或舒张试验。对25(OH)D3与乙酰甲胆碱PD20FEV1(PD20MCH-FEV1)、FEV1增加值、FEV1增加率的相关性进行分析。结果哮喘患者血清25(OH)D3浓度均低于正常参考值。支气管激发试验中,25(OH)D3与PD20MCH-FEV1呈正相关(P0.001,r=0.73);支气管舒张试验中,25(OH)D3与FEV1增加值及增加率均呈正相关(r分别为0.53、0.59,P值均0.01)。结论成人哮喘患者血清25(OH)D3浓度比正常值低;血清25(OH)D3浓度与哮喘患者气道高反应性呈负相关,与β2受体激动剂作用后气道阻塞的改善情况呈正相关。     

老年COPD合并呼衰患者血清CysC、VEGF、ACTA水平与病情严重程度的相关性

目的分析老年慢性阻塞性肺疾病(chronic obstructive pulmonary diseases, COPD)合并呼吸衰竭(respiratory failure, RF)患者血清胱氨酸蛋白酶抑制剂C(cystatin protease inhibitor C, CysC)、血管内皮生长因子(vascular endothelial growth factor, VEGF)、激活素A(activin A, ACTA)水平与病情严重程度的相关性。 方法选择四川大学华西医院住院治疗的106例老年COPD合并RF患者为RF组,按动脉血氧分压(PaO₂)将患者分为轻度组36例、中度组41例和重度组29例,另选取医院相同时间段收治的47例单纯COPD患者为非RF组,比较各组患者血清CysC、VEGF、ACTA水平及一秒钟用力呼气容积占预计值百分比(FEV₁)、一秒钟用力呼气容积占用力肺活量百分比(FEV₁/FVC)差异,并分析血清CysC、VEGF、ACTA水平与FEV1%、FEV₁/FVC相关性。 结果RF组患者血清CysC、ACTA水平高于非RF组(P<0.05),VEGF水平、FEV1%、FEV₁/FVC低于非RF组(P<0.05);老年COPD合并RF患者病情越严重,血清CysC、ACTA水平越高,VEGF水平、FEV1%、FEV₁/FVC越低,轻度组、中度组和重度组患者组间存在显著差异(P<0.05);Pearson相关检验结果显示,老年COPD合并RF患者血清CysC与FEV1%、FEV₁/FVC均呈负相关(r＝-0.530,P<0.01;r＝-0.594,P<0.01);VEGF与FEV1%、FEV₁/FVC均呈正相关(r＝0.571,P<0.01;r＝0.668,P<0.01);ACTA与FEV1%、FEV₁/FVC均呈负相关(r＝-0.604,P<0.01;r＝-0.557,P<0.01)。 结论老年COPD合并RF患者血清CysC、VEGF、ACTA水平与其病情严重程度存在密切相关性,有助于对患者及时作出病情评估。     

血清尿酸与支气管哮喘急性发作的相关性

目的探讨哮喘患者血清尿酸水平与哮喘急性发作及严重程度的关系。方法选取2015年1月-2016年12月在武汉大学人民医院呼吸内科治疗的哮喘急性发作的入院患者118例,根据GINA标准分为轻、中、重度三组,以健康人为对照组34例。纳入研究患者均检测血清尿酸水平和肺功能。结果与对照组相比,哮喘急性发作患者血清尿酸水平明显升高,哮喘严重程度越重,血清尿酸水平升高越显著(P0.05)。女性哮喘急性发作患者血清尿酸水平与第一秒用力呼气容积(FEV1)占预计值百分比、用力肺活量(FVC)占预计值百分比、呼气峰流速(PEF)占预计值百分比呈负相关(P0.01)。结论哮喘患者血清尿酸水平与哮喘急性发作及严重程度密切相关。     

