Objective To explore the treatment effects of one-way valve lung volume reduction surgery for heterogeneous emphysema.Methods Seven heterogeneous emphysema Beagle dogs were each implanted in right lung2-4 pieces ofbronchial one-way valve.The animals were sacrificed two months later.Macro- and microscopic pathology changes of the lungs were observed.Results Of 21 valves implanted，2 were expectorated，and 19 were in normal position.The dogs did not have obvious adverse reactions.Generally specimens of the occluded lobes had different levels of lung volume decrease，such as texture stiffened，focal scar formation，atelectasis，pulmonary fibrosis.Pathological biopsy showed moderate alveolitis and pulmonary interstitial fibrosis.Conclusion One-way valve lung volume reduction is effective for heterogeneous emphysema
Objective To investigate whether the sleep-induced hypoxemia ( SIH) at different time and different level have different effects on pulmonary emphysema and coagulation systemfunction in the rats with pulmonary emphysema. Methods Thirty Wistar rats were randomly divided into three groups( n = 10 in each group) . All rats were exposed to cigarette smoke twice a day ( 30 min each time) . From29th day on, the rats in Group A ( pulmonary emphysema with short SIH) were also exposed to mixed gas of 12. 5% oxygen for 1. 5 hours during sleeping time every day ( the expose time was divided into 4 periods, 22. 5 min each) . The rats in Group B ( pulmonary emphysema with mild SIH) were also exposed to mixed gas of 15% oxygen for three hours during sleeping time every day( the expose time was divided into 4 periods, 45 min each) . The rats in Group C( pulmonary emphysema with standard SIH) were also exposed to mixed gas of 12. 5% oxygen for three hours during sleeping time every day( the expose time was divided into 4 periods,45 min each) . After continuous exposure for 56 days, the rats were sacrificed. Semi-quantitative image analytic method was employed for histopathological analysis including pathological score of lungs, mean linear intercept ( MLI) and mean alveolus number( MAN) . ATⅢ, FIB, vWF, FⅧ were measured. Results All animals in three groups manifested the histopathological features of emphysema. Pathological scores of lungs and MLI of every group were significantly different from each other( F = 21. 907, F = 18. 415, all P lt; 0. 05) , Group A [ ( 61. 90 ±4. 25) % , ( 92. 45 ±1. 78) μm] and Group B[ ( 64. 60 ±3. 95) % , ( 92. 80 ±3. 65) μm] were significantly lower than Group C[ ( 73. 30 ±3. 86) % , ( 99. 32 ±2. 81) μm, q= 8. 96, q =6. 84, q = 12. 64, q =9. 65, all P lt; 0. 05] . Levels of FIB were significantly different among three groups ( F = 20. 592, P lt; 0. 05) while FIB in Group A[ ( 189. 98 ±5. 29) mg/ dL] and Group B[ ( 182. 70 ±2. 78) mg /dL] were significantly lower than that in Group C[ ( 198. 40 ±7. 37) mg/ dL, q = 4. 86, q= 9. 07, all P lt; 0. 05] , and FIB in Group A was significantly higher than that in Group B( q = 4. 20, P lt; 0. 05) . Levels of FⅧ were significantly different from each other( F = 33. 652, P lt;0. 05) while FⅧ in Group A[ ( 232. 26 ±4. 17) % ]and Group B[ ( 242. 53 ±14. 50) % ] were significantly lower than that in Group C[ ( 303. 25 ±32. 93) % ,q= 10. 73, q = 9. 18, all P lt; 0. 05] . Conclusions Pulmonary emphysema and hypercoagulable states increases with time and severity of SIH in rats with pulmonary emphysema. The elevated activity of blood coagulation factor may be a critical role in the hypercoagulable states.
Objective To investigate the role of vascular endothelial growth factor ( VEGF) in the pathogenesis of emphysema and its relationship with tumor necrosis factor alpha ( TNF-α) . Methods 48 rats were randomly divided into four groups, ie. a normal control group, an emphysema group, a rhTNFR∶Fc intervention group, and a sham intervention group. The rats in the emphysema group, the rhTNFR: Fc intervention group, and the shamintervention group were exposed to cigarette smoking for 80 days. After 30 days of exposure, rhTNFR: Fc hypodermic injection was administered in the rhTNFR: Fc intervention group while placebo was injected in the sham intervention group as control. Lung tissue sections were stained by hematoxylin and eosin. Mean linear intercept ( MLI) and mean alveolar numbers ( MAN) were measured to estimate the extent of emphysema. The level of TNF-αin serumand BALF, and the level of VEGF in BALF were measured with ELISA. Results In the emphysema group, MLI was higher and MAN was lower than those in the normal control group. Moreover, the levels of TNF-αin serum and BALF were higher, and thelevel of VEGF in BALF was lower significantly ( P lt;0. 05) . After the intervention with rhTNFR∶Fc, MAN increased and the serum TNF-αdecreased significantly compared with the emphysema group ( P lt; 0. 05) .However there were no significant differences in MLI, VEGF, and TNF-α in BALF ( P gt; 0. 05 ) . No correlation was found between the level of TNF-αand VEGF in BALF in the emphysema group. Conclusion VEGF and TNF-αare related to the pathogenesis of emphysema of smoking rats, and may contribute to the development of emphysema in different pathways.
