骨化性气管支气管病( tracheobronchopathia osteochondroplastica,TPO 或TO) , 是一种罕见的气管内膜系统的良性病变, 主要以气管和主支气管黏膜下多发性骨和软骨组织结节状增生为特征, 通常引起气道狭窄[ 1] 。大多数患者没有临床症状, 因此易被误诊和漏诊。本文将TO 的临床特征做一综述, 以提高对该病的认识。
ObjectiveTo compare the expressive differences of plasma Kerbs von den lungen-6 (KL-6) in patients with idiopathic interstitial pneumonia (IIP) and connective tissue disease associated secondary interstitial pneumonia (CTD-SIP), and analyze the clinical significances.MethodsThe clinical data and peripheral blood of 399 inpatients with interstitial pneumonia and 50 healthy controls were collected from January 2011 to December 2014 in Nanjing Drum Tower Hospital. The level of plasma KL-6 was measured by chemiluminescence immunoassay method. The subjects were divided into IIP (n=233) group and CTD-SIP (n=166) group, usual interstitial pneumonia (UIP) pattern and non-UIP pattern, and stable (S) UIP group and acute exacerbation (AE) UIP group. Statistical analyses were performed by using IBM SPSS 19.0 (SPSS, Inc., Chicago IL, USA) to compare the differences of plasma KL-6 in groups.ResultsThere were more male subjects (61.8%) in the IIP group, and the average age of (62.3±12.5) years was significantly older (both P<0.01). Plasma KL-6 levels in the IIP ［(1 822.7±1 505.2) U/ml) and the CTD-SIP group ［(1 846.7±1 625.3) U/ml］ were significantly higher than the healthy control group ［(190.2±88.7) U/ml］ (both P<0.001). However, there was no any difference of KL-6, white blood cell count (WBC), lactate dehydrogenase (LDH), C-reactive protein (CRP) and erythrocyte sedimentation rate between the IIP and the CTD-SIP group. The level of plasma KL-6 was positively correlated to WBC, LDH and CRP in the IIP group (r=0.159, P=0.016; r=0.380, P<0.001; r=0.158, P=0.015, respectively); and it was positively correlated to LDH and CRP in the IIP group (r=0.187, P=0.016 and r=0.068, P=0.032) in the CTD-SIP group. There was no significant difference of plasma KL-6 between the UIP and non-UIP subgroups (P>0.05). The difference of plasma KL-6 between the S-UIP and AE-UIP subgroup was significant (P<0.001 and P=0.023). There was no any significant difference of plasma KL-6 among the subgroups with CTD patients (primary Sjögren’s syndrome, n=90; rheumatoid arthritis, n=20; polymyositis/dermatomyositis, n=26; undifferentiated connective tissue disease, n=10; anti-neutrophil cytoplasmic antibody associated vasculitis, n=15 and systemic sclerosis, n=5) (P=0.785 2).ConclusionsPlasma KL-6 may be a useful biomarker for interstitial pneumonia. It can show the disease activities, but is not able to distinguish IIP from SIP.
ObjectiveTo analyze the clinical characteristics and survival of pulmonary fibrosis (PF) patients complicated with lung cancer (LC) (PL-LC). MethodsFifty-three patients with PF diagnosed as LC from January 2008 to March 2014 in Nanjing Drum Tower Hospital were included in this study. Univariate analysis and Cox regression analysis were used to detect the effects of clinical variables on survival. Kaplan-Meier method was used to calculate the median survival time (MST) and overall survival (OS). ResultsMale patients (n=48, 90.6%) and patients with a history of smoking (n=42, 79.2%) were more easily suffered from PF-LC. The average age was 68.6±9.5 years. Cox multivariate analysis revealed that Velcro crackles (P=0.009) and clinical stage (P=0.013) were the independent risk factors of survival in the patients with PF-LC. The MST of 53 patients was 6.0 months.The survival rates of 1-year and 2-year were 34.1% and 22.0%, respectively. Forty-two (79.2%) patients were idiopathic pulmonary fibrosis (IPF) complicated with LC, and 11 (20.8%) patients were secondary pulmonary fibrosis (SPF) complicated with LC. OS difference between two groups was not significant (P=0.610). OS of NSCLC group (n=37) was significantly prolonged than that of SCLC group (n=6) and unclassified pathological pattern group (n=10) (P=0.035). OS of Ⅰ and Ⅱstage patients (n=13) was significantly longer than that of Ⅲ and Ⅳ stage patients (n=40) (P=0.002). MST and OS of patients with LC treated (n=31) were significantly better than those of untreated patients (n=22) (P < 0.001) and OS of patients treated by comprehensive therapy (n=11) was significantly prolonged than that of patients treated by mono-therapy (n=20) (P=0.036). ConclusionsVelcro crackles and clinical stages are the independent risk factors of prognosis in PF-LC patients. It is beneficial to survival if the PF patients with LC were treated by comprehensive therapy.
