Volume 96  ·  Issue 06  ·  2016

Tumors have a long history with us human beings. The British Guardian reported that there was cancer in the dinosaur period. Cancer occurred based on various genetic defects, not a single disease, but a loose combination of hundreds of disease factors. Cancer, like human beings, is constantly evolving for survival. The longer the life span, the greater the possibility of cancer, and no one can completely avoid the risk of cancer.

acute respiratory distress syndrome (ARDS) is a kind of acute and diffuse inflammatory lung injury. It is one of the common respiratory critical diseases that endanger human health. The mortality rate of severe ARDS patients in intensive care unit (ICU) is 40% ~50%^[1,2,3]。 Mechanical ventilation is the key medical measure in the treatment of ARDS patients. Rational mechanical ventilation treatment strategy can significantly reduce the mortality rate, otherwise it will further aggravate the deterioration of the disease^[4]。 In recent years, with the deepening of the understanding of the pathophysiology of ARDS and the continuous development of clinical respiratory support technology, the mechanical ventilation treatment strategy of ARDS has also undergone significant changes. In order to update the understanding of mechanical ventilation therapy for ARDS and standardize its clinical application, the Respiratory Critical Care Medicine Group of Respiratory Medicine Branch of Chinese Medical Association summarized and constructed 12 important problems in clinical practice according to the latest research progress at home and abroad, and adopted the evidence-based medicine method-GRADE (Grades of Recommendation, Assessment, Development, and Evaluation), which is widely used in the world^[5]The "Guidelines for Mechanical Ventilation in Patients with Acute Respiratory Distress Syndrome (Trial)" (hereinafter referred to as the "Guidelines") was developed.

To explore the multidisciplinary therapeutic mode, clinical effect and prognostic factors of pancreatic cancer with liver metastases (PCLM).

We retrospectively selected 497 consecutive patients with PCLM who were pathologically diagnosed and treated at Tianjin Medical University Cancer Hospital, from January, 2000 to December, 2012. Clinical characteristics, treatment modality, survival condition and factors associated with prognosis of these cases were analyzed, and efficacy of multidisciplinary treatment model was evaluated.

Of these patients, the male/female ratio was 1.85∶1, with a median age of 59. A total of 358 (72.0%) cases had synchronous liver metastases, and 173 (34.8%) cases complicated with extrahepatic metastases. The 0.5, 1, 3, 5 year survival rates of 497 patients were 44.1%, 19.7%, 3.2% and 2.2%, respectively, with a median survival (MS) of 5.4 months. Patients who were treated with 3 or more approaches (including surgery, chemotherapy, radiation therapy, interventional therapy, and physiotherapy) had a longer median survival time than patients treated with 2 or only 1 approach (MS: 8.6 vs 5.2 vs 4.6 months, P< 0.001). Multivariate analysis for clinical features and treatment modality showed that age, weight loss, ascites, karnofsky performance score (KPS), primary site resection, albumin, carbohydrate antigen (CA) 19-9, resection of liver metastases, radiation therapy and systemic chemotherapy were prognostic variables with statistical significance.

PCLM is a refractory malignant tumor. Age >60, weight loss (≥10% within 3 months), ascites, KPS <80, albumin<35 g/L, and CA19-9 ≥500 U/ml were the most relevant predictors of poor survival. Multimodal treatment using curative resection of pancreatic cancer and/or liver metastases, systemic chemotherapy and radiation therapy may improve the prognosis and survival rate sufficiently.

To evaluate the security, feasibility and therapeutic efficacy of modified Appleby operation for carcinoma of the body and tail of pancreas.

From March 2010 to February 2015 modified Appleby operation was performed in 17 patients with carcinoma of the body and tail of the pancreas. The biochemical indices of fasting plasma blood (FPB), body weight (BW), visual analogue pain intensity scale (VAS score) and the quality of life index were evaluated before and 1 day , 1, 2, 6weeks after surgery. Survival time, tumor recurrence time, hospitalization time and treatment-related complications were analyzed.

