Objective To explore the prognostic significance of baseline clinical and pulmonary physiological variables on idiopathic pulmonary fibrosis ( IPF) . Methods Patients diagnosed with IPF according to 2011 ATS/ERS/JRS/ALAT statementwere selected from Nanjing DrumTower Hospital between January 1, 2002 and July 31, 2010. The baseline characteristics were abstracted, including age, gender, smoking history, corticosteroid, delay before diagnosis, body mass index, finger clubbing, oxygenation index ( PaO2 /FiO2 ) , C-reaction protein, erythrocyte sedimentation rate ( ESR) , serum lactate dehydrogenase ( LDH) , albumin, vital capacity ( VC) , forced vital capacity ( FVC) , total lung capacity ( TLC) , and singlebreath diffusing capacity of the lung for carbon monoxide ( DLCO) . The relationships between all factors and survival were examined with a univariate Cox proportional-hazard model. Kaplan-Meier method was used to assess the survival probabilities between groups with different baseline characteristics. Results Eighty-four patients were included in this study, with the median survival time of 34. 7 months. PaO2 /FiO2 , FVC% pred, VC% pred, TLC% pred, and DLCO% pred showed significant associations with the mortality of IPF ( hazard ratios 0. 940-0. 994, P lt; 0. 01) . The Kaplan-Meier analyses for above variables also showed significant differences ( P lt;0. 05) . Besides, the statistical difference of survival probability could be found between the patients with elevated serumLDH and those with normal LDH ( 27. 0 months vs. 43. 1 months, P =0. 014) . Conclusions Baseline oxygenation and pulmonary function parameters may indicate the prognosis of IPF patients. Serum LDH may provide clinicians with additional prognostic information.
目的 探讨骨髓增生异常综合征（MDS）患者的临床特点。 方法 选取我院2008年3月－2012年10月确诊为MDS的231例患者临床资料进行回顾性分析。患者年龄21～87岁，中位年龄59岁。 结果 231例患者中，难治性血细胞减少伴多系发育异常（RCMD）最多见，占45.0%（104/231）；以贫血乏力症状就诊多见占66.7%（154/231）；血常规中以全血细胞均减少多见占61%（141例/231例）；网织红细胞以正常或增高为主占61%（141/231）；低荧光值增高多见62%（144/231）。乳酸脱氢酶和铁蛋白在各诊断亚型及各国际预后积分系统（IPSS）评分间存在差异，其中乳酸脱氢酶在难治性贫血伴原始细胞增多2型（RAEB-2）中高于综合组：难治性贫血（RA）、 难治性贫血伴环状铁粒幼细胞（RAS）、5q?综合征及RCMD相比较差异有统计学意义（P＜0.05），高危组乳酸脱氢酶高于中危1组及中危2组，其差异有统计学意义（P＜0.05），高危组铁蛋白高于中危1组其差异有统计学意义（P＜0.05），其余差异无统计学意义（P＞0.05）。染色体异常率为39%，其中20例为复杂染色体核型，IPSS评分中危1最多见为52.4%（55/105）。 结论 MDS临床表现多样，缺乏特异性，需综合骨髓涂片、活检、细胞遗传学的结果提高诊断率。
Objective To detect the activity of lactate dehydrogenase (LDH) and LDH isoenzyme, and to explore the relation between biological behavior ofpancreatic cancer and glycolysis. MethodsConsecutive 12 cases of pancreatic ductal adenocarcinoma and 12 benign lesions such as insulinoma from October 2006 to July 2008 were collected, as well as normal pancreatic tissues. The total activity of the LDH was detected by the LDH testing kits, and the iosenzyme pattern of LDH was inspected by the France Sebia hydrasys. ResultsCompared to the normal tissue, LDH activity ofpancreatic cancer and adjacent non-cancerous tissue was significantly higher (P＜0.05). LDH iosenzyme pattern in cancer tissue was also significantly different, the percentage of LDH4 and LDH5 increased obviously, and were greater than that innormal tissue (P＜0.05). ConclusionThe alteration of LDH activity and its isoenzyme pattern are possibly related to the pathogenesis of pancreatic cancer. Inhibit the LDH activity may be a new therapeutic strategy.
