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国际呼吸杂志
国际呼吸杂志

白春学

半月刊

1673-436X

guojihuxi@163.com

0311-86266873

050017

河北省石家庄市中山东路361号

国际呼吸杂志/Journal International Journal of Respiration北大核心CSTPCD
查看更多>>1981年创刊，中华医学会、河北医科大学主办。本刊原名国外医学呼吸系统分册，系医学科技期刊，中华医学会系列刊物之一。办刊宗旨：贯彻、执行国家的政策法规和规范标准，坚持理论与实践、普及与提高相结合的原则，促进国内、外学术交流。报道内容：介绍国内、外呼吸疾病的新动态、新成果、新技术和新经验。主要栏目：诊治指南、专家述评、专家共识、专家笔谈、论著、综述、继续教育、呼吸介入、研究报道、专题讲座、临床经验、病例分析、病例报告、病例讨论、呼吸读片等。读者对象：呼吸科、急诊科、ICU、小儿科、老年科、胸外科、微创治疗中心、睡眠中心、变态反应科的医师和护士，以及从事呼吸领域基础研究和临床研究的科技工作者。
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    慢性肝病、肝硬化患者感冒处理之我见

    杨竹黄志寅唐承薇薛芳...
    125-128页
    查看更多>>摘要：慢性肝病、肝硬化患者免疫力下降，容易患普通感冒。笔者在研读《成人普通感冒诊断和治疗临床实践指南(2023)》(简称《感冒指南》)基础上，结合慢性肝病、肝硬化患者感冒后常陷入的误区，根据国内外文献及自己的前期科学研究、临床探索，提出治疗上的独特见解，对《感冒指南》在这一特殊人群应用进行了有益拓展，有望规范临床治疗慢性肝病、肝硬化患者普通感冒。 Patients with chronic liver disease and cirrhosis are prone to common cold because of insufficient immunity。The insights into treatment of common cold in patients with chronic liver disease and cirrhosis are presented， based on the practice guidelines for the diagnosis and management of common cold in adults 2023， literature， the common clinical misunderstanding， and the preliminary scientific research as well as clinical exploration。It may be helpful to expand the application of the guidelines in this special population and to standardize the clinical treatment of common cold in patients with chronic liver disease and cirrhosis。

    感冒慢性肝病肝硬化药物性肝损伤

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    《成人普通感冒诊断和治疗临床实践指南(2023)》解读

    陈旭岩张陈光王秋红
    129-135页
    查看更多>>摘要：本文对《成人普通感冒诊断和治疗临床实践指南(2023)》进行解读。根据该指南中纳入的临床研究、循证医学证据得出的推荐意见进行总结分析。该指南为国内关于感冒治疗的首部专业性指南，主要涉及：(1)感冒流行病学及病原学；(2)感冒诊断及鉴别诊断；(3)感冒治疗等方面。通过对该指南的归纳总结，为感冒的临床治疗提供系统化的参考。 This article interpretatedClinical practice guidelines for diagnosis and treatment of common cold in adults (2023)， summarized and analyzed the recommendations based on the clinical studies and evidence-based medicineresearch included in the guidelines。This is the first professional guidebookfor colds treatment in China， mainly involving: (1) epidemiology and etiology of colds (2) diagnosis and differential diagnosis of colds (3) treatment of colds。This interpretation will provide a systematic reference for the clinical treatment of colds。

    感冒诊断治疗,指南

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    自然杀伤T细胞与肺部疾病

    李晴晴聂汉祥薛芳
    136-142页
    查看更多>>摘要：自然杀伤(NK)T细胞是一种非经典的天然T细胞亚群，可以识别CD1d分子递呈的脂质抗原。根据T细胞受体基因编码序列的可变性，通常将NKT细胞分为2个亚群，即Ⅰ型NKT细胞和Ⅱ型NKT细胞。Ⅰ型NKT细胞可以分为NKT1、NKT2、NKT17和NKT10细胞等亚群。研究显示NKT细胞在肺部疾病发生发展中发挥重要作用。本文将对NKT细胞的分类、发育分化及其在肺部疾病中的作用进行探讨。 Natural killer (NK) T cell， a non-classical subset of T cells， can recognize lipid antigens presented by CD1d molecules。NKT cells are typically categorized into two subgroups， namely type Ⅰ NKT cells and type Ⅱ NKT cells， based on the variability of T cell receptor gene coding sequences。Type Ⅰ NKT cells can be further subdivided into subgroups like NKT1， NKT2， NKT17， and NKT10 cells。Research indicates that NKT cells have a significant impact on the occurrence and progression of pulmonary diseases。This article explores NKT cell classification， development， differentiation， and their role in pulmonary diseases。