There was no hospital mortality in this study. Pancreatic fistula and diarrhea were the major complications. The overall complication rate was 47.1%. The liver function index of ALT and AST were increased on postoperative day 1, and they were restored to normal after one week. Blood glucose has no obvious abnormal increase and abdominal pain was completely relieved. The VAS score decreased after surgery comparing with before (1.9±3.6 vs 83.2±8.5, P<0.05). Life quality assessment was significantly higher. The body weight of patients after surgery has a mean increment of (4.1±1.3)kg than that before surgery (68.1±4.3 vs 64.0±6.7,P<0.05). A significant rise of the overall quality of life index was observed after surgery (93.8±9.7 vs 68.6±6.7,P<0.05). The recurrence rates of 1, 2, 3 and 5 years were 22.9%, 58.9%, 72.6% and 72.6%, respectively. Median recurrence time was (20.0±3.8 m) (95%CI: 12.6-27.4 m). The survival rates of 1, 2, 3 and 5 years were 80.4%, 54.2%, 32.5% and 16.3%, respectively. The median survival time was (26.0±6.0)m (95%CI: 14.2-37.8 m).

Modified Appleby operation for pancreatic cancer is safe and feasible. It can relieve abdominal pain, improve the quality of life, improve the survival rate and prolong the survival time.

To explore the feasibility of the telescopic technique associated with mucosectomy in preventing pancreatic fistula after pancreaticoduodenectomy (PD).

The data of 39 patients who received PD in the Affiliated Hospital of Nantong University was retrospecively analyzed. We developed a safe and simple method of pancreaticojejunostomy in 39 patients, in whom approximately 3 cm of jejunal mucosa was cut to improve the adhesion between the loop and pancreatic parenchyma after end-to-end invagination.

This procedure was proved to be much more expeditious, and only 2 of 39(5.1%)patients had pancreatic leakages, who were treated with drainage only. No hemorrhage or cholangitis was observed. No postoperative mortality was observed.

The telescopic technique associated with mucosectomy is an acceptable and safe surgery for pancreaticojejunal anastomosis.

To investigate whether Sirolimus could affect the glycolytic catabolism pathways of pancreatic carcinoma through the control of hypoxia induced factor (HIF-1α) to inhibit the growth of tumor, and explore the potential mechanism of targeting the signaling pathways of mTOR for the treatment of pancreatic carcinoma.

Sirolimus was applied to treat the pancreatic carcinoma in nude mice orthotopic transplantation model, its difference with the control group was compared; RT-PCR and Western blot were used to measure the mRNA and protein expression of mTOR, HIF-1α, Glucose carrier protein 1 (GLUT-1) and Hexokinase Ⅱ (HK-Ⅱ), respectively; the changes of activity of HK-Ⅱ in the tumor was determined.

The tumor mass of the control group (1.97±0.21)g was significantly larger than that of the Sirolimus group (0.38±0.10)g (P<0.01), and the volume of the control group (1.40±0.15) mm³ was significantly larger than that of the Sirolimus group (0.27±0.07) mm³ (P<0.01). The expressions of mTOR, GLUT-1 and HK-Ⅱ mRNA in the control group were higher than those of the Sirolimus group (P<0.05), while no significant change was observed in the expression of HIF-1α (P>0.05); the expressions of p-mTOR, HIF-1α, GLUT-1 and HK-Ⅱ proteins in the control group were higher than those of the Sirolimus group (P<0.05). The activity of HK-Ⅱ in the control group was higher than that of the Sirolimus group (P<0.05).

Sirolimus could affect the expression of GLUT-1 and HK-Ⅱ in pancreatic carcinoma through the effects of HIF-1α to inhibit tumor growth, indicating that blocking the mTOR pathway could control the glycolytic metabolism pathways of pancreatic carcinoma, which may become the new strategy for the treatment of pancreatic carcinoma.