ObjectiveTo investigated the levels of aldolase A (ALDOA) in pleural effusion in patients with different pathological types of lung cancer and patients with tuberculous pleurisy,and the correlation between ALDOA and carcinoembryonic antigen (CEA),lactate dehydrogenase(LDH). Methods80 cases of pleural effusion samples were collected,of which 65 cases of lung cancer (malignant group) and 15 cases of tuberculous pleurisy (TB group). All the patients were not treated with anti-inflammatory or steroid therapy. ALDOA concentrations in pleural effusion were detected by ELISA and the contents of CEA and LDH in pleural fluid were detected by chemiluminescence assay. ResultsThe levels of ALDOA,CEA and LDH in the malignant group were 46.75±21.39 ng/mL,82.24±56.63 ng/mL,755.76±382.54 U/L respectively,and were 23.92±17.21 ng/mL,2.55±1.67 ng/mL,and 388.37±163.87 U/L in the TB group respectively. The levels of ALDOA,CEA and LDH in the malignant group were significantly higher than those in the TB group (P<0.01). The concentrations of ALDOA in malignant pleural effusion from different pathological types of lung cancer were 71.65±32.09 ng/mL(adenocarcinoma),22.43±18.23 ng/mL(small cell lung cancer),and 19.16±13.85 ng/mL(squamous cell carcinoma),respectively. The concentration of ALDOA in malignant pleural effusion from the adenocarcinoma patients was significantly higher than that in the other two types (P<0.05). The concentration of CEA was 112.40±62.71 ng/mL(adenocarcinoma),62.45±54.78 ng/mL(small cell lung cancer),and 71.87±52.4 ng/mL(squamous cell carcinoma),respectively. It was significantly higher in adenocarcinoma than that in other two types (P<0.05). The levels of LDH were 661.81±328.93 U/L(adenocarcinoma),737.62±315.41 U/L(small cell lung cancer),767.85±503.28 U/L(squamous cell carcinoma),respectively. There was no significant difference in three types(P>0.05). The concentrations of ALDOA in pleural effusion from the patients with lung cancer or tuberculous pleurisy were positively correlated with the concentrations of CEA and LDH (P<0.01 or 0.05). ConclusionThe levels of ALDOA,CEA and LDH in malignant pleural effusion from lung cancer patients were significantly higher than those in pleural effusion from patients with tuberculous pleurisy. The ALDOA and CEA levels in malignant pleural effusion from lung adenocarcinoma patients were significantly higher than those in small cell lung cancer and squamous cell carcinoma patients. There were highly positive correlation between ALDOA,CEA and LDH levels.
ObjectiveTo summarize the clinical, radiological and pathological characteristics of acquired immune deficiency syndrome (AIDS) combined with Pneumocystis carinii pneumonia (PCP), so as to improve the clinicians' understanding of the disease. MethodsThe clinical data of 50 AIDS patients combined with PCP admitted between February 2006 and May 2015 were retrospectively analyzed, including medical history, physical signs, laboratory examination, chest high resolution CT (HRCT), pathological characteristics, treatment and prognosis, etc. ResultsThe clinical features of AIDS patients combined with PCP included cough, dyspnea and fever, without obvious positive signs in the lung.The patients were divided as a mild group, a moderate group and a severe group according to the levels of PaO2.There was significant difference among three groups in serum albumin level [(23±3) g/L vs. (30±5) g/L and (28±6) g/L, P < 0.01].There were no significant differences among three groups in CD4+ T lymphocyte and lactate dehydrogenase (LDH) (P > 0.05).The typical chest radiograph feature of HRCT was ground-glass shadows in both lungs, and may be associated with reticular shadows or "gravel sign" and cyst.Of 50 patients, 16 patients were diagnosed via pathology of transbronchial lung biopsy(TBLB) and only 5 patients were diagnosed via silver staining of the bronchoalveolar lavage fluid (BALF).The other patients were clinically diagnosed.100% of the patients were treated with sulfamethoxazole (SMZco), 64%with caspofungin, and 72% with glucocorticoid.All the patients relieved with no death in hospital. ConclusionWhen a patient got cough, dyspnea and fever, especially ground glass on HRCT in both lungs, AIDS combined with PCP should be highly considered, and diagnostic treatment with SMZco and CD4+ T lymphocyte measurement should be conducted as soon as possible, so as to reduce misdiagnosis and mortality.