Objective To analyze the risk factors of invasive pulmonary aspergillosis (IPA) in patients with interstitial pneumonia. Methods The clinical data of 770 cases of interstitial pneumonia admitted between December 2010 and August 2015 were collected. Among them, 46 cases were combined with IPA and 724 cases were not ombined with IPA. The clinical data was analyzed to explore the risk factors of IPA in patients with interstitial pneumonia. Results Univariate analysis showed that in the aspects of age (t=3.348, P=0.001), serum albumin level (t=8.381, P < 001), broad-spectrum antibiotic used within 3 months (χ2=87.157, P < 001), long-term administration of glucocorticoid (χ2=57.462, P < 001), long-term administration of immunosuppressive agents (χ2=31.715, P < 001), imaging in UIP type (χ2=20.632, P < 001), diabetes mellitus (χ2=9.737, P=0.002) and heart failure (χ2=9.300, P=0.002), there were significant differences between two groups. After multivariate logistic regression analysis, broad-spectrum antibiotic used within 3 months (OR=4.773, P < 001), long-term administration of glucocorticoid (OR=9.195, P < 001), long-term administration of immunosuppressive agents (OR=2.662, P=0.046), imaging in UIP type (OR=5.725, P < 001), and diabetes mellitus (OR=3.847, P=0.003) were found to be the risk factors of IPA in patients with interstitial pneumonia. Serum albumin level was negatively correlated with the occurrence of IPA in patients with interstitial pneumonia. Conclusions Various factors contribute to the occurrence of IPA in patients with interstitial pneumonia. Miscellaneous appropriate measures should be taken to reduce the incidence of IPA.
Objective To investigate the colonization, risk factors and prognosis of Pneumocystis jirovecii (P.jirovecii) colonization in patients with Pulmonary alveolar proteinosis (PAP). Methods The patients with Pulmonary alveolar proteinosis who were admitted to the Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital from March 2019 to December 2022 were retrospectively analyzed. Polymerase chain reaction/next-generation metagenomic sequencing were used to detect the colonization of P. jirovecii in bronchoalveolar lavage fluid, and then to investigate the colonization rate, risk factors and outcome of P. jirovecii in PAP patients. Results A total of 25 patients were included in the study, of which 7 were colonized by P. jirovecii (28.0%). The rate of using antibiotics before admission in the colonizing group was significantly higher than that in the non-colonizing group (85.7% vs 33.3%, P=0.030). Total blood lymphocytes (1.4×109/L vs. 1.8×109/L, P=0.048), CD3+T cells (0.83×109/L vs. 1.34×109/L, P=0.010), CD4+T cells (0.48×109/L vs. 0.85×109/L, P=0.010) were significantly lower than those in the non-colonizing group, lactate dehydrogenase (469.9 U/L vs. 277.3 U/L, P=0.005) was significantly higher than those in the non-colonizing group. A higher proportion of colonizing group required combination therapy (57.1% vs. 11.1%, P=0.032); but there was no significant difference in the percentage of whole-lung ground-glass opacification, lung function, oxygen index and outcome. Lactate dehydrogenase was positively correlated with the percentage of whole-lung ground-glass opacification of PAP, but negatively correlated with oxygen index, percentage of predicted forced vital capacity and percentage of predicted diffusion capacity for carbon monoxide. Conclusions The colonization rate of P. jirovecii in PAP patients was high. Reduced lymphocyte count in peripheral blood of PAP patients and antibiotic use before diagnosing were risk factors for P. jirovecii colonization.