    肺疾病自然杀伤T细胞自然杀伤T细胞亚群

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    高通量测序技术在肺真菌病诊断中的研究进展

    张丹丹兰箭薛芳
    143-147页
    查看更多>>摘要：肺真菌病是一种病死率较高的肺部炎症性疾病，其临床表现缺乏特异性，早期诊断困难。传统的真菌检测方法的检出率和诊断准确性受到一定限制。高通量测序又称为下一代测序技术或二代测序技术，是一种新型的病原体检测手段，可以同时检测多个微生物的核酸序列，从而具有在混合感染和罕见真菌感染的诊断中更有优势的特点。高通量测序技术仍存在局限性，需要结合临床区分定植菌和致病菌。 Pulmonary fungal disease is a kind of pulmonary inflammatory disease with high fatality。The lack of specificity in clinical manifestations leads to difficult early diagnosis。The detection rate and diagnostic accuracy of traditional fungal detection methods are limited。High-throughput sequencing， also known as next-generation sequencing (NGS)， is a new method for pathogen detection， which can detect the nucleic acid sequences of multiple microorganisms at the same time。Therefore， it has more advantages in the diagnosis of mixed infection and rare fungal infections。NGS technology still has some limitations， however， and it is necessary to distinguish colonized fungi from pathogenic fungi based on clinical practice。

    肺真菌病高通量测序多重感染罕见病原体诊断准确性

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    Th17/Treg免疫平衡治疗气道炎症的研究进展

    麻雪晴白诗瑶赵杰禹孙佳敏...
    148-153页
    查看更多>>摘要：辅助性T细胞17(Th17)和调节性T细胞(Treg)共同来自幼稚的CD4＋T淋巴细胞。研究显示，在气道炎症中Th17细胞对炎症有促进作用，而Treg细胞抑制自身免疫。Th17和Treg细胞比例失衡会促使气道炎症的出现。因此，维持Th17/Treg细胞免疫平衡在气道炎症的治疗上至关重要。同时，一些影响这些细胞产生和维持的调节因子也很重要，包括T细胞受体信号、共刺激信号、细胞因子信号等。本文就Th17/Treg细胞与这些调节因子之间的平衡的功能、作用及其在慢性阻塞性肺疾病和支气管哮喘中的临床意义进行阐述。 Helper T cell 17 (Th17) and Regulatory T cell (Treg) are derived from naive CD4+ T lymphocytes。In airway inflammation， Th17 cells can promote inflammation， while Treg cells can inhibit autoimmunity。The imbalance of Th17 and Treg cells can promote airway inflammation。Therefore， maintaining Th17/Treg cell immune balance is important in the treatment of airway inflammation。At the same time， some regulatory factors that affect the production and maintenance of these cells are also important， including T cell receptor signals， co-stimulatory signals， cytokine signals， etc。This article reviews the function and role of the Th17/Treg cells balance in chronic obstructive pulmonary disease and in bronchial asthma， so as to explore the clinical significance of the balance。

    哮喘肺疾病,慢性阻塞性辅助性T细胞17T淋巴细胞,调节性平衡

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    雷帕霉素在甲型H1N1流感病毒感染中对糖酵解和炎性因子的调节作用