中性粒细胞胞外诱捕网水平联合肺功能对哮喘急性发作预测意义

目的分析中性粒细胞胞外诱捕网水平(NETs)联合肺功能指标对支气管哮喘急性发作预测意义。 方法选择2015年6月至2018年6月我院收治的89例支气管哮喘患者，按照疾病发病程度分为急性发作期支气管哮喘56例为A组和非急性发作期支气管哮喘33例为B组。比较血清游离DNA/NETs(cf-DNA/NETs)水平、最大呼气量(PEF)、第一秒用力呼气容积(FEV₁)，随访2年，统计A组患者的预后情况，根据患者是否死亡分为存活组和死亡组，以Logistic回归分析探讨急性发作期支气管哮喘患者预后的影响因素，以受试者工作特征曲线(ROC)判定血清cf-DNA/NETs水平、PEF、FEV₁预测急性发作期支气管哮喘患者病情变化的价值。 结果对比血清cf-DNA/NETs水平、PEF、FEV₁，A组血清cf-DNA/NETs水平比B组高，A组PEF、FEV₁比B组低(P<0.05)。死亡组有创通气治疗、合并肺心病、合并COPD例数占比对存活组高(P<0.05)，死亡组血清cf-DNA/NETs水平比存活组高(P<0.05)，死亡组PEF、FEV₁比存活组低(P<0.05)。Logistic多因素回归分析结果显示，血清cf-DNA/NETs水平、PEF、FEV₁、有创通气治疗均为支气管哮喘急性发作期患者预后的影响因素(P<0.05)。ROC曲线显示，血清cf-DNA/NETs水平、PEF、FEV₁及三者联合预测急性发作期支气管哮喘患者死亡的曲线下面积(AUC)分别为0.915、0.762、0.777、0.756(P<0.05)。 结论血清cf-DNA/NETs水平联合PEF、FEV₁预测支气管哮喘急性发作有意义。     

布地奈德与白三烯拮抗剂对哮喘患儿肺功能及FeNO的意义

目的分析吸入布地奈德联合白三烯拮抗剂对哮喘患儿肺功能及呼出气一氧化氮(FeNO)的影响。 方法选择2016年1月至2019年12月在我院诊治的86例哮喘患儿,观察组45例、对照组41例,观察组采用吸入布地奈德联合白三烯拮抗剂治疗,对照组采用吸入布地奈德治疗;比较两组通气肺功能呼气峰流速值(PEF)、第一秒用力呼吸量(FEV₁)、一秒用力呼气容积与用力肺活量的比值(FEV₁/FVC%)、最大呼气中段量(MMEF25、50、75)、FeNO、症状消失时间、不良反应及治疗后6个月内急性发作次数、哮喘急性发作再住院次数及院时间。 结果两组治疗后PEF、FEV₁、FEV₁/FVC、MMEF25、50、75均较治疗前显著上升,FeNO较治疗前显著下降,且观察组PEF、FEV₁、FEV₁/FVC、MMEF25、50、75显著高于对照组,FeNO显著低于对照组(P<0.05);观察组哮鸣音、咳嗽、湿啰音及喘息消失时间较对照组短,差异有统计学意义(P<0.05);两组不良反应发生率比较差异无统计学意义;且观察组哮喘急性发作次数、急性发作再住院次数均较对照组少,院时间较对照组短(P<0.05)。 结论较单纯吸入布地奈德治疗哮喘患儿,联合白三烯拮抗剂对肺功能、气道炎症的改善更显著,有利于症状改善,减少哮喘急性发作次数。     

