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1.·½¸£µÂ£¬ÖÜÂÀ£¬¶¡å¥£¬µÈ. ÏÖ´úҽѧʵÑé¼¼ÇÉÈ«Ê飨ϲᣩ£®±±¾©£º±±¾©Ò½¿Æ´óѧÖйúкÍÒ½¿Æ´óѧÍŽá³öÊéÉ磬1995
2.ФʫÁÁ£¬¸ß˼º££¬Ñî³½Ô«£®³£Ñ¹È±ÑõÐÔ´óÊó·Î¶¯Âö¸ßѹģ×ÓµÄˢУ®ÁÙ´²ÐÄѪ¹Ü²¡ÔÓÖ¾£¬2001,17 (4):190
3.¾£Ö¾³É£®ÎÒ¹ú·Î¶¯Âö¸ßѹר¼Ò¹²Ê¶²ûÊÍ£®ÖйúÊÊÓÃÄÚ¿ÆÔÓÖ¾£¬2007,27 (4):246-249
4.ÕÔ誣¬ÁõÈØ£¬ÀîºéÌΣ¬µÈ£®Ò°°ÙºÏ¼îÓÕµ¼·Î¶¯Âö¸ßѹСÐÍÖíµÄ²¡Àí¸Ä±ä£®ÄÏ·½Ò½¿Æ´óѧѧ±¨£¬2012,32 (6):867-869
5.Allen K, Haworth SG. Impaired adaptation of pulmonary circulation to extrauterine life in newborn pigs exposed tohypox:ia:An ultrastructural study. J Pathol, 1986, 150(3): 205-212
6.Rahman I, Adcock lM. Oxidative stress and redox regulation of lung inilammal:ion in COPD. Eur Respi.r J, 2006, 28 (1):219-242
7.Sethi S,Mahler DA,Marcus P,el al. Inflammation in COPD:implications for management. Am J Med,2012, 125(12): 1162-1170
8.Tamimi A, Serrlarevic D, Hanania NA. The effects of cigarette smoke on airway inflammation in asthma and COPD:Therapeulic implications. Respir Med,2012,106 (3):319-328