To screen the nutritional risk in patients with Crohn's disease (CD), to explore the prevalence and characteristics of nutritional risk in CD patients, and to identify the possible risk factors.

A cross-sectional study was performed in 712 patients who was diagnosed as CD in the Center for Inflammatory Bowel Disease of First Affiliated Hospital of Sun Yat-sen University between January 2003 and January 2014. Montreal classification was used to classify CD, Crohn's Disease Activity Index (CDAI) was used to evaluate disease activity, and Nutritional Risk Screening 2002 (NRS2002) was used to assess the nutritional risk in each patient. Reappraisal with NRS 2002 was conducted in patients followed up for 1 year to identify the possible effect of treatment on nutritional risk of the CD patients.

The prevalence of nutritional risk was 65.2% (464/712) in the enrolled CD patients. The prevalence of nutritional risk was significantly different among patients with different disease activity (χ²=117.169, P<0.001), also significantly different among patients of different age at diagnosis (χ²=11.256, P=0.004), with different lesion location (χ²=18.841, P=0.001) and different disease behavior (χ²=15.793, P<0.001), but not significantly different in patients of different sex (χ²=0.601, P=0.245). Multivariate Logistic regression showed that the independent predictive risk factors for nutritional risk included abdominal tenderness (OR=1.895, 95%CI: 1.080-3.324); mild (OR=1.846, 95%CI: 1.179-2.890), moderate (OR=4.410, 95%CI: 2.701-7.200) and severe (OR=14.069, 95%CI: 1.718-115.192) disease activity; B2 (stricturing) (OR=1.620, 95%CI: 1.034-2.538) and B3 (penetrating) (OR=1.920, 95%CI: 1.025-3.596) types of disease behavior; and high level with erythrocyte sedimentation rate (ESR) (OR=1.024, 95%CI: 1.015-1.034). On the other hand, >40 years at diagnosis (A3 type) ( OR=0.332, 95%CI: 0.135-0.814) and high albumin level (OR=0.962, 95%CI: 0.934-0.990) were independent protective factors for nutritional risk. After 1-year follow-up, nutritional risk was eliminated in 32.0%(111/347)of the patients, and the rate was higher in patients received surgery than in those treated with medicine alone (42.9%(54/126)vs 25.8%(57/221), χ ²=10.742, P=0.001).

Two thirds of CD patients may have nutritional risk at diagnosis, which may differ with disease activity and Montreal classification. Abdominal tenderness, disease activity, B2 and B3 types of disease behavior, and high ESR may be independent risk factors for nutritional risk, whereas A3 type of age at diagnosis and high albumin level may be independent protective factors.

To analyze the efficacy and safety of surgery and endovascular management in treating Takayasu arteritis.

The data of 116 patients (24 males and 92 females; mean age (32±12) years) with Takayasu arteritis and underwent surgery or endovascular therapy was retrospective analyzed. According to the two different surgical procedures, the patients were divided into two groups: open repair group and endovascular repair group. One hundred and fifty-four surgical procedures were done including 69 cases of open repair and 85 cases of endovascular repair. A total of 211 arterial lesions were revascularized (open repair 114; endovascular repair 97).

Among the 154 surgical procedures, 11(7.1%) presented a complication during perioperative period including 6(8.7%) of open repair and 5(5.9%) of endovascular repair. After a median follow-up of 38.5(0.5-142.0) months, three(4.3%) cases of stroke and death were observed in open repair group, two(2.3%) cases of stroke and 4(4.7%) cases of death were observed in endovascular repair group. At 1, 3, 5 and 10 years of follow-up, primary patency rate of open repair and endovascular repair were 95.0% and 89.3%, 84.3% and 69.8%, 73.3% and 56.3%, 53.4% and 48.1%, respectively; Primary assisted patency rate were 100% and 97.5%, 90.4% and 78.2%, 79.1% and 72.8%, 60.7% and 54.0%, respectively; Secondary patency rate were 100% and 98.8%, 95.6% and 92.7%, 85.8% and 78.1%, 74.8% and 58.0%, respectively. Cumulative survival rate were 97.0% and 100%, 97.0% and 97.6%, 97.0% and 90.6%, 91.3% and 84.5%, respectively (χ²=0.182, P=0.669).

