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Objective@#To analyze the epidemiological characteristics of acute paraquat(PQ)poisoning in children in southwest Shandong, and the risk factors for pulmonary interstitial fibrosis.@*Methods@#This retrospective study was performed on the clinical data of children with acute PQ poisoning admitted from January 2013 to December 2017 in 12 hospitals in southwest Shandong.All participants were divided into pulmonary interstitial fibrosis group and no pulmonary interstitial fibrosis group on the basis of the chest CT 14 days after poisoning.The epidemiological characteristics and risk factors of pulmonary interstitial fibrosis were analyzed.@*Results@#During the study period, a total of 307 children with acute PQ poisoning were admitted to 12 hospitals, of which 61 (19.87%) were suffering from acute PQ poisoning.Forty-nine cases with complete clinical data were analyzed, including 26 male and 23 female patients poisoned by oral.The age distribution ranged from 8 months to 14 years.Poisoning mainly occured from July to September of each year.The mortality of acute PQ poisoning was 8.2%(4/49), and the incidence of pulmonary interstitial fibrosis in survival patients was 44.4%(20/45). Statistical differences (P<0.05) were found between the pulmonary interstitial fibrosis and no pulmonary interstitial fibrosis, with regard to the times of blood purification, the time from poison exposure to blood purification, the application rate of glucocorticoids, the concentration of PQ in urine, the pediatric critical illness score, the time from poison exposure to gastric lavage, the white blood count at admission, serum creatinine, arterial blood lactate, PaO2, PaCO2, and PaO2/FiO2; however, there was no significant difference in the proportion of blood purification treatment, the mode of blood purification treatment, alanine aminotransferase, aspartate aminotransferase, urea nitrogen, creatine kinase and troponin.Stepwise logistic regression analysis showed that the time from exposure to poison to gastric lavage(OR=0.683, 95%CI 0.210-2.222)and to blood purification(OR=0.0133, 95%CI 0.004-0.042), the times of blood purification(OR=2.862, 95%CI 1.450-5.648), concentration of PQ in urine(OR=1.435, 95%CI 1.085-1.898), and the use of glucocorticoids(OR=0.190, 95%CI 0.048-0.757) were the risk factors for pulmonary interstitial fibrosis(P<0.05).@*Conclusion@#Early gastric lavage and blood purification, increasing the frequence of adminitrating purification appropriately, using low-dose glucocorticoids can reduce the incidence of pulmonary interstitial fibrosis of children with acute PQ poisoning.
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Objective To observe the role of Zhenqi Fuzheng granules in the treatment of patients with severe pneumonia respiratory failure. Methods A retrospective research was conducted, 96 patients with severe pneumonia admitted to the Department of Critical Care Medicine of the First People Hospital of Baiyin were enrolled, and they were divided into a western medical conventional treatment group (47 cases) and a combined traditional Chinese and western medicine treatment group (49 cases) according to the different treatment methods. A variety of conventional rescue treatments were carried out in the western medicine routine treatment group (conventional group); while in the combined traditional Chinese and western medicine conventional treatment group (combined group), based on the western medical therapies in the conventional group, at the same time, additionally Zhenqi Fuzheng granules 5 g dissolved in 20 mL warm boiled water were given by nasal feeding to the patients, 2 times daily, 7-10 days constituting a therapeutic course, and after 3 courses, the clinical therapeutic effects were evaluated. The mortality and changes of pre- and post-treatment levels of immunoglobulin, procalcitonin (PCT), C-reactive protein (CRP), course of disease, times of using antibacterial drug and ventilator, and changes in lung exudation before and after treatment, and incidence of pulmonary fibrosis were observed in the two groups. Results The mortality of combined group was significantly lower than that of the conventional group [14.29% (7/49) vs. 36.17% (17/47), P < 0.05]. After treatment, the levels of immunoglobulins were significantly higher than those before treatment, while the levels of PCT and CRP were significantly lower than those before treatment in both groups, and the changes after treatment in the combined group were more obvious than those in conventional group [IgG (g/L): 12.48±2.36 vs. 10.35±3.01, IgA (g/L): 4.16±1.08 vs. 3.18±1.13, IgM (g/L): 5.01±1.15 vs. 3.62±1.02, PCT (mg/L): 1.48±1.36 vs. 2.35±1.01, CRP (mg/L): 8.48±2.36 vs. 10.35±2.01, all P <0.05]. Compared with those in conventional group, the patient's disease course, times of using antibacterial drug and ventilator were significantly shorter in combined group [the course of disease (days): 10.86±2.64 vs. 14.38±3.02, time of using antibacterial drug (days): 11.29±3.54 vs. 13.96±4.21, time of using ventilator (days): 8.26±2.64 vs. 10.25±3.08, all P <0.05]; Compared with those in the conventional group, the cases with significant reduction of pulmonary exudation and the cases with complete absorption of pulmonary exudation were markedly increased, while the cases of pulmonary fibrosis were obviously decreased in the combined group (cases of reduction of pulmonary exudation:15 cases vs. 10 cases, complete absorption of pulmonary exudation: 16 cases vs. 9 cases; cases of pulmonary fibrosis:8 cases vs. 10 cases, all P < 0.05). Conclusion Zhenqi Fuzheng granules can significantly reduce the mortality and inflammatory factor levels, raise immunoglobulin, shorten the course of disease and times of using antimicrobial drugs and ventilator, reduce pulmonary exudation and incidence of pulmonary fibrosis obviously in patients with severe pneumonia.
