Biological markers as indicators of exposure and pneumoconiotic risk: Prospective study

This research is designed to evaluate a number of biological markers to estimate harmful exposure on coal miners from different mining regions in France and to relate the outcome to differences in prevalence of coal worker pneumoconiosis (CWP) between these regions. Eight epidemiological groups of active and ex-miners (smokers and non-smokers) have been selected in the French collieries (North, Lorraine and Provence) according to their occupational and pneumoconiotic status. The following biomarkers have been evaluated: cellularity of sputum, elementary analysis of particles in TEM/EDAX, plasma neutral metalloendo peptidase elastase type (NMEP), leucocyte elastase (HLE), fibronectin (FN) and elastin peptides. Pulmonary alveolitis, expressed by sputum cellularity, is different between active workers groups but not related to the general background of pneumoconiosis prevalence in the French collieries. In the plasma parameters, fibronectin, HLE and NMEP significantly increased in all groups of coal mine workers as compared to the control group, except for fibronectin parameter in Lorraine collierie. The degree of increase of these parameters allow us to discriminate the different groups and suggest that plasma FN, HLE and NMEP may be considered as biological markers of chronic inhalation of coal mine dust particles. The decrease of elastin peptides level in the Lorraine group alone suggests a specific alteration of elastin metabolism. These parameters were not related to the development of pneumoconiosis and its degree of severity.     

慢性阻塞性肺疾病的肺生物学标记物研究进展

与慢性阻塞性肺疾病（COPD）有关的很多炎症细胞、介质,正逐渐为人们所熟知。本文讨论支气管活组织切片、痰液、支气管肺泡灌洗液、呼出气凝物等方面的有关生物标记在COPD研究中的进展。     

Sputum induction as a research tool for the study of human respiratory mucus

The study objectives were to compare in vitro transportability and physical properties of respiratory mucus, obtained invasively by direct collection (DC) right after endotracheal intubation and non-invasively by sputum induction with 3% hypertonic saline solution inhalation (SI) 24 h before the anesthesia. Twenty-two patients with no pulmonary disease scheduled for elective abdominal surgical procedures were studied. The parameters analyzed and the main results are as follows. (1) Transportability by cilia (MCT), SI was higher than DC (0.94+/-0.25 and 0.62+/-0.25; P<0.001). There was a significant correlation between the two methods and DC could be estimated by: DC=0.21+(0.44 SI) (r=0.44; P<0.001). (2) Transportability by cough (CC), SI was higher than DC (68.23+/-32.1 and 33.58+/-19.04 mm; P=0.002). (3) Contact angle (CA), SI was lower than DC (10+/-3 degrees and 22+/-14 degrees ; P=0.025). (4) Rheological properties (no significant difference obtained between SI and DC). These results indicated that SI changes mucus physical properties and transportability in non-expectorators.     

Diagnosis of squamous-cell carcinoma of the lung by sputum cytology: with special reference to correlation of diagnostic accuracy with size and proximal extent of resected tumor

Sputum cytology was performed in 179 cases of squamous-cell carcinoma of the lung; 134 cases were diagnosed as positive. There were no significant differences in diagnostic accuracy of sputum cytology between tumors sizes. In cases with tumors extending proximally into the main, lobar, or segmental bronchi, the diagnostic accuracy of sputum cytology was significantly higher than in cases where the proximal invasion of tumor was limited to the peripheral bronchi. In cases with tumors 3 cm or less in diameter, when tumors extended proximally into main, lobar, or segmental bronchi, the diagnostic accuracy of sputum cytology was significantly higher than in cases with tumors extending proximally into subsegmental or subsubsegmental bronchi. In peripherally located squamous-cell carcinoma, in cases in which the tumor arose in subsegmental or subsubsegmental bronchi, carcinoma could be detected by sputum cytology even when it was roentgenographically occult.     

686例痰阳肺结核病人短程直接督导化疗效果观察

目的 为观察短程直接督导化疗(dots)对痰阳肺结核病人的治疗效果。方法 统计分析我县防疫站门诊1993—1999年686例痰阳肺结核病人的治疗结果。结果 686例痰阳肺结核病人中：初治痰阳病人496例,治愈487例,治愈率98、1％,复治痰阳病人190例,治愈175例,治愈率为92.1％。结论 痰阳肺结核病人采用(dots)方法治疗,病人由村医生直接治疗,治疗中乡镇医生管理,督导6次以上,县卫生防疫站督导员督导3次以上,实践证明,短程直接督导化疗能提高痰阳肺结核病人的治愈率。     

