老年慢性阻塞性肺疾病急性加重期患者测定呼出气一氧化氮的临床意义

【摘要】目的 探讨呼出气一氧化氮（FeNO）在老年慢性阻塞性肺疾病急性加重期（AECOPD）患者治疗中的作用和临床价值。方法 选取2016年12月-2018年6月我院就诊的老年AECOPD患者100例,根据FeNO测量值,纳入FeNO<27ppb组患者50例,FENO≥27ppb组患者50例,两组患者分为激素治疗组及非激素治疗组各25例,分别检测两组患者治疗前后的FeNO值及症状评估,评价治疗效果。结果FeNO≥27ppb组中,激素治疗组的治疗效果明显好于非激素治疗组;激素治疗组FeNO测量值与治疗前后相比,测量值明显下降,差异有统计学意义（P＜0.05）。FeNO<27ppb组中激素治疗组与非激素治疗组的治疗效果差异无统计学意义。在两组中的非激素治疗组中,FeNO<27ppb组中显效有效总例数高于FeNO≥27ppb组,FeNO测量值治疗前后相比差异无统计学意义。结论 FeNO检测可作为COPD患者诊疗中的临床辅助检查工具。在反映AECOPD患者的气道炎症水平,预测患者对激素的反应性及指导老年患者的用药方面有一定的意义。     

肺磨玻璃结节诊治进展

目的:探讨测定呼出气一氧化氮(FeNO)对老年慢性阻塞性肺疾病急性加重期(AECOPD)患者炎症水平的评估作用和临床价值。方法:选取老年AECOPD患者100例,根据FeNO测量值,分为FeNO27 ppb组50例,FeNO≥27 ppb组50例,2组患者又分为激素治疗组及非激素治疗组各25例,分别检测2组患者治疗前、后的FeNO值并评价疗效。结果:FeNO≥27 ppb组中,激素治疗组的疗效明显好于非激素治疗组;激素治疗组治疗后FeNO测量值明显下降。FeNO27 ppb组中,激素治疗组与非激素治疗组比较,疗效差异无统计学意义。非激素治疗的所有患者中,FeNO27 ppb组中显效、有效总例数高于FeNO≥27 ppb组,FeNO测量值治疗前后比较,差异无统计学意义。结论:FeNO检测可作为AECOPD患者临床辅助检查工具,有助于反映患者的气道炎症水平,预测患者对激素的反应性,对指导老年患者的用药有一定的意义。     

经气管镜下APC联合冷冻治疗中央气道病变腔内生长的临床研究

目的探究经气管镜下氩等离子体凝固(APC)联合冷冻治疗中央气道病变腔内生长的临床效果。方法选取2019年1月开始到6月在韶关市第一人民医院诊断及拟行APC联合冷冻治疗的中央气道病变患者30例,采用APC联合冷冻治疗,对比患者治疗前后肺功能,包括:用力肺活量(FVC)、第1秒用力呼气量(FEV 1)、FEV 1/FVC;动脉血气指标,包括:氧分压(PaO 2)、二氧化碳分压(PaCO 2);6分钟步行实验结果(6MWD);气管狭窄程度及气促指数。结果治疗前后患者的FVC无明显差异(P>0.05),治疗后患者的FEV 1%及FEV 1/FVC均较治疗前显著提高(P<0.05),治疗后患者的PaO 2水平较治疗前显著提高且PaCO 2显著下降(P<0.05),治疗后6MWD距离较治疗前显著提高(P<0.05),治疗后患者气管狭窄程度及气促指数分级显著优于治疗前(P<0.05)。结论经气管镜下APC联合冷冻治疗中央气道病变腔内生长的效果显著。     