多索茶碱治疗不同FeNO水平ACO患者的疗效及表观调控意义

目的分析多索茶碱治疗不同呼出气一氧化氮(FeNO)水平哮喘-慢阻肺重叠(ACO)疗效分析及表观调控意义。 方法选取2016年12月至2021年12月我院收治的48例ACO患者,根据患者FeNO水平分为观察组23例(FeNO>50 ppb)、对照组25例(25 ppb1%)、FEV₁占用力肺活量百分比(FEV₁/FVC)]及组蛋白乙酰化(HAT)、去乙酰化修饰(HDAC)活性。 结果观察组治疗前FeNO、EOS%高于对照组,NEU%低于对照组(P<0.05);两组FeNO、NEU%、血清总IgE降低,EOS%、FEV₁%、FEV₁/FVC升高(P<0.05);对照组NEU%低于治疗前(P<0.05),观察组治疗前后NEU%无显著差异(P>0.05);观察组治疗后FEV₁%、FEV₁/FVC高于对照组(P<0.05);两组治疗后HAT活性低于治疗前,HDAC活性高于治疗前(P<0.05)。 结论多索茶碱治疗观察组FeNO的ACO效果好,可降低气道高反应性,提高肺功能,其机制与表观遗传调控有关。     

ACO患者血清Fbg、FeNO、IgE水平变化与肺功能相关性研究

目的探讨支气管哮喘-慢性阻塞性肺疾病重叠综合征(ACO)患者血清中纤维蛋白原(Fbg)、呼出气一氧化氮(FeNO)、免疫球蛋白E(IgE)的变化水平与肺功能的相关性。 方法选择2016年1月至2018年5月期间在我院接受治疗的支气管哮喘急性发作期患者56例,慢阻肺急性加重期患者51例,ACO急性加重期患者45例,同时选取50例健康者作为对照。检测受试对象的外周血嗜酸性粒细胞数量、Fbg和IgE水平、FeNO以及肺功能指标。采用Pearson相关性分析Fbg、FeNO、IgE与1 s用力呼气容积(FEV₁),FEV₁改善值,用力肺活量(FVC)的关系。绘制受试者工作特征(ROC)曲线,并计算Fbg、FeNO、IgE指标曲线下面积(AUC)。 结果①三组患者嗜酸性粒细胞数量和血浆IgE水平明显高于对照组(P<0.05);但是三组患者之间比较,未见统计学差异(P>0.05)。ACO患者血清Fbg水平高于哮喘组患者(P<0.05),FeNO检测值高于慢阻肺患者(P<0.05);②ACO患者FEV₁、FEV₁改善值和FVC值明显高于对照组和慢阻肺组受试者,但是FEV₁值高于哮喘组患者,而FEV₁改善值和FVC值低于哮喘组患者(P<0.05);③ACO患者血浆Fbg水平与FEV₁、FEV₁改善值和FVC值均呈负相关性(P<0.05),而FeNO值仅与FEV₁值呈负相关性(P<0.05)。而血浆IgE水平与FEV₁改善值呈正负关性(P<0.05);④经ROC曲线分析,Fbg、FeNO、IgE联合检测ROC曲线的AUC为0.892(95%CI：0.773-0.948),敏感性和特异性分别为89%和78%。 结论Fbg、FeNO和IgE与ACO患者肺功能指标密切相关,有助于临床鉴别ACO、支气管哮喘以及慢性阻塞性肺疾病。     

Vanin-1在慢性阻塞性肺疾病患者血清中的表达及临床意义

目的 探讨Vanin-1在慢性阻塞性肺疾病(COPD)患者血清中的表达及临床意义。方法 前瞻性选取2022年3月至2022年12月入上海交通大学医学院附属第九人民医院黄浦分院呼吸内科门诊住院部就诊的COPD稳定期患者136例作为COPD组,同时选取体检健康,无肺气肿病史、既往无慢性支气管炎,肺功能检查无气流受限的受试者100例作为对照组。收集受试者临床资料和肺功能指标进行对比分析,收集受试者空腹的静脉血分离血清,采用酶联免疫吸附试验法(ELISA)检测Vanin-1与IL-6、TNF-α水平,采用比色法检测活性氧簇(ROS)水平。采用受试者工作特征曲线(ROC曲线)分析评价Vanin-1对COPD的诊断价值。结果 COPD组的吸烟指数高于对照组(P<0.01),第1秒用力呼气容积(FEV₁)、第1秒用力呼气容积占预计值百分比(FEV₁%pred)、用力肺活量(FVC)、第1秒用力呼气容积/用力肺活量(FEV₁/FVC)明显低于对照组,差异具有统计学意义(P<0.001);COPD组中Vanin-1的表达水平明...     

