目的 探讨特发性间质性肺炎（IIPs）[非特发性肺间质性纤维化（IPF）型]合并弥漫性肺部出血综合征患者治疗方案以及应用价值。方法 报道1例IIPs（非IPF型）合并弥漫性肺部出血综合征患者的治疗经过以及结果,结合文献分析治疗IIPs（非IPF型）合并弥漫性肺部出血综合症临床应用价值。结果 该文报道 l 例特发性肺间质肺炎（非IPF型）伴弥漫性肺泡出血综合征的老年男性患者,合并呼吸、循环衰竭,启用静脉-静脉体外膜肺氧合（VV-ECMO）抢救并成功撤机,病情好转出院。结论 IIPs作为病因以及发病机制未明、临床表现多样的一类肺间质性疾病,需临床多学科协作,及早诊断、治疗,才能成功挽救患者。

Objective To explore the treatment plan and application value of idiopathic interstitial pneumonia（non IPF）complicated with diffuse alveolar hemorrhage syndrome．Methods A case of idiopathic interstitial pneumonia（non IPF）complicated with diffuse alveolar hemorrhage syndrome was reported．The clinical application value of treatment of idiopathic interstitial pneumonia（non IPF）complicated with diffuse alveolar hemorrhage syndrome was analyzed combined with the literature．Results A case of idiopathic interstitial pneumonia（non IPF type）with diffuse alveolar hemorrhage syndrome was reported in this paper． Combined with respiratory and circulatory failure,veno-venous extracorporeal membrane oxygenation was used to rescue and successfully wean,and the condition improved and discharged．Conclusions Through the curative effect evaluation of this patient,it is believed that idiopathic interstitial pneumonia,as a kind of pulmonary interstitial disease with unknown etiology and pathogenesis and diverse clinical manifestations,need clinical multidisciplinary cooperation,early diagnosis and treatment,in order to successfully save the patient．

目的 探讨复方甘草口服液联合泼尼松治疗特发性肺间质纤维化急性加重期患者的疗效。方法 选取张掖市第二人民医院2020年1月—2023年10月收治的128例特发性肺间质纤维化急性加重期患者,应用随机数字表法分为两组,每组各64例。对照组采取泼尼松治疗,观察组采取复方甘草口服液联合泼尼松治疗。对比其临床疗效,治疗前后血清肺纤维化指标及炎症因子水平,最后对比其不良反应发生率。结果 观察组总有效率93.75%,高于对照组的79.69%（χ²=5.490,P=0.019）;治疗前两组层黏连蛋白（LN）、Ⅲ型前胶原肽（PC-Ⅲ）、透明质酸（HA）对比差异无统计学意义（P>0.05）,治疗后两组患者LN、PC-Ⅲ、HA均降低,观察组[（89.25±7.61）μg/L;（68.33±7.68）mg/L;（81.53±8.54）μg/L]低于对照组[（96.17±8.34）μg/L;（75.68±8.25）mg/L;（95.68±9.25）μg/L],对比差异有统计学意义（t₁=4.903,P₁<0.001;t₂=5.217,P₂<0.001;t₃=8.992,P₃<0.001）;治疗前两组患者肿瘤坏死因子-α（TNF-α）、白细胞介素-4（IL-4）、IL-10、转化生长因子（TGF-β1）对比差异无统计学意义（P>0.05）,治疗后两组TNF-α、IL-4、IL-10、TGF-β1水平降低,观察组[（61.94±8.24）ng/L;（4.43±1.17）ng/mL;（65.49±13.24）g/L;（114.73±13.12）pg/mL]低于对照组[（75.52±9.43）ng/L;（6.31±1.28）ng/mL;（79.27±9.38）g/L;（147.76±15.46）pg/mL],对比差异有统计学意义（t₁=8.675,P₁<0.001;t₂=8.673,P₂<0.001;t₃=6.794,P₃<0.001;t₄=13.032,P₄<0.001）;两组不良反应发生率对比差异无统计学意义（7.81% vs 6.25%,χ²=0.120,P=0.730）。结论 复方甘草口服液联合泼尼松治疗特发性肺间质纤维化急性加重期疗效显著,可辅助延缓患者肺纤维化发展进程,减轻机体炎症反应,安全性较高。

