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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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    布地奈德福莫特罗粉吸入剂对胸腔镜肺切除术后患者咳嗽和肺功能的影响

    孙静瑶侯兆垚夏天刘畅...
    59-64页
    查看更多>>摘要：目的 探究便携式布地奈德福莫特罗粉吸入剂对胸腔镜肺切除术后患者咳嗽和肺功能的影响。 方法 本研究为非随机对照试验，采用非随机抽样的方法选取2022年12月至2023年5月于河南省人民医院胸外科行胸腔镜肺切除术的188例患者为研究对象。根据术后布地奈德福莫特罗粉吸入剂的用药情况，将术后1周内自行停药的患者纳入对照组(92例)，术后持续用药4周及以上的患者纳入病例组(96例)。收集患者的基本特征包括性别、年龄、身体质量指数、体表面积、吸烟史、术后吸烟人数、手术切除类型、手术时长和术后体力活动等级。比较2组患者术前1周和术后1个月时中文版莱斯特咳嗽问卷(LCQ-MC)评分的差异，以及术前、术后LCQ-MC评分的差异。比较2组患者术后LCQ-MC评分下降值和肺功能指标下降率的差异。 结果 2组患者性别、年龄、身体质量指数、体表面积、吸烟史、术后吸烟人数、手术切除类型、手术时长和术后体力活动等级比较，差异均无统计学意义(均P>0.05)。2组患者术前1周LCQ-MC评分比较差异无统计学意义(Z＝1.17，P＝0.241)，病例组术后1个月时LCQ-MC评分高于对照组[18.66(18.25，19.21)分比16.79(16.22，17.15)分，Z＝11.08，P<0.001]。病例组和对照组术后1个月时LCQ-MC评分均低于术前1周[18.66(18.25，19.21)分比20.03(19.15，20.48)分，16.79(16.22，17.15)分比20.17(19.85，20.46)分，Z值分别为8.16、8.33，均P<0.001]，对照组患者术后LCQ-MC评分下降值高于病例组[3.30(2.98，3.73)分比1.32(1.03，1.66)分，Z＝11.57，P<0.001]。病例组第1秒用力呼气容积下降率、用力肺活量下降率、第1秒用力呼气容积/用力肺活量下降率、呼气流量峰值下降率、最大自主通气量下降率、最大呼气中期流量下降率和肺一氧化碳弥散量下降率均低于对照组[(7.45±9.03)%比(24.73±8.98)%，(8.70±9.02)%比(22.24±9.84)%，－0.77(－6.09，1.19)%比3.50(－0.35，7.12)%，(4.48±11.46)%比(16.68±11.63)%，2.67(－12.20，11.64)%比14.97(4.64，22.49)%，(6.72±21.88)%比(30.49±18.15)%，10.89(3.32，18.37)%比18.07(8.80，24.42)%]，而残气量/肺总量下降率高于对照组[2.91(－5.40，8.86)%比－9.32(－16.80，－1.29)%]，差异均有统计学意义(均P<0.001)。 结论 便携式布地奈德福莫特罗粉吸入剂能够改善胸腔镜肺切除术后患者的咳嗽症状并促进肺功能康复。 Objective To explore the effect of portable budesonide-formoterol inhalation powder on cough and lung function in patients after thoracoscopic pulmonary resection. Methods It was a non-randomized controlled trial.One hundred and eighty-eight patients who underwent thoracoscopic pulmonary resection at the Department of Thoracic Surgery in Henan Provincial People′s Hospital between December 2022 and May 2023 were enrolled using the non-random sampling method.According to the post-operative use of portable budesonide-formoterol inhalation powder, patients with self-withdrawal within a week postoperatively were included in the control group (n=92), and those with a continuous medication for a minimum of 4 weeks were included in the case group (n=96).Baseline characteristics, including gender, age, body mass index (BMI), body surface area, smoking history, number of postoperative smokers, type of surgical resection, surgical duration, and postoperative physical activity level were recorded.The mandarin Chinese version of the Leicester cough questionnaire (LCQ-MC) scores at 1 week preoperatively and at 1 month postoperatively were compared between the two groups, as well as the differences in the LCQ-MC scores before and after surgery.The declines of postoperative LCQ-MC scores and lung function were compared between the two groups. Results There were no significant differences in the gender, age, BMI, body surface area, smoking history, number of postoperative smokers, type of surgical resection, surgical duration, and postoperative physical activity level between the two groups (all P>0.05).There was no significant difference in the LCQ-MC scores at 1 week preoperatively between the two groups (Z=1.17, P=0.241).However, the LCQ-MC scores at 1 month postoperative were significantly higher in the case group than those of the control group (18.66 [18.25, 19.21] points vs 16.79 [16.22, 17.15] points, Z=11.08, P<0.001).The LCQ-MC scores at 1 month postoperatively were significantly reduced in both groups compared to those at 1 week preoperatively (case group: 18.66 [18.25, 19.21] pointsvs 20.03 [19.15, 20.48] points control group: 16.79 [16.22, 17.15] pointsvs 20.17 [19.85, 20.46] points Z=8.16 and 8.33, respectively both P<0.001).Patients in the control group experienced a higher decline in the LCQ-MC scores than that of the case group (3.30 [2.98, 3.73] pointsvs 1.32 [1.03, 1.66] points, Z=11.57, P<0.001).Patients in the case group showed significantly lower decline rate of forced expiratory volume in one second (FEV1) ([7.45±9.03]% vs [24.73±8.98]%), forced vital capacity (FVC)([8.70±9.02]%vs [22.24±9.84]%), FEV1/ FVC (-0.77 [-6.09, 1.19] % vs 3.50 [-0.35, 7.12]%), peak expiratory flow ([4.48±11.46]%vs [16.68±11.63]%), maximal voluntary ventilation (2.67 [-12.20, 11.64]%vs 14.97 [4.64, 22.49]%), maximal mid-expiratory flow ([6.72±21.88]%vs [30.49±18.15]%), and diffusion capacity of carbon monoxide of lung (10.89 [3.32, 18.37]%vs 18.07 [8.80, 24.42]%) compared to that of the control group, and a significantly higher decline rate of residual volume/total lung capacity (2.91 [-5.40, 8.86] %vs -9.32 [-16.80, -1.29]%) (all P<0.001). Conclusions Portable budesonide-formoterol inhalation powder can effectively alleviate cough symptoms and promote pulmonary function recovery in patients following thoracoscopic pulmonary resection.

