慢性阻塞性肺疾病( COPD) 是由吸烟诱发, 以气流持续受限为特征, 与CD4 + T 细胞及CD8 + T 细胞密切相关的由炎症及自身免疫反应引起的疾病[ 1] 。CD8 + T 细胞发挥效应及其所受调节的机制是COPD 炎症持续放大且戒烟后也不能缓解的关键, 对其在COPD 炎症中免疫作用及机制的研究有助于突破COPD 抗炎治疗和免疫调节治疗的难点, 对遏制甚至逆转COPD 炎症发展进展过程具有重要意义。Tc17 细胞是近年发现的一种分泌前炎症细胞因子IL-17 的CD8 + T 细胞亚群, 其分泌IL-17、IL-21、 IL-22等细胞因子, 与肺部炎症、哮喘、类风湿性关节炎等炎症免疫性疾病关系密切。在COPD 的肺部炎症中, Tc17 细胞很可能是连接CD4 + T 细胞和CD8 + T 细胞的另一条重要途径, 共同参与COPD 的炎症和免疫方面的机制。
Objective To explore the ultrastructure characteristics of pulmonary arteries in smokers with normal lung function and with chronic obstructive pulmonary disease ( COPD) . Methods 33 patients who undertook surgery for peripheral lung cancer were collected. According to smoking history and pulmonary function, the patients were divided into three groups, ie. non-smokers with normal pulmonary function ( group A, n = 10) , smokers with normal pulmonary function ( group B, n = 13) , and smokers in stable phase of COPD ( group C, n = 10) . Normal lung tissues without cancer were sampled and observed under light and electric microscope. Results ①Compared with group A, the thickness of intimal layer of intra-acinar pulmonary muscular arteries of group B and C were significantly higher, the area of their lumenwas lower, and the proportion of their muscular arteries was higher( P lt; 0. 01) . ②Ultrastructure of small pulmonary arteries of group A showed that intimal layer was normal, so as to endothelial cells and smooth muscle cells. Collagen fiber was not increased. Ultrastructure observation of group B showed that endothelialcells were distorted, basal membrane was thick, and collagen fiber increased in vessels. Ultrastructure observation of group C showed that endothelial cells degenerated, vascular intima thickness increased, andsynthetic phenotype smooth muscle cells increased. ③ Smoking index was positively correlated with the proportion of muscular arteries and the proportion of intimal area( r =0. 464,0. 635, P lt;0. 05, respectively) ,and negatively correlated with the proportion of lumen area( r= - 0. 603, P lt;0. 05) . Conclusions Smokers with normal lung fuction and with COPD show the similar ultrastructural characterizations in endothelial cells, smooth muscle cells, and pulmonary arterial remodeling, which related closely to smoking.
ObjectiveTo explore the clinical characters, diagnosis and treatment of Penicilliosis marneffei (PSM) in healthy hosts. MethodsThe clinical data of three cases of PSM involving the lung, bronchus and pleura in healthy hosts were retrospectively analyzed, and the case reports of Penicillium marneffei (PM) infection in healthy hosts were summarized by searching database for related articles, with "Penicilliosis marneffei" as key word both in English and Chinese literatures. ResultsThe main clinical manifestations of three PSM patients included fever, cough, lymphadenopathy, and elevated white blood cell counts.Series of chest computed tomography of three cases demonstrated atypical and extensive lung lesions.The fiberoptic bronchoscopy of the 2nd case showed several irregular nodules on the bronchial wall.The thoracoscopy of the 3rd case showed much pleural adhesions and small nodules on visceral and parietal pleura.Final diagnosis of PSM was confirmed by the fungal culture, and all patients received antifungal treatment.The symptoms relieved on medication but reoccurred on discontinuation.Literature review identified 36 cases of PSM in healthy hosts.The main clinical features were fever, cough/expectoration, skin rash/skin abscess and elevated white blood cell counts.The most common used antifungal drug was amphotericin B alone or combined with traconazole.The thoracic radiological imaging showed that roughly half of them had clearly thoracic lesions (20/36, 55.65%), and the pulmonary inflammatory infiltrate shadow was most common.Seventeen cases (47.22%) were misdiagnosed as tuberculosis. ConclusionsPulmonary involvement is common in healthy hosts with PSM and the thoracic radiological features are variable and unspecific, so PSM is easy to be misdiagnosed as tuberculosis.The PSM patients need a longer treatment than other fungal infections.