血浆降钙素原对慢性阻塞性肺疾病急性加重患者抗生素应用的指导意义

目的:探讨血浆降钙素原(PCT)水平对慢性阻塞性肺病急性加重(AECOPD)患者抗生素治疗的指导价值。方法:150例AECOPD患者,根据住院登记单、双号分为PCT指导组(n=75,在血浆PCT水平指导下使用抗生素)和经验治疗组(n=75)。PCT指导组对PCT≥0.25μg/L患者、经验治疗组依据临床表现采用单一或多种抗生素治疗。比较PCT诊断感染阳性率和传统痰培养诊断感染阳性率差异;比较两组抗生素使用率、使用时间和使用种类差异;比较抗生素治疗前后两组PCT、白细胞计数(WBC)、中性粒细胞百分比(NEUT)、C反应蛋白(CRP)和呼吸困难指数(mMRC)、痰培养阳性率、功能状态评分(FPI-SF)等的变化;比较两组临床有效率、二重感染发生率、平均住院时间、平均住院费用及随访半年内再发病总次数、再住院总次数及死亡率。结果:以PCT≥0.25μg/L为界值诊断AECOPD细菌感染阳性率与传统痰培养阳性率差异无统计学意义(69.33%Vs 64.00%,P0.05);PCT指导组痰培养阳性率高于经验治疗组(64.00%Vs 48.0%,P0.05)。PCT指导组抗生素使用率低于经验治疗组(P0.01),使用时间短于经验治疗组(P0.01),限制级抗生素使用少于经验治疗组(P0.05)。两组治疗前和治疗后PCT、WBC、NEUT、CRP、mMRC及FPI-SF组间比较无统计学差异(P0.05)。但两组组内治疗后较治疗前各指标均显著降低(P0.05或P0.01)。两组的临床有效率无明显差异(P0.05),但PCT指导组二重感染率显著低于经验治疗组(P0.05),住院时间短于经验治疗组(P0.01),住院费也少于经验治疗组(P0.01)。半年随访,两组再发病总次数、再住院总次数、死亡率等指标差异均无统计学意义(P0.05)。结论:血浆PCT水平对AECOPD患者抗生素的合理使用有一定指导意义。     

慢性阻塞性肺疾病急性加重期血液流变性观察

目的 :观察慢性阻塞性肺疾病 (COPD)急性加重期患者血液流变学特性。方法 :检测6 0例急性加重期、4 5例稳定期患者及 12 0例健康体检者的全血粘度、血浆粘度、血沉、红细胞压积和纤维蛋白原等血液流变学指标。结果 :COPD急性加重期患者与COPD稳定期患者和健康体检者血液流变测定值有显著性差异 (P <0 .0 5 ) ,除血浆粘度外其余项目测定值均有统计学意义 (P <0 .0 5 )。结论 :COPD急性加重期病人血液流变性有明显改变 ,可为病情评估、疗效评价和预后判断提供帮助     

慢性阻塞性肺疾病急性加重期与慢性阻塞性肺疾病并发社区获得性肺炎患者的临床对比

目的 探究慢性阻塞性肺疾病急性加重期与慢性阻塞性肺疾病并发社区获得性肺炎患者的临床对比,旨在为临床的诊断和治疗提供科学依据。方法 选取2017年3月~2018年3月于我院接受治疗的82例COPD患者为研究对象,按照随机数表法分为两组,其中观察组42例为AECOPD患者,对照组40例为COPD合并CAP患者,比较两组患者的临床症状、肺功能以及PCT、CRP水平。结果 观察组患者呼吸困难、咳脓痰、精神差、发热等临床症状的发生率均低于对照组,差异具有统计学意义（P＜0.05）。观察组患者FEV1、FVC、FEV1/FVC分别为（64.15±7.26）ml、（62.85±7.29）ml、（62.03±5.54）%,均高于对照组的（52.51±5.75）ml、（50.85±6.74）ml、（52.34±5.61）%,差异具有统计学意义（P＜0.05）。观察组患者PCT和CRP分别为（0.52±0.07）ng/L和（21.51±1.35）mg/L,均低于对照组的（0.97±0.08）ng/L和（40.05±1.57）mg/L,差异具有统计学意义（P＜0.05）。结论 AECOPD患者与COPD合并CAP患者相比,临床症状发生情况较少,肺功能较好,对患者进行相关检测,能够提高治疗效果。     