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OBJECTIVE@#To evaluate the clinical efficacy of umbilical moxibustion in the treatment of patients with idiopathic pulmonary interstitial fibrosis complicated with gastroesophageal reflux of lung-spleen deficiency.@*METHODS@#A total of 116 patients with idiopathic pulmonary fibrosis complicated with gastroesophageal reflux of lung spleen-deficiency were randomized into an observation group (58 cases) and a control group (58 cases). In the control group, the routine treatment was applied; in the observation group, on the base of the treatment as the control group, the umbilical moxibustion was used. The treatment was given 2 times a week, 2 h each time for 12 weeks, and followed up for 12 weeks after treatment. The composite physiological indicators (CPI), TCM syndrome scores, the St. George respiratory questionnaire score (SGRQ) and 6-minute walk test (6MWT) were compared before and after treatment in the two groups.@*RESULTS@#The improvement of the TCM syndrome scores (cough, post-activity shortness of breath, fatigue, heartburn, acid reflux), CPI score and 6MWT in the observation group was better than those in the control group (all 0.05). There was no significant difference in the scores of CPI scores and syndromes (cough and fatigue) between the two groups at 12 weeks after treatment (all >0.05). The 6MWT, SGRQ scale scores and syndrome scores (post-activity shortness of breath, acid reflux, heartburn) were better than those in the control group in the follow up (all <0.05).@*CONCLUSION@#Umbilical moxibustion can improve the ventilation and diffusion function of lung in patients with idiopathic pulmonary fibrosis and gastroesophageal reflux of lung-spleen deficiency, reduce clinical symptoms and improve patients' quality of life and activity endurance. And it has long-term effect.
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Humans , Gastroesophageal Reflux , Idiopathic Pulmonary Fibrosis , Therapeutics , Moxibustion , Qi , Quality of Life , SpleenABSTRACT
Objective To investigate the levels of transformation growth factor-β1 (TGF-β1),vascular endothelial growth factor (VEGF) and insulin growth factor-Ⅰ (IGF-Ⅰ) role in the pathogenesis of serum of patients with combined pulmonary fibrosis and emphysema (CPFE).Methods Recruited 20 patients with CPFE,40 cases with idiopathic pulmonary interstitial fibrosis (IPF) and 40 cases with emphysema who were admitted to our hospital during July 2011 to February 2012.Serum levels of TGF-β1,VEGF and IGF-Ⅰ were detected by ABC-ELISA.Results Serum levels of TGF-β1 and IGF-Ⅰ were significantly higher in patients with CPFE and IPF than these in patients with emphysema (TGF-β1:(160.73 ± 40.62) ng/L vs.(167.35 ± 42.82) ng/L vs.(128.75 ±35.77) ng/L; IGF-Ⅰ:(179.65 ±60.73) ng/L vs.(192.32 ±58.75) ng/L vs.(148.73 ±49.67) ng/L,P ＜ 0.05 or P ＜ 0.01).The IPF group had significantly higher serum level of VEGF than the emphysema group ((506.12 ±82.37) ng/L vs.(437.31 ±62.58) ng/L,P ＜0.01).Serum levels of TGF-β1 and IGF-Ⅰ in CPFE and emphysema groups were positively correlated (r =0.885,0.918 respectively,P ＜ 0.01).Smokers in the CPFE group had significandy lower level of serum VEGF than those who did no smoke ((406.19 ± 66.94) ng/L vs.(482.88 ± 79.91) ng/L,t =-2.287,P =0.035).Conclusion Serum level of VEGF increased significantly in the IPF group,suggesting the participation of VEGF in pulmonary interstitial fibrosis.IGF-Ⅰ involved in the pathogenesis of pulmonary interstitial fibrosis.TGF-β1 and IGF-Ⅰ have a positive linear regressive relationship,which indicates that they may work synergistically in the process of the fibrosis.