Objective To investigate the efficacy of compound licorice oral liquid combined with prednisone in patients with acute exacerbations of idiopathic pulmonary interstitial fibrosis. Methods A total of 128 patients with acute exacerbation of idiopathic pulmonary interstitial fibrosis admitted to Zhangye Second People's Hospital from January 2020 to October 2023 were divided into two groups by random number table method,with 64 patients in each group．The control group received prednisone treatment,while the observation group received compound licorice oral liquid combined with prednisone treatment．Compare its clinical efficacy,serum pulmonary fibrosis indicators and inflammatory factor levels before and after treatment,and finally compare its incidence of adverse reactions. Results The total response rate in the observation group was 93.75%,which was higher than the 79.69% in the control group（χ²=5.490,P=0.019）．There was no difference between the two groups of LN,PC-III,and HA（P>0.05）,LN,PC-III and HA were decreased in both groups,while the observation group[（89.25±7.61）μg/L;（68.33±7.68）mg/L;（81.53±8.54）μg/L] was lower than the control group[（96.17±8.34）μg/L;（75.68±8.25）mg/L;（95.68±9.25）μg/L],the contrast difference was statistically significant（t₁=4.903,P₁<0.001;t₂=5.217,P₂<0.001;t₃=8.992,P₃<0.001）．There was no difference in TNF-α,IL-4,IL-10,and TGF-β1 between the two groups before treatment（P>0.05）,lower levels of TNF-α,IL-4,IL-10,and TGF-β1 in the two patient groups after treatment,the observation group[（61.94±8.24）ng/L;（4.43±1.17）ng/mL;（65.49±13.24）g/L;（114.73±13.12）pg/mL] was lower than the control group[（75.52±9.43）ng/L;（6.31±1.28）ng/mL;（79.27±9.38）g/L;（147.76±15.46）pg/mL],the contrast difference was statistically significant（t₁=8.675,P₁<0.001;t₂=8.673,P₂<0.001;t₃=6.794,P₃<0.001;t₄=13.032,P₄<0.001）．There was no difference in the incidence of adverse effects between the two groups（7.81% vs 6.25%,χ²=120,P=0.730）. Conclusions The combination of compound licorice oral liquid and prednisone has a significant therapeutic effect on the acute exacerbation of idiopathic pulmonary interstitial fibrosis．It can assist in delaying the progression of pulmonary fibrosis in patients,reducing the body's inflammatory response,and has high safety．

目的 探讨血浆置换联合泼尼松（PDN）联合环磷酰胺（CTX）治疗抗黑色素瘤分化相关基因5（MDA5）抗体阳性皮肌炎（DM）伴肺间质纤维化（ILD）患者疗效及安全性。方法 回顾性分析2014年6月—2023年6月普洱市人民医院诊断的MDA5阳性DM伴ILD患者40例,其中治疗组20例,采用血浆置换联合PDN 1 mg/kg每日1次口服,4周后减量,每周减总量10%,CTX 1 g每月1次静脉滴注,共6次治疗;另20例设为对照组,采用PDN 1 mg/kg每日1次口服,4周后减量,每周减总量10%,CTX 1 g每月1次静脉滴注,共6次治疗,分别于治疗后3月、6月检测一氧化碳弥散量（DLCO）、第1秒用力呼气量（FEV₁）,血清铁蛋白（SF）、C-反应蛋白（CRP）、涎液化糖链抗原（KL-6）、MDA5转阴率行疗效评估。结果 在治疗3个月和6个月时,两组患者的DLCO、FEV1、SF、CRP、KL-6、MDA5转阴率等指标的完全缓解率不一致。其中,3个月时,治疗组上述指标的完全缓解率依次为95%、85%、90%、90%、90%、85%,对照组依次为15%、20%、20%、15%、0%、0%。两组患者在治疗3个月的DLCO、FEV1、SF、CRP、KL-6水平和MDA5转阴数均有所不同。其中治疗组的DLCO、KL-6、CRP水平均较对照组降低（P<0.01）,治疗组FEV₁水平较对照组升高（P<0.01）,治疗组SF水平较对照组降低（P<0.05）,两组治疗6个月时,治疗组上述指标缓解率依次为95%、85%、90%、90%、90%、85%,对照组依次为20%、25%、20%、20%、20%、5%。两组患者在DLCO、FEV₁、SF、CRP、KL-6水平以及MDA5转阴数和死亡例数方面比较差异均有统计学意义,其中治疗组的DLCO、KL-6和CRP水平均较对照组降低（P<0.01）,治疗组FEV₁水平较对照组升高（P<0.01）,SF水平治疗组较对照组降低（P<0.05）。结论 在MDA5抗体阳性DM伴ILD患者治疗中,给予血浆置换联合PDN、CTX治疗,可以提高疗效,降低病死率。