    宋融融徐九洋刘智博曹彬...
    154-161页
    查看更多>>摘要：目的 探讨免疫抑制剂雷帕霉素对流感病毒复制的影响及在流感病毒感染后调节糖酵解和炎性因子的作用。 方法 本研究为实验研究，采用甲型H1N1流感病毒株A/PR/8分别感染人肺泡上皮细胞系A549和永生化小鼠骨髓源巨噬细胞(iBMDM)，构建流感病毒感染细胞模型。使用人非小细胞肺癌细胞系A459设置空白对照组、感染对照组、感染雷帕霉素组、感染二甲亚砜组，在流感病毒感染及雷帕霉素处理48 h后，使用空斑法和血凝法测定上清液病毒滴度，定量聚合酶链反应法检测细胞内病毒基因、糖酵解相关基因(PDK3、PKM、GAPDH、LDHA、HK2、PGAM1、PGK1)和炎性因子干扰素α(IFN-α)、Caspase-1、白细胞介素(IL)-1β、IL-18、IL-6、IL-8、凋亡相关斑点样蛋白(ASC)]基因相对量的表达。设置巨噬细胞空白对照组，巨噬细胞感染对照组和巨噬细胞感染雷帕霉素组，使用小鼠永生化骨髓巨噬细胞(iBMDM)在流感病毒感染及雷帕霉素处理24 h后，酶联免疫吸附测定法检测上清肿瘤坏死因子(TNF)-α浓度。进行3次平行重复实验。 结果 感染雷帕霉素组A549细胞上清中的病毒滴度与感染对照组、感染二甲亚砜组比较差异均无统计学意义(均P>0。05)。感染雷帕霉素组NP基因CT值较感染对照组和感染二甲亚砜组升高，分别为[(17。50±0。35)比(16。43±0。12)和(16。52±0。27)，差异有统计学意义，均P<0。05]；感染对照组A549细胞上清中炎性因子基因GAPDH、LDHA、HK2、PGAM1表达量均较空白对照组上调，分别为[(2。34±0。32)比(1。01±0。16)、(2。43±0。18)比(1。01±0。18)、(2。63±0。48)比(1。00±0。06)，(17。97±1。13)比(1。00±0。09)差异有统计学意义，均P<0。05]；与感染对照组相比，感染雷帕霉素组下调了GAPDH、LDHA、HK2、PGAM1的相对表达量，分别为[(1。48±0。19)比(2。34±0。32)、(1。79±0。09)比(2。43±0。18)、(1。65±0。28)比(2。63±0。48)、(10。48±0。81)比(17。97±1。13)，差异有统计学意义，均P<0。05]；感染雷帕霉素组基因PDK3、PKM、PGK1与感染对照组比较差异无统计学意义(均P>0。05)]。感染对照组A549细胞上清中Caspase-1、IL-6、IL-8基因的相对表达量较空白对照组上调，分别为[(47。02±2。07)比(1。00±0。09)、(17。59±2。14)比(1。00±0。04)、(3。86±0。44)比(1。01±0。19)，差异有统计学意义，均P<0。05]。以感染复数＝20流感病毒感染iBMDM细胞24 h后，巨噬细胞感染对照组上清液中TNF-α的浓度较巨噬细胞空白对照组升高(260。60±38。90)ng/L比(44。96±3。12)ng/L，而巨噬细胞感染雷帕霉素组的TNF-α的浓度降低了(132。20±12。29)ng/L比(260。60±38。90)ng/L，差异有统计学意义(均P<0。05)。 结论 雷帕霉素减少流感病毒NP蛋白基因在肺泡上皮细胞中的表达，同时可有效减轻流感病毒感染引起的糖酵解通路激活，并降低感染后巨噬细胞炎症反应。 Objective To investigate the effect of the immunosuppressant rapamycin on viral replication in influenza virus-infected cell， and to determine its role in regulating glycolysis pathway and inflammatory response during influenza virus infection。 Methods This was an experimental study。Human alveolar epithelial cell A549 and iBMDM (immortalized murine bone marrow-derived macrophages) cell lines were infected with influenza virus A/H1N1/PR/8 to construct a cell model of influenza virus infection。Human non-small cell lung cancer cell line A459 was used to set up a blank control group， an infection control group， a rapamycin infection group， and a dimethyl sulfoxide infection group。At 48 hours post infection and rapamycin treatment， the cell culture supernatant virus titer was determined by plaque assay and hemagglutination assay the expression levels of viral gene， glycolysis genes (PDK3， PKM， GAPDH， LDHA， HK2， PGAM1， and PGK1)， and inflammatory factor interferon α， Caspase-1， Interleukin (IL)-1β， IL-18， IL-6， IL-8， and apoptosis associated speckle like protein (ASC) genes were determined with real time quantitative PCR (RQ-PCR)。 