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Objective To investigate the curative effect of modified Yanghe decoction on pulmonary interstitial fibrosis.Methods In this study,62 patients suffering fiom pulmonary interstitial fibrosis were randomly divided into 2 groups with the use of the Random Number Table method.31 cases in the treatment group were treated with modified Yanghe decoction,while 31 cases in the control group were treated with prednisone,40 mg/d (produced by Zhejiang Xianju Pharmaceutical Factory).The dosages of prednisone were gradually reduced a month later.The changes and improvement in symptoms,pulmonary function,chest CT,etc were observed and analyzed after three month.Results The study showed that the total?effective?rates of the treatment group and control group were 83.9％ (26/31) and 58.1％ (18/31) respectively,and the difference had statistical significance (P=0.031,P＜0.05).The integrals of gasping,breathlessness,cough and Velcros Rale of the treatment group before the treatment were (3.1 ± 2.61),(4.1 ± 1.53),(1.38 ± 1.02),(1.56 ±2.34)respectively while those of the control group were (2.83±2.34),(3.90±1.67),(1.28±1.24),(1.61±2.14) respectively.The after-treatment integrals of the treatment group were (1.1 ± 1.06),(1.52± 1.40),(0.36±0.71),(0.65±0.67)respectively while those of the control group were(1.2± 1.33),(2.15±1.31),(0.41±0.70),(0.78 ± 0.30)respectively.Compwered with their symptoms before the treatment,there was obviousimprovement in the symptoms of both groups after the treatment,(P＜0.05),but the difference in these aspects between the two groups had no statistical significance (P＞0.05).Before the treatment,the total lung capacity,vital capacity,diffusion function,arterial oxygen pressure of the treatment group were (69.80±21.7) ％,(73.16±16.38) ％,(51.46± 16.42) ％,(69.70± 10.74) mm Hg (1 mm Hg=0.133 kPa) respectively while those of the control group were(77.52 ± 15.96)％,(74.57 ± 20.73)％,(55.68 ± 17.27)％,(64.86 ± 11.40)mm Hg respectively.After the treatment,the total lung capacity,vital capacity,mass function,arterial oxygen pressure of the treatment group were (82.31±21.65)％,(83.66±17.32)％,(62.34±17.96)％,(83.51±9.37)mm Hg respectively while those of the control group were (85.06± 16.10) ％,(85.72± 20.40) ％,(68.32± 20.16) ％,(79.61 ±9.41)mm Hg respectively.Compwered with their symptoms before the treatment,there was obvious improvement in the symptoms of both groups after the treatment (P＜0.05),but the difference in these aspects between the two groups had no statistical significance (P＞0.05).Conclusion Modified Yanghe decoction can be effectively applied in the prevention and treatment of pulmonary interstitial fibrosis.
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Objective To study the differences between the animal model of pulmonary injury/ fibrosis induced by using paraquat and that induced by using bleomycin in mice in order to establish an ideal mouse pulmonary fibrosis model.Methods Thirty healthy and 8 ～ 10 weeks old male C57BL/6J (C57) mice were randomly (random number) divided into paraquat group (n =10),bleomycin group (n =10),and control group (n =10).Paraquat ( 10 mg/kg) was given to mice intraperitoneally once every three days for 5 times in paraquat group.Bleomycin was injected into trachea of mice in a dose of 3 mg /kg in bleomycin group.The mice were sacrificed 7 days,14 days and 21 days after administration of drug.The general physical condition,body weight and pulmonary pathological changes were observed.Data were analyzed with SPSS13.0 statistical package.The comparison was made between two groups with mann -whitney U- test.Results Both agents could induce pulmonary injury and fibrosis.After comparison of survival rate,body weight,pulmonary histopathological change and rate of successful modelling,the repeated low - dose of paraquat injected intraperitoneally was proved to be a method of more simple and effective with high success rate of modeling in comparison with the conventional technique of intratracheal injection of bleomycin.Conclusions By the comparison between two methods of establishing pulmonary injury and fibrosis models in mice,the method of repeated low - dose intraperitoneal injection of paraquat is superior over the bleomycin - induced method in respect of higher rate of successful modelling.
