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Effects of Aspergillus fumigatus spores on airway inflammation and airway responsiveness on asthmatic rat model

Objective To explore the effects of Aspergillus fumigatus（A. fumigatus） spores on airway inflammation and responsiveness in asthmatic rats.Methods Seventy male Wistar rats were randomly divided into Ⅰ and Ⅱ groups（n=35 in each group），then Group Ⅰ and Group Ⅱ were subdivided into a normal control group（n=5），an asthma group（n=10），a spores-treated control group（n=10），and a spores-treated asthma group（n=10）.The rats were sensitized to ovalbumin（OVA） and challenged with aerosol OVA to establish the asthma model.The effects of A. fumigatus spores on asthmatic rats before and after OVA aerosol challenging were investigated in Group Ⅰ and Group Ⅱ，respectively.The parameters associated with bronchial epithelial damage were observed by total protein concentration in BALF measured by BCA method.Total and differential cell counts in BALF were also counted.The airway resistance and airway responsiveness were calculated by transpulmonary pressure and gas flow rate.Results In Group Ⅰ，the total protein in BALF in the asthma group treated with A. fumigatus spores before OVA challenging（Group CA） was increased remarkably compared to the asthma group（Group A1）[（1.125±0.254）μg/mL vs（0.825±0.173）μg/mL，Plt;0.01].The nonspecific airway resistances induced by different concentration of acetylcholine in Group CA ［（0.997±0.196）cm H2O•mL-1•s-1，（1.123±0.142）cm H2O•mL-1•s-1，（1.130±0.197）cm H2O•mL-1•s-1］were increased significantly compared to Group A1 [（0.655±0.089）cm H2O•mL-1•s-1，（0.687±0.048）cm H2O•mL-1•s-1，（0.821±0.043）cm H2O•mL-1•s-1]（all Plt;0.05）.In Group Ⅱ，however，the above parameters in the asthma group treated with A. fumigatus spores after OVA challenging（Group AC） were not dramatically increased compared with the asthma group（Group A2）（all Pgt;0.05）.The differences in the total and differential cell counts in BALF in Group CA were not remarkable compared to other subgroups in Group Ⅰ（all Pgt;0.05）.But the BALF neutrophil count in Group AC was increased obviously compared to Group A2 ［（2.488±0.420）×106 vs （0.936±0.459）×106，Plt;0.05］.Conclusion These data indicate that exposure to A. fumigatus spores before challenging causes aggravated epithelial damage and increased airway resistance in an asthma rat model.

狼疮性肾炎合并肺部多重真菌感染一例

肺曲霉菌病的外科治疗

目的探讨肺曲霉菌病的临床特点与外科治疗原则。方法回顾分析32例肺曲霉菌病患者的临床资料和手术治疗结果，手术施行采用标准后外侧切口肺叶切除术6例，楔形切除术3例，胸腔镜或胸腔镜辅助改良后外侧微创小切口楔形切除术15例，肺叶切除术6例，肺段切除术2例。结果21例无肺原发疾病，11例有肺原发疾病。痰菌检查阳性率为13．3％（2／15），术前诊断符合率为28．1％（9／32）；术后并发症发生率为15．6％（5／32），其中切口皮下积液、肺膨胀不良各2例，气胸1例；随访32例，随访10～160个月，无咯血或血痰、肺曲霉菌病复发或播散。结论肺曲霉菌病多数无肺原发疾病和症状，无论有否症状均应手术治疗，而微创外科手术治疗并发症少且较轻，是首选的治疗方法。

Completely Video-assisted Thoracopic Surgery for Pulmonary Aspergilloma: A Case Control Study

ObjectiveTo discuss the possibility and safety of video-assisted thoracoscope surgery for pulmonary aspergilloma. MethodsWe retrospectively analyzed the clinical data of 39 patients with pulmonary aspergilloma in Beijing Chaoyang Hospital between June 2009 and May 2014. The patients were divided into two groups according to their operation method including a conventional thoracotomy surgery group (open group, n=11) and a video-assisted thoracoscope pneumonectomy group (VATS group, n=28). There were 8 male patients and 3 female patients with age of 29-64 (50.7±9.7) years in the open group. There were 13 male patients and 15 female patients with age of 20-75 (55.4±15.3) years in the VATS group. We compared clinical effectiveness between the two groups. ResultsThe operations of all patients were performed successfully. There were statistical differences between the two groups in the average length of operative time (P=0.001), the loss of intraoperative blood (P=0.005), and the score of pain (P=0.001). There was no statistical difference in lead flow of postoperative chest (P>0.05) and the time of hospitalization (P>0.05). ConclusionVideo-assisted thoracoscope surgery in the treatment of pulmonary aspergilloma could be feasible, safe, and effective based on our study. It is worth of clinical application and popularization．

The Interpretation of Diagnosis and Treatment Guidelines of Aspergillosis from Infectious Diseases Society of America in 2008