    肺切除术胸腔镜布地奈德,富马酸福莫特罗复方合剂咳嗽呼吸功能试验

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    p16基因甲基化状态对吉西他滨联合顺铂治疗中晚期肺鳞癌疗效的影响

    游波蒋雪莲毛建川刘兰...
    65-72页
    查看更多>>摘要：目的 探讨p16基因甲基化状态对吉西他滨联合顺铂治疗中晚期肺鳞癌患者疗效的影响。 方法 本研究为前瞻性队列研究，采用非随机抽样的方法选取2017年3月至2022年6月岳池县人民医院收治的129例中晚期肺鳞癌患者为研究对象。根据患者p16基因甲基化状态分为甲基化组(44例)和未甲基化组(85例)。所有患者均接受4个疗程吉西他滨联合顺铂化疗，疗程结束后评估化疗疗效。收集患者的临床资料包括年龄、性别、吸烟情况、肿瘤分期、组织学分类、Karnofsky功能状态(KPS)评分、原发肿瘤大小、淋巴结转移、远处转移、合并疾病个数、美国东部肿瘤协作组(ECOG)评分和p16基因甲基化状态。分别于化疗前和第2次化疗后检测2组患者的血清肿瘤标志物水平，包括血管内皮生长因子(VEGF)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)、癌胚抗原(CEA)、糖类抗原125(CA125)和糖类抗原50(CA50)。通过门诊复查、电话等方式对患者进行随访，随访时间截至2023年2月，记录患者的总生存期。多因素logistic回归分析影响吉西他滨联合顺铂化疗治疗中晚期肺鳞癌患者疗效的因素。通过Kaplan-Meier法绘制生存曲线，并采用Log-rank检验比较不同p16基因甲基化状态中晚期肺鳞癌患者的生存曲线。 结果 2组患者性别、年龄、临床分期、组织学分类、原发肿瘤大小比较差异均无统计学意义(均P>0.05)。未甲基化组淋巴结转移为N0、远处转移为M0比例均高于甲基化组[62.35%(53/85)比27.27%(12/44)，70.59%(60/85)比40.91%(18/44)，均P<0.05]。未甲基化组化疗前和第2次化疗后KPS评分均高于甲基化组[(71.74±3.36)分比(70.12±4.17)分，(75.93±5.28)分比(72.77±5.52)分，均P<0.05]，且甲基化组和未甲基化组第2次化疗后KPS评分均高于化疗前(均P<0.05)。甲基化组患者化疗前和第2次化疗后VEGF、CYFRA21-1、CEA、CA125、CA50水平均高于未甲基化组，且甲基化组和未甲基化组第2次化疗后VEGF、CYFRA21-1、CEA、CA125、CA50水平均低于化疗前(均P<0.05)。未甲基化组化疗疗效较甲基化组好(Z＝23.96，P<0.001)，未甲基化组客观缓解率、疾病控制率均高于甲基化组[42.35%(36/85)比9.09%(4/44)，80.00%(68/85)比40.91%(18/44)，均P<0.001]。单因素分析结果显示，年龄≥70岁患者未缓解率高于年龄<70岁患者[76.62%(59/77)比57.69%(30/52)]，合并疾病个数>3个患者未缓解率高于合并疾病个数≤3个患者[79.75%(63/79)比52.00%(26/50)]，ECOG评分>1分患者未缓解率高于ECOG评分≤1分患者[85.92%(61/71)比48.28%(28/58)]，p16基因甲基化患者未缓解率高于未甲基化患者[93.18%(41/44)比56.47%(48/85)]，淋巴结转移为N1患者未缓解率高于N0患者[87.50%(56/64)比50.77%(33/65)]，远处转移为M1患者未缓解率高于M0患者[80.39%(41/51)比61.54%(48/78)]。多因素logistic回归分析结果显示，年龄≥70岁、合并疾病个数>3个、ECOG评分>1分、p16基因甲基化、有淋巴结转移、有远处转移是影响中晚期肺鳞癌患者接受吉西他滨联合顺铂化疗疗效的独立危险因素。Log-rank检验结果显示未甲基化组患者的生存状态优于甲基化组患者(χ2＝5.33，P＝0.001)。 结论 p16基因甲基化是影响吉西他滨联合顺铂治疗中晚期肺鳞癌患者疗效的独立危险因素。 Objective To investigate the effect of the methylation status of the p16 gene on efficacy of gemcitabine combined with cisplatin for patients with middle-stage and advanced lung squamous cell carcinoma (LSCC). Methods It was a prospective cohort study.One hundred and twenty-nine patients with middle-stage and advanced LSCC treated in the People′s Hospital of Yuechi County from March 2017 to June 2022 were enrolled by non-random sampling method.According to the methylation status of the p16 gene, patients were divided into methylation group (n=44) and non-methylation group (n=85).All patients received 4 chemotherapy courses of gemcitabine plus cisplatin, followed by the evaluation of the efficacy.Clinical data were collected, including age, sex, smoking status, tumor stage, histological classification, the Karnofsky performance status (KPS) score, primary tumor size, lymph node metastasis, distant metastasis, number of associated diseases, Eastern Cooperative Oncology Group (ECOG) performance status score, and methylation status of the p16 gene.Serum tumor markers, including vascular endothelial growth factor (VEGF), cyto-keratin 19 fragment antigen 21-1 (CYFRA21-1), carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125) and carbohydrate antigen 50 (CA50) were measured before chemotherapy and after the second course of chemotherapy.They were followed up by outpatient reexamination and telephone up