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ObjectiveTo study the HIF-1α expression in rats with paraquat poisoning (PQP).MethodsNinety-six healthy SD rats were randomly (random number) divided into 2 groups ( n =48 in each group) : PQP group and control group. The PQP group was further divided into six subgroups as per thedifferent intervals after Paraquat intoxication. Samples from 6 PQP subgroups and control group were taken at 0 h, and 2 h, 6 h, 12 h, 24 h, 48 h, 72 h and 120 h after paraquat administration. Aarterial blood wascollected for blood gas analysis, and the sections of lung tissue were stained with hematoxyhn-eosin and masson's trichrome to detect the trichrome positive area, and HIF-1α was detected by immunohistochemistryAll data were processed with one-factor analysis of variance and Pearson correlation analysis. ResultsTwo hours after paraquat poisoning, the levels of HIF-1α protein and the collagen were both significantly upregulated in the lung tissue in rats with paraquat poisoning. However, the hypoxemia existed until 72h.There was correlation between levels of Masson's trichrome positive area and HIF-1α positive area (r =0. 819, P ＜0. 05 ). There was correlation between the levels of lactic acid in blood gas analysis and HIF-1α positive area (r=0. 761, P＜0. 05. But there was no correlation between levels ofPO2 and HIF-1α positive area (r=-5.24, P＞0. 05). ConclusionsThe level of HIF-1α was up-regulated in rats with paraquat poisoning and it was not associated with hypoxemla.
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Objective To study the clinical effect ofprednisone combined with Shuxuening injection on pulmonary interstitial fibrosis. Methods 120 cases were randomly recruited into a treatment group and a control group. The control group was treated with prednisone, and the treatment group was additionally given Shuxuening injection on the basis of the control group. The changes of vital capacity (VC), PO_2, PCO_2 and imaging were observed. Results The total effective rate was 81.67% and 66.67% in the treatment group and the control group Respectively, showing significant difference (P<0.05). VC and PO_2 were raised in both groups after the treatment (P<0.05), while the treatment group showed better results than the control group (P<0.05). PCO2 were also raised in both groups after the treatment (P<0.05), while there was no significant diference between the two groups (P > 0.05). There were 27 cases (45.00%) and 19 cases (31.67%) showed improvement in imaging in the treatment group and the control group respectively, manifesting a significant difference (P<0.05) . Conclusion Treatment of prednisone with Shuxuening injection is better than prednisone on pulmonary interstitial fibrosis. This method is worthy of clinic promotion.
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The interstitial lung disease associated with connective tissue disease is beyonded to the lung bi disease or the lung wei disease. The basic pathology of pulmonary fibrosis is deficiency in origin, which is focused on lung, spleen and kidney. And excess is caused by stagnation of phlegm and blood. Deficiency, phlegm and blood can be finded during all over the pulmonary course. The deficiency in origin and the excess in superficiality often affect each other. In clinical course, the disease is assigned to four key kinds. At present, superiority has been made in the treatment of the interstitial lung disease with TCM. Moreover, it is necessary to research it with TCM furtherly to resove more difficult problems.
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Lung involvement in systemic sclerosis(SSC) is common but usually occurs late in the course. Skin changes usually occur before the pulmonary findings. In this report, a patient who developed pulmonary interstitial fibrosis without skin changes is presented. A diagnosis of SSC lung involvement was made histologically. The a nti-scl-70 antibody test was positive. Esophageal manometry revealed a lower amplitude in the lower two-third of the esophagus and pressure in the lower esophageal sphincter. Here we report a case of wystemic sclerosis sine scleroderma presenting as pulmonary interstitial fibrosis with a review of the relevant literatures.
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Humans , Diagnosis , Esophageal Sphincter, Lower , Esophagus , Fibrosis , Lung , Manometry , Scleroderma, Systemic , Sclerosis , SkinABSTRACT
Objective To study the effects of polysaccharide from Ecklonia kurome on pulmonary interstitial fibrosis induced by bleomycin in rats.Methods The pulmonary interstitial fibrosis model was established by endotracheal injection of bleomycin in rats.25,50,100mg?mL-1 doses of the polysaccharide from Ecklonia kurome were ig administered to the rats respectively,and the contants of hydroxyproline in rat lung were determined by kits at 0,3,7,14,28 d after the model was made.Results At 7,28d after the model was made,the treatment groups of middle and high doses compared with the model group showed signi-ficantly decrease of hydroxyproline level(P