Lung Function and Cytokine Levels in Professional Athletes

Objective. Previous studies have demonstrated that exercise-induced asthma and bronchial hyperresponsiveness commonly occur in athletes. The present study investigates pulmonary function and cytokine levels in professional athletes to explore the impact of various sports on respiratory system function and to evaluate the possible role of systemic anaphylaxis. Methods. Lung function was measured at rest in professional athletes without a history of smoking. Athletes were recruited from 10 different sports including swimming, water ballet, shooting, volleyball, softball, football, kickboxing, fencing, judo, and track and field. Measurements included forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), vital capacity (VC), peak expiratory flow (PEF), maximal mid-expiratory flow curve (MMEF), and forced expiratory flow rate (FEF_{25 - 75}%). In addition, the medical history of all athletes was recorded. Correlations between lung function measurements and the different sports, age, gender, height and weight were analyzed. In some athletes, serum was sampled to detect IL-4 and IL-10 concentrations. In these subjects, the correlation between pulmonary function and cytokine levels was analyzed. Results. A total of 147 professional athletes and 30 healthy volunteers were enrolled in the study. Allergic rhinitis and asthma were detected only in swimmers with an incidence of 56.52% (13/23) and 8.70% (2/23), respectively. Lung function measures were significantly correlated with sport, age, gender, height, and weight. Ventilation functions (including FVC, FEV₁, FEV₁/FVC, and MMV) in male athletes were superior to those in females, and the ventilation functions in swimmers were superior to those in others. However, the small airway functions (MMEF, FEF₅₀, FEF₇₅) in swimmers and in track and field athletes were lower than predicted (swimmers: 72%, 70%, and 78%, respectively; track and field athletes: 79%, 75%, and 99%, respectively). Serum analyses for IL-4 and IL-10 revealed that IL-4 concentrations were higher in swimmers 69.34 ± 22.4 pg/mL relative to non-swimmers (p = 0.000). By contrast IL-10 concentrations were lower in swimmers 34.94 ± 9.71 pg/mL than that in the static group (44.69 ± 16.32 pg/mL; p = 0.027). IL-4 levels were negatively correlated with FEV₁%, FEF₂₅%, FEF₅₀%, and MMEF%. By contrast, IL-10 levels were not correlated with any of these measures. Conclusions. The lung function measurements were correlated with sport, age, gender, height, and weight in the various athletes. The lung capacity of swimmers was greater than that of other athletes. Small airway dysfunction was observed in some swimmers and endurance athletes. We observed an association between systemic anaphylaxis and small airway dysfunction after prolonged regular training, particularly following swimming and endurance training.     

EOS、总IgE与儿童哮喘严重程度和肺功能的相关性

目的分析血嗜酸性粒细胞(EOS)、总IgE与儿童哮喘严重程度和肺功能的相关性。 方法选择2018年1月至2021年1月我院收治并确诊的55例支气管哮喘患儿,根据病情严重程度分为轻度组18例、中度组22例、重度组15例。对比不同病情严重程度组儿童血清EOS、总IgE、FeNO及肺功能第1秒用力呼气容积占预测值百分比(FEV₁% pred)、呼气峰值流速(PEF)和用力肺活量(FVC)水平变化;观察给予吸入性糖皮质激素(ICS)治疗前后,哮喘组儿童上述指标变化情况;采用Spearman秩相关和Pearson相关性分析血清EOS、总IgE与儿童哮喘FeNO、病情严重程度及肺功能的相关性。 结果哮喘组儿童FeNO及血EOS%、总IgE水平升高,肺功能指标FEV₁% pred、PEF、FVC明显降低(P<0.05);重度哮喘组上述指标高于/低于中度组,中度组高于/低于轻度组(P<0.05)。ICS治疗后,哮喘组儿童FeNO及血EOS%、总IgE水平较治疗前降低,肺功能指标升高,治疗前后差异有统计学意义(P<0.05)。儿童哮喘血EOS%和总IgE水平呈正相关(P<0.05);血EOS%、总IgE与FeNO和病情严重程度呈正相关,与FEV₁% pred呈负相关(P<0.05),与PEF和FVC未见显著相关性(P>0.05)。 结论儿童哮喘血EOS和总IgE水平明显升高,与FeNO、病情严重程度及肺功能相关,监测血EOS和总IgE水平变化可为儿童哮喘的临床诊治和病情监测提供参考。     