to February 2023, and the overall survival was recorded.Multivariate logistic regression analysis was performed to identify risk factors for the chemotherapy efficacy of gemcitabine combined with cisplatin in patients with middle-stage and advanced LSCC.The survival curve was drawn by the Kaplan-Meier method, followed by comparing the survival curves in patients with middle-stage and advanced LSCC with different methylation statuses of the p16 gene by Log-rank test. Results There were no significant differences in sex, age, clinical stage, histological classification and primary tumor size between the two groups (all P>0.05).The rates of patients with N0 of lymph node metastasis (62.35% [53/85]vs 27.27% [12/44]) and M0 of distant metastasis (70.59% [60/85]vs 40.91% [18/44]) were significantly higher in the non-methylation group than those of methylation group (both P<0.05).The KPS scores before chemotherapy ([71.74±3.36] pointsvs [70.12±4.17] points) and after the second course of chemotherapy ([75.93±5.28] pointsvs [72.77±5.52] points) were significantly higher in the non-methylation group than those of methylation group (both P<0.05), and the KPS scores after the second course of chemotherapy were significantly higher than those before chemotherapy in both groups (bothP<0.05).The levels of VEGF, CYFRA21-1, CEA, CA125 and CA50 before chemotherapy and after the second course of chemotherapy were significantly higher in the methylation group than those of non-methylation group (allP<0.05), which, after the second course of chemotherapy were significantly lower than those before chemotherapy in both groups (allP<0.05).The chemotherapy efficacy was significantly better in the non-methylation group than that of the methylation group (Z=23.96, P<0.001).The objective remission rate (42.35% [36/85]vs 9.09% [4/44]) and disease control rate (80.00% [68/85]vs 40.91% [18/44]) in the non-methylation group were significantly higher than those of the methylation group (both P<0.001).Univariate analysis showed that the non-remission rates were significantly higher in patients aged ≥70 years (76.62% [59/77]vs 57.69% [30/52]), with more than 3 diseases (79.75% [63/79]vs 52.00% [26/50]), ECOG score >1 point (85.92% [61/71] vs 48.28% [28/58]), p16 gene methylation (93.18% [41/44] vs 56.47% [48/85]), N1 of lymph node metastasis (87.50% [56/64]vs 50.77% [33/65]) and M1 of distant metastases (80.39% [41/51]vs 61.54% [48/78]) than those of counterparts.Multivariate logistic regression analysis showed that age ≥70 years, concomitant diseases >3, ECOG score >1 point, p16 gene methylation, lymph node metastasis and distant metastasis were independent risk factors affecting the chemotherapy efficacy of gemcitabine and cisplatin for patients with middle-stage and advanced LSCC.Log-rank test showed that the survival was better in the non-methylation group than that of the methylation group (χ2=5.33, P=0.001). Conclusions The p16 gene methylation is an independent risk factor affecting the efficacy of gemcitabine combined with cisplatin for patients with middle-stage and advanced LSCC.

    肺肿瘤基因,p16吉西他滨顺铂治疗结果

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    Yes相关蛋白调控肺动脉平滑肌细胞增殖的分子机制