Both of the surgical revascularization and endovascular management are safe and effective in the treatment of Takayasu arteritis. Although long-term patency of endovascular therapy is low, it can be performed repeatedly and can be used as a preferred approach in treating a short stenosis. Surgical repair shows excellent long-term durability, it seems to be more suitable for complex lesions and failure cases of endovascular management.

To compare the effectiveness of the jaw thrust and the trapezius squeezing test(TST) for laryngeal mask airway (LMA) insertion in infants and children under sevoflurane anesthesia.

A total of 100 children aged from 6 month to 3 years, American Society of Anesthesiologists(ASA) Ⅰ-Ⅱ and undergoing minor operation were enrolled from January to June 2015 in Tianjin Children's Hospital. The patients were randomly divided into jaw thrusting group (Group J,n=50)and trapezius squeezing group(Group T, n=50). Anesthesia was induced with sevoflurane. When children's eyelash reflex lose, jaw thrust/trapezius squeeze was applied every 15 seconds.It's considered that the depth of anesthesia was not enough, and test reaction was positive if any movements of body, limbs or toes were found at the point of test. Sevoflurane should be keep on inhalation until negative test reaction was appeared. Then LMA was inserted immediately.The time required for the negative test, end-tidal sevoflurane concentrations (ETsev), the index of Narcotrend anesthesia monitor(NT), the occurrence of gross purposeful movements, coughing, gagging, breath-holding, laryngospasm or an SpO₂ < 90% during LMA insertion in two groups of patients were observed and recorded. The condition of LMA insertion and the rate of successful insertion were evaluated. The blood pressure(BP), heart rate(HR) and SpO ₂ were also recorded before and after LMA insertion.

In group J and group T, the time required for the negative test was (2.31±1.03) vs (2.85±0.97)min(t=-2.462, P<0.05), ETsev was(3.25±1.02)% vs (3.81±0.87) %(t=-2.361, P<0.05), the depth of anesthesia NT index was(50.41±5.38) vs (41.32±4.92)(t=3.021, all P<0.05). All of above results were significantly different. The successful rate of the first attempt LMA insertion was 78% vs 100%(χ²=12.36 , P<0.01), respectively. The differences had statistical significance. The conditions of LMA insertion in group T were superior to those in group J. The incidences of gross purposeful movements, coughing, gagging, breath-holding and SpO₂<90% during LMA insertion in group J were 20%, 16%, 10%, 14% and 8%, which were higher than those in group T (2%, 2%, 0, 2%, 0), the differences were significant(χ²=8.27, 5.98, 5.26, 4.89, 4.17, all P<0.05). No significant change in blood pressure, heart rate and SpO₂ were found before and after inserting LMA in two groups.

The trapezius squeezing test is a superior indicator of adequate condition for LMA insertion compared to the jaw thrust in infants and young children under sevoflurane anesthesia.

To investigate the methylation status of promoters of protocadherin-10 (PCDH10) and Ras-association domain family 1A (RASSF1A) genes in colorectal cancer (CRC), and to study its relationship with development and progress of CRC.

Tumor tissues were collected from 75 CRC patients who received surgical treatment in the Affiliated Hospital of Guizhou Medical University in the period from 2007 to 2010. Methylation-specific polymerase chain reaction (MSP) was applied to detect the methylation status of PCDH10 and RASSF1A gene promoters in CRC and adjacent normal colorectal mucosa. The relationship between methylation of PCDH10 and RASSF1A and clinicopathological features of CRC was analyzed using chi-squared test.