咳嗽变异性哮喘患者疗效与布地奈德福莫特罗疗程的相关性研究

背景咳嗽变异性哮喘(CVA)是引起成年人慢性咳嗽的主要原因,布地奈德福莫特罗作为治疗此病的重要药物,其最佳疗程目前尚无统一定论,如何在保证治疗安全性的同时尽可能使患者获益是当前临床研究热点和难点。目的探讨CVA患者疗效与布地奈德福莫特罗疗程的相关性。方法选取廊坊市人民医院门诊2018年8月至2020年3月收治的CVA患者200例,按照随机数字表法将所有患者分为A组56例、B组69例和C组75例。患者均予以常规对症治疗及布地奈德福莫特罗粉吸入治疗,其中A组疗程为8周、B组疗程为16周、C组疗程为24周。比较三组患者治疗前后肺通气功能指标〔用力肺活量(FVC)、第1秒用力呼气容积(FEVl)、呼气流量峰值(PEF)〕、气道炎症指标〔白介素(IL)-10、IL-5〕、过敏指标〔血嗜酸粒细胞计数(EOS)、血清免疫球蛋白E(IgE)水平〕及哮喘控制测试(ACT)评分。指标间的相关性分析采用Spearman秩相关分析。结果B、C组患者治疗后FVC、FEV_(1)、PEF、痰IL-10水平高于A组,痰IL-5水平、血EOS及血清IgE水平低于A组(P<0.05);C组患者治疗后FVC、FEV_(1)、PEF、痰IL-10水平高于B组,痰IL-5水平、血EOS及血清IgE水平低于B组(P<0.05)。B、C组患者治疗后ACT评分高于A组,C组患者治疗后ACT评分高于B组(P<0.05)。Spearman秩相关分析结果显示,CVA患者治疗后FVC(r_(s)=0.265)、FEV_(1)(r_(s)=0.326)、PEF(r_(s)=0.417)、痰IL-10水平(r_(s)=0.412)及ACT评分(r_(s)=0.358)与布地奈德福莫特罗疗程呈正相关(P<0.001),痰IL-5水平(r_(s)=-0.386)、血EOS(r_(s)=-0.315)及血清IgE水平(r_(s)=-0.391)与布地奈德福莫特罗疗程呈负相关(P<0.001)。结论随着布地奈德福莫特罗疗程增加,CVA患者肺通气功能、过敏情况及哮喘控制效果逐渐改善,气道炎症逐渐减轻,故本研究建议布地奈德福莫特罗疗程为24周。     