    柯蕊和平张伟史文花...
    73-78页
    查看更多>>摘要：目的 研究Yes相关蛋白(YAP)调控肺动脉平滑肌细胞(PASMCs)增殖的分子机制。 方法 本研究为实验研究。选取健康SD大鼠，体质量70～80 g。培养大鼠PASMCs，根据是否给予S1P刺激将PASMCs分为S1P组和对照组，蛋白质印迹法检测细胞磷酸化YAP(p-YAP)和β-catenin、CyclinD1蛋白水平。按照转染control干扰小RNA(siRNA)或YAP siRNA后再给予S1P刺激的情况不同，将PASMCs分为对照组、S1P组、si＋S1P组、si-YAP＋S1P组，蛋白质印迹法检测各组细胞中β-catenin和CyclinD1的蛋白水平。按照转染control siRNA或β-catenin siRNA后再给予S1P刺激的情况不同，将PASMCs分为对照组、S1P组、si＋S1P组、si-β-catenin＋S1P组，蛋白质印迹法检测各组细胞中CyclinD1的蛋白水平。按照转染control siRNA或YAP siRNA或β-catenin siRNA后再给予S1P刺激的情况不同，将PASMCs分为对照组、S1P组、si＋S1P组、si-YAP＋S1P组和si-β-catenin＋S1P组，BrdU掺入法检测各组细胞增殖情况。 结果 S1P组p-YAP水平低于对照组[(0.61±0.09)比(1.00±0.11)，P＝0.009]，β-catenin和CyclinD1蛋白水平高于对照组[(1.98±0.14)比(1.00±0.10)，(1.94±0.15)比(1.00±0.08)，均P＝0.001]。si-YAP＋S1P组β-catenin、CyclinD1水平均低于S1P组[(1.15±0.09)比(1.95±0.12)，(1.18±0.16)比(1.96±0.05)，均P<0.01]。si-β-catenin＋S1P组CyclinD1水平低于S1P组[(1.18±0.24)比(1.95±0.24)，P<0.01]。S1P组细胞增殖率高于对照组[(169.69±12.85)%比(100.00±12.52)%，P<0.01]，si-YAP＋S1P组、si-β-catenin＋S1P组细胞增殖率均低于S1P组[(126.33±14.56)%比(169.69±12.85)%，(128.10±15.25)%比(169.69±12.85)%，均P<0.01]。 结论 YAP/β-catenin/CyclinD1信号通路可以调控PASMCs增殖。 Objective To examine the molecular mechanisms of Yes-associated protein (YAP) in regulating the proliferation of pulmonary arterial smooth muscle cells (PASMCs). Methods It was an experimental study.PASMCs were separated from healthy Sprague-Dawley (SD) rats weighing 70-80 g. Primary PASMCs were cultured and stimulated with S1P or blank control, followed by the detection of the expressions of phosphorylated YAP (p-YAP), β-catenin and CyclinD1 by Western blot.Then, PASMCs were induced with blank control, S1P, S1P+ transfection of si-NC, and S1P+ transfection of si-YAP, followed by the detection of the protein expressions of β-catenin and CyclinD1 by Western blot and assessment of cell proliferation by BrdU assay.PASMCs were further induced with blank control, S1P, S1P+ transfection of si-NC, and S1P+ transfection of si-β-catenin, followed by the detection of the protein expression of CyclinD1 by Western blot and assessment of cell proliferation by BrdU assay. Results The expression of p-YAP ([0.61±0.09] vs [1.00±0.11], P=0.009) was significantly lower in S1P-induced PASMCs than that of blank control, while protein expressions of β-catenin ([1.98±0.14] vs [1.00±0.10], P=0.001) and CyclinD1 ([1.94±0.15] vs [1.00±0.08], P=0.001) were significantly higher.Protein expressions of β-catenin ([1.15±0.09] vs [1.95±0.12], P<0.01) and CyclinD1 ([1.18±0.16]vs [1.96±0.05], P<0.01) were significantly lower in PASMCs induced with S1P+ transfection of si-YAP than those induced with S1P.Protein expression of CyclinD1 ([1.18±0.24]vs [1.95±0.24], P<0.01) was significantly lower in PASMCs induced with S1P+ transfection of si-β-catenin than those induced with S1P.The proliferative rate was significantly higher in PASMCs induced with S1P ([169.69±12.85]%vs [100.00±12.52]%, P<0.01) than that of blank control.The proliferative rate was significantly lower in PASMCs induced with S1P+ transfection of si-YAP ([126.33±14.56]%vs [169.69±12.85]%, P<0.01) and S1P+ transfection of si-β-catenin ([128.10±15.25]%vs [169.69±12.85]%, P<0.01) than that induced with S1P. Conclusions The YAP/β-catenin/CyclinD1 signaling pathway promotes proliferation of PASMCs.

    肺动脉高压肺动脉平滑肌细胞细胞增殖Yes相关蛋白β-catenin

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    新型冠状病毒感染康复期IgG抗体水平及疫苗接种关系