背景: 吸烟与肺气肿及放射学所见肺间质性异常有关。肺间质性异常与肺总量减少、肺气肿严重程度之间相关的程度尚不了解。方法: 我们从一个吸烟者队列获得了2508 张肺部高分辨率计算机体层摄影( HRCT) 扫描影像, 并在其中的2416 张( 96% ) 中研究了肺间质性异常。我们用线性和逻辑回归( 分析) 评价了肺间质性异常与HRCT 测量的肺总量、肺气肿之间的相关性。结果: 在被评价的2416 张HRCT扫描影像中, 194 张( 8% ) 有肺间质性改变。在校正了相关协变量的统计学模型中, 肺间质性改变与肺总量减少[ - 0. 444 L, 95% 可信区间( CI) - 0. 596 ～- 0. 292, P lt;0. 001] 以及肺气肿相关。此肺气肿发生率相对较低, 标准为肺衰减阈值为- 950 个亨斯菲尔德单位( - 3% , 95% CI - 4 ～- 2, P lt;0. 001) 和- 910 个亨斯菲尔德单位( - 10% , 95% CI - 12 ～ - 8, P lt;0. 001) 定义。与无肺间质性异常者相比, 有异常者更多表现为限制性肺功能损害( 肺总量lt; 预测值的80% , 比值比为2. 3, 95% CI 1. 4 ～3. 7,P lt;0. 001) , 而较少符合慢性阻塞性肺疾病( COPD) 的诊断标准( 比值比为0. 53,95% CI 0. 37 ～0. 76, P lt;0. 001) 。肺间质性异常对肺总量和肺气肿的影响取决于COPD 的状态( 相互作用P lt;0. 02) 。肺间质性改变与较多暴露于烟草烟雾以及当前的吸烟状况呈正相关。结论: 在吸烟者中, 肺间质性异常———大约每12 张HRCT扫描影像就有1 例———主要与肺总量以相关, 并也与肺气肿相关。【述评】间质性肺病肺功能改变以限制性通气功能障碍和弥散功能降低为主要特征, COPD 以阻塞性通气功能障碍为主要表现, 常伴有肺总量和残气容积增加。COPD 合并间质性肺病患者的肺功能改变情况缺乏研究。本研究采用HRCT 扫描评价了吸烟患者合并肺间质性异常时肺气肿和肺容积的改变, 结果发现有肺间质性改变吸烟患者常表现为限制性通气功能障碍。研究者主要通过HRCT 测量研究肺气肿和肺容积改变, 并未通过肺功能仪测定患者的通气功能和弥散功能改变, 如能将影像学改变与肺功能测定结合则更准确反映吸烟合并肺间质性异常者肺通气功能及肺容积改变。
Objective Chronic obstructive pulmonary disease( COPD) is highly heterogeneous. In theory, the patients with same clinical manifestations, treatment response and prognosis can be classified into one phenotype, which may have same biological or physiological mechanisms. In this study the profiles of patients with COPD including body mass index( BMI) , Goddard score, fractional exhaled nitric oxide( FeNO) were analyzed in order to find some special phenotypes.Methods Patients with COPD at stable stage in Ruijin Hospital from May 2011 to February 2012 were evaluated with COPD assessment test ( CAT) in Chinese version, St. George’s Respiratory Questionnaire( SGRQ) , hospital anxiety and depression( HAD) rating scale, pulmonary function test, and 6-minute walking test ( 6MWT) . Baseline data was collected including height, weight, drug use, times of exacerbation, etc. Results A total of 126 patients were recruited. The patients with low BMI had poorer quality of life, lower FEV1 , poorer diffusion function, and higher Goddard score, and was easier to develop anxiety and depression. The patients with high BMI had lower oxygen saturation at rest. We failed to define a certain kind of phenotype according to FeNO. The patients of emphysema phenotype( assessed by Goddard score) had lower BMI, decreased lung diffusion capacity, and poorer quality of life. Conclusion The study can define COPD patients into some special phenotypes( low BMI and emphysema phenotype) , but failed to define a certain kind of phenotype according to FeNO.
