曲霉在自然界中广泛分布，约20种曲霉能感染人类和动物，其中最常见的有烟曲霉、黄曲霉、土曲霉和黑曲霉等。曲霉孢子在空气中传播，人吸入后曲霉可以在气道内定植、致敏、感染，当人体免疫功能低下时可产生危及生命的侵袭性肺曲霉病（IPA）。近年来IPA发病率呈上升趋势，已成为仅次于念珠菌病的主要肺部真菌感染性疾病[1]。虽然IPA已成为器官移植受者、恶性血液病和恶性肿瘤患者等高危人群的重要死因，但对其发病机制了解甚少。本文着重论述近年来IPA发病机制的研究进展。
现已认识到免疫反应、转录因子核因子κB( NF-κB) 的激活、细胞因子、中性粒细胞的激活和肺泡渗入、凝血级联反应、肾素-血管紧张素系统等多种因素构成的复杂网络参与急性肺损伤/急性呼吸窘迫综合征( ALI/ARDS) 的发病过程[ 1-5] 。虽然脓毒症、创伤、肺炎等ALI/ARDS诱发因素很常见, 但仅有部分病人发生ALI/ARDS, 并且具有相似临床特征的ALI/ARDS病人可有截然不同的结果, 这种异质性引起研究者对影响ALI/ARDS 易感性和预后的遗传因子进行鉴别的浓厚兴趣[ 6] 。由于数量庞大的表现型变异, 不完全的基因外显率、复杂的基因-环境相互作用及高度可能的基因座不均一性而使ALI 遗传学的研究受到挑战[ 7] 。近年来基因组学技术被应用于ALI/ARDS 发病机制的研究, 加深了人们对ALI/ARDS的认识并有可能发展出新的治疗策略以降低其发病率和病死率。
Cough variant asthma is a special type of asthma, of which the only or main symptom is cough, and it is the main cause of chronic cough. Early diagnosis and treatment can prevent cough variant asthma developing into typical asthma. This article summarizes the progress in pathogenesis, diagnosis and assessment, treatment, and prognosis of cough variant asthma, aiming to improve the prevention and treatment of this disease, and increase the patients’ quality of life.
Objective To analyze the data from patients with pathologically proved granulomatous lung disease, including etiology, clinical, radiological features and laboratory results. Methods 36 patients with granulomatous lung disease confirmed by lung biopsy in Shanghai First People’s Hospital of Shanghai Jiao Tong University from January 2008 to June 2012 were retrospectively reviewed. The clinical presentation, radiological features and laboratory results were collected and statistically analyzed.Results After haematoxylin and eosin stain combined with special stain, the diagnoses were comfirmed, ie.13 cases of mycobacterial infection, 5 cases of aspergillar infection, 4 cases of cryptococcal infection, 6 cases of sarcoidosis, 4 cases of Wegener’s granulomatosis, 4 cases of unknown causes. Cough was the most common clinical symptom, followed by expectoration. Some patients also developed fever, chest tightness and weight loss. The lesions were widely distributed, of which the right upper lung was the common lesion of mycobacterial infection, inferior lobe of right lung was the common lesion of aspergillar infection. The common lesion of cryptococcal infection was uncertain. The common lesions of sarcoidosis and Wegener ’s granulomatosis were in left upper lung. Small nodule was the most common shapes of lesion, while mass and consolidation were present sometimes. Cavity, air bronchogram, pleural effusion, hilar and mediastinal lymph node enlargement could be found in the chest CT. Interferon gamma release assay, galactomannan antigen assay and latex agglutination test were helpful in the diagnosis of mycobacterial infection, aspergillar infection and cryptococcal infection induced granuloma. Conclusions The clinical presentations and radiological features of granulomatous lung disease are nonspecific. Histopathology obtained through biopsy is the key for the diagnosis. Immunological examination, test of new antigens to microorganism and clinical microorganism detection are valuble in the diagnosis and differential diagnosis of granulomatous lung disease.
Objective To investigate the effects of TiotropiumBromide on airway inflammation in a rat model of chronic obstructive pulmonary disease( COPD) . Methods Thirty Wistar rats were randomly divided into three groups. Group A received normal breeding as normal control. Group B and group C received LPS( 200 μg, intratracheally injected at the 1st and the 14th day) and tobacco exposure( from the 2nd day to the 30th day except the 14th day) to establish COPD model. And group C received a nebulized dose of Tiotropium Bromide( 0. 12 mmol / L, 10 minutes) 30 minutes before the tobacco exposure each time. Airway resistance and compliance were measured before sacrificed. Histological examination was performed with Hematoxylin-Eosin staining. The concentrations of IL-8 and LTB4 , total and differential cells counts in bronchoalveolar lavage fluid( BALF) were examined, and the concentrations of IL-8 and LTB4 in blood serum were also examined by ELISA. Results Severe lung inflammation and decreased lung function were demonstrated in the rats in the group B compared with those in the group A. The inflammatory cell counts in BALF, and the levels of IL-8 and LTB4 in BALF and serum were significantly increased in the group B compared with those in the group A. Tiotropium Bromide administration improved the parameters above. Conclusions The results suggest that Tiotropium Bromide can alleviate the lung inflammation and improve the lung function in a rat COPD model. These effects may be exerted through reducing the mediators of inflammation.