    安树昌刘国田黄新逄晓莉...
    79-84页
    查看更多>>摘要：目的 了解新型冠状病毒感染(COVID-19)康复期IgG抗体水平及其与新型冠状病毒疫苗接种的关系。 方法 本研究为前瞻性队列研究。采用非随机抽样的方法，选取2023年2月至5月在清华大学第一附属医院呼吸与危重症医学科门诊和病房就诊的185例COVID-19康复者为研究对象。记录患者一般资料、发病时间、病情严重程度、接种新型冠状病毒疫苗情况。收集患者感染后6、8、10、12、14、16、18周不同时间点静脉血，采用半定量磁微粒化学发光法检测血清免疫球蛋白(Ig)G、IgM抗体水平。按照新型冠状病毒疫苗接种情况分为疫苗接种组(接种2剂次以上灭活疫苗，共130例)和疫苗未接种组(因各种原因未能接种疫苗，共55例)。将2组中>75岁康复者分别纳入亚组，疫苗接种亚组(18例)和疫苗未接种亚组(28例)。比较康复者整体、2组和2亚组各时间点的IgG、IgM抗体水平。 结果 185例COVID-19康复者中男80例，女105例；年龄62.0(40.5，75.0)岁；111例(60.00%)合并基础病。2组患者的性别比较差异无统计学意义(χ2＝0.03，P＝0.874)；疫苗未接种组年龄、合并基础病、重症或危重症比例均较疫苗接种组高，差异均有统计学意义(均P<0.01)。2亚组患者的性别、年龄、重症或危重症比例比较差异均无统计学意义(均P>0.05)；疫苗未接种亚组合并基础病比例较疫苗接种亚组高，差异有统计学意义(χ2＝4.30，P＝0.038)。全体康复者体内IgM抗体水平均为阴性。康复者整体IgG抗体水平在感染后第10周达到峰值，之后逐渐下降，于随访期末达最低值。疫苗接种组感染后第6、8、10、12、14、16、18周的IgG抗体水平均高于疫苗未接种组，差异均有统计学意义[157.9(73.4，240.0)比4.7(1.7，17.7)，Z＝2.36；132.0(75.3，213.1)比2.8(0.7，52.6)，Z＝3.77；137.7(79.9，227.0)比1.1(0.4，15.2)，Z＝4.51；134.5(81.4，211.9)比1.0(0.5，2.9)，Z＝3.49；92.4(68.9，112.9)比1.7(1.2，2.4)，Z＝2.84；61.2(33.3，108.7)比2.9(1.3，12.8)，Z＝3.45；57.1(32.7，87.6)比1.1(0.8，8.3)，Z＝4.06；均P<0.05]。疫苗接种亚组感染后第8、12、16周的IgG抗体水平均高于疫苗未接种亚组，差异均有统计学意义[261.5(225.4，304.9)比13.8(0.5，126.8)，Z＝2.34；134.5(104.8，283.6)比1.2(0.5，2.9)，Z＝2.74；61.5(10.9，147.8)比1.9(1.2，27.4)，Z＝2.11；均P<0.05]。 结论 随着康复期延长，COVID-19康复者体内IgG抗体水平在达峰后逐渐下降。完成全程新型冠状病毒疫苗接种人群在患COVID-19后较未接种人群体内能产生更高水平的IgG抗体。 Objective To measure the titer of immunoglobulin G (IgG) antibody during the recovery period from coronavirus disease (COVID-19) and their relationship with COVID-19 vaccine administration. Methods It was a prospective cohort study.One hundred and eighty-five patients recovered from COVID-19 admitted in the outpatient and inpatient, Department of Respiratory and Critical Care Medicine, the First Hospital of Tsinghua University from February 2023 to May 2023 were enrolled using the non-random sampling method.Baseline characteristics, onset time, severity, and COVID-19 vaccine administration details were recorded.Blood samples were collected at 6, 8, 10, 12, 14, 16, and 18 weeks after the infection of COVID-19.Serum titers of IgG and IgM antibodies were measured by the semi-quantitative magnetic particle chemiluminescence method.Participants were categorized into vaccination group (received ≥2 doses of vaccinations, n=130) and non-vaccination group (n=55).Participants over 75 years old and recovered from COVID-19 were subgrouped into vaccination subgroup (n=18) and non-vaccination subgroup (n=28).IgG and IgM titers were compared in the overall cohort, two groups and two subgroups. Results Among 185 patients recovered from COVID-19, there were 80 males and 105 females with the mean age of 62.0(40.5, 75.0) years.There were 111 cases (60.00%) of underlying diseases.There was no significant difference in gender between vaccination group and non-vaccination group (χ2=0.03, P=0.874).The age and proportions of patients combined with underlying diseases, and severe or critically ill patients in the non-vaccination group were significantly higher than those in the vaccination group (all P<0.01).In subgroups, there were no significant differences in the gender, age and proportion of severe or critically ill patients (allP>0.05), but the proportion of patients with underlying diseases in the non-vaccination subgroup was significantly higher than that in the vaccination subgroup (χ2=4.30, P=0.038).Negative IgM was detected in all participants.The IgG titer peaked at week 10 post-infection, which was gradually declined by the end of the follow-up period.The IgG titer in vaccination group at 6 weeks (157.9[73.4, 240.0] vs 4.7[1.7, 17.7], Z=2.36), 8 weeks (132.0[75.3, 213.1] vs 2.8[0.7, 52.6], Z=3.77), 10 weeks (137.7[79.9, 227.0] vs 1.1[0.4, 15.2], Z=4.51), 12 weeks (134.5[81.4, 211.9] vs 1.0[0.5, 2.9], Z=3.49), 14 weeks (92.4[68.9, 112.9] vs 1.7[1.2, 2.4], Z=2.84), 16 weeks (61.2[33.3, 108.7] vs 2.9[1.3, 12.8], Z=3.45) and 18 weeks (57.1[32.7, 87.6] vs 1.1[0.8, 8.3], Z=4.06) was significantly higher than that of non-vaccination group (all P<0.05).The IgG titer in vaccination subgroup at 8 weeks (261.5[225.4, 304.9]vs 13.8[0.5, 126.8], Z=2.34), 12 weeks (134.5[104.8, 283.6] vs 1.2[0.5, 2.9], Z=2.74) and 16 weeks (61.5[10.9, 147.8] vs 1.9[1.2, 27.4], Z=2.11) was significantly higher than that of non-vaccination subgroup (all P<0.05). Conclusions As the recovery period extends, serum titer of IgG antibody increases to the peak and gradually decreases in patients recovered from COVID-19.Individuals who have completed the full course of the COVID-19 vaccine generate higher titers of IgG antibodies after the infection of COVID-19 compared to those who have not been vaccinated.