The rate of PCDH10 methylation in CRC tissue was significantly higher than that in colorectal normal mucosa (58.7%(44/75)vs 22.7%(17/75), P<0.01). There was no significantly correlation between methylation of PCDH10 and patients' age, gender, tumor site, Dukes stage, and lymph node metastasis(allP>0.05). The rate of RASSF1A methylation in CRC tissue was significantly higher than that in colorectal normal mucosa (64.6%(42/65)vs 15.4%(10/65),P<0.01). There was no significantly correlation between methylation of RASSF1A and patients' age, gender, and tumor site (allP>0.05), but the patients in high Dukes stages and with lymph node metastasis had higher RASSF1A methylation rate(92.9%(26/28)vs 43.2%(16/37), 92.9%(26/28)vs 43.2%(16/37), bothP<0.05).

CRC tissues demonstrate high level of methylation of PCDH10 and RASSF1A genes, which may play a crucial role in the pathogenesis of CRC. The aberrant hypermethylation of RASSF1A gene is observed in more advanced CRC, suggesting that the RASSF1A gene methylation may be related to progression of CRC.

To calculate the survival rate of patients with superficial esophageal squamous carcinoma who received esophageal resection and to explore factors that affect prognosis.

There were 285 patients with pTis-T1 esophageal carcinoma who underwent esophagectomy during 2007-2011. Their cumulative survival rates were calculated using life tables. Nine factors that may have impact on postoperative survival of superficial esophageal carcinoma were selected. The Kaplan-Meier method and COX's regression model were used to select prognostic factors, estimate prognostic index, and establish risk stratification.

The 1-, 3- and 5-year overall survival rates of superficial esophageal carcinoma patients were 97%, 86%, and 82%, respectively. Tumor length, stenosis, depth of invasion, differentiation degree, lymph node metastasis, and vascular tumor thrombus were associated with prognosis according to univariate analysis. Depth of invasion (OR=2.065, P=0.029), lymph node metastasis (OR=2.049, P=0.041), differentiation degree (OR=3.828, P=0.000), stenosis(OR=2.129, P=0.048), and vascular tumor thrombus (OR=4.222, P=0.004) were independent prognostic factors in multivariate analysis. A prognostic models was thus established and all the patients were divided into low-risk, moderate-risk and high-risk group, with the 3-year survival rates being 95%, 84%, and 51%, and 5-year survival rates being 93%, 79%, and 44%, respectively.

Patients with superficial esophageal cancer have relatively favorable prognosis. Depth of invasion, differentiation degree, stenosis, lymph node metastasis, and vascular tumor thrombus may be independent factors of poor prognosis. Survival rate of moderate- and high-risk patients is yet to be improved.

To investigate the protective effect of compound bismuth and magnesium granules on aspirin-induced gastric mucosal injury in rats and its possible mechanism.

Acute gastric mucosal injury model was developed with intraperitoneal injection of aspirin in Wistar rats. The rats were divided into normal control group, injury group, sucralfate protection group, compound bismuth and magnesium granules protection group and its herbal components protection group(each group 12 rats). In the protection groups, drugs as mentioned above were administered by gavage before treated with intraperitoneal injection of aspirin. To evaluate the extent of gastric mucosal injury and the protective effect of drugs, gastric mucosal lesion index, gastric mucosal blood flow, content of gastric mucosal hexosamine, prostaglandins (PG), nitric oxide(NO), tumor necrosis factor (TNF), and interleukin (IL) -1, 2, 8 were measured in each group, and histological changes were observed by gross as well as under microscope and electron microscope.

