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大环内酯类药物在慢性气道炎症性疾病中的作用与争议

慢性阻塞性肺疾病合并支气管扩张的相关临床研究

目的探讨慢性阻塞性肺疾病（简称慢阻肺）合并支气管扩张患者的临床特点及痰和血清中中性粒细胞弹性蛋白酶（NE）、基质金属蛋白酶-9（MMP-9）的表达情况。方法收集呼吸科门诊定期检查的中重度稳定期慢阻肺患者 25 例，行胸部高分辨 CT 检查，按照支气管扩张评分将患者分为单纯慢阻肺组 14 例及慢阻肺合并支气管扩张组 11 例。患者给予体重指数（BMI）、肺功能、改良英国医学研究委员会问卷（mMRC）、6 分钟步行距离（6MWD）评分，通过 BMI、气流受限程度、呼吸困难、运动耐量评定 BODE 指数。留取患者外周静脉血和诱导痰，采用酶联免疫吸附试验分别测定血清和痰的 NE 和 MMP-9 水平；根据痰涂片计数白细胞总数和分类。结果与单纯慢阻肺组相比，慢阻肺合并支气管扩张组 BODE 指数显著增高（5.2±1.2 比 3.6±1.3，P<0.01）；mMRC 评分显著升高［（1.5±0.5）分 比（0.8±0.6）分，P<0.01］。FEV1%pred、BMI、6MWD 无明显差异。慢阻肺合并支气管扩张组痰中巨噬细胞显著增多［（0.62±0.07）×106/ml 比（0.50±0.07）×106/ml，P<0.05］，MMP-9 表达增高［（32.6±5.08）ng/ml 比（28.1±5.14）ng/ml，P<0.05］。慢阻肺合并支气管扩张组支气管扩张评分与 BODE 指数呈显著正相关（r=0.869，P<0.01），与痰 MMP-9 也呈显著正相关（r=0.625，P<0.05）。结论慢阻肺合并支气管扩张的患者较单纯慢阻肺对比其 MMP-9 在痰上清水平增高，mMRC 评分及 BODE 指数更高，生活质量更差。

16S rRNA-base analysis of bacterial diversity in the induced sputum of patients with acute exacerbation of chronic obstructive pulmonary disease

ObjectiveTo explore the characteristics of induced sputum microbiome in the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).MethodsInduced sputum samples from 55 patients with AECOPD and 45 patients with stable COPD were analyzed by sequencing of 16S rRNA gene. Microbiota was measured by alpha diversity, beta diversity and LDA effect size analysis (LefSe).ResultsThe microbiome diversity of induced sputum in the AECOPD group was lower than that in the stable COPD group. The microbiome richness in the AECOPD group was higher than that in the stable COPD group. The microbiome structure changed in the AECOPD group compared with the stable COPD group. The proportion of some common pathogens got enriched. The levels of hypersensitive C reactive protein (hs-CRP), interleukin-8 (IL-8), tumor necrosis factor alpha (TNF-α) and Global Initative for Chronic Obstructive Lung Disease (GOLD) grade were negatively related to the diversity of microbiome in the AECOPD group.ConclusionsThe microbiome diversity of induced sputum in AECOPD patients is decreased, and is negatively correlated with the levels of hs-CRP, IL-8, TNF-α and GOLD grade. There are differences in the microbiome structure between AECOPD and stable COPD patients. Some enrichment of common pathogens are found in the induced sputum of patients with AECOPD. These results suggest that there is a significant bacterial dysbiosis in patients with AECOPD.

Penicilliosis marneffei Involving the Lung in Healthy Hosts: Three Cases Report and Literature Review

ObjectiveTo explore the clinical characters, diagnosis and treatment of Penicilliosis marneffei (PSM) in healthy hosts. MethodsThe clinical data of three cases of PSM involving the lung, bronchus and pleura in healthy hosts were retrospectively analyzed, and the case reports of Penicillium marneffei (PM) infection in healthy hosts were summarized by searching database for related articles, with "Penicilliosis marneffei" as key word both in English and Chinese literatures. ResultsThe main clinical manifestations of three PSM patients included fever, cough, lymphadenopathy, and elevated white blood cell counts.Series of chest computed tomography of three cases demonstrated atypical and extensive lung lesions.The fiberoptic bronchoscopy of the 2nd case showed several irregular nodules on the bronchial wall.The thoracoscopy of the 3rd case showed much pleural adhesions and small nodules on visceral and parietal pleura.Final diagnosis of PSM was confirmed by the fungal culture, and all patients received antifungal treatment.The symptoms relieved on medication but reoccurred on discontinuation.Literature review identified 36 cases of PSM in healthy hosts.The main clinical features were fever, cough/expectoration, skin rash/skin abscess and elevated white blood cell counts.The most common used antifungal drug was amphotericin B alone or combined with traconazole.The thoracic radiological imaging showed that roughly half of them had clearly thoracic lesions (20/36, 55.65%), and the pulmonary inflammatory infiltrate shadow was most common.Seventeen cases (47.22%) were misdiagnosed as tuberculosis. ConclusionsPulmonary involvement is common in healthy hosts with PSM and the thoracic radiological features are variable and unspecific, so PSM is easy to be misdiagnosed as tuberculosis.The PSM patients need a longer treatment than other fungal infections.