老年慢性阻塞性肺疾病急性加重期患者呼出气NO的临床意义

目的:探讨测定呼出气一氧化氮(FeNO)对老年慢性阻塞性肺疾病急性加重期(AECOPD)患者炎症水平的评估作用和临床价值。方法:选取老年AECOPD患者100例,根据FeNO测量值,分为FeNO27 ppb组50例,FeNO≥27 ppb组50例,2组患者又分为激素治疗组及非激素治疗组各25例,分别检测2组患者治疗前、后的FeNO值并评价疗效。结果:FeNO≥27 ppb组中,激素治疗组的疗效明显好于非激素治疗组;激素治疗组治疗后FeNO测量值明显下降。FeNO27 ppb组中,激素治疗组与非激素治疗组比较,疗效差异无统计学意义。非激素治疗的所有患者中,FeNO27 ppb组中显效、有效总例数高于FeNO≥27 ppb组,FeNO测量值治疗前后比较,差异无统计学意义。结论:FeNO检测可作为AECOPD患者临床辅助检查工具,有助于反映患者的气道炎症水平,预测患者对激素的反应性,对指导老年患者的用药有一定的意义。     

2426例次硬质气管镜的临床应用

目的 探讨硬质气管镜治疗中央型气道病变的适应证和治疗价值.方法 回顾性分析1 307例中央型气道病变患者,平均年龄(53.2±1.7)岁,均在全身麻醉下插入硬质气管镜进行介入治疗2 426次.结果 1 307例气道疾病患者中1 034恶性肿瘤例进行了1 947例次硬质镜治疗,273良性病变例进行了479例次硬质镜治疗.病变部位适应于所有大气道.不良反应:硬质镜插入失败及术后出现喉水肿各8例次(占0.3％),失败者均改为喉罩操作.6例次(o.2％)牙齿脱落,10例次(0.4％)声门或气管上段擦伤.硬质镜治疗后气道狭窄明显减轻,患者病情明显好转.结论 硬质气管镜适应于气道内复杂或严重病变的患者,且较为安全、可靠.     

硬质气管镜联合可弯曲支气管镜治疗恶性重度中央型气道狭窄

目的探讨硬质气管镜联合可弯曲支气管镜在恶性重度中央型气道狭窄治疗中的效果及可行性。方法回顾性分析2014年5月至2016年12月在第四军医大学唐都医院呼吸与危重症医学科经支气管肺活检病理确诊恶性重度中央型气道狭窄患者128例,其中A组(62例):采用硬质支气管镜联合可弯曲支气管镜介入治疗,依据镜下表现采用冷冻、电圈套扎、氩等离子体凝固(APC)电刀等方法清除肿瘤组织。B组(66例):全麻下单纯使用可弯曲支气管镜进行介入治疗,观察两组患者的治疗效果:狭窄改善程度,氧合指数、气促指数;所需支气管镜操作次数、总操作时长、并发症。结果 (1)A组治疗总有效率为95.1%,B组为93.9%,差异无统计学意义,但显效患者A组(20例)明显多于B组(10例),差异有统计学意义(P0.05);(2)对于瘤体基底较宽致主气管狭窄的28例患者,A组13例患者治疗前狭窄程度为(84.1±3.8)%,治疗后狭窄程度为(34.1±3.6)%,B组15例治疗前后分别(85.2±4.8)%和(43.2±3.9)%,A组气道狭窄改善更为明显,差异具有统计学意义(P0.05);(3)A组患者所需支气管镜进入操作次数为(6.5±0.8)次,显著低于B组(9.4±1.0)次,A组所需操作总时长(1.2±0.3)h,明显低于B组(2.1±0.4)h患者,两组患者并发症比较无明显差异,均未出现心跳骤停、持续恶性心律失常、大出血等严重并发症。结论应用硬质气管镜联合可弯曲支气管镜可快速清除恶性重度气道狭窄患者的瘤体组织,缓解气道狭窄,尤其针对基底宽广的重度气道狭窄,是一种有效且安全的方法,值得临床推荐。     