Objective To explore the effect of plasmapheresis combined with prednisone（PDN）plus cytoxan（CTX）on patients with anti-melanoma differentiation-associated gene 5（MDA 5）antibody-positive dermatomyositis（DM）with interstitial lung disease（ILD）. Methods The data of 40 patients with MDA 5 positive DM and ILD diagnosed in the People's Hospital of Pu'er City from June 2014 to June 2023 were retrospectively was analyzed．Twenty patients of the treatment group were treated with plasmapheresis combined with PDN 1mg / kg once daily,which was reduced by 10% per week after 4 weeks．The other 20 patients of the control group were treated with PDN 1mg / kg once daily,which was reduced after 4 weeks by 10% per week,and CTX 1g once per month．diffusing capacity of the lungs for carbon monoxide（DLCO）,forced expiratory volume in the first second（FEV₁）,serum ferritin（SF）,C-reactive protein（CRP）,Krebs Von den Lungen-6（KL-6）and MDA5 negative conversion rate were measured at 3 and 6 months after treatment,respectively. Results At 3 and 6 months of treatment,complete remission rates of DLCO,FEV₁,SF,CRP,KL-6,MDA 5 conversion and other indicators were inconsistent．Among them,at 3 months,the complete response rate of the above indicators in the treatment group was successively：95%,85%,90%,90%,90% and 85%．The control group was 15%,20%,20%,15%,and 0%,0%．Statistical analysis showed that the levels of DLCO,FEV₁,SF,CRP,KL-6 and MDA 5 significantly varied at 3 months of treatment．Pairwise comparison of LSD found that the DLCO,KL-6 and CRP levels in the treatment group were significantly lower than the control group（P<0.01）,the FEV₁ level in the treatment group was significantly higher（P<0.01）,and the SF level in the treatment group was significantly lower（P<0.05）．After 6 month of treatment,the complete response rate of the above indicators in the treatment group were 95%,85%,90%,90%,90% and 85%,and the complete response rate of the above indicators in the control group was 20%,25%,20%,20%,20% and 5%．Statistical analysis showed the levels of DLCO,FEV₁,SF,CRP,KL-6 for the amount of MDA 5 and the number of deaths between two groups were significantly different．Further pairwise comparison of LSD showed that the DLCO,KL-6 and CRP levels in the treatment group were significantly lower compared with the control group（P<0.01）,the FEV₁ level was significantly increased compared with the control group（P<0.01）,and the SF treatment group was significantly decreased compared with the control group（P<0.05）. Conclusions In the treatment of patients with MDA 5 antibody positive DM with ILD,the treatment of plasmapheresis combined with PDN and CTX can significantly improve the efficacy and reduce the mortality rate．