Objective To explore the clinical characteristics of patients with lymphoma firstly manifested as symptoms in respiratory system. Methods The clinical data of 9 patients with lymphoma were analyzed retrospectively and discussed with literature review. Results There were 7 males and 2 females with an average age of 48.2 years and a median disease course of 20 days. All patients were diagnosed by pathology while specimens were obtained by cervical lymph node biopsies in 2 cases, by CT-guided percutaneous lung biopsies in 2 cases, by bronchoscope mucosal biopsies in 2 cases, by transbronchial needle aspiration biopsies in 1 case, by thoracoscope lung biopsies in 1 case, and by ascites cell block inspection in 1 case. The main symptoms were cough (7/9), expectoration (3/9), fever (3/9) and wheeze (2/9). Chest CT showed tumors (3/9, multiple in 1 case), enlarged mediastinal lymph nodes (6/9), enlarged hilar lymph nodes (3/9), pulmonary consolidation (3/9), pleural effusion (6/9, bilateral in 3 cases), pleural thickening (2/9), pulmonary atelectasis (2/9), patchy shadow (7/9), pericardial effusion (1/9). Laboratory examination demonstrated elevated cancer antigen 125 (CA125) in 7 cases while elevated lactic acid dehydrogenase (LDH) in 4 cases. One patient died during hospitalization in the respiratory department, 1 patient auto-discharged without further treatment, 1 patient died in follow-up period. Five patients remain alive up to now. Conclusions The symptoms of patients with lymphoma are atypical while the chest radiological findings are varied. CA125 and LDH play important role in evaluating disease and predicting prognosis in patients with lymphoma.
Objective To evaluate the significance of lactate dehydrogenase (LDH) as a predictor of in-hospital mortality in patients with acute aortic dissection(AAD). Methods We conducted a retrospective analysis of the clinical data of 445 AAD patients who were admitted to the Second Xiangya Hospital of Central South University and the Changsha Central Hospital from January 2014 to December 2017 within a time interval of ≤14 days from the onset of symptoms to hospital admission, including 353 males and 92 females with the age of 45-61 years. LDH levels were measured on admission and the endpoint was the all-cause mortality during hospitalization. Results During hospitalization, 86 patients died and 359 patients survived. Increased level of LDH was found in non-survivors compared with that in the survived [269.50 (220.57, 362.58) U/L vs. 238.00 (191.25, 289.15) U/L, P<0.001]. A nonlinear relationship between LDH levels and in-hospital mortality was observed. Using multivariable logistic analysis, we found that LDH was an independent predictor of in-hospital mortality in the patients with AAD [OR=1.002, 95% CI (1.001 to 1.014), P=0.006]. Furthermore, using receiver operating characteristic (ROC) analysis, we observed that the best threshold of LDH level was 280.70 U/L, and the area under the curve was 0.624 (95% CI 0.556 to 0.689). Conclusion LDH level on admission is an independent predictor of in-hospital mortality in patients with AAD.
