2017年 · 第40卷第01期

2016 is fleeting, and 2017 has come our way. At the end of the year, we see the achievements of Chinese Journal of Tuberculosis and Respiration, and we sincerely thank you for your full support and selfless help to this journal over the past year. In order to better communicate with readers, authors and all people from all walks of life who support us, this magazine officially opened the WeChat platform in August 2016, and the public subscription number is: Chinese Journal of Tuberculosis and Respiratory. On the WeChat platform, you can see the latest consensus or guidelines for disease diagnosis and treatment and wonderful and practical articles published in this journal. Please add your attention.

The etiology of infectious diseases varies greatly according to different countries or regions. Every country with a large geographical area and a large population should have its own independent guidelines, and must not copy any other guidelines. It is undeniable that the guidelines formulated by European and American countries are usually relatively more well-founded, influential and authoritative. But even so, we should make appropriate amendments based on our own local research results, and if necessary, we should not hesitate to deny some of their views, and establish a more "grounded" guide that suits our own national conditions. Clinical medicine, especially infectious diseases, develops rapidly, and some views of "authoritative" guidelines will change dynamically and be updated constantly. Even some views are poorly considered or wrong at the beginning of their presentation, and have no universal application value. We must remain sober about this, and cannot go with the flow, follow what others say, and blindly worship without principle. Such as the 2016 U.S. Hospital Acquired Pneumonia (HAP) Guidelines of Concern^[1]There are three most important amendments. One is to completely deny the concept of medical institution-related pneumonia (HCAP), and the other two emphasize single-drug and short-course treatment respectively. The first is equivalent to correcting one's mistakes, and we raise our hands in favor. The author still has doubts about the second and third articles, and they do not meet the consensus regulations of many foreign experts and the current status of clinical medication, so they must be treated differently in clinical practice. Another example is Article 13 of the Guide, which states that drugs should be administered according to the pharmacokinetic and pharmacodynamic (PK/PD) characteristics of drugs, but only emphasizes the need for shortening the medication interval and continuous infusion, and does not mention how concentration-dependent drugs should be applied at all. It is easy to mislead people that "continuous infusion" should be required regardless of the type of drug. Such an oversight should not have appeared in such an authoritative guide. It cannot be denied that the clinical research in the field of infection in China is not in-depth enough, there are not enough influential papers, and the sample size is not large enough. However, because it comes from the local area and is based on its own etiological characteristics, its reference value is definitely greater than that of similar foreign studies. We can't just use evidence-based medical evidence grading theory to deny domestic research results, and mainly rely on foreign research results to formulate guidelines. The conclusions drawn must be wrong and will mislead clinical diagnosis and treatment.

Bronchiectasis (bronchiectasis) was first developed in 1819 by the French scholar Laennec^[1]Description, its characteristic symptoms include chronic cough, mucous or purulent sputum, and hemoptysis^[2,3]。 Bronchiectasis is a structurally destructive disease of the lung, and once it is formed, it is incurable. Although clinically common, related research lags far behind other lung diseases. To understand a disease from a clinical point of view, it is necessary to know its incidence, risk factors, pathogenesis, influence on patients and reasonable treatment plan, etc. However, there is lack of sufficient research data on these problems of bronchiectasis.

Bronchiectasis (bronchiectasis) is a chronic respiratory diseases with the characteristics of long course of disease and progressive decline of lung function, which can cause a huge socio-economic burden and reduce the quality of life of patients. In developed countries, bronchiectasis was once called "orphan disease", but in China, due to the infectious factors in early childhood not effectively controlled in time or the lack of unified and standardized treatment in the early stage of the disease, bronchiectasis has always been a common disease in China, but bronchiectasis is far less paid attention to in China than bronchial asthma and COPD^[1]。

Unconsciously, 2016 is about to complete its historical mission, and the footsteps of 2017 have quietly arrived. At the end of the year and the beginning of the year, let's review the progress made in tuberculosis prevention and control at home and abroad in 2016, and look forward to 2017.

A 47-year-old female was admitted to our hospital on December 5, 2015 due to "rash for 11 months, limb weakness for more than 8 months, cough and sputum for more than 3 months, and intermittent fever for 11 days". The patient developed rash on the forehead, periorbital, right neck and chest without obvious trigger 11 months ago. He went to the local hospital and was diagnosed as "allergy", and anti-allergic treatment was ineffective. I developed limb weakness 8 months ago and went to the local hospital, which was found to be 247 U/L for alanine aminotransferase, 545 U/L for aspartate aminotransferase, 9 879 U/L for creatine kinase, 371 U/L for creatine kinase isoenzyme, 1 092 U/L for lactate dehydrogenase, 1 158 U/L for α-hydroxybutyrate dehydrogenase and positive for antinuclear antibody (ANA) (1:320). Electromyography showed myogenic damage to the right biceps brachii, right anterior tibialis muscle, and left and right quadriceps femoris muscles, and the diagnosis was "dermatomyositis". Oral methylprednisolone 75 mg/d (reduced by 10 mg per month, reduced by 5 mg per month after 4 months of taking, and it has been reduced to 25 mg/d at this admission) and methotrexate 10 mg/week (the dosage was not adjusted at this admission) to control the disease. More than 3 months ago, I had a cough and yellow purulent sputum after catching a cold. I went to the local hospital for examination: C-reactive protein was 200 mg/L (reference value 0-10 mg/L), and ESR was 86 mm/1 h (reference value 0-20 mm/1 h); CT of the chest showed inflammation of both lungs, a small amount of pericardial effusion, bilateral pleural thickening, and a small amount of bilateral pleural effusion, partially wrapped. He was diagnosed as "dermatomyositis and respiratory tract infection", and was given anti-infective treatment for more than 2 weeks, and the symptoms were relieved. Re-examination of chest CT showed bronchiectasis and infection in the dorsal segment of the lower lobe of the right lung and the upper lobe of the left lung, inflammatory lesions in the lower lobes of both lungs, and bilateral pleural nodules. Two weeks ago, I coughed and expectorated again. Chest CT showed inflammatory changes in the lower lobe of the right lung and the left lung, and hypertrophy of the left pleura. Intermittent fever occurred 11 days ago, with a maximum body temperature of 39 ℃, accompanied by bilateral abdominal pain, which was aggravated when coughing. Abdominal magnetic resonance (MRI) examination in the local hospital showed left waist and left paraspinal lesions (Figure 1), chest CT showed nodules in both lungs, multiple nodules in bilateral pleura were significantly increased than before, partial consolidation of the left lower lung, bilateral pleural thickening, a small amount of pleural effusion, and a small amount of pericardial effusion. He was diagnosed as "dermatomyositis and pulmonary infection", and was treated with clindamycin phosphate, piperacillin/sulbactam and fluconazole, but the efficacy was poor, and he was later transferred to our hospital.