现代人面临更大的工作与生活压力,每天的生活节奏较快,因此经常出现饮食不规律、饮食结构不合理等现象,这样就增加了肠胃疾病的发生率。胃肠道间质瘤（GIST）以人体胃肠道最为常见的肿瘤疾病,该病患者占全部胃肠道间叶性肿瘤患者人数的80%以上。GIST根据疾病进展、间质瘤体积等不同因素又能够分为不同的疾病类型,需采取对应的诊断措施与治疗措施。本文将针对胃小间质瘤的流行病学、临床症状、临床诊断以及治疗措施等进行研究与分析,以供参考。

Modern people are facing greater pressure in work and life,and the pace of daily life is fast．Therefore,irregular diet and unreasonable diet structure often occur,which increases the incidence of gastrointestinal diseases．Gastrointestinal stromal tumor（GIST）is the most common tumor disease in human gastrointestinal tract,accounting for over 80% of all patients with gastrointestinal mesenchymal tumors．GIST can be divided into different types according to different factors such as disease progression and stromal tumor volume,thus corresponding diagnostic and therapeutic measures should be taken．This paper studied and analyzed the epidemiology,clinical symptoms,clinical diagnosis and treatment of gastric small stromal tumors for reference．

目的 探索实体肿瘤内部不同区域的间质液压（IFP）分布的异质性。方法 通过建立新西兰大白兔的皮下浅肌层VX2移植瘤模型,通过超声造影观察肿瘤的大小、形状、血流灌注等成瘤情况,并在超声引导下通过针芯法（WIN法）测量41只荷瘤兔VX2移植瘤内部不同区域的IFP。结果 41只荷瘤兔的VX2移植瘤的中央IFP为（23.79±8.07） mmHg、肿瘤外周1/2IFP为（15.58±5.22）mmHg、肿瘤外周1/4IFP为（8.29±5.47）mmHg,IFP从中央到外周逐步降低（F=70.85,P<0.001）。结论 VX2移植瘤内不同区域的IFP存在异质性,即从中央到外周IFP呈梯度显著降低。

Objective To explore the heterogeneity of interstitial fluid pressure（IFP）distribution in different regions of solid tumors．Methods The model of VX2 tumor was established in New Zealand white rabbits．The size,shape and blood perfusion of the tumor were observed by contrast-enhanced ultrasound,the IFP of VX2 tumor in 41 rabbits was measured by the wick-in-needle method（WIN method）under the guidance of ultrasound．Results The mean values of central IFP,peripheral 1/2 IFP and peripheral 1/4 IFP were（23.79±8.07） mmHg,（15.58±5.22 ）mmHg and （8.29±5.47） mmHg,respectively by statistical analysis,the IFP values changed significantly with different regions（F=70.85,P<0.001）．Conclusions There is heterogeneity of IFP in different regions of VX2 xenografts,that is,from the center to the periphery,the IFP decreased significantly．

目的 探讨透明帽辅助下套扎切除小胃肠道间质瘤(gastrointestinal stromal tumor,GIST)的临床应用价值。方法 回顾性分析2017年2月—2020年2月在我院行透明帽辅助下小GIST套扎切除术151例患者的临床资料,分析其完整切除率、复发率、并发症发生率、手术时间、住院天数等指标。结果 151例小GIST患者中,瘤体位于胃底91例,胃体53例,胃窦7例,均采用透明帽辅助下完整切除病变。150例病变部位切除后肉眼及病理所见包膜完整无残留,1例分2次套扎后才完全切除肉眼无残留。术中活动性出血3例,无术后迟发性出血,术中主动穿孔105例,穿孔直径最大约1 cm。发生气胸及纵隔气肿3例,局限性腹膜炎3例,发热4例。所有病例经内镜下止血、修补及对症处理后均好转,无1例术中及术后转外科治疗;平均手术时间(28.3±7.6)min,平均住院时间为(4.3 ±1.9)天。病理结果显示极低危险度胃肠道间质瘤132例,低危险度胃肠道间质瘤19例。术后随访复查胃镜均无复发征象。结论 透明帽辅助下套扎切除术胃小GIST操作简单,安全、有效,具有临床推广的价值。