    新型冠状病毒感染新型冠状病毒IgG抗体疫苗接种

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    血清PCT、VEGF、pro-ADM对NICU患儿呼吸机相关性肺炎的预测价值

    杨遥樊梦洁罗刚王秋红...
    85-91页
    查看更多>>摘要：目的 探讨血清降钙素原(PCT)、血管内皮生长因子(VEGF)、前肾上腺髓质素(pro-ADM)水平对新生儿重症监护病房(NICU)患儿发生呼吸机相关性肺炎(VAP)的预测价值。 方法 本研究为病例对照研究，采用非随机抽样的方法选取2018年3月至2021年3月宜昌市中心人民医院NICU收治的接受机械通气治疗的100例患儿为研究对象。根据住院期间是否合并VAP将患儿分为VAP组(30例)和非VAP组(70例)。比较2组患儿性别、胎龄、出生1 min Apgar评分、住院天数、出生日龄、机械通气天数、气管插管次数、有无重复吸痰和胃内容物误吸情况。比较2组患儿机械通气治疗前后血清PCT、VEGF、pro-ADM水平。应用受试者操作特征曲线分析血清PCT、VEGF、pro-ADM水平预测NICU患儿发生VAP的价值。多因素logistic回归分析NICU患儿发生VAP的危险因素。 结果 2组患儿性别、胎龄、出生日龄比较差异均无统计学意义(均P>0.05)。VAP组患儿出生1 min Apgar评分<7分者、住院天数≥7 d者、机械通气天数≥5 d者、气管插管次数≥2次者、有重复吸痰者、有胃内容物误吸者占比均高于非VAP组[60.00%(18/30)比38.57%(27/70)，70.00%(21/30)比41.43%(29/70)，63.33%(19/30)比35.71%(25/70)，73.33%(22/30)比32.86%(23/70)，66.67%(20/30)比37.14%(26/70)，76.67%(23/30)比40.00%(28/70)，均P<0.05]。VAP组患儿机械通气治疗前后血清PCT、VEGF、pro-ADM水平均高于非VAP组[治疗前PCT：(3.18±0.78) mmol/L比(2.17±0.59) mmol/L，治疗后PCT：(2.56±0.52)mmol/L比(2.15±0.45) mmol/L，治疗前VEGF：(89.64±16.29) ng/L比(68.97±13.59) ng/L，治疗后VEGF：(75.37±13.27) ng/L比(66.37±12.39) ng/L，治疗前pro-ADM：(37.61±10.39) μg/L比(25.61±9.67) μg/L，治疗后pro-ADM：(30.67±8.63) μg/L比(24.67±6.34) μg/L，均P<0.05]，VAP组患儿机械通气治疗后血清PCT、VEGF、pro-ADM水平均低于治疗前(均P<0.05)。受试者操作特征曲线显示，血清PCT、VEGF、pro-ADM水平预测NICU患儿发生VAP的曲线下面积分别为0.739(95%CI：0.614～0.864)、0.873(95%CI：0.785～0.962)、0.911(95%CI：0.835～0.987)。当PCT的最佳截断值为2.91 mmol/L时，敏感度为86.7%，特异度为56.7%；当VEGF的最佳截断值为82.86 ng/L时，敏感度为90.0%，特异度为76.7%；当pro-ADM的最佳截断值为31.28 μg/L时，敏感度为93.3%，特异度为31.3%。出生1 min Apgar评分<7分、住院天数≥7 d、机械通气天数≥5 d、气管插管次数≥2次、有重复吸痰、有胃内容物误吸、PCT≥2.91 mmol/L、VEGF≥82.86 ng/L、pro-ADM≥31.28 μg/L是NICU患儿发生VAP的独立危险因素。 结论 血清PCT、VEGF、pro-ADM水平对NICU患儿发生VAP均有一定预测价值，PCT、VEGF、pro-ADM升高是NICU患儿发生VAP的独立危险因素。 Objective To explore the predictive values of serum procalcitonin (PCT), vascular endothelial growth factor (VEGF), pro-adrenomedullin (pro-ADM) in children with ventilator-associated pneumonia (VAP) in neonatal intensive care unit (NICU). Methods It was a case-control study involving 100 children receiving mechanical ventilation treatment in NICU of Yichang Central People′s Hospital from March 2018 to March 2021 selected by non-random sampling method.They were divided into VAP group (30 cases) and non-VAP group (70 cases) according to the development of VAP during hospitalization or not.Gender, gestational age, Apgar score 1 min after birth, length of hospitalization, age of birth, length of mechanical ventilation, times for tracheal intubations, repeated sputum aspiration and aspiration of stomach contents were compared between the two groups.Serum PCT, VEGF and pro-ADM levels before and after mechanical ventilation were compared between the two groups.The value of serum PCT, VEGF and pro-ADM levels in predicting VAP in NICU children was analyzed by plotting the receiver operator characteristic (ROC) curves.Multivariate logistic regression analysis was performed to identify risk factors for VAP in NICU children. Results There were no significant differences in the gender, gestational age and age of birth between groups (all P>0.05).The proportion of children in VAP group with Apgar score 1 min after birth <7 points (60.00% [18/30]vs 38.57% [27/70]), hospitalization days ≥7 d (70.00% [21/30]vs 41.43% [29/70]), mechanical ventilation days ≥5 d (63.33% [19/30]vs 35.71% [25/70]), times for tracheal intubations ≥2 times (73.33% [22/30]vs 32.86% [23/70]), repeated sputum aspiration (66.67% [20/30]vs 37.14% [26/70]) and aspiration of stomach contents (76.67% [23/30]vs 40.00% [28/70]) was significantly higher than that of non-VAP group (all P<0.05).Serum PCT, VEGF and pro-ADM levels in VAP group before (PCT, [3.18±0.78] mmol/Lvs [2.17±0.59] mmol/L VEGF, [89.64±16.29] ng/Lvs [68.97±13.59] ng/L pro-ADM, [37.61±10.39] μg/Lvs [25.61±9.67] μg/L) and after mechanical ventilation (PCT, [2.56±0.52] mmol/L vs [2.15±0.45] mmol/L VEGF, [75.37±13.27] ng/Lvs [66.37±12.39] ng/L pro-ADM, [30.67±8.63] μg/Lvs [24.67±6.34] μg/L) were both significantly higher than those of non-VAP group (all P<0.05).The serum levels of PCT, VEGF and pro-ADM in VAP group after mechanical ventilation treatment were significantly lower than those before treatment (allP<0.05).ROC curves showed that the area under the curve (AUC) of serum PCT, VEGF and pro-ADM levels in predicting VAP in NICU children was 0.739 (95%CI: 0.614-0.864), 0.873 (95%CI: 0.785-0.962) and 0.911 (95%CI: 0.835-0.987), respectively.When the optimal cut-off value of PCT was 2.91 mmol/L, the sensitivity was 86.7% and the specificity was 56.7%.When the optimal cut-off value of VEGF was 82.86 ng/L, the sensitivity was 90.0% and the specificity was 76.7%.When the optimal cut-off value of pro-ADM was 31.28 μg/L, the sensitivity was 93.3% and the specificity was 31.3%.Apgar score 1 min after birth < 7 points, length of hospitalization ≥7 d, length of mechanical ventilation ≥5 d, times for tracheal intubations ≥2 times, repeated sputum aspiration, aspiration of stomach contents, PCT≥2.91 mmol/L, VEGF≥82.86 ng/L, and pro-ADM≥31.28 μg/L were independent risk factors for VAP in children with NICU. Conclusions Serum PCT, VEGF and pro-ADM have certain predictive value in VAP in NICU children.The increases in serum PCT, VEGF and pro-ADM are independent risk factors for the occurrence of VAP in NICU children.

