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原发性纤毛不动综合征一例

慢性阻塞性肺疾病急性加重期生物标志物的研究进展

以胸腔积液为首要表现的多发性骨髓瘤一例

目的 分析多发性骨髓瘤合并胸膜转移患者的临床特征。方法 回顾性分析1例多发性骨髓瘤合并胸腔积液患者的临床资料、实验室检查、影像学检查、病理学结果及预后，并复习相关文献。结果 患者为52岁女性，经血常规、生化常规、血清肿瘤标志物及胸腔穿刺行积液常规、生化、肿瘤标志物及细胞学等检查，发现患者中度贫血、肿瘤标志物神经元特异性烯醇化酶显著升高，胸腔积液沉渣见大量浆细胞。经局部麻醉内科胸腔镜胸膜活检，镜下见胸膜肥厚，血管扩张、紊乱，部分结节样增生。后组织病理诊断为浆细胞瘤，结合后续尿蛋白电泳等检查，确诊为多发性骨髓瘤。经化疗及自体干细胞移植术等治疗，患者于13个月后因疾病复发死亡。多发性骨髓瘤出现胸膜浸润的患者较为罕见，多为预后不良的标志，神经元特异性烯醇化酶升高也可作为其预后相关指标。对于疑难胸膜疾病，创伤性相对较小的内科胸腔镜手术可作为诊断的重要手段。 结论 合并胸腔积液的多发性骨髓瘤患者临床特征不典型，需重视胸腔积液细胞学检查并及时获取组织病理。

The clinical phenotype of acute exacerbation of chronic obstructive pulmonary disease by cluster analysis

ObjectiveTo explore the clinical phenotype of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) by cluster analysis and provide a basis for individualized treatment.MethodsA total of 515 patients with acute exacerbation of COPD admitted to this department from January 2014 to December 2016 were enrolled. The age, duration, smoking index, number of hospitalizations in the past 1 year, hospitalization days, treatment costs and other information were collected for cluster analysis.ResultsThe patients were divided into three categories of phenotype: " mild-glucocorticoid resistance-antibiotic dependent”," mild-glucocorticoid sensitive”, and " serious complication”. The patients with the first two phenotypes had a milder condition and lower hospitalization costs. There were differences in the time and cumulative dose of glucocorticoids in different pathways, antibiotic use time and usage rate. The third phenotype was the most serious, with the highest cost of hospitalization, and may merge or co-exist with other diseases such as cardiovascular disease and digestive tract disease.ConclusionCluster analysis may identify different phenotypes of acute exacerbation of COPD to provide a reference for clinical individualized treatment.

Clinical significance of blood eosinophils in patients with acute exacerbation of chronic obstructive pulmonary disease

ObjectiveTo analyze the features and clinical significance of blood eosinophils (EOS) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).MethodsThe general data, laboratory examination and treatment of patients with AECOPD admitted to this department from January 2014 to December 2016 were analyzed retrospectively. Based on the inclusion of treatment targets for blood EOS according to 2018GOLD, patients were divided into group A (EOS<100 cells/μL), group B (100 cells/μL≤EOS≤300 cells/μL), and group C (EOS>300 cells/μL) with two cut-off levels. The differences in general data, severity, and glucocorticoid use between group A, group B and group C were compared.ResultsA total of 515 patients with AECOPD were enrolled. 10.87% of patients had blood EOS>300 cells/μL, and 39.03% of patients had blood EOS≥100 cells/μL. Patients in group B and C were younger, with shorter disease duration, intensive care unit stay time, non-invasive mechanical ventilation use time. The time of glucocorticoid administration was significantly shortened, and the cumulative dose of venous glucocorticoid, hospitalization cost, and total drug cost were also lower than those of group A (all P<0.05).ConclusionsPatients in group B and C are younger, shorter in disease duration, lower in severity and more responsive to glucocorticoid therapy. Blood EOS can be used as a marker to guide glucocorticoid therapy in patients with AECOPD.