Bronchiectasis (bronchiectasis) is a common and frequently occurring disease in respiratory department, which seriously affects the quality of life of patients, increases the hospitalization rate and mortality rate, and brings a heavy economic burden to society^[1,2]。 For a long time, bronchiectasis has been regarded as a purulent infection in China, and less attention and research have been paid to it^[2]。 In recent years, with the aging of the population, the widespread application of high-resolution chest CT and the increasing attention of clinicians, the detection rate of bronchiectasis has been increasing, and the disease has regained the attention of researchers at home and abroad. Some new treatment methods including macrolides and inhaled antibiotics have accumulated more and more evidence-based evidence in clinical application. However, bronchiectasis is a heterogeneous group of diseases, and there are obvious differences in etiology, clinical manifestations, progression rate and outcome. Unfortunately, the lack of objectively recognized severity assessment tools for the disease for a long time has brought great troubles to clinicians, researchers and patients. In recent years, some important progress has been made in evaluating the severity of bronchiectasis. The progress is summarized as follows.

Bronchiectasis (bronchiectasis) is a chronic airway infectious disease with cough, expectoration and hemoptysis as the main manifestations. Bronchiectasis has been mistaken for a rare disease, but the prevalence of bronchiectasis in the UK in 2013 was 566.1/100,000 per year for women and 485.5/100,000 for men^[1]。 The prevalence of bronchiectasis in 7 provinces and cities in China is higher than 1% (10,000/100,000)^[2]。 Bacterial infection can cause airway inflammation and structural destruction. Pseudomonas aeruginosa was isolated from sputum in 29.7% of patients with stable bronchiectasis and Haemophilus influenzae in 9.5%^[3]。 Bacterial infection triggers airway inflammation and impairs lung function, especially in patients with P. aeruginosa colonization^[4]In addition to elevated levels of blood C-reactive protein and IL-8 and IL-1 β in sputum, these patients have worse lung function and more frequent acute exacerbations^[5]。 Pseudomonas aeruginosa clearance reduces risk of acute exacerbation^[6]To improve the clinical symptoms and prognosis of patients.

Bronchial asthma (asthma) is a chronic inflammatory disease characterized by airway hyperresponsiveness, inflammatory cell infiltration, excessive mucus production and airway remodeling, involving a variety of cells and cytokines. As the most common inflammatory cells in the airways, the role of alveolar macrophages in asthma has attracted increasing attention. Phenotypic diversity and plasticity are two important characteristics of alveolar macrophages^[1]。 Alveolar macrophages intervene in the pathophysiological process of asthma mainly by participating in airway inflammation and airway remodeling.

Pulmonary hypertension is characterized by progressive increase of pulmonary vascular pressure and resistance, and eventually leads to right heart failure. Its pathological features are abnormal contraction and remodeling of the distal pulmonary artery, including abnormal proliferation of pulmonary smooth muscle and endothelial cells. Pulmonary vein is an important part of pulmonary circulation, and its structural and functional changes directly affect the hemodynamic indexes of pulmonary circulation and pulmonary ventilation function. In recent years, the role of pulmonary vein in the pathogenesis of pulmonary arterial hypertension has been paid more and more attention by researchers. The results show that chronic hypoxia can not only cause the remodeling of human pulmonary arterioles but also the remodeling of distal pulmonary veins, and its pathological changes are media thickening and intima fibrosis^[1]。 Moreover, the proliferation and migration of distal pulmonary vein smooth muscle occurred in the rat model of hypoxic pulmonary hypertension^[2]。 However, the role of pulmonary vein in the pathogenesis of pulmonary hypertension is still unclear at present. Further in-depth research on the role of pulmonary vein in the pathogenesis of pulmonary hypertension can increase the understanding of the pathogenesis of the disease and provide new ideas for clinical diagnosis and treatment.

Sleep dyspnea is a group of clinical syndromes with complex etiology and serious harm to human health, among which OSAHS is the most common. The results of clinical studies show that OSAHS is a systemic disease and can cause multiple organ damage throughout the body. In recent years, OSAHS has gradually become one of the hot issues of common concern in respiratory department and other disciplines. In order to understand the current situation and development trend of OSAHS research in China, the research literature related to OSAHS published in the Chinese Medical Association series journals from 2011 to 2015 is summarized, counted and analyzed using bibliometric methods, and the reports are as follows.