Abstract: Objective To evaluate the clinical effects and health economics of lung volume reduction surgery（LVRS）, single lung transplantation（SLTx） and bilateral lung transplantation（BLTx） for patients with end-stage emphysema. Methods A total of 61 patients with end-stage emphysema, including 39 patients who underwent LVRS（LVRS group）, 14 patients who underwent SLTx（SLTx group）, and 8 patients who underwent BLTx（BLTx group） from September 2002 to August 2008 in Wuxi People’s Hospital, were analyzed retrospectively. Lung function, arterial blood gas analysis and 6-minute walk distance（6-MWD）were assessed before their surgery and 6 months, 1-year and 3-year after their surgery respectively. Their 1-year and 3-year survival rates were observed. Cost-effectiveness analyses were made from a health economics perspective. Results Compared with their preoperative results, their mean forced expiratory volume in 1 second（FEV1.0）in LVRS group increased by 75%, 83% and 49% at 6 months, 1-year and 3-year postoperatively, by 176%, 162% and 100% in SLTx group, and by 260%, 280% and 198% in BLTx group respectively. Their mean forced vital capacity（FVC）in LVRS group increased by 21%, 41% and 40% at 6 months, 1-year and 3-year postoperatively, by 68% , 73% and 55% in SLTx group, and by 82%, 79% and 89% in BLTx group respectively. Their exercise endurance as measured by 6-MWD increased by 75%, 136% and 111% in LVRS group at 6 months, 1-year and 3-year postoperatively, by 513%, 677% and 608% in SLTx group, and by 762%, 880% and 741% in BLTx group respectively. The 1-year and 3-year survival rates after operation were 74.40% and 58.90% in LVRS group, 85.80% and 64.30% in SLTxgroup, and 62.50% and 50.00% in BLTx group respectively. The three years’ cost utility of SLTx group was significantly higher than that of BLTx group（1 668.00 vs.1 168.55, P＜ 0.05）and LVRS group （1 668.00 vs. 549.46, P＜ 0.05）. Conclusion SLTx and BLTx are better than LVRS in improving patients’ lung function and exercise endurance for end-stage emphysema patients. LVRS is more cost-effective than SLTx and BLTx in the early postoperative period. With the development of medical technology and decreased expenses of lung transplantation and immunosuppressive agents, lung transplantation will become the first surgical choice for end-stage emphysema patients.
Objective To investigate the effect of lung volume reduction surgery （LVRS） on messenger RNA expression levels of cytoskeletal proteins in diaphragmatic muscle tissues of emphysematous rabbits. Methods A total of 40 rabbits were randomly divided into 4 groups （10 rabbits in each group） ：normal control group, emphysema group, sham operation group and LVRS group. Rabbits in control group were intratracheally administered with 0.9% normal sodium, but those in other groups were intratracheally administered with 0.4% papain at the dose of 0.5 ml/kg and inhaled cigarette smoke to induce emphysema model. Then, rabbits in emphysema group were fed routinely, however, after median sternotomy , bilateral LVRS was performed in LVRS group but not in sham operation group. The mRNA expression levels of titin and nebulin in the diaphragmatic muscles of rabbits in each group were detected by reverse transcription-polymerase chain reaction（RT-PCR）. Results Compared with control group, the mRNA expression levels of titin and nebulin in the rabbit diaphragm of emphysema groups and sham operation group decreased significantly （P〈0.01 ）, so did those in LVRS group （P〈0.05）. But it increased significantly in LVRS group compared with emphysema group and sham operation group （P〈0.05）. Conclusion LVRS can increase the mRNA expression levels of titin and nebulin in diaphragmatic muscle tissues of emphysematous rabbits, which may be the associated mechanisms at the molecular level in restoring the functions of the emphysematous diaphragm by LVRS.
Lung volume reduction surgery （LVRS） has been applied generally since it was redeveloped and lucubrated. A recent large, multicenter trial showed LVRS can improve lung function, exercise capacity, quality of life, and even survival in certain highly selected patients. LVRS has been developed as an effective therapy for severe emphysema, which offers a new approach for the victims of emphysema. The development of operative technique and clinical effect about LVRS are reviewed in this article.