呼出气一氧化氮测定对成人支气管哮喘治疗的指导价值

目的探讨呼出气一氧化氮测定对成人支气管哮喘治疗的指导作用。方法选取于合肥市第一人民医院门诊就诊的74例明确诊断的哮喘患者,所有患者完善呼出气一氧化氮(FeNO)检查,肺功能测定,记录第一秒用力呼气容积(FEV_1)及一秒率(FEV_1/FVC),并填写哮喘控制测试(ACT)评分表。根据FeNO值,分为FeNO升高组(n=40)和FeNO正常组(n=34),两组患者均给予吸入用糖皮质激素/长效β_2受体激动剂(ICS/LABA,布地奈德福莫特罗粉吸入剂,160ug,4.5ug)1吸bid规律治疗。3月后复诊,复测FeNO,肺功能(FEV_1和FEV_1/FVC)及ACT评分量表。结果两组患者治疗后ACT评分较治疗前均有好转(治疗前后有统计学差异,P0.05),治疗后FeNO升高组较FeNO正常组ACT评分更高,差异具有统计学意义(P0.05)。两组治疗前均无完全控制患者,治疗后FeNO升高组完全控制率明显高于FeNO正常组,差异具有统计学意义(χ~2=6.796,P0.05)。两组患者FEV_1和FEV_1/FVC治疗后较治疗前均有好转(治疗前后有统计学差异,P0.05),治疗后两组间无统计学差异(P0.05)。治疗前FeNO升高组FeNO值与ACT评分呈负相关(r=-0.783,P0.05);治疗前FeNO正常组FeNO值与ACT评分无相关性。两组ACT改善程度与FeNO下降程度均无相关性。结论吸入ICS/LABA对FeNO升高的支气管哮喘患者疗效较好,可用于预测哮喘患者对吸入ICS/LABA治疗的反应,指导哮喘治疗方案。     

FeNO水平在哮喘-慢性阻塞性肺疾病重叠治疗前后的变化及与气道炎症的关系

目的探讨呼出气NO(FeNO)水平在哮喘-慢性阻塞性肺疾病重叠(ACO)治疗前后的变化及其与气道炎症初筛指标间的关系。方法选择ACO患者52例为研究组,以上病例均给予ICS/LABA规范治疗,分别于治疗前后进行FeNO检测,同时采集外周血清总IgE、嗜酸性粒细胞百分比(EOS%)等指标,了解治疗前后FeNO水平、血清IgE及EOS的变化,以同期健康志愿人群(30例)为对照组;分析ACO病人FeNO水平与血清IgE、EOS等指标的关系。结果ACO病人FeNO水平与对照组比较,显著增高(P0.05),经应用ICS/LABA规范治疗12周后,ACO病人FeNO水平较治疗前显著下降(P0.05);Pearson相关分析表明FeNO与血清IgE浓度、嗜酸性粒细胞百分比均呈正相关(r值分别为:0.641、0.391,P0.01)。结论ACO病人经激素+β2受体激动剂规范治疗后FeNO水平均显著降低,此变化同病人气道炎症变化具有较好相关性。     

增强 CT 与超声造影对胆囊良恶性病变的诊断价值比较

目的：比较胆囊良恶性病变的超声造影（CEUS）和增强CT（CECT）诊断结果,探讨两者对胆囊占位性病变的诊断价值。方法回顾性分析53例胆囊病变患者的临床资料,患者均行CEUS和CECT检查。结果53例患者中,3例CEUS和CECT均无增强,为胆泥,占总数的5．67％;25例为良性病变,占总数的47．17％;25例为胆囊癌,占总数的47．17％。胆囊良恶性病变CEUS和CECT增强水平之间的诊断差异无统计学意义（ P均＞0．05）。早期高增强的良性病变的CEUS增强减低时间明显比早期高增强的恶性病变长（P＜0．01）。良性病变和恶性病变在CEUS、CECT上表现为不均匀增强病灶的发生率、胆囊壁完整性破坏的发生率之间的差异无统计学意义（ P均＞0．05）。 CEUS和CECT对胆囊病变诊断的检出率、准确率、敏感性、特异性之间的差异均无统计学意义（ P均＞0．05）。结论 CEUS和CECT对胆囊良恶性病变的诊断效能相似,两者诊断胆囊疾病可以互补。     

消化道疾病血清CRP与肿瘤标志物的联合检测意义

目的探究血清CRP和肿瘤标志物检测对于消化道疾病的临床意义。方法选取我院2013年3月~2015年7月收治的消化道疾病患者90例作为研究对象,其中良性病变者45例,恶性病变者45例,同时选取同期在院体检的健康者45例作为对照组,分别检测各组的血清CRP和肿瘤标志物(AFP、CA125、CA19-9)水平,并予以消化道疾病患者治疗后,比较治疗前后上述指标变化情况。结果消化道疾病患者血清CRP、肿瘤标志物水平显著高于对照组,且恶性组较良性组高;同时发现消化道疾病患者经过治疗后,明显较前改善,差异均有统计学意义(P0.05)。结论血清CRP和肿瘤标志物检测对于消化道疾病诊断以及良恶性和预后判断均具有重要的意义,值得临床推广应用。     