Objective To explore the clinical value of resection of small gastrointestinal stromal tumor(GIST) with transparent cap assisted band ligation. Methods The clinical data of 151 patients who underwent ligation of small GIST assisted with transparent cap in our hospital from February 2017 to February 2020 were retrospectively analyzed, and the complete resection rate, recurrence rate, and complication rate, operation time, hospitalization days and other indicators were analyzed. Results Among the 151 patients with small GIST, 91 cases were located in the fundus of the stomach, 53 cases were in the stomach body, and 7 cases were in the antrum of the stomach. All the lesions were completely resected with the aid of transparent cap. Among lesions of 150 cases, the envelopes were intact and no residue was seen by naked eyes and pathology examination, and 1 case was completely resected after 2 ligations. There were 3 cases of active bleeding, no delayed bleeding, and 105 cases of iatrogenic perforation during the operation. The maximum diameter of the perforation was about 1 cm. There were 3 cases of pneumothorax and mediastinal emphysema, 3 cases of localized peritonitis, and 4 cases of fever. After hemostasis, repair and symptomatic treatment under endoscopy, no case was transferred to surgical departmat during or after operation; the average operation time was (28.3±7.6) minutes, and the average hospital stay was (4.3±1.9) days. Pathological results showed there were 132 cases of very low-risk gastrointestinal stromal tumors and 19 cases of low-risk gastrointestinal stromal tumors. There was no sign of recurrence in the gastroscope during the follow-up. Conclusion The transparent cap assisted ligation resection of small GIST was simple, safe and effective, and had the value of clinical promotion.

目的 观察紧密连接蛋白在高尿酸血症致大鼠肾损害模型中的表达变化以及非布司他的干预疗效。方法 将SD大鼠分为正常组,高尿酸血症组(模型组),非布司他组(干预组);氧嗪酸联合尿酸诱导制作高尿酸血症大鼠模型,给予非布司他进行干预,分别于6周后检测各组大鼠血中尿素氮(BUN)、血肌酐(Scr)、尿酸(UA)水平,免疫组化及RT-PCR方法检测紧密连接蛋白包括膜周蛋白-1(ZO-1)、跨膜蛋白(occludin) 的表达变化,采用Masson染色检测大鼠肾间质病理改变。结果 6周时,模型组、干预组ZO-1、occludin表达较正常组降低(均P<0.05);干预组ZO-1、occludin表达较模型组增加,差异有统计学意义(均P<0.05),与正常组相比,模型组、干预组RIF指数均增高(均P<0.05),干预组RIF指数低于模型组,高于正常组(均P<0.05)。结论 紧密连接蛋白表达的降低在高尿酸血症肾间质纤维化发展过程中起着举足轻重的作用,并与血尿酸水平及肾功能损害密切相关。非布司他通过降低血尿酸水平,能改善紧密连接蛋白的表达,延缓肾功能损害,起到肾保护作用。

Objective To observe the expression of tight junction protein in hyperuricemia induced renal damage model in rats and the intervention effect of febuxostat. Methods SD rats were randomly divided into three groups: normal control group, model control group, febuxostat treatment group. Hyperuricemia was induced in rats with oxonic acid per time for three times per day, by gavage and combined with uric acid added in drinking water, while febuxostat were administered by gavage in febuxostat treatment group.The blood of rats were collected to analyse the differences of control, model and treatment group on changes of blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA). Immunohistochemistry was used to assay ZO-1 and occludin protein expression and quantitive real time PCR to detect the expression of ZO-1 and occludin in renal tissue of renal interstitial fibrosis model rats induced by hyperuricemia. Paraffin section of kidney was maked and then performed Masson staining to make sure the model is successful. Results At 6 weeks, the expressions of ZO-1 and occludin in the model group and treatment group were lower than those in the normal group (all P<0.05). The expressions of ZO-1 and occludin in the treatment group were higher than those in the model group (all P<0.05). Compared with the normal group, the RIF index in the model group and treatment group were higher (all P<0.05), and the RIF index in the treatment group was lower than that in the model group and higher than that in the normal group (all P<0.05). Conclusion The downregulated expression of ZO-1 and occludin plays a crucial role during the development of hyperuricemia in renal interstitial fibrosis, and are closely related to UA level and renal function impairment. Febuxostat may improve the expression of tight junction by downregurating UA, reduce renal fuction impairment and play a role in renal protection.

