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Acute respiratory distress syndrome (ARDS) refers to acute diffuse lung injury caused by a variety of intrapulmonary and/or extrapulmonary factors such as infection and trauma. Uncontrolled inflammatory response is the main pathological feature. Different functional states of alveolar macrophages have different effects on inflammatory response. Transcription activating factor 3 (ATF3) is a fast response gene in the early stage of stress. In recent years, it has been found that ATF3 plays an important role in regulating the inflammatory response of ARDS by regulating the function of macrophages. This paper reviews the regulatory effects of ATF3 on alveolar macrophage polarization, autophagy and endoplasmic reticulum stress and its effects on the inflammatory process of ARDS, aiming to provide a new research direction for the prevention and treatment of ARDS.
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Objective:To explore the clinical characteristics of imported malaria from Africa, and the correlation between blood lipids and disease severity.Methods:The clinical data of 172 imported malaria patients from Africa were collected from January 1, 2018 to January 31, 2021 in Guangzhou Eighth People′s Hospital, Guangzhou Medical University. The general conditions, clinical symptoms, laboratory tests, treatment and prognosis of the patients were analyzed retrospectively. The independent samples t-test, Mann-Whitney U test and binary multivariate logistic regression analysis were used for statistical analysis when appropriate. Results:A total of 172 patients were divided into 39 severe cases and 133 non-severe cases in this study. The main infection species was Plasmodium falciparum, with a total of 153 cases (89.0%), and the severe cases were all falciparum malarias. Compared with the non-severe group, the white blood cell count and triacylglycerol level were increased in the severe group.The differences were both statistically significant ( Z=2.397 and 4.368, respectively; both P<0.05). The hemoglobin, hematocrit, platelet count, high-density lipoprotein cholesterol, apolipoprotein A (ApoA)Ⅰ and ApoAⅠ/apolipoprotein B (ApoB) were significantly decreased in the severe group. The differences were all statistically significant ( Z=-4.473, -4.464, -4.750, -4.826, -5.488 and -4.419, respectively; all P<0.01). The total cholesterol and low-density lipoprotein cholesterol were also reduced in the severe group. The differences were both statistically significant ( t=3.817 and 5.285, respectively; both P<0.01). The area under receiver operator characteristic curve of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triacylglycerol, ApoAⅠ, and ApoAⅠ/ApoB were 0.754, 0.727, 0.730, 0.789 and 0.733, respectively (all P<0.01). When the Youden index was at its maximum, the best cut-off value of ApoAⅠ was 0.535 g/L with sensitivity of the prediction for severe malaria of 79.5% and the specificity of 68.4%. ApoAⅠ had independent predictive value for severe malaria (odds ratio ( OR)=0.013, 95% confidence interval ( CI) 0.002 to 0.086, P<0.01), and stratified according to the best cut-off value, the risk of severe malaria when ApoA Ⅰ<0.535 g/L was 8.396 times of ApoA Ⅰ≥0.535 g/L ( OR=8.396, 95% CI 3.557 to 19.820, P<0.01). The case fatality rate of severe malaria was 2.6%(1/39). Conclusions:The imported malaria patients from Africa are mainly infected with Plasmodium falciparum and the case fatality rate of severe malaria is high. The high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triacylglycerol, ApoAⅠ, ApoAⅠ/ApoB of blood lipids show higher predictive value for severe malaria, among which, ApoAⅠ has independent predictive value for severe malaria. Changes in blood lipids will help to identify severe malaria as early as possible, improve the cure rate, and reduce the risk of death.
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High mobility group protein B1 (HMGB1), a highly conversed non-histone nucleoproteins with strong pro-inflammatory property, is one of the inflammatory mediator of the acute respiratory distress syndrome (ARDS). Numerous studies have confirmed that HMGB1 regulates ARDS by binding to receptor for advanced glycation end product (RAGE), Toll-like receptor (TLR) and etc. And it can significantly increase the mortality of ARDS. But the mechanism of HMGB1 release is still unclear. This study focuses on the HMGB1 release progress, which connected with Janus kinases/signal transducer and activator of transcription (JAK/STAT), nuclear factor-κB (NF-κB), Notch, inflammasome, tumor necrosis factor (TNF), mitogen-activated protein kinase (MAPK), reactive oxygen species (ROS), peroxisome proliferator-activated receptor (PPAR) and other signaling or dependent pathways in ARDS.