Contents of hexosamine, NO, and PG in all the protection groups were significantly higher than those in the injury group (all P<0.01), and content of NO in the compound bismuth and magnesium granules group was significantly higher than that in the sucralfate group ((11.29±0.51) vs(10.80±0.36)nmol/ml,P<0.05). The gastric mucosal lesion index, contents of TNF, and IL-1, 2, 8 were significantly lower in all the protection groups than in the injury group (allP<0.01), and contents of IL-2 and IL-8 in the compound bismuth and magnesium granules group were significantly lower than those in the sucralfate group ((328.17±6.56) vs(340.23±8.05)pg/ml,P<0.01; (170.82±7.31) vs(179.31±7.80)pg/ml,P<0.05). Tissue injury and inflammatory reaction in all the protection groups were obviously mitigated compared with the injury group.

Compound bismuth and magnesium granules and its herbal components may have significant protective effect on aspirin-induced gastric mucosal injury.

To explore the expression and mechanism of different nitric oxide synthase in cerebral hyperperfusion rats.

Male Wistar rats were anesthetized and a ventral midline incision was made. The bilateral common carotid arteries were gently separated. Each artery was ligated with a 5-0 silk suture. Sham groups underwent the same operation without occlusion two weeks later, the ligature was loosened under a microscope to induce reperfusion. Phenylephrine was administered at concentration of 50 μg/ml via tail vein.After hyperperfusion, the expression of iNOS and eNOS in hippocampus , cortex and common carotid arteries of rats brain was observed by using Western blot of each group.

The expression of iNOS in differernt sites were increased significantly after reperfusion of 24 hours. The ratio of iNOS and β-actin in hippocampus in sham, BCAO, HP, HP 24 and HP 48 groups were 21.10±2.53, 24.37±2.30, 28.34±2.86, 43.76±2.58, 38.90±3.17, respectively. There was significant difference between HP 24 and other groups ( F=13.03, all P<0.05). The ratio of iNOS and β-actin in cortex in each group were 12.98±2.31, 15.00±1.66, 14.71±1.48, 34.76±5.01, 32.60±5.73, respectively (F=8.42, all P<0.05). The ratio of iNOS and β-actin in common carotid arteries in each group were 7.30±2.55, 8.83±1.45, 4.76±0.71, 28.00±2.21, 26.29±3.33 (F=24.82, all P<0.05). While the levels of eNOS in that three sites presented no significant change(allP>0.05).

Hyperperfusion can induce iNOS ecpression in quantities in hippocamps, cortex and common carotid arteries. These levesl would last until 48 hours after reperfusion. This process suggests that iNOS is the possible mechanism of hyperperfusion.

Pulmonary function in patients with severe chronic obstructive pulmonary disease (COPD) is no longer suitable for lung resection, but lung volume reduction surgery in such high-risk patients can improve lung function, relieve symptoms and improve quality of life in a short time, and buy time for donors waiting for lung transplantation^[1,2,3]。 Our hospital has gained some experience in the anesthesia management of lung volume reduction surgery in patients with severe COPD, which is summarized as follows.