    肺炎,呼吸机相关性重症监护病房,新生儿降钙素原血管内皮生长因子类前肾上腺髓质素

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    先天性肺气道畸形的诊治现状和问题

    彭思琪杨澜黄茂彭卫...
    92-97页
    查看更多>>摘要：先天性肺气道畸形(CPAM)作为最常见的先天性肺发育畸形，是一组可累及气道和肺实质的异质性罕见病。随着医学影像学技术的发展和人们健康体检意识的增强，在胎儿期CPAM被越来越多地发现，给临床医师在产前和产后患儿管理方面带来了新的挑战。部分CPAM患者由产前超声和常规体检发现，还有一部分患者因出现结构性或感染性并发症于就诊时发现。对于CPAM的流行病学、无症状患者的治疗方式和随访时间等存在争议，国内外尚无统一的CPAM诊疗指南。2021年，中国多位小儿外科专家联合发表《先天性肺气道畸形诊疗中国专家共识(2021版)》指导临床医师工作。本文着重介绍CPAM的诊治现状，并讨论疾病自然史、CPAM发展为恶性肿瘤等尚存争议的问题。 As the most frequent congenital lung malformation, congenital pulmonary airway malformation (CPAM) is a rare and heterogeneous disorder involving the airways and lung parenchyma.With the continuous progress of medical imaging technology and the increase of health awareness, CPAM is increasingly found in the fetal period, presenting clinicians with a unique set of challenges to prenatal and postpartum management.Some CPAM patients are found by prenatal ultrasound and routine physical examination, while others are diagnosed when they develop structural or infectious complications.Due to many aspects of the epidemiology, treatment of asymptomatic patients, and follow-up time remaining mired in controversy, there is no unified management guideline of CPAM at home and abroad.In 2021, a number of pediatric surgeons in China jointly published the " National Expert Consensus on Diagnosis & Treatment of Congenital Pulmonary Airway Malformations in China (2021)". Our article offered a clinically focused review of recent advances in the diagnosis and treatment of CPAM and discussed the remaining controversial issues like the natural history and malignant transformation.