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Objective To evaluate the application value of early lung ultrasound score(LUS)in the eval-uation of severity and prognosis of severe pneumonia and investigate its correlations with oxygenation index(OI), alveolar-arterial oxygen difference(A-aDO2),lymphocyte count(LYM),positive end-expiratory pressure(PEEP), acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score,and clinical pulmonary infection score (CPIS). Methods Thirty severe pneumonia patients admitted to intensive care unit(ICU)of Guangzhou Eighth People's Hospital from May 2015 to July 2017 were enrolled,including 14 cases with low PEEP and 16 cases with high PEEP. Among them,17 patients were diagnosed with non-viral pneumonia and 13 ones with viral pneumonia;15 of them survived,and 15 died. The clinical data and cores of all patients were recorded by one observer,including baseline date,OI,A-aDO2,LYM,PEEP,and APACHEⅡ and CPIS score. The other observer was specifically responsible for pulmonary ultrasonography and LUS. The correlation between LUS and OI,A-aDO2,LYM,PEEP, as well as APACHEⅡand CPIS scores was analyzed by bivariate correlation analysis. Receiver operator character-istic curves(ROC)were plotted,and the prediction value,sensitivity and specificity of high PEEP and mortality by LUS were calculated respectively. Results LUS had a negative correlation with OI(r =-0.755,P = 0.000) and LYM(r =-0.518,P = 0.03),and a good positive correlation with A-aDO2(r = 0.642,P = 0.000),PEEP (r = 0.583,P = 0.001),APACHEⅡ(r = 0.461,P = 0.010)and CPIS(r = 0.595,P = 0.001)was respectively found. LUS in the survival group was significantly lower than the death group(15.00 ± 5.90 vs. 22.27 ± 4.68,P<0.01),low PEEP group was obviously lower than high PEEP group(14.23 ± 5.40 vs. 22.00 ± 4.98,P < 0.01), and there was no significant difference between non-viral pneumonia group and viral pneumonia group(18.59 ± 6.49 vs. 18.69 ± 6.56,P > 0.05). The area under ROC cure(AUC)was calculated:the predictive value for high PEEP by LUS was 19,with the sensitivity of 77% and specificity of 92%,and the patients with LUS > 17 had a high mortality,with the sensitivity for predicting death of 87% and specificity of 67%. Conclusion Bedside lung ultrasound can easily evaluate the changes in pulmonary ventilation area ,and early LUS has important clinical application value in assessing the severity and prognosis of severe pneumonia patients.
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Objective To analyze the risk factors of chronic obstructive pulmonary disease (COPD) in acute exacerbation (AE-COPD)complicated with pulmonary embolism ,and to provide reference for the pathogenesis and treatment .Methods A total of 73 patients with COPD suspected PE admitted to our hospital from May 2015 to April 2016 were enrolled in this study .All patients were examined including WBC ,Neu% ,CRP ,IL-8 ,ESR ,PCT ,ET-1 ,D-dimer ,fibrinogen ,NT-proBNP ,myocardial enzyme ,arterial blood gas ,lactic acid ,CT pulmonary angiography(CTPA)within 48 h of admission .The risk factors of AECOPD with PE or with-out PE were analyzed .Results There were 15 cases with PE ,58 cases without PE in all objects .Neu% ,PCT ,NT-proBNP ,D-di-mer ,LDH ,cTnI ,CRP ,IL-8 ,ET-1 in patients with PE were significant higher than those in patients without PE (P<0 .05) .In the PE group ,the correlation coefficient between CRP and IL-8 was 0 .457(P=0 .087) ,the correlation coefficient between CRP and ET-1 was 0 .598(P=0 .019) ,the correlation coefficient between IL-8 and ET-1 was 0 .695(P=0 .004) .Conclusion Acute exacer-bation of COPD combined with PE is associated with the severity of inflammation in the body ,the more serious the inflammatory re-action ,the corresponding increase in myocardial injury ,the higher the risk of PE .
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Objective To analyze the risk factors of chronic obstructive pulmonary disease (COPD) in acute exacerbation (AE-COPD)complicated with pulmonary embolism ,and to provide reference for the pathogenesis and treatment .Methods A total of 73 patients with COPD suspected PE admitted to our hospital from May 2015 to April 2016 were enrolled in this study .All patients were examined including WBC ,Neu% ,CRP ,IL-8 ,ESR ,PCT ,ET-1 ,D-dimer ,fibrinogen ,NT-proBNP ,myocardial enzyme ,arterial blood gas ,lactic acid ,CT pulmonary angiography(CTPA)within 48 h of admission .The risk factors of AECOPD with PE or with-out PE were analyzed .Results There were 15 cases with PE ,58 cases without PE in all objects .Neu% ,PCT ,NT-proBNP ,D-di-mer ,LDH ,cTnI ,CRP ,IL-8 ,ET-1 in patients with PE were significant higher than those in patients without PE (P<0 .05) .In the PE group ,the correlation coefficient between CRP and IL-8 was 0 .457(P=0 .087) ,the correlation coefficient between CRP and ET-1 was 0 .598(P=0 .019) ,the correlation coefficient between IL-8 and ET-1 was 0 .695(P=0 .004) .Conclusion Acute exacer-bation of COPD combined with PE is associated with the severity of inflammation in the body ,the more serious the inflammatory re-action ,the corresponding increase in myocardial injury ,the higher the risk of PE .
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Objective To evaluate the effect of oral roxithromyein on lung function in chronic obstructive pulmonary disease (COPD) and analyse the probable mechanism. Methods Fifty patients with COPD were divided randomly into treatment group (25 eases) and control group (25 eases). The control group was treated with base therapy, and the treatment group was treated with oral roxithromycin beside base therapy, 0.15 g, twice one day for one year. Then the changes of peripheral blood neutrophil and lung function was observed before and after treatment, and the times of acute exacerbation were statistically analyzed.Results There was significant difference in the changes of peripheral blood neutrophil in treatment group (P<0.05). The ratio of forced expiratory volume in one second and forced vital capacity (FEV_1/FVC),FEV_1% pred, peak expiratory flow, maximal vital volume had no obvious change in treatment group (P>0.05), but had obvious decrease in control group (P<0.05 ). There was significant difference in the changes of lung function in two groups(P<0.05 ). The times of acute exacerbation were 10(40%) in treatment group and 19 (76%) in control group, and the times of need to be in hospital were 6 (24%) and 13 (52%)respectively. There were significant difference (P<0.05). Conclusion Long-term oral roxithromyein can protect the lung function of COPD patients, the probable mechanism is that roxithromyein inhibit the neutrophil's function.