A macrophage blank control group， a macrophage infection control group， and a macrophage rapamycin infection group were set up。At 24 hours post mouse iBMDM infection and rapamycin treatment， the supernatant cytokine tumor necrosis factor(TNF)-α in iBMDM culture was measured by ELISA。Three parallel replicate experiments were performed。 Results There was no significant difference in viral titer in the supernatant of A549 cells between the rapamycin infection group and infection control group， rapamycin infection group and dimethyl sulfoxide infection group (both P>0。05)。 The CTvalue of influenza virus NP gene in the rapamycin infection group was higher than that in the infection control group (17。50±0。35vs 16。43±0。12) and in the dimethyl sulfoxide infection group (17。50±0。35 vs 16。52±0。27)， with significant differences (both P<0。05)。 The expressions of GAPDH， LDHA， HK2， and PGAM1 in the infection control group were up-regulated compared with those in the blank control group， with significant differences (2。34±0。32vs 1。01±0。16， 2。43±0。18 vs 1。01±0。18， 2。63±0。48 vs 1。00±0。06， 17。97±1。13 vs 1。00±0。09)(all P<0。05)。 Compared with the infection control group， rapamycin treatment down-regulated the expressions of GAPDH， LDHA， HK2， and PGAM1， with significant differences (1。48±0。19vs 2。34±0。32， 1。79±0。09 vs 2。43±0。18， 1。65±0。28 vs 2。63±0。48， 10。48±0。81 vs 17。97±1。13)(all P<0。05) there was no significant differences for PDK3， PKM， and PGK1 between the two groups (P>0。05)。 The relative expressions of Caspase-1， IL-6， and IL-8 in the infection control group were up-regulated compared with the blank control group (47。02±2。07， 1。00±0。09， 17。59±2。14vs 1。00±0。04， 3。86±0。44 vs 1。01±0。19)(all P<0。05)。 After 24 h of infection with influenza virus multiplicity of infection (MOI)=20， the concentration of TNF-α in the cell supernatant of the macrophage infection group increased compared with that of the macrophage blank control group ([260。60±38。90] ng/Lvs [44。96±3。12] ng/L)， while the concentration of TNF-α in the rapamycin infection group was reduced， with significant differences ([132。20±12。29] ng/Lvs [260。60±38。90] ng/L) (all P<0。05)。 Conclusions Rapamycin reduces the expression of NP gene of influenza virus in alveolar epithelial cells， and can effectively reduce the up-regulation of glycolysis-related enzyme genes caused by influenza virus infection， as well as reduce the inflammatory response of macrophages after infection。