结核性胸膜炎患者化疗时是否加用糖皮质激素对肺功能动态变化的对比研究

目的 探讨结核性胸膜炎患者化疗时是否加用糖皮质激素对肺功能的动态变化。方法 回顾性分析首都医科大学附属北京胸科医院2015年5月至2018年5月收治的结核性胸膜炎患者172例,对患者的肺通气、容积、弥散功能和呼吸肌力学指标在化疗前,以及化疗第1、6、12个月末进行4次检测;根据在抗结核药品化疗方案的基础上是否加用糖皮质激素分为两组,即加用组60例(醋酸泼尼松+2H-R-Z-E/10H-R-E)和未加用组112例(2H-R-Z-E/10H-R-E)。肺通气功能的检测指标为患者用力肺活量检测值占正常预计值的百分比(FVC)、第1秒用力呼气容积检测值占正常预计值的百分比(FEV₁% pred)、第1秒钟用力呼气容积/用力肺活量比值占正常预计值的百分比(FEV₁/FVC% pred)、用力呼出75%肺总量时瞬间呼气流量检测值占正常预计值的百分比(FEF₇₅)、最大分钟通气量检测值占正常预计值的百分比(MVV% pred);肺容积功能的检测指标为残气量检测值占正常预计值的百分比(RV% pred)、肺总量检测值占正常预计值的百分比(TLC% pred)、残气量/肺总量比值占正常预计值的百分比(RV/TLC% pred);弥散功能的检测指标为肺弥散量检测值占正常预计值的百分比(D_LCO)和肺泡容量校正的肺弥散率检测值占正常预计值的百分比(D_LCO/VA% pred);呼吸肌力学的检测指标为气道阻力检测值占正常预计值的百分比(Rtot% pred、呼气峰流量检测值占正常预计值的百分比(PEF% pred)、吸气峰值流量实测值(PIF),通过对检测指标的观察,了解肺功能的变化。肺功能测定结果按“测定值/正常预计值×100%”表示(除PIF为实测值),符合正态分布的计量资料采用“$\overline{x}$±s”进行统计描述,统计学处理采用t检验;不符合正态分布的计量资料采用中位数(四分位数)[M(Q₁,Q₃)] 表示,统计学处理采用Z检验,P<0.05为差异有统计学意义。结果 (1)结核性胸膜炎患者化疗前,以限制性通气功能障碍为主,FVC% pred为(62.1±13.4)%,FEV₁% pred为(64.4±15.5)%,FEV₁/FVC% pred为(87.0±11.1)%,MVV% pred (65.7±21.1)%,FEF₇₅% pred为61.6(41.6,83.0)%,RV% pred为111.3(89.8,131.4)%, TLC% pred为 (77.0±16.9)%,RV/TLC% pred为(146.9±35.9)%, D_LCO% pred为(62.6±18.3)%,D_LCO/VA% pred为(92.3±16.6)%,PEF% pred为(64.1±18.13)%,PIF为 3.2(2.3,4.1)L/s,Rtot% pred为96.0(69.3,118.9)%]。(2)化疗过程中,第1、6、12个月末 FVC<80%的患者分别为80.2%(138/172)、75.0%(129/172)、0.0%(0/0);化疗第6个月末D_LCO<80%的患者为44.2%(76/172)); (3)加用组和未加用组患者在化疗前、化疗第1、6、12个月末FEF₇₅% pred[分别为(68.7(49.8,84.1)%和60.7(39.4,80.7)%);87.1(70.5,94.4)%和73.1(51.9,87.0)%;80.1(66.5,111.9)%和66.8(59.9,87.2)%;90.4(55.3,102.9)%和78.4(54.6,87.3)%],两组比较差异均无统计学意义值分别为-1.091、-0.111、-1.609、-1.171,P值均>0.05); MVV% pred[分别为(65.8±19.4)%和(65.5±18.6)%);(86.9±18.6)%和(79.5±18.7)%;(90.3±16.0)%和(86.3±16.0)%;(96.8±11.1)%和(87.3±19.8)],两组比较差异均无统计学意义(t值分别为1.043、0.444、0.708、1.113,P值均>0.05)。结论 结核性胸膜炎患者治疗前、治疗第1个月末肺功能减退主要表现为限制性通气功能障碍和弥散功能减退,治疗第6个月末仅通气功能恢复正常,而弥散功能在治疗第12个月末恢复正常;早期糖皮质激素辅助治疗对结核性胸膜炎患者的肺功能无明显影响。     