呼出气一氧化氮在哮喘中的临床意义

目的哮喘以慢性气道炎性反应为特征,主要涉及嗜酸性粒细胞的募集和活化。呼出气一氧化氮(fractional exhaled nitric oxide, FeNO)是气道炎症的一个非侵入性标志物。本文探讨了FeNO在哮喘中的临床意义。 方法我们评估了94例哮喘患者治疗前后的FeNO和肺功能参数及哮喘控制检测(asthma control test, ACT)评分,其中完成1个月随访的有75例,完成3个月随访的有73例,分析了我院哮喘患者控制水平的一些相关因素。 结果发现诊断时的FEV1%在预测哮喘控制时最具优势,哮喘患者根据ACT评分划分的不同控制状态的FeNO和肺功能参数无明显差异。FeNO和肺功能参数,ACT评分及血IgE,血嗜酸性粒细胞计数之间无明显相关性。FEV1%与ACT评分之前存在正相关(r＝0.04184,P＝0.0492)。无过敏性鼻炎(allergic rhinitis, AR)组,FeNO和ACT评分之间存在负相关(r＝0.2015,P＝0.0128)。3个月治疗后FeNO和ACT评分之间仍无明显相关性。 结论哮喘患者治疗前后的FeNO可以评估患者的治疗效果,而FeNO并不能预测哮喘的控制状态及恶化风险,FEV1%在预测哮喘控制方面具有临床意义。     

气管支气管结核的支气管镜诊治分析

目的分析46例气管支气管结核患者诊治情况及分析诊治过程中误诊、延迟诊断原因。方法分析46例患者支气管镜检查前误诊病因、镜下表现与刷检、黏膜活检、临床表现、气道狭窄情况。结果非呼吸专科医师就诊或诊所就诊39例,至诊断气管支气管结核时间1月~3年,中位数时间42天;2例患者首次支气管镜检查就发现中心气道狭窄,治疗后共有5例患者出现不同程度气道狭窄。7例患者住院支气管镜检查后诊断支气管结核,诊断气管支气管结核中位数时间为7.5天,治疗后未发生气道狭窄。两组在诊断时间上比较,P0.05,差异有统计学意义;两组在气道狭窄发生率上比较,P0.05,差异无统计学意义。结论气管支气管结核容易被非呼吸专科医师误诊,提高医师认知,及时行支气管镜检查、治疗,才能减少并发症的发生。     

呼出气一氧化氮检测在变应性支气管肺曲霉菌病诊疗中的应用

目的探讨呼出气一氧化氮(FeNO)检测在变应性支气管肺曲霉菌病(ABPA)诊疗中的应用,为ABPA的诊疗及管理提供新思路。方法收集2016年12月至2020年1月于河南省人民医院呼吸内科确诊的30例ABPA患者作为观察组;同期收集就诊于河南省人民医院呼吸内科非ABPA哮喘患者74例作为对照组,其中完善烟曲霉特异性血清免疫球蛋白E(IgE)及血清总IgE者41例。回顾性分析2组患者临床资料。结果2组患者年龄、性别及病程相比较,差异无统计学意义。观察组患者烟曲霉特异性IgE、血清总IgE、血嗜酸粒细胞计数、FeNO均高于对照组(t值分别为4.049、8.077、2.051、2.894,P值均<0.05)。spearman相关系数分析结果显示FeNO与ABPA具有一定相关性(r=-0346,P<005)。结论FeNO与ABPA的诊断具有一定的相关性,可为ABPA患者诊疗提供帮助。     

Residual exhaled nitric oxide elevation in asthmatics is associated with eosinophilic chronic rhinosinusitis