    流感病毒A型雷帕霉素糖酵解炎性因子

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    西安市重症新型冠状病毒Omicron变异株感染人群临床特征及预后风险因素分析

    马银娟权瑞宇米九运魏霞...
    162-168页
    查看更多>>摘要：目的 分析重症新型冠状病毒Omicron变异株感染人群免疫学、影像学临床特征及死亡预后风险因素。 方法 本研究为回顾性研究。采用非随机抽样法。选择2022年11月1日至2023年2月1日西安市第九医院确诊新型冠状病毒Omicron变异株感染重型及危重型患者为研究对象，以2023年2月1日为时间点，根据预后不同分为死亡组和生存组，收集患者人口学资料、免疫学特征[自然杀伤细胞、T淋巴细胞、B淋巴细胞、免疫球蛋白(Ig)M、IgG、IgA]及胸部定量CT，分析生存组与死亡组患者间数据的差异，利用二元logistic回归分析影响重型及危重型Omicron变异株感染人群死亡的独立危险因素。利用受试者工作特征曲线比较不同生物学标志物之间的预测价值。 结果 共纳入重症新型冠状病毒Omicron变异株感染患者138例，其中死亡组43例(男32例，女11例)，生存组95例(男55例，女40例)，2组性别构成比差异无统计学意义(χ2＝3。47，P＝0。063)。死亡组高龄患者、危重型患者占比高于生存组(χ2值分别为5。54、46。01，均P<0。05)。死亡组淋巴细胞(CD4＋T淋巴细胞、CD8＋T淋巴细胞及B淋巴细胞)、自然杀伤细胞计数低于生存组(均P<0。05)；死亡组Ig水平与生存组相比差异无统计学意义(均P>0。05)。死亡组患者全肺病变容积和百分比高于生存组(均P<0。05)，且不论在生存组还是死亡组，右肺病变容积均大于左肺病变容积(均P<0。05)。二元logistic回归分析显示：年龄≥65岁(OR＝1。20，95%CI：1。05～1。37)、肺部病变范围≥552。00 ml(OR＝28。18，95%CI：3。05～260。56)和合并糖尿病(OR＝16。45，95%CI：1。37～198。15)是重症新型冠状病毒Omicron变异株感染人群死亡的独立危险因素。 结论 重症新型冠状病毒Omicron变异株感染人群存在免疫失调，其中年龄≥65岁、肺部病变范围≥552。00 ml、合并糖尿病可作为评估重症新型冠状病毒Omicron变异株感染患者死亡的独立危险因素。 Objective To analyze the clinical features and the risk factors of death prognosis in people infected with severe SARS-CoV-2 Omicron Variant in Xi′an city。 Methods This was a retrospective study。A non-random sampling method was used。Patients severely infected with SARS-CoV-2 Omicron Variant in the Ninth Hospital of Xi′an from November 1， 2022 to February 1， 2023 were selected as research subjects。According to different prognosis on February 1， 2023 as the time point， they were divided into death group and survival group。Demographic data， immunological features (NK cells， T lymphocytes， B lymphocytes， IgM， IgG， and IgA)， and CT imaging characteristics of the patients were analyzed。The independent risk factors for death in people infected with Omicron variant strains were analyzed by binary logistic regression。The predictive value of different biomarkers was compared using the receiver operating characteristic curve。 Results A total of 138 patients were included， with 43 cases in the death group (32 males， 11 females) and 95 cases in the survival group (55 males， 40 females)。 There was no statistically significant difference in gender between the two groups (χ2=3。47， P=0。063)。 The proportions of elderly patients and critically ill patients in the death group were higher than those in the survival group (χ2=5。54， 46。01 respectively， both P<0。05)。 The counts of lymphocytes (CD4+ T lymphocytes， CD8+ T lymphocytes， and B lymphocytes) and NK cells in the death group were lower than those in the survival group (all P<0。05)。 There was no statistically significant difference in the level of Ig between the two groups (allP>0。05)。 The proportion of total lung lesion in death group was higher than that in the survival group (P<0。05)。 The volume of total right lung lesion was higher than that in the left lung in both the survival and death groups (bothP<0。05)。 Binary logistic regression analysis showed: age ≥65 years old (OR=1。20， 95%CI: 1。05-1。37)， lung lesion range ≥552。00 ml (OR=28。18， 95 %CI: 3。05-260。56)， and diabetes (OR=16。45， 95%CI: 1。37-198。15) are independent risk factors for death in people infected with SARS-CoV-2 Omicron Variant。 Conclusions Immune disorders exist in people infected with SARS-CoV-2 Omicron Variant。Age ≥65 years old， lung lesion range ≥552。00 ml， and diabetes can be used as risk factors for evaluating hospital mortality in the patients。

    新型冠状病毒Omicron变异株重症患者免疫影像学特点预后风险因素

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    新型冠状病毒感染诱发支气管哮喘患者的临床特征及肺功能特点