检测痰脱落细胞p16基因甲基化对周围型肺癌的诊断价值

目的　探讨检测痰脱落细胞p16基因甲基化对周围型肺癌的诊断价值。方法　应用甲基化特异性PCR(methylation specificPCR ,MSP)对 5 0例周围型肺结节患者及 2 0例正常人痰脱落细胞p16基因甲基化改变进行检测 ,将检测结果与术后病理报告相对照。结果　周围型肺癌痰脱落细胞 p16MSP阳性率( 2 7/ 44 ,61.4%)明显高于良性周围型肺结节 ( 1/ 6,16.7%)及正常人 ( 3 / 2 0 ,15 .0 %) ( χ2 值分别为 4.2 81和11.869,P <0 .0 5 ) ,良性周围型肺结节 p16MSP阳性率与正常人无显著性差异 ( χ2 =0 .13 6,P >0 .0 5 )。鳞癌和腺癌患者痰脱落细胞 p16MSP阳性率无显著性差异 ( χ2 =3 .416,P >0 .0 5 )。如果以痰脱落细胞 p16MSP阳性作为判断肺结节恶性的标准 ,其诊断周围型肺癌的阳性预测值为 96.4%,阴性预测值 2 2 .7%,灵敏度 61.4%,特异度 83 .0 %。结论　检测痰脱落细胞 p16基因甲基化对周围型肺癌具有辅助诊断价值     

痰液沉渣切片和痰涂片检查诊断肺癌的比较性研究

目的　寻找更快捷准确的痰液检查肺癌癌细胞的方法。方法　对经手术切除病理确诊的 12 0例肺癌患者 ,进行痰液涂片和痰液沉渣切片两种方法检查癌细胞的比较性研究。结果　 ( 1) 12 0例肺癌患者痰涂片发现癌细胞 3 8例 ( 3 1.67%) ,而痰沉渣切片检出癌细胞 86例 ( 71.67%) (P <0 .0 0 1)。两种方法联合检出癌细胞 10 9例 ,检出率为 90 .83 %,显著优于单纯的痰沉渣切片法 (P <0 .0 0 1)。 ( 2 )痰沉渣切片HE染色能明确肺癌组织学类型的为 5 5 /86例 ( 63 .95 %) ,而痰涂片仅能分型 6/3 8例 ( 15 .79%) (P <0 .0 0 1)。 ( 3 )痰液沉渣切片可进一步作免疫组化染色 ,绝大部分HE染色不能分型的病例 ( 2 9/3 1)得以明确分型。结论　痰液沉渣切片方法简便、取材全面、癌细胞检出率高 ,并且能进行组织学分型 ,值得临床上推广应用     

宁波市1996-2004年结核病痰涂片质控分析

目的探讨宁波市加强痰涂片质量保证提高发现结核病传染源。方法宁波市1996~2004年结核病人年报表按涂阳新登记对7个县(市)、区设在综合性医院,有5个县(市)、区设在疾病预防控制中心报告单位统计分析。结果1996~2004年痰涂片质控抽查,平均阳性符合率略低于卫生部室间质控≥98%的标准,阴性符合率符合卫生部室间质控≥96%的标准,质控质量总体呈上升趋势。9年间发现19 768例结核病人,涂阳病人8 317例。其中综合性医院发现涂阳病人3 974例占47.8%,疾控中心发现涂阳病人4 343例占52.2%。结论加强痰涂片质量控制,是提高发现结核病传染源的保证。痰检工作需领导重视,加强措施,固定人员,加强业务培训,抓痰检质控,保证检出率,达到高发现传染源的目的。     

COPD患者急性加重期血清与痰中TNF-α、白细胞三烯B4水平的变化及意义

目的 探讨TNF-α、白细胞三烯B4（LTB4）在慢性阻塞性肺病急性加重期（AECOPD）血清与痰中的含量变化及临床意义.方法 分别检测28例AECOPD患者治疗前后血清与痰中TNF-α、LTB4的含量变化,并以26例健康体检者作对照.结果 AECOPD患者治疗前血清与痰中TNF-α水平分别为（30.12±9.32）ng/L、（9.86±2.56）ng/L,明显高于治疗后[（16.69±4.28）ng/L、（4.69±1.06）ng/L]（P均〈0.05）; AECOPD患者治疗前血清与痰中LTB4水平分别为（2.925±0.855）ng/L、（3.152±0.986）ng/L,明显高于治疗后[（2.206±0.653）ng/L、（2.355±0.701）ng/L]（P均〈0.05）.结论 动 态监测血清与痰中TNF-α、LTB4变化对于评价COPD急性加重期患者病情具有一定的临床意义.     

肺炎性假瘤及球形肺结核细胞增殖研究

目的了解肺炎性假瘤及球形肺结核是否存在细胞增殖异常。方法用流式细胞仪对9例患者(其中5例肺炎性假瘤、4例球形肺结核病)痰液细胞DNA含量进行分析,并与痰细胞学检查、手术及经皮肺活检组织P53、PCNA、Ki67免疫组化分析结果作比较。结果以最后病理诊断为标准,肺炎性假瘤及球形肺结核患者异倍体检出率分别为40%(2/5)与50%(2/4),其相应的病变组织切片PCNA、Ki67免疫组化染色也阳性,但P53免疫组化染色阴性。结论部分炎性假瘤及结核球存在细胞增殖异常。痰细胞DNA含量分析是发现增殖异常的有效辅助方法,可能有利于肺癌的早期诊断。