Objective: Eosinophilic chronic rhinosinusitis (ECRS) is as a subgroup of chronic rhinosinusitis (CRS) with nasal polyps. ECRS is a refractory disease closely related to bronchial asthma. Fractionated exhaled nitric oxide (FeNO) levels were reportedly elevated in some asthmatics with CRS after adequate treatment, suggesting that residual eosinophilic airway inflammation or ECRS might affect FeNO levels. Methods: To investigate the association between asthma with ECRS and FeNO levels, we examined FeNO levels in 133 asthmatics (99 with ECRS and 34 without ECRS) and 13 patients with ECRS without asthma. The severity of asthma was defined by the Global Initiative for Asthma guidelines and that of sinusitis was evaluated by the sinus CT score based on the Lund–Mackay scale. Results and conclusions: FeNO levels were elevated even in well-controlled asthmatics with ECRS, whereas asthmatics without ECRS and ECRS patients without asthma did not have high FeNO levels (>50?ppb). Although FeNO levels were not correlated with asthma severity, they were positively correlated with the sinus CT score. In asthmatics with ECRS, patients with higher FeNO levels had more severe ECRS and asthma. There is a possibility of having comorbid ECRS, particularly in asthmatics with high FeNO levels even after adequate treatment, including ICS, suggesting that asthma and ECRS may be closely associated as one airway disease with eosinophilic inflammation. Continual awareness of the coexistent ECRS is ideally recommended for asthmatics with high FeNO levels.     

Is Exhaled Nitric Oxide a Useful Adjunctive Test for Assessing Asthma?

Rationale. To determine the general utility of clinical (Asthma Control Test) and physiologic (forced expiratory volume in the first second of exhalation [FEV₁] and fractionated exhaled nitric oxide level [FeNO]) parameters for characterizing asthma patients. Methods. Two cross-sectional independent studies simultaneously enrolled 100 patients in the US and 109 patients in Spain ≥ 18 years of age with a physician-diagnosis of asthma and confirmed by a ≥ 12% improvement in FEV₁ after bronchodilators or the presence of airway hyperresponsiveness, a central feature of asthma, as measured by methacholine challenge (PC₂₀ < 10 mg/mL). There was no restriction on asthma severity or treatment. Patients were excluded if they had a diagnosis of chronic obstructive pulmonary disease and/or were current cigarette smokers. Statistical analyses were performed to compare ACT, FeNO, and spirometry within and between sites. Results. Population characteristics revealed significant differences in distributions of age, percent-predicted FEV₁ (%FEV₁), FeNO, inhaled corticosteroid usage, and atopy between the two populations. The Spain site enrolled younger patients with milder asthma, based on higher %FEV₁ values and less frequent treatment with inhaled corticosteroids. At each site, mean FeNO levels decreased as asthma control categories increased, and means were lower in the US. There was a negative correlation between ACT and FeNO that was statistically significant for Spain patients not treated with inhaled corticosteroids. Conclusions. The results of this study support the use of FeNO as an adjunctive tool for assessing asthma primarily in mild inhaled corticosteroid (ICS)-naïve asthma patients. The lack of correlation of ACT with FeNO in this and other studies across the entire population appears to reflect the heterogeneity of asthma patients who have an admixture of asthma severity and treatment regimens making it very difficult to appreciate the nuances of sensitive tests like FeNO.     