无创通气治疗慢性阻塞性肺疾病急性加重期的护理体会

通过对57例慢性阻塞性肺疾病急性加重期患者进行无创通气治疗的护理,总结护理要点.正确评估患者病情,保证气道通畅,加强基础护理、心理护理、呼吸机相关护理是保证通气治疗有效,加快病情好转的关键.     

慢性阻塞性肺疾病频繁急性加重患者的临床特征分析

目的 观察慢性阻塞性肺疾病（COPD）频繁急性加重患者与非频繁急性加重患者临床特征的差异。方法 回顾性纳入2016年1月~2018年12月合肥市第一人民医院呼吸内科住院的274例COPD急性加重患者,根据患者上一年急性加重次数分为频繁组（住院次数≥2次/年）143例和非频繁组（住院次数＜2次/年）131例,比较两组性别、年龄、病程、吸烟量、mMRC评分、共患疾病（高血压、冠心病、糖尿病）、白细胞计数、中性粒细胞百分比、淋巴细胞百分比、嗜酸粒细胞百分比、降钙素原（PCT）、血气指标（pH、PaO2、PaCO2）及血氧饱和度（SpO2）,多因素Logistic回归分析COPD频繁急性加重的危险因素。结果 两组性别、年龄、白细胞计数、淋巴细胞百分比、嗜酸粒细胞百分比、PCT、pH、PaCO2、共患疾病（高血压、冠心病、糖尿病）比较,差异无统计学意义（P＞0.05）;频繁组病程、吸烟量、mMRC评分、中性粒细胞百分比、SpO2、PaO2均高于非频繁组,差异均有统计学意义（P＜0.05）;多因素Logistic回归分析显示,病程、吸烟量、mMRC评分、中性粒细胞百分比是COPD频繁急性加重的独立危险因素。结论 COPD频繁急性加重多病程较长,患者多长期吸烟,临床中应重视病程长、吸烟量大、mMRC评分高、中性粒细胞百分比高的COPD患者,加强对其的监护管理,防止发生COPD频繁急性加重。     

中性粒细胞CD64指数指导慢性阻塞性肺疾病急性加重期抗生素应用的探讨

目的 研究CD64指数在减少慢性阻塞性肺疾病急性加重期（AECOPD）患者抗生素应用中的意义。方法 选取2017年1月~10月入住我院的120例AECOPD患者,随机分为对照组和实验组,各60例。对照组根据2016年GOLD指南使用抗生素,实验组根据入院2 h内CD64指数水平来决定是否使用抗生素,在第4天、第8天复测CD64指数水平,若第8天CD64指数≤3,则停用抗生素,相反则继续使用抗生素。比较两组不同时间CD64指数、出院时相关指标（临床有效率、抗生素使用时间、住院时间、平均抗生素花费）、出院后1年内相关指标包括:至下次急性加重时间、随访1年内急性加重次数、住院次数及第一秒用力呼气容积（FEV1）变化。结果 治疗后第4天和第8天,实验组CD64指数水平分别为（1.84±0.65）、（0.86±0.05）,对照组CD64指数水平分别为（2.52±0.30）、（1.45±0.03）均较入院时的（3.47±1.00）、（3.04±1.12）降低,且实验组CD64指数在治疗后第4天和第8天均低于对照组,差异有统计学意义（P＜0.05）;②实验组抗生素使用时间、住院时间、平均抗生素花费均少于对照组,差异有统计学意义（P＜0.05）;两组的临床有效率、至下次急性加重时间、随访1年内急性加重次数、住院次数及FEV1变化比较,差异无统计学意义（P＞0.05）。结论 CD64指数可有助于决定AECOPD患者是否使用抗生素,对AECOPD患者抗生素的使用有重要的指导意义     