联合检测半乳甘露聚糖和（1→3）-β-D葡聚糖在诊治侵袭性曲霉菌感染中的研究进展

近年随着广谱抗生素和免疫抑制剂的使用，侵袭性真菌感染（invasive fungal disease，IFD）的发病率逐年上升。其中侵袭性曲霉病（invasive aspergillosis，IA）在IFD中比例逐年增高。侵袭性曲霉菌感染在血液科和重症加强治疗病房（ICU）最为常见，其次为呼吸内科、感染科和免疫科，IA为免疫功能低下患者致死率高的主要原因，造血干细胞移植（HSCT）患者中IA的发病率为2%~26%，在血液病和造血干细胞移植患者中IA死亡率高达70.0%~90.0%。造成死亡率高的主要原因是在病程早期不能对IA进行可靠诊断，往往使患者延误治疗而死亡。因此，选择正确、合适的早期诊断方法对疾病的预后具有决定性意义。传统的诊断方法如影像学、真菌直接镜检、培养及组织病理学检查的敏感性不高，检出率低，难以用于早期诊断。因此，新的诊断方法对IA的治疗至关重要。血清学诊断方法是应用免疫和生化方法检测血清或其他体液中的真菌细胞壁和胞质成分，分为抗原和抗体检查两类。但由于IFD多继发于严重免疫受损患者，往往缺乏可检测到的抗体，或者抗体的产生变化较大，因此以检测真菌抗原为主。目前半乳甘露聚糖（GM）和（1→3）-β-D葡聚糖（BG）成为真菌检查中非常重要的两个抗原。

侵袭性肺迟缓曲霉病一例报道

目的 通过本病例及综述以提升对侵袭性肺迟缓曲霉病早期病原学诊断的重视，并为治疗方案提供参考依据。方法 回顾我科诊治的1例COVID-19感染后继发的侵袭性肺迟缓曲霉病患者的临床资料，复习既往文献总结分析肺迟缓曲霉病的临床表现、诊断及治疗用药方案。结果 患者79岁，老年男性，咳嗽、咳痰伴呼吸困难4月余。胸部CT提示：双肺数个结节灶，部分结节内空洞形成；散在实变影。G实验、GM结果阴性。气管镜肺泡灌洗液送检mNGS查见迟缓曲霉菌。给予伏立康唑治疗后效不佳，且继发肝功能异常，调整为艾沙康唑治疗后临床症状及肺部影像学征象好转。复习文献，共有12例个案报道，其中8例存在免疫抑制状态，4例合并慢性阻塞性肺病，6例为器官移植术后。临床选药以伏立康唑和两性霉素B居多，虽经治疗仍有66.7%（8例）患者在确诊后7周内死亡。结论 本例为国内外首次使用艾沙康唑成功治疗侵袭性肺迟缓曲霉病的报告。侵袭性肺迟缓曲霉病属于罕见病，免疫抑制状态是其高危因素。该病进展迅速，具有高度耐药性，预后差，病死率高，早期病原学诊断尤为关键。

无哮喘的变应性支气管肺曲霉病一例

目的 报道并分析1例变应性支气管肺曲霉病（allergic bronchopulmonary aspergillosis，ABPA）的临床特点、诊断及治疗方法。方法 结合文献资料分析我科2019年诊治的1例ABPA的病例。结果 该患者诊断明确，治疗稍有曲折。ABPA常发生于肺部有基础疾病者，尤其是支气管哮喘或囊性纤维化者。临床表现主要是咳嗽、咳痰、喘息、胸闷；实验室检查血清总IgE水平和曲霉特异性IgE水平上升，以及嗜酸性粒细胞数增加；胸部影像学表现为反复的肺部游走性浸润影和中心性支气管扩张等。治疗包括糖皮质激素和抗真菌治疗，对于不能耐受糖皮质激素的患者，抗IgE抗体治疗有益。结论 临床上ABPA容易误诊、误治，特别是无哮喘病史时，其诊断更加困难。因此早期诊断和正确治疗可以减少ABPA造成的肺损伤，改善患者的预后。

侵袭性肺曲霉菌感染诊治进展

随着社会老龄化, 抗肿瘤药物、免疫抑制剂和器官移植等治疗的广泛开展, 在危重患者中广谱抗生素药物的长期应用, 与之伴随的是真菌感染发生的逐年增多, 其中侵袭性曲霉菌感染因其感染隐匿, 难以诊治和高死亡率等特点被临床医生所重视。按我国医院感染监控网分析, 医院真菌感染率从1993 ～1996 年的13. 9% 上升至1998 ～1999 年的17. 1% 、1999 ～2000 年的24. 4% 。侵袭曲霉菌病特别是肺部曲霉菌感染多发生在有严重基础疾病的患者,预后差, 病死率达50% ～100% [ 1 ] 。本文回顾相关研究文献中关于侵袭性肺曲霉菌诊治进展, 高危人群, 目前诊断检测技术的临床价值, 抗曲霉菌药物特点和治疗现状。

Role of aspergillus infection in bronchiectasis and its diagnosis and treatment

Bronchiectasis is a heterogeneous disease characterized by abnormal expansion of the bronchi, manifested by cough, sputum, and recurring lung infections. As one of the common fungi of lung infection, aspergillus can not only appear as the outcome of the disease in bronchiectasis, but also as an inducement to participate in the disease progression, and ultimately complicate the course of bronchiectasis. This article describes the susceptibility factors and pathogenic mechanisms of aspergillus in bronchiectasis, and further introduces the diagnosis and treatment status of bronchiectasis combined with aspergillus infection, aiming to clarify the effect of aspergillus infection on bronchiectasis and provide new thinking directions for its clinical diagnosis and treatment.