    王莉洁赵丽娜徐文帅骆琼珍...
    169-175页
    查看更多>>摘要：目的 分析新型冠状病毒感染诱发支气管哮喘(哮喘)患者的临床特征及肺功能特点。 方法 本研究为回顾性研究。分析2023年2－7月清华大学附属北京清华长庚医院门诊诊治的165例新型冠状病毒感染诱发哮喘患者的临床资料，根据临床分型，分为典型哮喘(CA)组和咳嗽变异性哮喘(CVA)组，比较2组患者的过敏史、临床特征、血常规、血清总免疫球蛋白E(IgE)、呼出气一氧化氮(FeNO)、肺功能、气道激发试验等。 结果 165例新型冠状病毒感染诱发哮喘患者中，女109例(66。1%)，年龄(45。9±15。6)岁，主要临床表现为咳嗽(128例，77。6%)、气短或呼吸困难(49例，29。7%)、胸闷(47例，28。5%)、咳痰(15例，9。1%)，患者肺功能不同程度受损。CA组年龄高于CVA组[(49。6±16。2)岁比(42。8±14。5)岁，t＝2。82，P＝0。005]。相比CA组，CVA组患者对哮喘诱发或加重因素更敏感(42。0%比22。1%，χ2＝7。44，P＝0。006)。2组经口FeNO和经鼻FeNO差异均无统计学意义(均P>0。05)。CVA组外周血嗜酸性粒细胞、总IgE水平均低于CA组(均P<0。05)。尽管2组肺通气、小气道功能、弥散功能、残总比等指标差异无统计学意义(均P>0。05)，但进一步分析发现，CVA组患者肺通气储备功能中-重度受损比例低于CA组(6。8%比16。9%，χ2＝4。08，P＝0。043)，且气道可逆试验阳性比例低于CA组(38。6%比67。5%，χ2＝13。74，P<0。001)。 结论 新型冠状病毒感染诱发哮喘患者主要表现为咳嗽、气短、胸闷。相比CA组，CVA组患者外周血嗜酸性粒细胞、IgE水平较低，肺通气储备功能中-重度受损、气道可逆试验阳性比例均较低。 Objective To analyze the clinical features and pulmonary function characteristics of patients with asthma induced by coronavirus infection。 Methods This was a retrospective study。A total of 165 patients who were diagnosed with asthma induced by coronavirus infection in the out-patient of Beijing Tsinghua Changgung Hospital from February 2023 to July 2023 were included。According to clinical classification， they were divided into classic asthma (CA) group and cough variant asthma (CVA) group。The allergy history， clinical symptoms， blood routine， serum total immunoglobulin E (IgE)， fractional exhaled nitric oxide (FeNO)， lung function， airway provocation test， etc。of the two groups were compared。 Results Among 165 coronavirus infection induced asthma patients， 109 (66。1%) were female， the average age was 45。9±15。6 years。The main clinical manifestations of coronavirus infection induced asthma were cough (128 cases， 77。6%)， shortness of breath or dyspnea (49 cases， 29。7%)， chest tightness (47 cases， 28。5%)， and expectoration (15 cases， 9。1%)。 Lung function was impaired to some extent in these patients。The average age in CA group (49。6±16。2 years) was significantly older than that in CVA group (42。8±14。5 years)(t=2。82， P=0。005)。 Compared with CA group， patients in CVA group were more sensitive to asthma inducers or aggravating factors (42。0% vs 22。1%， χ2=7。44， P=0。032)。 There was no significant difference between the two groups in FeNO either orally or nasally (both P>0。05)。 The eosinophil count in peripheral blood and total IgE level of CVA group were significantly lower than those in CA group (P<0。05)。 As to the pulmonary function characteristics， although there were no significant differences between the two groups in pulmonary ventilation， small airway function， diffusion function， and total residual ratio (allP>0。05)， further analysis showed that the ratio of moderate-to-severe impairment of lung ventilation reserve function was lower in the CVA group than that in the CA group (6。8%vs 16。9%， χ2=4。08， P=0。043)， and the proportion of patients with positive bronchodilation tests in the CVA group was lower than that in the CA group (38。6% vs 67。5%， χ2=13。74， P<0。001)。 Conclusions The main clinical manifestations of asthma induced by coronavirus infection are cough， shortness of breath， and chest tightness。The eosinophil count in the periphery blood and IgE level in CVA group were lower than those in the CA group。The proportion of patients with moderate-to-severe impairment of lung ventilation reserve function and the proportion of patients with positive bronchodilation tests in CVA group were lower than those in CA group。