呼出气一氧化氮及食管pH监测对支气管哮喘和胃食管反流病的诊断与鉴别价值

目的探讨呼出气一氧化氮（FeNO）对诊断和鉴别支气管哮喘及合并胃食管反流病的价值及其与24h食管pH测定的关系。方法选取2010年3月至2011年2月在我科住院的支气管哮喘患者16例、胃食管反流病患者20例及支气管哮喘合并胃食管反流病患者16例,分别测定FeNO、白细胞分类计数及百分比、24h食管pH测定中pH〈4的时间百分比,pH〈4的总次数,pH〈4大于5min以上的次数及DeMeester评分,分别比较三组FeNO水平的差异及与上述测定指标的关系。结果FeNO、嗜酸性粒细胞（EOS）、嗜酸性粒细胞百分比（EOS％）在三组组间存在总体差异,组间两两比较发现,哮喘组和哮喘合并胃食管反流病组比胃食管反流病组FeNO、EOS、EOS％均显著增高（P〈0．05—0．01）;哮喘组比哮喘合并胃食管反流病组FeNO显著增高（P〈0．05）,而EOS、EOS％无明显差异;哮喘组FeNO水平与EOS和EOS％有显著相关性（P〈0．05）;但胃食管反流病（GERD）组及哮喘合并胃食管反流病组FeNO水平与EOS没有明显的相关性;胃食管反流病组和哮喘合并胃食管反流病组FeNO水平与pH〈4的时间百分比、pH〈4的总次数、pH〈4发作大于5min的次数及DeMeester评分值均有非常显著的相关性（P均〈0．01）;哮喘组FeNO水平与24h食管pH监测结果没有相关性。结论FeNO是一项检测气道炎症的敏感指标,尤其能反映嗜酸性粒细胞气道炎症;在哮喘合并胃食管反流病患者中,吸入酸性胃内容物可能以双重作用影响FeNO的变化,提示在哮喘合并胃食管反流病患者中,FeNO的增加可能部分反映了胃酸反流的严重程度;FeNO对于哮喘和哮喘合并胃食管反流病患者具有较好的诊断价值,同时为鉴别哮喘和哮喘合并胃食管反流病患者与胃食管反流病提供了可靠的依据。     

Absence of bacterial colonization of the airways after therapeutic rigid bronchoscopy without stenting.

Following airway stenting, bacterial colonization of the airways with potentially pathogenic micro-organisms occurs within 4 weeks after treatment in the majority of patients. The objective of this study was to prospectively investigate whether nonstenting therapeutic rigid bronchoscopy (using laser, cryotherapy, mechanical dilatation or debridement) is followed by airway colonization or infection. Protected specimen brush sampling of the central airways and quantitative culture were performed immediately prior to, and 4 weeks after nonstenting therapeutic rigid bronchoscopy in 20 consecutive patients with central airway lesions. Prior to therapeutic bronchoscopy, airway colonization/infection was present in nine of 20 (45%) patients. In these nine patients, 10 different potential pathogens were identified: Streptococcus pneumoniae (four cases), Pseudomonas aeruginosa (three), Haemophilus influenzae (two), and Serratia marcescens (one). Eight of these nine patients had a history of postobstructive infections, of which three were currently being treated with antibiotics. Four weeks following therapeutic bronchoscopy, airway colonization/infection was present in five of 20 (25%) patients, each of whom had airway colonization/infection prior to bronchoscopy. In three of these five patients, the same organisms were found 4 weeks after bronchoscopy as at baseline bronchoscopy. In two of five patients new organisms were identified: one case of Streptococcus viridans and one case of Haemophilus parainfluenzae, both considered to be nonpathogens. In four of nine patients with airway colonization/infection prior to bronchoscopy, the airways were clear of micro-organisms after the procedure. The authors conclude that: 1) nonstenting therapeutic rigid bronchoscopy is not complicated by airway colonization or infection by new potential pathogens; and 2) therapeutic rigid bronchoscopy led to clearing of airway colonization/infection in almost half of the patients studied.     

