2015年 · 第38卷第05期

For a long time, people have been devoted to finding biomarkers and detection technologies that can reflect airway inflammation in bronchial asthma (asthma), and considerable achievements have been made in the past 30 years. The existing non-invasive detection technologies of airway inflammation mainly include airway reactivity measurement, bronchial challenge test, induced sputum cell count, FeNO measurement, exhaled air condensate (EBC) detection and peripheral blood inflammatory index measurement. The above technologies have been used in clinical practice for many years, and clinical workers in China have accumulated rich experience, and the application value evaluation and clinical research of new non-invasive detection technologies (such as FeNO and EBC) have also been carried out. In the past ten years, in the research in the field of airway inflammation detection technology in China, there are not only research achievements reflecting the actual situation in China and having Chinese characteristics, but also a considerable number of low-level repetitive studies. The "Chinese Expert Consensus on the Clinical Application of Noninvasive Airway Inflammation in Evaluating Bronchial Asthma" published in this issue puts forward guidance on the clinical application and evaluation of non-invasive airway inflammation detection technology on the basis of reviewing and summarizing relevant literature at home and abroad, and combining with the experience and experience of many experts in this field. However, there are still some problems in the clinical application and research of non-invasive airway inflammation technology, so some suggestions and opinions are put forward to discuss with domestic colleagues.

Bronchial asthma (asthma) is one of the most common chronic respiratory diseases that seriously endangers human health. It is a chronic airway inflammatory disease, which is involved in a variety of inflammatory cells (such as eosinophils, mast cells, T lymphocytes and neutrophils, etc.), structural cells (such as airway smooth muscle cells, airway epithelial cells, etc.) and cellular components. This chronic inflammation leads to airway hyperresponsiveness, usually with widespread and variable reversible airflow restriction, and causes recurrent symptoms such as wheezing, shortness of breath, chest tightness or cough, often attacking and aggravating at night and/or early in the morning, which can be alleviated by itself or by treatment in most patients. The establishment of the theory of airway inflammation in asthma is the most important progress in the field of asthma research in the past 40 years, which has triggered a revolutionary progress in asthma therapeutics.

Bronchial asthma (asthma) is a chronic airway inflammatory disease characterized by reversible airflow restriction and airway hyperresponsiveness. The cellular components involved in airway inflammation include both structural cells and circulating inflammatory cells, and they release many mediators. How they are interrelated and how they are related to airway hyperresponsiveness is still unclear. For a long time around these problems have carried out fruitful research work at home and abroad and made important progress. The author will make a brief introduction here for the readers' benefit.

The most important pathological change in bronchial asthma (asthma) is chronic inflammation of the airway, and the level of airway inflammation is closely related to airway hyperresponsiveness, which is the root cause of clinical symptoms^[1]。 Therefore, the assessment of airway inflammation, especially the development and clinical application of non-invasive airway inflammation assessment methods, is of great significance to deeply understand the pathophysiological changes and characteristics of asthma, guide the management of asthma, and better achieve the overall control goal of asthma^[2]。

Plethysmography is a very important component of a complete lung volume examination^{[1,2,3,4,5,6]}。 Gas dilution method for lung volume measurement has been described in detail in the lung volume examination section of this guide series^[1]This section will introduce the method of lung volume and airway resistance examination based on plethysmography technique.

Airway inflammation is an important feature of bronchial asthma (asthma), and its long-term persistence can lead to airway mucosal damage, airway hyperresponsiveness and airway remodeling. Therefore, monitoring and evaluating the level of airway inflammation is an important content of asthma management. Although there is no recognized detection index of airway inflammation, there are many methods available to evaluate airway inflammation in asthma, mainly including invasive and non-invasive methods. Invasive methods usually refer to trans-bronchoscopic biopsy, bronchoalveolar lavage and surgical pathological biopsy, etc. Such examinations will bring discomfort and pain to patients, so they are difficult to carry out widely in clinical practice. Non-invasive methods, such as airway reactivity detection, induced sputum detection and exhaled nitric oxide detection, have become more and more mature. However, airway inflammation in asthma involves the interaction of various inflammatory cells, cell components and inflammatory mediators, resulting in certain heterogeneity in its pathophysiological mechanism and clinical manifestations, and it is difficult for a single index to fully reflect the level and prognosis of airway inflammation. Therefore, non-invasive biomarkers representing different types of asthmatic airway inflammation have become the focus of current research. The research progress of these noninvasive biomarkers is reviewed as follows.