A 77-year-old male was admitted to the hospital on 7 February 2013 mainly due to "anorexia for 3 days". The patient had anorexia 3 days before admission, no abdominal pain, no nausea, vomiting, no yellowing staining of the skin and sclera, no defecation for 3 days, and exhaustion. He went to the emergency department of our hospital, and the routine blood test showed: hemoglobin 85 g/L; Fecal occult blood positive (+); Gastroscopy showed: multiple gastric ulcers; He was discontinued from aspirin, fasted water, acid suppression, fluid rehydration and other treatments, and was admitted to the hospital for further treatment. Past history: 50-year history of hypertension, highest blood pressure 180/110 mmHg (1 mmHg =0.133 kPa), long-term oral felodipine 2.5 mg/d, blood pressure control; He had a history of cerebral infarction for 10 years, and was treated with long-term oral aspirin 100 mg/d and Tongxinluo and ginkgo leaves; 10 years of chronic glomerulonephritis. Physical examination at admission: pulse 80 beats/min, blood pressure 110/60 mmHg, anemia appearance, no obvious positive signs on heart, lung and abdomen examination. Laboratory test after admission: blood routine: white blood cells 13.37×10⁹/L, hemoglobin 76 g/L, platelets 213×10⁹/L; Biochemistry: alanine aminotransferase 14 U/L, aspartate aminotransferase 30 U/L, total bilirubin 34.54 μ mol/L, direct bilirubin 12.57 μ mol/L, creatinine 131 μ mol/L, urea nitrogen 15.28 mmol/L; Coagulation function: prothrombin time (PT) 12.9 s, prothrombin activity 76.6%, activated partial prothrombin time 42 s, plasma fibrinogen 2.22 g/L, D-dimer 9.8 mg/L; After admission, the active gastrointestinal bleeding of the patient was controlled after treatment. Three days after admission, the patient complained of muscle pain in the right lower limb with fever, and the body temperature was 39.0 ℃. Blood test routine: white blood cells 5.7×10⁹/L, the percentage of midline granulocytes was 0.821, and the soft tissue ultrasound of the right leg showed that there was no echo and flocculate echo between the fat layer and the muscle layer in the inner and lower part of the right thigh, with a range of about 6.1 cm ×3.4 cm. Hematoma was considered first; CT of the right lower limb showed: swelling of the soft tissue on the medial and posterior side of the right thigh, mass-like slightly high-density shadow, peripheral exudation, and possible hematoma; According to the orthopedic consultation advice, the patient was treated with hot compress and intravenous drip of second-generation cephalosporin antibiotics for anti-infective treatment. The pain and swelling of the patient's right lower limb gradually decreased, and the extent of hematoma gradually decreased. 15 days after admission, the patient suddenly lost consciousness and lost consciousness after vomiting twice. The blood pressure was 130~150/80~90 mmHg, and the heart rate was 138 beats/min. Emergency head CT showed multiple cerebral hemorrhage and subarachnoid hemorrhage in the right temporal region, right temporofrontal parietal lobe, head of corpus callosum, part of the sulcus and cistern; Right subarachnoid hemorrhage was not excluded, the left lateral ventricle and the third ventricle were compressed and narrowed, the fourth ventricle was narrowed, and the midline shifted to the left; Please consult with neurology and surgery to explain the advantages and disadvantages of craniotomy and puncture and hematoma drainage to the family members. The family members gave up the operation and asked for conservative treatment. The treatment effect of dehydration and brain rejuvenation was not good, and the patient died nearly 10 hours later.

There are many risk factors for bronchial asthma, including host factors such as genetics and obesity, as well as environmental factors such as smoking and pet keeping^[1]Long-term repeated stimulation by various factors eventually leads to the occurrence of airway remodeling in asthma. Airway remodeling involves immune, inflammatory and structural changes of the airway, which are characterized by irreversible airflow restriction, increased airway resistance and increased airway hyperresponsiveness. It is the pathological basis of refractory asthma^[2]。 Early studies showed that serum angiotensin (Ang) converting enzyme (ACE) activity was significantly increased in asthma patients, and total IgE levels were significantly correlated with serum ACE activity, suggesting that asthma may be related to renin-Ang system (RAS)^[3,4]。 In recent years, in the studies of myocardial vascular remodeling and renal fibrosis, it has been found that local fibrosis and collagen deposition are accompanied by RAS expression^[5,6]。 The involvement of local RAS in the process of airway remodeling and related signaling pathways in asthma has gradually become a research hotspot.

At present, the clinical effect of anti-inflammatory therapy is mainly based on the symptomatic control and lung function changes of patients, but some studies have shown that there is no significant correlation between ventilatory function measurement and airway inflammation degree^[1]。 Although endobronchial biopsy, induced sputum detection and peripheral blood eosinophil (EOS) counting can be used to evaluate the degree of airway inflammation, these methods are high risk, time-consuming and labor-intensive, or lack high sensitivity and specificity, so it is difficult to be widely used in clinical practice.