未控制支气管哮喘患者痰嗜酸粒细胞水平与肺功能相关性分析

目的分析未控制支气管哮喘(哮喘)患者不同水平痰嗜酸粒细胞的临床特点,探讨未控制哮喘患者痰嗜酸粒细胞与肺功能的相关性。方法纳入2017年8月至2019年9月就诊于内蒙古自治区人民医院呼吸与危重症医学科的未控制哮喘患者167例病例资料进行回顾性研究,根据诱导痰嗜酸粒细胞百分比结果将患者分为2组,以痰嗜酸粒细胞百分比≥2.5%为嗜酸粒细胞增高组(105例),痰嗜酸粒细胞百分比<2.5%为嗜酸粒细胞正常组(62例)。分析2组患者血嗜酸粒细胞计数、呼出气一氧化氮(FeNO)、吸入沙丁胺醇后第1秒用力呼气容积(FEV1)增加量等的差异以及上述指标与痰嗜酸粒细胞的相关性。结果与嗜酸粒细胞正常组相比,嗜酸粒细胞增高组血嗜酸粒细胞计数、FeNO及合并过敏性疾病比例更高;哮喘病程及吸入沙丁胺醇后FEV1增加量则低于嗜酸粒细胞正常组(P值均<0.05)。痰嗜酸粒细胞与血嗜酸粒细胞、FeNO呈正相关(r=0.398、0.584,P值均<0.05),与吸入沙丁胺醇后FEV1增加量呈负相关(r=-0.426,P<0.01)。采用受试者工作特征曲线分析FeNO及血嗜酸粒细胞的诊断价值。FeNO诊断气道嗜酸性炎症的最佳截断值为28.5 ppb,其敏感度为86.9%,特异度为66.0%(曲线下面积为0.812)。血嗜酸粒细胞计数诊断气道嗜酸性炎症的最佳截断值为185个/μl,其敏感度为62.9%,特异度为69.4%(曲线下面积为0.667)。结论未控制哮喘患者的气道炎症表型多为嗜酸粒细胞型,嗜酸粒细胞性哮喘对支气管扩张剂反应较差,气道嗜酸性炎症可能有导致气道重塑的风险;同时血嗜酸粒细胞、FeNO对判断哮喘的气道炎症表型有一定的辅助作用。     

Outcome of treated advanced non-small cell lung cancer with and without central airway obstruction

OBJECTIVE: In patients with advanced non-small cell lung cancer (NSCLC) treated with chemotherapy, we compared survival in patients with treated central airway obstruction to those who did not have central airway obstruction. METHODS: One hundred forty-four patients with advanced and inoperable NSCLC were included. These consisted of 52 consecutive patients treated with therapeutic bronchoscopy plus chemotherapy with or without radiotherapy (group A) and 92 consecutive patients who did not have central airway obstruction treated with chemotherapy alone (group B). Chemotherapy consisted of cisplatin or carboplatin, and one third-generation chemotherapy agent. RESULTS: There was no significant difference in the survival of patients with and without central airway obstruction (p = 0.395). There was no influence of the histologic subtype on survival in both groups combined and also in each group separately. Median survival in patients belonging to group A was 8.4 months and those in group B was 8.2 months; 3-, 6-, and 12-month survival rates in patients in group A were 90%, 71%, and 40%, respectively, and those in group B were 82%, 63%, and 34%. CONCLUSION: Patients having advanced NSCLC with locally treated malignant central airway obstruction in combination with chemotherapy do not have a worse survival compared to those with advanced NSCLC without central airway obstruction. Therapeutic bronchoscopy should be offered to patients with NSCLC and central airway obstruction.     

支气管镜下激光、球囊扩张联合冷冻治疗良性中心气道狭窄的疗效分析

目的研究支气管镜下激光、球囊扩张联合冷冻治疗良性中心气道狭窄(CAS)的疗效分析。方法本研究对象为2017年11月-2018年8月于我院治疗的42例良性CAS患者,随机数字表法均分为两组。对照组21例患者采用支气管镜下激光、球囊扩张治疗,观察组21例患者在此基础上联合冷冻治疗,随访10个月,记录围术期情况,比较术后当天、1月、10个月气道狭窄再通疗效,各随访时间采用美国胸科学会(ATS)气促评分标准评价呼吸困难指数,镜下观察肉芽肿、黏膜水肿、管腔通畅等情况。结果观察组术后早期呼吸困难发生率显著低于对照组(P<0.05),均无气胸、大咯血、纵隔气肿等发生;两组术后当天气道狭窄疗效评价差异无统计学意义(P>0.05),术后1月、10个月观察组气道狭窄疗效优于对照组(P<0.05);观察组术后当天、1月、10个月呼吸困难指数均显著低于对照组(P<0.05);观察组术后肉芽肿能够较快形成稳定非挛缩样瘢痕,并保持稳定管腔扩大状态;对照组易出现黏膜水肿,残留肉芽肿,容易出现管腔再狭窄。结论支气管镜下激光、球囊扩张联合冷冻治疗良性CAS疗效更佳,术后呼吸更畅通,同时冷冻治疗能改善激光、球囊扩张治疗后出现的医源性黏膜水肿及肉芽肿引起的气道再度狭窄。