Influence of Age on Diurnal Variability in Measurements of Spirometric Indices and Respiratory Pressures

We evaluated variations in spirometric indices (i.e., forced vital capacity [FVC], peak expiratory flow [PEF], and forced expiratory volume in 1 sec [FEV,₁]) and static respiratory muscle pressures (i.e., maximum static inspiratory pressure [PI_max] and maximum static expiratory pressure [PE_max]) within a span of 12 hr in 60 healthy elderly subjects, 60 young subjects, and 30 Chronic Obstructive Pulmonary disease (COPD) patients. There were no differences among data of FVC, PEF, FEV₁, Pl_max, and PE_max on three separate occasions within a day in the elderly or the young. The mean coefficient of variation (CV) values of PEF and Pl_max on three occasions were 3.0 ± 0.3% and 4.2 ± 0.4% in the elderly, and 2.4 ± 0.2% and 3.7 ± 0.3% in the young, respectively. No subjects had more than 9% CV on each measurement in the study, suggesting that there is no significant daytime variation in measurement of expiratory flow and respiratory pressures in young and elderly people. However, FVC, PEF FEV₁, and Pl_max values in the morning were smaller than those measured at the other two occasions in COPD patients. The results indicate that COPD affects diurnal variation in pulmonary function, but age alone has little impact on diurnal variation.     

Symptomatic Vascular Rings in Adulthood: An Uncommon Mimic of Asthma

Symptomatic thoracic vascular rings presenting in adulthood are thought to be rare. During a 3-year time period, we diagnosed four cases of symptomatic vascular rings, which had been treated unsuccessfully for suspected asthma. Spirometry was characterized by normal forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV₁), and FEV₁/FVC, decreased peak expiratory flow (PEF), and truncation of the expiratory flow volume loop. Chest radiographs revealed a right aortic arch in each case with computed tomography (CT) or magnetic resonance imaging (MRI) confirming the diagnosis of a vascular ring. The specific abnormalities consisted of right aortic arch with mirror branching of the main arteries and persistent ligamentum arteriosum; right aortic arch with diverticulum and a fibrous embryonic left arch; right aortic arch with aberrant left subclavian artery arising from a diverticulum of Kommerell; and a right aortic arch with persistent ligamentum arteriosum. Although they are uncommon, vascular rings first presenting in adulthood as a mimic of asthma are not rare. This diagnosis should be considered in adults when abnormal truncation of the flow-volume loop occurs or when radiographic aortic arch abnormalities are found.     

Dietary Intake of Soy Genistein is Associated with Lung Function in Patients with Asthma

To determine if micronutrient intake is associated with asthma severity, we administered the Block food frequency questionnaire to participants in a randomized clinical trial of the safety of influenza vaccine for asthmatics. The nutrition substudy included 1033 participants, aged 12-75. Intake of antioxidant vitamins, soy isoflavones, total fruits and vegetables, fats, and fiber was compared with asthma severity at baseline [forced expiratory volume in 1 second (FEV₁), peak expiratory flow rate (PEF), asthma symptoms] and the rate of asthma exacerbations during the 2 weeks following influenza vaccination. The only nutrient that had a consistent association with asthma severity was genistein, a soy isoflavone. None of the nutrients evaluated were related to asthma exacerbation rate when adjusted for known confounders. The FEV₁ in genistein consumers of at least 250 µg/1000 Kcal/day was 82.1% predicted, 79.9% predicted for those who consumed between 1 and 249 µg/1000 kcal, and 76.2% predicted in genistein nonconsumers (p = 0.006); the PEF was 82.7% predicted, 80.8% predicted, and 78.3% predicted, respectively (p = 0.009). There were no differences in the Asthma Symptom Utility Index (ASUI). We could not account for these results based on differences in demographics, body mass index, or consumption of other nutrients. Thus, increasing consumption of genistein is associated with better lung function in patients with asthma. Further studies are needed to determine whether dietary supplementation with genistein can reduce asthma severity.