    肺囊腺瘤样畸形,先天性产前诊断治疗恶变

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    机器学习算法在静脉血栓栓塞症防治中的研究进展

    席霖枫杨浩宇刘敏翟振国...
    98-103页
    查看更多>>摘要：机器学习(ML)作为人工智能的重要分支，现已广泛应用于疾病诊断和评估。静脉血栓栓塞症(VTE)是一种常见的血栓性疾病，临床诊疗过程需要精确高效的评估策略。随着医工交叉逐渐深入和ML方法学的不断优化，在VTE预防诊治领域，ML发挥着越来越重要的作用，相关研究取得显著进展。ML可协助识别VTE的风险因素，建立针对性的风险预测模型。通过对多模态数据的整合，ML可辅助医生快速准确地进行VTE诊断和严重程度评价。在VTE治疗领域，ML可协助制定抗凝药物、剂量和疗程等临床决策，同时预测药物相关不良反应尤其是出血风险。另外，ML也可辅助新药的研发，通过探讨VTE的发病机制从而寻找干预靶点。 As an important branch of artificial intelligence, machine learning (ML) has been widely used in disease diagnosis and evaluation.Venous thromboembolism (VTE) is a common thrombotic disease, which requires accurate and efficient assessment strategies in clinical settings.With the gradual deepening of medical and engineering crossover and the continuous optimization of ML methodology, ML plays an increasingly important role in the prevention and treatment of VTE.Meanwhile, significant progresses have been made on relevant research.ML can help identify the risk factors for VTE and establish a targeted risk prediction model.Through the integration of multi-modality data, ML can assist clinicians to quickly and accurately diagnose and evaluate the severity of VTE.In the field of VTE treatment, ML can assist in making clinical decisions like the use of anticoagulant drugs, dosages and course of treatment, and predicting drug-related adverse effects, especially the risk of bleeding.In addition, ML can also assist in the development of new drugs by exploring the pathogenesis of VTE to find intervention targets.

    静脉血栓栓塞人工智能机器学习

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    妊娠期肺栓塞的诊治和预防研究进展

    杨露邢西迁王秋红
    104-109页
    查看更多>>摘要：妊娠期肺栓塞的临床表现缺乏特异性，容易漏诊或误诊。许多无临床症状的肺栓塞未能引起医生和患者的重视，导致严重后果甚至死亡。其诊断需要结合患者的临床表现和辅助检查综合分析。妊娠期肺栓塞的诊断和治疗有别于非妊娠期，因此有必要开展相关研究以加强妊娠期肺栓塞的预防和管理，降低病死率，改善患者预后。本文就妊娠期肺栓塞的危险因素、诊断、治疗和预防等方面的研究进展作一综述，为临床医师的诊治提供参考。 The clinical presentation of pulmonary embolism during pregnancy lacks specificity and it is easily and missed or misdiagnosed.Many pulmonary embolisms without clinical symptoms have not been concerned, leading to serious consequences or even death.The diagnosis requires a comprehensive assessment of clinical manifestations and auxiliary testing.The diagnosis and treatment of pulmonary embolism during pregnancy differ from those in the non-gestational period.Therefore, it is necessary to carry out relevant research to strengthen the prevention and management of pulmonary embolism during pregnancy, reduce the fatality rate and improve the prognosis.This article summarized the research progress in risk factors, diagnosis, treatment and pregnancy of prevention embolism during pregnancy, and provided some references for its clinical management.

    肺栓塞孕妇诊断治疗

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    成人吸入性一氧化氮治疗及其临床应用进展

    丁悦加贾建伟葛慧青段思琦...
    110-114页
    查看更多>>摘要：一氧化氮是血管内皮细胞产生的天然血管扩张因子。目前吸入性一氧化氮(iNO)已获批用于新生儿持续性肺动脉高压治疗，而对于成人患者，iNO治疗已在右心导管术期间急性肺血管反应试验中被证实有明确作用。近年来随着对iNO研究的深入，更多的疾病能从iNO治疗中获益。本文就iNO的作用机制及其相关临床应用进展作一综述，以进一步加深对iNO的生理效应及其在成人中临床应用效果的了解。 Nitric oxide is a natural vasodilator produced by vascular endothelial cells.Inhaled nitric oxide (iNO) is currently approved for the treatment of persistent pulmonary hypertension of the newborn.In adults, iNO therapy has been validated for its definite efficacy on acute pulmonary vascular response testing during right heart catheterization.In recent years, with the deepening of iNO research, iNO therapy has been able to benefit various diseases.This article reviewes the mechanism of iNO and its related clinical applications, thus further deepening the understanding of its physiological effects of iNO and clinical application in adults.

    一氧化氮吸入性一氧化氮血管扩张因子生理效应临床应用

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    褪黑素与呼吸系统疾病相关研究进展

    王洁李龙刘胜菲陈凤...
    115-119页
    查看更多>>摘要：呼吸系统疾病的发生率逐年攀升，因此其预防、诊断和治疗也日益被重视。褪黑素是一种吲哚衍生激素，主要由松果体中的色氨酸合成，以响应各种生理刺激。褪黑素现已被证实对正常组织有多种影响，如抗氧化、抗炎、抗凋亡、抗癌、抗病毒和免疫调节等，是近年来研究的热点，因其具有良好的耐受性且不良反应小，在治疗多种呼吸系统疾病方面具有潜在的应用前景。本文就褪黑素的产生过程、作用机制，以及其在常见呼吸系统疾病中的具体作用作一简要概述，旨在为临床治疗提供思路。 The incidence of respiratory diseases annually increases.Therefore, the prevention, diagnosis and treatment of respiratory diseases have been gradually concerned.Melatonin (MT) is an indole-derived hormone synthesized primarily from tryptophan in the pineal gland in response to various physiological stimuli.The various effects of MT on normal tissues have been validated, such as antioxidant, anti-inflammatory, anti-apoptotic, anti-cancer, anti-viral and immunomodulatory properties.MT has been a research hotspot in recent years because of its good tolerance and less adverse events, presenting a potential application to the treatment of respiratory diseases.This article summarizes the production process, mechanism of action and specific role of MT in common respiratory diseases, thus providing references for the clinical treatment.

    呼吸道疾病氧化应激褪黑素核因子κB

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