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电视胸腔镜双侧肺减容术21例

目的　总结电视胸腔镜双侧肺减容术（BLVRS）治疗慢性阻塞性肺气肿（COPE）的临床经验，并观察其疗效。　方法　2009年9月至2010年9月，南京医科大学附属南京医院对21例COPE患者行电视胸腔镜 BLVRS，均为男性，年龄（65.71±9.05）岁。采用电视胸腔镜专用切缝器（Endo-GIA）切除过度充气的肺大泡组织，常规用4-0 Prolene线连续往返缝合。术后观察患者的肺功能、血气分析指标和6 min步行距离（6-MWD）的变化，并与术前进行比较，评价手术疗效。　结果　无围术期死亡，术后住院时间（13.20±4.60） d，胸腔引流时间（5.33±3.67） d。术后持续肺漏气 （5.91±3.52） d 12例，出现急性呼吸衰竭1例，广泛皮下气肿2例，合并肺部感染5例，均经相应的处理治愈。随访21例，随访时间6个月，术后6个月第1秒用力呼气容积［（1.63±0.23） L vs. （1.21±0.17） L］、动脉血氧分压［（77.62±6.98） mm Hg vs. （67.54±8.12） mm Hg］和6-MWD ［（430.55±80.49） m vs. （283.48±108.12） m］较术前增加，动脉血二氧化碳分压（PaCO2）、、残气量（RV） 较术前降低（P＜0.05）。　结论　电视胸腔镜BLVRS安全、有效，特别对非均质性肺气肿，可明显改善患者的生活质量，近期效果显著。

毛霉菌病致急性髓细胞性白血病患者鼻毁损一例

Clinical and Laboratory Study of a Case of Chronic Myelogenous Leukemia Blastic Transformation with Rare Hypodiploid t(1;9;22)

【摘要】　目的　观察慢性粒细胞性白血病（chronic myelogenous leukemia， CML）急变（blast crisis，BC）患者罕见染色体异常的临床及实验室特点。　方法　2010年2月1例患者因咳嗽和高热来我院就诊，采用常规方法检查患者骨髓细胞，应用R显带技术和荧光原位杂交技术分析骨髓细胞核型。　结果　患者具有CML-BC的典型临床及实验室特点，同时核型出现不典型t（1；9；22）合并亚二倍体罕见核型异常，临床表现病情进展快，对伊马替尼疗效差，生存期短。　结论　慢性粒细胞性白血病患者在急变期出现伴不典型Ph染色体的亚二倍体复杂核型为高危核型，此类患者可能存在对伊马替尼的耐药，如能取得血液学缓解应尽早接受异基因骨髓造血干细胞移植，争取获得长期疗效。【Abstract】　Objective　To report a case of chronic myelogenous leukemia (CML) blastic transformation into acute myelogenous leukemia with rare atypical hypodiploid t(1;9;22) complex chromosome abnormalities, and to analyze its clinical and laboratory characteristics. 　Methods　A 47-year-old man was referred to our hospital due to cough and high fever in February 2010. We collected and analyzed the patient’s clinical materials, and performed chromosomal karyotype analysis with R-banding and fluorescence in situ hybridization (FISH).　Results　The patient demonstrated typical clinical and laboratory characteristics of blastic crisis of chronic myelogenous leukemia (CML-BC) and displayed rare atypical hypodiploid t(1;9;22) complex chromosome abnormalities. Meanwhile, the disease was rapidly progressive, with poor response to imatinib and had short overall survival.　Conclusions　CML-BC patients with hypodiploidy complex chromosome abnormalities are in high risk. They may show drug-resistance to imatinib. Thus, for this type of patients, once the hematological remission is achieved, allogeneic stem cell transplant should be performed as soon as possible to get better opportunity for long-term survival.

Expression of liver X receptors and protein phosphatase 1A and their relationship with airway remodeling in bronchial asthma patients

ObjectiveTo detect the expression of Liver X receptors (LXRs), protein phosphatase 1A (PPM1A), transforming growth factor-β1 (TGF-β1) and Smad2 in peripheral blood of bronchial asthma patients, and to explore whether LXRs and PPM1A are related to airway remodeling.MethodsSubjects were divided into healthy control group, mild and moderate asthma group and severe asthma group, with 30 subjects each. Lung function and high-resolution computed tomography examination were performed on patients with bronchial asthma to define airway remodeling. Peripheral blood was extracted and the serum levels of LXRα, LXRβ, PPM1A, TGF-β1 and Smad2 were detected after centrifugation. Then the data were analyzed.ResultsThe airway remodeling level of the mild and moderate asthma group was significantly higher than that of the control group. The airway remodeling level of the severe asthma group was significantly higher than that of the mild and moderate asthma group. Serum LXRα, LXRβ in asthma group were higher than those in the control group. The levels of LXRα and LXRβ in severe asthma were higher than those in mild and moderate asthma group. There was no significant correlation between LXRs and airway remodeling. The PPM1A level in mild and moderate asthma group was lower than that in the control group. The levels of PPM1A in severe asthma were lower than that in mild and moderate asthma group. PPM1A level was negatively correlated with airway remodeling.ConclusionsThe level of PPM1A in asthma patients is lower than that in healthy subjects, and is negatively correlated with the degree of airway remodeling. Serum LXRs in asthmatic patients are higher than that in healthy subjects, but LXRs are not significantly correlated with airway remodeling.