    新型冠状病毒感染哮喘咳嗽变异性哮喘临床特征肺功能

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    重度肝硬化患者合并侵袭性肺曲霉菌病的临床特征和短期预后

    郑曹沛张新张玲孙宇晴...
    176-183页
    查看更多>>摘要：目的 研究重度肝硬化合并侵袭性肺曲霉菌病(IPA)患者的临床特征和短期预后的危险因素。 方法 本研究为回顾性队列研究。采用随机抽样的方法连续性收集2011年12月1日至2022年12月1日，因肝硬化就诊于首都医科大学附属北京佑安医院的患者。随访患者诊断为IPA后28 d的结局，记录为死亡或存活。比较死亡组和存活组患者的临床特征、治疗和预后，采用Kaplan-Meier生存曲线评估使用伏立康唑和非使用伏立康唑治疗的患者预后，采用Cox回归分析患者的预后危险因素。 结果 本研究共纳入74例重度肝硬化合并IPA的患者，随访28 d，死亡36例，病死率为48。6%(36/74)。死亡组患者的年龄(57。4±11。7)岁大于存活组(49。4±14。7)岁，差异有统计学意义(t＝2。58，P<0。05)。2组患者的性别、吸烟、重度肝硬化的病因、临床表现、合并症、影像学表现，差异均无统计学意义(均P>0。05)。死亡组患者的白细胞计数、降钙素原、血肌酐和国际标准化比值，呼吸衰竭的比例，住院期间接受侵入性操作≥5次的比例，以及因病情加重入住重症监护室的比例，均高于存活组患者(均P<0。05)。Kaplan-Meier生存分析提示，与使用非伏立康唑治疗IPA的重度肝硬化患者相比，使用伏立康唑者28 d病死率更低[40。0%(20/50)比66。7%(16/24)，χ2＝4。54，P＝0。033]。Cox多因素回归分析显示PCT≥0。5 μg/L(RR：3。743，95%CI：1。435～9。763，P<0。05)和呼吸衰竭(RR：2。586，95%CI：1。291～5。177，P<0。05)是重度肝硬化合并IPA患者短期预后的独立危险因素。 结论 重度肝硬化合并IPA患者的短期病死率高。PCT≥0。5 μg/L和呼吸衰竭是这类患者短期预后的独立危险因素。使用伏立康唑治疗重度肝硬化患者的IPA，病死率相对较低。 Objective To investigate the clinical features of the patients with severe liver cirrhosis complicated by invasive pulmonary aspergillosis (IPA) and to explore the risk factors for short-term prognosis。 Methods This study was a retrospective cohort study。The data of the patients diagnosed with liver cirrhosis and treated at Beijing You An Hospital affiliated to Capital Medical University from December 1， 2011， to December 1， 2022 were collected using a random sampling method。The outcome of the patients 28 days after diagnosis of IPA was followed up and recorded as death or survival。Clinical characteristics， treatment， and prognosis were compared between the death and survival groups， the prognosis of patients treated with and without voriconazole was assessed using Kaplan-Meier survival curves， and the prognostic risk factors were identified using Cox regression。 Results A total of 74 patients with severe liver cirrhosis complicated by IPA were included in this study。The patients were followed up for 28 days， with 36 deaths， resulting in a mortality rate of 48。6% (36/74)。 The age of the death patients was significantly higher than that of the survivors (57。4±11。7) years vs (49。4±14。7) years， with statistical significance (t=2。58， P<0。05)。 There were no statistically significant differences between the two groups in terms of gender， smoking， etiology of severe liver cirrhosis， clinical manifestations， comorbidities， and radiological findings (P>0。05)。 Compared with the survivors， the patients in the death group had higher white blood cell counts， procalcitonin (PCT) levels， serum creatinine， international normalized ratio (INR)， proportion of respiratory failure， proportion of invasive procedures performed ≥5 times during hospitalization， and proportion of intensive care unit (ICU) admission due to disease exacerbation， (P<0。05)。 Kaplan-Meier survival analysis indicated that compared with severe liver cirrhosis patients treated with non-voriconazole therapy for IPA， those treated with voriconazole had a lower 28-day mortality rate (40。0%[20/50]vs 66。7%[16/24]， P=0。037)。 Cox multivariate regression analysis showed that PCT≥0。5 μg/L ( RR: 3。743， 95%CI: 1。435-9。763， P<0。05)and respiratory failure (RR: 2。586， 95%CI: 1。291-5。177， P<0。05)were independent risk factors for short-term prognosis of these patients。 Conclusions Short-term mortality rate is high in patients with severe liver cirrhosis complicated by IPA。PCT≥0。5 μg/L and respiratory failure are independent risk factors for short-term prognosis in such patients。Using voriconazole to treat IPA patients with severe liver cirrhosis is associated with relatively lower mortality rate。

