【摘要】 目的 研究肺癌患者的氣道高反應性和肺通氣功能情況，并探討其易感因素，為肺癌患者肺通氣功能的臨床評估提供依據。 方法 對2010年4月-2011年4月收治的40例肺癌患者（A組）進行術前肺功能檢測及氣管激發試驗，選取同期的健康體檢者40例做對照組（B組），并采用logistic逐步回歸分析肺癌患者的氣道高反應性的易感因素。 結果 ①A組患者的用力肺活量、第1秒用力呼氣容積（forced expiratory volume in one second，FEV1）、最高呼氣流量（peak expiratory flow，PEF）以及最大呼氣中期流量均小于B組，且差異有統計學意義（P=0.000）；②A組的FEV1估計異常人數和PEF估計異常人數均多于B組（Plt;0.05）；③A組組胺氣道激發試驗陽性者多于B組（χ2=5.000，P=0.025），且A組PD20FEV1低于對照組[分別為（4.69±0.82）、（8.32±1.43）μmol/L；t=13.930，P=0.000]；④logistic逐步回歸分析表明影響A組患者的氣道高反應性的因素為年齡、分型、TNM分期、病史、吸煙。 結論 肺癌氣道反應性增高，且肺功能下降，由于肺癌氣道高反應性的易感因素較多，因此需對合并因素較多者進行及時的預防，防止由于氣道阻力增加和氣道狹窄引起的胸悶、咳嗽、喘息和呼吸困難等癥狀。【Abstract】 Objective To learn the condition of bronchial hyper-reactivity and pulmonary function in patients with lung cancer, and explore the risk factors for bronchial hyper-reactivity in order to provide clinical reference for pulmonary function evaluation in patients with lung cancer. Methods Forty patients with lung cancer treated in our hospital from April 2010 to April 2011 (research group) took pulmonary function and tracheal stimulation tests before operation, and in the meanwhile, 40 healthy people were chosen as controls. The logistic regression analysis was employed to analyze the risk factors for bronchial hyper-reactivity. Results The forced vital capacity, forced expiratory volume in one second (FEVl), peak expiratory flow (PEF) and maximal mid expiratory flow in the research group patients were all significantly lower than those in the control group patients (P=0.000). The number of patients with estimated FEVl and PEF abnormality in the research group was more than that in the control group (P=0.05). The number of patients positive in histamine bronchial provocation test in the research group was more than that in the control group (χ2=5.000, P=0.025), and the PD20FEV1 level of the research group was lower than that of the control group [(4.69±0.82) and (8.32±1.43) μmol/L; t=13.930, P=0.000]. Logistic regression analysis showed that the risk factors for bronchial hyper-reactivity in patients with lung cancer were age, type, TNM stage, history of lung cancer, and smoking. Conclusions The airway reactivity elevates and the lung cancer pulmonary function decreases in lung cancer patients. Because there are many risk factors, prevention should be taken for patients with combined risk factors to avoid the occurrence of chest distress, cough, gasp and dyspnea caused by increased airway resistance and stricture.
目的 探討成人間活體肝移植術后受體真菌感染的特點與易感因素。 方法 回顧性分析2006年1月－2012年12月189例成人活體肝移植的臨床資料。采用Cox回歸分析受體術后真菌感染的易感因素。 結果 189例受體中有12例患者術后真菌培養陽性。術后最常見的真菌病原體為白假絲酵母菌，最常見的感染部位為肺部。多因素分析顯示術前低白蛋白[HR=0.792，95%CI（0.694，0.903），P=0.001]、術中大量輸血[HR=4.322，95%CI（1.308，14.277），P=0.016]、術后重癥監護病房（ICU）時間長[HR=3.399，95%CI（1.004，11.506），P=0.049]是活體肝移植術后真菌感染的易感因素。 結論 成人間活體肝移植術后真菌感染好發于肺部，與術前低白蛋白、術中大量輸血、術后ICU時間住院時間長有關。