目的 探讨以肺间质改变为主的不典型肺结核的CT特征。方法 收集2018 年1月—2018 年12月期间44例经我院临床及实验室确诊的以肺间质改变为主的不典型肺结核的CT影像学资料,进行归纳总结,分析其影像特点。结果 44例以肺间质改变为主的不典型肺结核其中14例患者在肺叶的分布呈局限性分布,其中主要分布于右肺上叶占13例;30例呈弥漫性分布;以间质改变为主的局限性分布及弥漫性分布的不典型肺结核均以细网织影、微结节、细支气管壁增厚、小叶间隔增厚为主要表现,树芽征、磨玻璃影在弥漫性分布中相对常见,其合并空洞、支气管扩张、纵膈淋巴结肿大钙化、胸膜炎、肺大疱的比例高于局限性分布患者;以肺间质改变为主的不典型肺结核呈局限性分布(14例)的患者预后良好,13例呈显著吸收,1例吸收良好;弥漫性分布(30例)的患者中,18例显著吸收,其中6例未吸收或吸收欠佳。结论 以肺间质为改变为主的非典型肺结核具有其特征性,了解其CT特点有助于提高临床诊断及更好的评价治疗预后。

Objective To discuss value of the CT features of atypical pulmonary tuberculosis with pulmonary interstitial changes and improve the early diagnosis of pulmonary tubeculosis. Methods The CT imaging data of 44 patients with atypical pulmonary tuberculosis with interstitial changes was collected from January 2018 to December 2018,and the imaging characteristics were analyzed. Results In 44 cases of atypical pulmonary tuberculosis,14 cases of atypical pulmonary tubeculosis were the localized distribution,13 cases were mainly in the right upper lobe,and 30 cases were diffuse distribution. The atypical pulmonary tuberculosis of the localized and diffuse distribution mainly with interstitial changes was characterized by tine reticular shadow,micnodule,thickening of bronchiole wall and thickening of interlobular Septa. Tree-bud sign and ground-glass shadow were common in diffuse distribution,and the proportions of cavity,bronchiectasis,mediastinal lymphadenopathy calcification,pleurisy and bullae were higher than that in localized distribution. The atypical pulmonary tuberculosis patients with localized pulmonary interstitial changes (14 cases) have a favourable prognosis,13 cases with significant absorption,1 case with favourable absorption,and 18 cases with the atypical pulmonary tuberculosis patients with diffuse pulmonary interstitial changes (30 cases) with significant absorption,6 cases with no absorption or poor absorption. Conclusion The atypical pulmonary tuberculosis with interstitial changes has its characteristics,and the CT features is helpful to improve the clinical diagnosis and better evaluation of treatment prognosis.

目的 从生物力学应力调控角度,探讨组织间质液压升高诱发肝纤维化的分子细胞机制。方法 人肝星状细胞随机分为3组,模型组:将其置于压力箱中施加恒定的高于大气压50 mmHg压力;实验组:加入ROCK抑制剂Y-27632(浓度10 μmol)置于与实验组相同条件;对照组:不加压置于相同培养箱中。应用RC-PCR检测其α-SMA、RhoA、ROCK mRNA的表达量,并应用免疫荧光染色分析其α-SMA、ROCK1、ROCK2蛋白表达情况。结果 间质液压变化对人肝星状细胞中α-SMAmRNA的表达量比对照组表达量增加,RhoA mRNA的表达先上升后下降,只对早期压力有变化,而 ROCK mRNA的表达量无明显变化。抑制剂组和压力组α-SMA 、ROCK1荧光强度较对照组增强,ROCK2荧光强度无明显变化,其中模型变化更显著。结论 细胞间质液压升高能通过RhoA/ROCK1信号通路引起肝星状细胞的活化。