    肝硬化侵袭性肺曲霉菌病伏立康唑预后

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    寄生虫感染相关嗜酸粒细胞增多相关性肺疾病的临床特征分析

    袁丁马宇雯戴妹薛玲娜...
    184-191页
    查看更多>>摘要：目的 分析寄生虫感染相关嗜酸粒细胞增多相关性肺疾病(EPD)的临床特征。 方法 横断面研究，采用目的抽样法收集2021年5月至2022年12月在广州医科大学附属第一医院诊断为寄生虫感染EPD患者25例的资料，根据国家寄生虫病卫生行业标准将其分为临床诊断组17例和确诊组8例，比较2组患者的流行病学史、人口学特征、临床表现及相关检查指标，随访患者驱虫治疗的效果。 结果 临床诊断组外周血嗜酸性粒细胞(EOS)显著高于确诊组，EOS重度升高的患者比例也更高(P＝0。026)。2组患者肺影像学主要改变为磨玻璃样、结节样、间质增厚。2组患者接受驱虫治疗后症状均好转，17例患者驱虫治疗后复查血EOS较治疗前下降(Z＝3。20，P＝0。006)，其中的8例患者在治疗后第1个月即可看到血EOS的显著下降(Z＝2。52，P＝0。012)。 结论 寄生虫感染相关EPD可以表现为外周血EOS重度升高，其病原学检出率不高，流行病学史的采集对于疾病诊断十分重要。对于有寄生虫病流行病学史、寄生虫抗体阳性、无肺外器官受累的EPD患者，诊断性驱虫治疗可以提高预后。 Objective To analyze the clinical characteristics of eosinophilic pulmonary disease (EPD) associated with parasitic infections， in order to provide a theoretical basis for early intervention and improved prognosis。 Methods This was a cross-sectional studyusing purposive sampling to collect data from 25 patients diagnosed with parasitic infection-associated EPD at the First Affiliated Hospital of Guangzhou Medical University from May 2021 to December 2022。According to the national parasitic disease health industry standards， patients were divided into clinical diagnostic group (17 cases) and confirmed group (8 cases)。 Epidemiological history， demographic characteristics， clinical manifestations， and relevant examination indicators of the patients were collected and compared， and the effectiveness of deworming treatment was followed up。 Results The peripheral blood eosinophils (EOS) in the clinical diagnostic group were significantly higher than those in the confirmed group， with higher proportion of patients with severe EOS elevation (P=0。026)。 The main changes in lung imaging for both groups were ground-glass opacity， nodular opacity， and interstitial thickening。After deworming treatment， symptoms improved in all patients， and in 17 cases， the blood EOS decreased after treatment (Z=3。20 P=0。006)， with 8 patients showing a significant decrease in blood EOS in the first month after treatment (Z=2。52 P=0。012)。 Conclusions Parasitic infection-associated EPD can present as severe peripheral blood eosinophilia， with a low pathogen detection rate， making the collection of epidemiological history crucial for disease diagnosis。For EPD patients with a history of parasitic disease epidemiology， positive parasitic antibodies， and no involvement of extrapulmonary organs， diagnostic deworming treatment can improve prognosis。

    肺疾病,寄生虫性嗜酸性粒细胞增多诊断性治疗流行病学

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