慢性阻塞性肺疾病(COPD)是一种具有气流受限特征的疾病，气流受限不完全可逆，呈进行性发展，其发病与肺部对有害气体或有害颗粒尤其是吸炯引起的异常炎症反应有关。一般来说，40岁以上的患者，如果过去或现在还在吸炯 有咳嗽、咳痰或气紧，就应考虑COPD可能。COPD的诊断与病情程度分级一般取决于肺功能检测所反映的气流受限程度，但是有越来越多的证据显示COPD的临床表现与气流受限程度不完全相关[1] 。因此，为了对COPD有一个全面系统的认识，还需要同时评估影像学表现、运动耐力和体重指数(BMI)。正是基于此项认识，有作者[2]认为COPD不能仅仅理解为一种肺部的慢性疾病，COPD患者常伴有全身多个系统的慢性病变，它可能是一种慢性全身性炎症综合征(chronic systemic inflammatory syndrome)o如有多个研究发现COPD可能伴有某种程度的全身炎症反应[3,4]，Gan等[5]通过荟萃分析认为，即使在稳定期COPD也有外周血中性粒细胞(尤其是活化的表型)增多、急性相反应蛋白(C反应蛋白和纤维蛋白原)、白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)水平增加。有趣的是，其他慢性疾病如慢性心力衰竭、肥胖、糖尿病甚至正常的老龄化也有同样程度的全身炎症反应 。
Objective To investigate the effects of extracellular signal regulated kinase ( ERK)signaling pathway on cell cycle of airway smooth muscle cells( ASMCs) in asthmatic rats. Methods Thirty Wistar rats were randomly assigned to a control group and an asthma group( 15 rats in each group) . Asthma model was established by ovalbumim sensitization and challenge. ASMC were isolated and cultured in vitro. The ASMCs from the asthmatic rats were treated with ERK activator epidermal growth factor ( EGF)and inhibitor PD98059, respectively. The expressions of cyclin D1 and CDK2 in ASMCs were detected by immunocytochemical staining. The expressions of ERK1 /2 and p-ERK1 /2 protein were observed by western blotting for measurement of ERK activation rate. Results Compared with the control group[ 54. 17 ±6. 11,61. 04 ±4. 09, ( 49. 91 ±3. 26) % , respectively] , the expressions of cyclin D1 protein and CDK2 protein,and the rate of ERK activation of ASMCs from the asthmatic rats significantly increased[ 76. 15 ±4. 88,92. 30 ±7. 95, ( 82. 37 ±5. 78) % , respectively] ( P lt; 0. 05) . Furthermore, compared with those before treatment, the expression of cyclin D1 and CDK2, and the rate of ERK activation of ASMCs significantly decreased after treatment with PD98059 [ 58. 78 ±4. 60, 69. 15 ±5. 83, ( 54. 01 ±4. 12) % , respectively]( P lt; 0. 05) , and significantly increased after treatment with EGF[ 119. 28 ±8. 14, 134. 77 ±9. 26, ( 91. 57 ±5. 32) %, respectively] ( P lt;0. 05) . Conclusion ERK1/ 2 participates in proliferation regulation of ASMCs in asthma by enhancing the expressions of cyclin D1 and CDK2, which promotes quiescent cells into S phase.
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.