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Analysis of Bronchial Hyper-Reactivity in Patients with Lung Cancer

【摘要】　目的　研究肺癌患者的气道高反应性和肺通气功能情况，并探讨其易感因素，为肺癌患者肺通气功能的临床评估提供依据。　方法　对2010年4月-2011年4月收治的40例肺癌患者（A组）进行术前肺功能检测及气管激发试验，选取同期的健康体检者40例做对照组（B组），并采用logistic逐步回归分析肺癌患者的气道高反应性的易感因素。　结果　①A组患者的用力肺活量、第1秒用力呼气容积（forced expiratory volume in one second，FEV1）、最高呼气流量（peak expiratory flow，PEF）以及最大呼气中期流量均小于B组，且差异有统计学意义（P=0.000）；②A组的FEV1估计异常人数和PEF估计异常人数均多于B组（Plt;0.05）；③A组组胺气道激发试验阳性者多于B组（χ2=5.000，P=0.025），且A组PD20FEV1低于对照组[分别为（4.69±0.82）、（8.32±1.43）μmol/L；t=13.930，P=0.000]；④logistic逐步回归分析表明影响A组患者的气道高反应性的因素为年龄、分型、TNM分期、病史、吸烟。　结论　肺癌气道反应性增高，且肺功能下降，由于肺癌气道高反应性的易感因素较多，因此需对合并因素较多者进行及时的预防，防止由于气道阻力增加和气道狭窄引起的胸闷、咳嗽、喘息和呼吸困难等症状。【Abstract】　Objective　To learn the condition of bronchial hyper-reactivity and pulmonary function in patients with lung cancer, and explore the risk factors for bronchial hyper-reactivity in order to provide clinical reference for pulmonary function evaluation in patients with lung cancer.　Methods　Forty patients with lung cancer treated in our hospital from April 2010 to April 2011 (research group) took pulmonary function and tracheal stimulation tests before operation, and in the meanwhile, 40 healthy people were chosen as controls. The logistic regression analysis was employed to analyze the risk factors for bronchial hyper-reactivity.　Results　The forced vital capacity, forced expiratory volume in one second (FEVl), peak expiratory flow (PEF) and maximal mid expiratory flow in the research group patients were all significantly lower than those in the control group patients (P=0.000). The number of patients with estimated FEVl and PEF abnormality in the research group was more than that in the control group (P=0.05). The number of patients positive in histamine bronchial provocation test in the research group was more than that in the control group (χ2=5.000, P=0.025), and the PD20FEV1 level of the research group was lower than that of the control group [(4.69±0.82) and (8.32±1.43) μmol/L; t=13.930, P=0.000]. Logistic regression analysis showed that the risk factors for bronchial hyper-reactivity in patients with lung cancer were age, type, TNM stage, history of lung cancer, and smoking.　Conclusions　The airway reactivity elevates and the lung cancer pulmonary function decreases in lung cancer patients. Because there are many risk factors, prevention should be taken for patients with combined risk factors to avoid the occurrence of chest distress, cough, gasp and dyspnea caused by increased airway resistance and stricture.

他汀类药物和血管紧张素Ⅱ受体拮抗剂治疗慢性阻塞性肺疾病的研究

慢性阻塞性肺疾病（COPD）以气道、肺实质和肺血管的慢性炎症为特征，近年来发现他汀类药物除降脂作用外，还可改善COPD患者的症状及预后。血管紧张素Ⅱ受体拮抗剂，能抑制肺血管缺氧性收缩以及慢性缺氧时血管的重建。能防止COPD患者肺动脉高压的病程进展及肺功能的下降。两者合用有协调作用，不仅能缓解COPD患者的症状，还能延缓COPD的进程，降低死亡率。

表皮生长因子受体突变合并程序性细胞死亡蛋白1配体高表达的晚期肺腺癌病例报告

成人非结核分枝杆菌肺病治疗研究进展

噻托溴铵在慢性阻塞性肺疾病急性加重期治疗的临床观察

目的　观察噻托溴铵治疗慢性阻塞性肺疾病急性加重期（AECOPD）的疗效。 方法　将2010年5月－2012年4月住院的100 例年龄50～80岁的中重度AECOPD患者随机分为治疗组（50例）和对照组（50例）。对照组给予吸氧、止咳、祛痰、雾化吸入布地奈德4 mL+硫酸特布他林4 mL（2次/d）抗炎，氨茶碱扩张气道，以及静脉使用抗生素抗感染、支持等常规治疗，治疗组在常规治疗基础上给予噻托溴铵干粉剂（18 μg，1次/d）吸入，疗程14 d。观察两组用药前后肺功能指标，呼吸困难评分以及血气分析指标的变化。 结果　两组患者用药后肺功能、呼吸困难评分及血气分析均较治疗前有明显改善，用药后与用药前比较差异有统计学意义（P＜0.05）；治疗组改善更明显，与对照组比较差异有统计学意义（P＜0.05）。 结论　噻托溴铵能明显改善中重度AECOPD患者的呼吸困难，肺功能及血气分析指标。