ObjectiveTo explore the independent factors related to clinical severe events in community acquired pneumonia patients and to find out a simple, effective and more accurate prediction method.MethodsConsecutive patients admitted to our hospital from August 2018 to July 2019 were enrolled in this retrospective study. The endpoint was the occurrence of severe events defined as a condition as follows intensive care unit admission, the need for mechanical ventilation or vasoactive drugs, or 30-day mortality during hospitalization. The patients were divided into severe event group and non-severe event group, and general clinical data were compared between two groups. Multivariate logistic regression analysis was performed to identify the independent predictors of adverse outcomes. Receiver operating characteristic (ROC) curve was constructed to calculate and compare the area under curve (AUC) of different prediction methods.ResultsA total of 410 patients were enrolled, 96 (23.4%) of whom experienced clinical severe events. Age (OR: 1.035, 95%CI: 1.012 - 1.059, P=0.003), high-density lipoprotein (OR: 0.266, 95%CI: 0.088 - 0.802, P=0.019) and lactate dehydrogenase (OR: 1.006, 95%CI: 1.004 - 1.059, P<0.001) levels on admission were independent factors associated with clinical severe events in CAP patients. The AUCs in the prediction of clinical severe events were 0.744 (95%CI: 0.699 - 0.785, P=0.028) and 0.814 (95%CI: 0.772 - 0.850, P=0.025) for CURB65 and PSI respectively. CURB65-LH, combining CURB65, HDL and LDH simultaneously, had the largest AUC of 0.843 (95%CI: 0.804 - 0.876, P=0.022) among these prediction methods and its sensitivity (69.8%) and specificity (81.5%) were higher than that of CURB65 (61.5% and 76.1%) respectively.ConclusionCURB65-LH is a simple, effective and more accurate prediction method of clinical severe events in CAP patients, which not only has higher sensitivity and specificity, but also significantly improves the predictive value when compared with CURB65.
Objective To summarize the clinical characteristics of pneumocystis pneumonia (PCP) secondary to interstitial lung disease (ILD) to improve the prophylaxis and management level of clinicians. Methods The clinical data of 50 patients with PCP secondary to ILD in the Department of Respiratory and Critical Care Medicine of Nanjing Drum Tower Hospital from January 2015 to December 2022 were collected. SPSS 26.0 software was used for statistical analysis. Results A total of 50 patients with PCP secondary to ILD were screened. Among the 50 patients, there were 23 males and 27 females, with a median age of 64 years old. Forty-eight cases (96%) had a history of glucocorticoid therapy with the median duration of 3 months; 31 (77.5%, 31/40) cases developed PCP in the first 6 months after glucocorticoid therapy; 34 cases had a history of glucocorticoid and immunosuppressants at the same time. None of the 50 ILD patients used drugs for PCP prophylaxis before developing PCP. The major clinical manifestations of PCP secondary to ILD were worse cough and shortness of breath or fever. Laboratory results showed 38 cases (76.0%) had peripheral blood total lymphocyte count <200/µL, 27 cases (54.0%) had CD4+ T cell count <200/µL, 34 cases (68.0%) had CD4+ T cell count <300/µL, 37 cases (74.0%) had CD3+ T cell count <750/µL, 34 cases (68.0%) had β-D-glucan test >200 pg/mL, 35 cases (70.0%) had lactic dehydrogenase > 350 U/L and 41 cases (82.0%) had type Ⅰ respiratory failure. High resolution computed tomography showed added ground-glass opacity and consolidation on the basis of the original ILD. Thirty-six cases were detected the Pneumocystis jirovecii by metagenomic next-generation sequencing with broncho-alveolar lavage fluid as the main source, and 2 cases by smear microscopy. All patients were treated with trimethoprim-sulfamethoxazole. After treatment, 29 cases were discharged with a better health condition, 10 cased died, and 11 cases left hospital voluntarily because of treatment failure or disease deterioration. Conclusions After the use of glucocorticoid and immunosuppressants, ILD patients are susceptible to life-threatening PCP. It is particularly important to make an early diagnosis. Attention should be paid to integrate the symptoms, levels of peripheral blood lymphocyte count, β-D-glucan test, lactic dehydrogenase and imaging findings to make an overall consideration. It is suggested to perform next-generation sequencing with broncho-alveolar lavage fluid at an early stage when patients can tolerate fiberoptic bronchoscopy to avoid misdiagnosis and missed diagnosis. ILD patients often develop PCP in the first 6 months after using glucocorticoid and immunosuppressants. During follow-up, peripheral blood CD4+ and CD3+ T cell count should regularly be monitored so as to timely prevent PCP.