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Clinical DiagnosticValue of Soluble Triggering Receptor Expressed on Myeloid Cells-1 in Ventilator- Associated Pneumonia

Objective To evaluate the diagnostic value of soluble triggering receptor expressed on myeloid cells-1 ( sTREM-1 ) in endotracheal aspirate and plasma of patients with ventilator-associated pneumonia ( VAP) . Methods The consentration of sTREM-1 in plasma and endotracheal aspirate, and serum high-sensitivity C-reactive protein ( hs-CRP) were measured by enzyme-linked immunosorbent assay ( ELISA) in 68 patients with VAP ( VAP group) , 50 patients underwent ventilation without VAP ( non-VAP group) , and 50 healthy individuals ( control group) . The sensitivity and specificity of each parameter were calculated. Results In the patients with VAP, sTREM-1 in plasma and endotracheal aspirate before treatment were significantly higher than that in the non-VAP group [ ( 143.62 ±46.82) pg/mL vs. ( 68.56 ±16.24) pg/mL, ( 352.86 ±92.57) pg/mL vs. ( 126.21 ±42.28) pg/mL, Plt;0.05] ; sTREM-1 in plasma and endotracheal aspirate on the 3rd and the 7th day during treatment were significantly decreased ( Plt;0. 05) . By ROC analysis, the cut-off value of sTREM-1 in endotracheal aspirate were 193.64 pg/mL, with sensitivity and specificity of 93.84% and 89.51% respectively. The areas under ROC curve of sTREM-1 in endotracheal aspirate were 0.912. Clinical diagnostic value of sTREM-1 in endotracheal aspirate was better than plasma sTREM-1 and serum hs-CRP ( areas under ROC curve were 0. 768 and 0. 704 respectively) . Conclusions sTREM-1 may be helpful for evaluating the therapeutic effect in patients with VAP. The diagnostic value of sTREM-1 in endotracheal aspirate may be superior to plasma sTREM-1 and serum hs-CRP.

全肺灌洗治疗吸入性肺炎一例

高频圈套器切除支气管内错构瘤一例并文献分析

目的 提高对支气管内错构瘤的临床认识。 方法 报道 2014 年 6 月诊断的 1 例支气管内错构瘤，并结合临床资料进行分析。 结果 支气管内错构瘤主要表现为呼吸困难，也可有咳嗽、咯血或阻塞性肺不张，易误诊为哮喘。胸部 CT、支气管镜检查是诊断气管内错构瘤的主要手段，组织病理学检查结果是确诊依据。治疗可根据肿瘤部位、大小以及患者状态选择手术或气管镜下切除。 结论 对支气管舒张剂治疗效果不好的呼吸困难患者应注意气管内肿瘤的可能，气管镜下冷冻切除是治疗气管内错构瘤的一种有效方法。

吉非替尼致间质性肺疾病二例并文献复习

目的 提高对吉非替尼所致间质性肺疾病诊断和治疗的认识。方法 对2 例吉非替尼所致间质性肺疾病予以报道, 结合有关文献进行回顾性分析。结果 间质性肺疾病是吉非替尼较严重的不良反应, 其所致肺损伤的危险因素包括高龄、吸烟史、PS gt;2、应用时已存在肺间质性疾病或肺部感染、曾用化疗或放疗者; 临床上早期多表现为发热、干咳和呼吸困难, 肺CT 多提示以双肺弥漫性毛玻璃样浸润影和肺实变为主; 大多在应用1 个月内发生, 进展迅速; 治疗上以激素为主, 辅以抗感染和无创呼吸支持治疗, 可在短时间内控制病情。结论 吉非替尼所致间质性肺疾病是临床上严重的不良反应, 激素治疗辅以无创呼吸支持可有效缓解病情。

尼达尼布治疗放射性肺损伤一例并文献复习

目的探讨放射性肺损伤的发病机制、临床表现、影像学特点、可能的治疗手段及预后。方法分析 1 例确诊为肺鳞癌合并放射性肺损伤并接受尼达尼布治疗患者的临床资料，结合相关文献复习，总结其临床特点、治疗过程及预后。结果本例为 72 岁男性肺鳞癌患者，经同步放化疗和放射性粒子植入术后并发放射性肺损伤，主要症状为活动后气促，胸部 CT 表现为双肺磨玻璃影和网格影，右下肺显著。经尼达尼布规范化治疗 4 个月后，临床症状以及影像学都明显缓解，随访 1 年，病情持续稳定，未见明显不良反应。文献复习发现，放射性肺损伤患者临床上多表现为干咳、发热及呼吸困难，重症患者可危及生命，影像学多表现为放射靶区的片状影，多以肺实变伴支气管充气征为主。最常用的治疗药物为糖皮质激素，也有少部分患者对激素治疗反应不佳，新的治疗手段仍在探索之中。结论放射性肺损伤是恶性肿瘤患者放疗过程中较常见的并发症，但目前治疗手段有限，尼达尼布作为一种新型的小分子靶向药，可能对放射性肺损伤具有一定的修复作用。