Human tuberculosis and bovine Mycobacterium tuberculosis in the Mycobacterium tuberculosis complex (MTBC) are currently the main pathogens of tuberculosis. The homology of human tuberculosis and M. bovis tuberculosis at the genomic level exceeds 99%^[1]It is not clinically distinguishable, but the tuberculosis caused by the two requires different treatment options. Bovine M. tuberculosis is naturally resistant to pyrazinamide (PZA) due to mutations in the pncA gene, but the two are more difficult to distinguish as the proportion of human M. tuberculosis resistant to PZA increases. This paper compares the two methods from the aspects of routine laboratory diagnosis, genotyping and molecular biology, and explores the detection methods for distinguishing bovine tuberculosis from human Mycobacterium tuberculosis and its progress which are more suitable for the national conditions in China.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common clinical disease with potential danger. Foreign data have shown that its incidence rate is 3% ~7% in adult men and 2% ~5% in women^[1]。 OSAHS can cause respiratory, cardiovascular, endocrine, genitourinary and other systemic damage, and is an independent risk factor for many systemic diseases^[2,3]。 Sexual dysfunction is prevalent in patients with OSAHS^[4]And its severity is closely related to the severity of OSAHS^[5]。 Erectile dysfunction (ED) is the most common for sexual dysfunction, with OSAHS present in about 91% of ED patients. The pathogenesis of ED in patients with OSAHS is not well understood. Nasal continuous positive airway pressure (N-CPAP) is an effective treatment for OSAHS, which can relieve intermittent hypoxia at night and improve the sleep structure of patients through continuous positive airway pressure ventilation^[6]。 In this study, the sex hormone level and sexual function status of patients with OSAHS were examined, and the related influencing factors of sexual dysfunction in patients with OSAHS were analyzed. Through the therapeutic effect of N-CPAP intervention in patients with severe OSAHS with ED, the possible therapeutic mechanism was discussed.

Langerhans cell histiocytosis (LCH) is a rare, unknown disease characterized by histiocytic infiltration that can affect multiple organ systems. It is more common in infants, young children or adolescents, and less common in adults. Pulmonary LCH may be primary in the lungs or part of systemic lesions, mostly in young adults. The naming of the disease is confusing. In 1997, the International Histiocyte Association reached an agreement on the clinical classification of LCH, which was classified into single organ involvement, single system involvement at multiple sites and multi-system involvement lesions^[1,2]。 Pulmonary LCH, which mainly occurs in adults with the lung as the only affected organ, has different course and prognosis from LCH with systemic involvement of the lung, and may represent two different disease processes. At present, it is believed that pulmonary LCH is a rare diffuse lung parenchymal disease associated with smoking. Lung biopsy data show that pulmonary LCH accounts for about 5% of pulmonary interstitial diseases. There are no clear genetic susceptibility factors, occupational and geographical differences, but it is closely related to smoking^[3]Statistics show that more than 90% of cases have a history of smoking. Two cases of pulmonary LCH admitted to our hospital are reported as follows.

Standardization of nouns is an inevitable requirement for the development of modern science. According to the requirements of the National Committee for Approval of Scientific and Technological Nouns and the Committee for Approval of Medical Nouns, the Committee for Approval of Respiratory Nouns headed by Professor Liu Youning has completed the compilation of Respiratory Nouns for 7 years, which will be officially published soon. This standard is the highest standard of domestic respiratory system noun specification and has legal status. In view of the particularity of lung function nouns and mechanical ventilation nouns, we will interpret these two parts here, not only accurately name the Chinese and English names and their meanings like "standard", but also briefly introduce their characteristics and clinical significance, so as to popularize and apply them as soon as possible. Lung function nouns mainly involve lung volume parameters, ventilation function parameters, ventilation function parameters, respiratory mechanics, lung function meter and its calibration, and lung function diagnosis. Mechanical ventilation nouns mainly involve mechanical ventilation pressure, respiratory patterns, basic ventilation modes, derivative and new ventilation modes, mechanical ventilation strategies, etc. This section interprets lung volume parameters.

The first Beijing Young Respiratory Scholars Salon in 2015 was held in Weilun Hall of Chinese Medical Association on January 29th, 2015. The theme of this salon was "Discussion on Clinically Difficult Cases", which was presided over by Dr. Shao Chi from the Respiratory Department of Peking Union Medical College Hospital. Beijing Hospital of the Ministry of Health and the Respiratory Department of Peking Union Medical College Hospital each provided one case.

Malignant pleural effusion (MPE) can be seen in many kinds of malignant tumors, and the appearance of MPE often suggests tumor metastasis and poor prognosis. In MPE, CD₄⁺The immune response elicited by T cells predominates. CDs expressing IL-17A and IL-17F₄⁺T cells are called Th17 cells. Th1 cells and Th17 cells are closely related, and inhibiting the expression of transcription factor T-bet in Th1 cells will inhibit the differentiation of Th17 cells and Th1 cells. Th17 cell differentiation requires IL-23 involvement, and T-bet can directly regulate the transcription of IL-23 receptor. Our previous studies showed that the proportions of Th1 and Th17 in human MPE were significantly higher than those in autologous peripheral blood, and there was a positive correlation between them, suggesting that Th1 and Th17 jointly participate in the pathogenesis of MPE.