还原型谷胱甘肽治疗慢性阻塞性肺疾病急性加重期临床疗效观察

目的：评价还原型谷胱甘肽在慢性阻塞性肺疾病急性加重期（AECOPD）治疗中的作用。方法：采用回顾性病例对照研究,从2011年6月-2013年6月在我院住院治疗的AECOPD患者中选取采用常规治疗联合还原型谷胱甘肽治疗的患者30例为观察组,并选择同期单纯采用常规治疗的30例为对照组。比较两组患者的临床疗效。结果：观察组患者与对照组患者比较,显效率高,症状体征积分低,临床症状缓解快,住院天数缩短。结论：还原型谷胱甘肽作为慢性阻塞性肺疾病急性加重期的辅助治疗有一定的疗效。     

慢性阻塞性肺疾病急性加重患者呼吸道病毒的检测分析

目的 探讨呼吸道病毒感染与慢性阻塞性肺疾病急性加重(AECOPD)的相关性.方法 随机选择140例慢性阻塞性肺疾病急性加重(AECOPD)患者,60例健康老年志愿者为对照组,分别检测呼吸道合胞病毒(RSV)、单纯疱疹病毒(HSV)、腺病毒(ADV)、巨细胞病毒(CMV)、副流感病毒(PIV)、流感病毒A/B(FluA/B)特异性抗体IgM水平,对组间阳性率进行比较.结果 AECOPD组患者中IgM阳性率依次为RSV＞PIV＞ FluA/B＞CMV＞ADV＞ HSV.AECOPD组与对照组各病毒抗体阳性率比较差异有统计学意义(P＜0.05).结论 病毒感染是AECOPD重要因素,病毒感染参与了AECOPD病情的进展过程,在呼吸道病毒流行的季节应做好预防工作.     

降钙素原在细菌感染所致慢性阻塞性肺疾病急性加重中的意义探讨

慢性阻塞性肺疾病(Chronic obstructive pulmonary diseases,COPD)是一种以气流受限为特征的慢性炎症性疾病。研究发现,在我国40岁以上年龄组发病率为8.2%,且随年龄增大,发病率逐年升高[1],COPD急性加重(Acute exacerbation of chronic obstructive pulmonary disease,AECOPD)可致患者肺功能进行性恶化,病死率增高。引起COPD急性加重的诱因有很多,其中80%是下呼吸道感染,而细菌感染约占50%[2]。尽管抗菌药物的使用在减少病死率和治疗失败率等方面大有益处,     

慢性阻塞性肺疾病急性加重期患者外周血Th17细胞的表达及临床意义

目的 探讨外周血Th17细胞在慢性阻塞性肺疾病急性加重期(AECOPD)患者中的表达及临床意义.方法 以260例慢性阻塞性肺疾病(COPD)患者为研究对象,按临床表现分为COPD稳定期组(130例)和AECOPD组(130例),同时选取50例健康体检者为对照组.采用流式细胞术检测外周血Th17细胞水平,酶联免疫吸附法检测外周血细胞因子IL-17水平,同时检测C-反应蛋白(CRP)及白细胞计数(WBC)水平,记录COPD评估测试(CAT)评分.结果 AECOPD组患者外周血Th17细胞、IL-17、CRP及WBC水平显著高于COPD稳定期组和正常对照组(P＜0.05);经过相应治疗后,AECOPD组患者外周血Th17细胞、IL-17、CRP、WBC水平及CAT评分均较治疗前明显降低,差异具有统计学意义(P＜0.05).相关性分析显示,AECOPD组患者外周血Th17细胞水平与CAT评分呈显著正相关(r=0.91,P＜0.01).外周血Th17细胞水平与炎性因子IL-17也呈正相关(r=0.89,P＜0.01),而AECOPD组患者外周血Th17细胞水平与CRP(r =0.084,P＞0.05)、WBC(r=0.063,P＞0.05)水平无显著相关性.ROC曲线分析显示,外周血Th17细胞水平的曲线下面积(AUC)为0.868(95％ CI0.774～0.918),以外周血Th17细胞水平3.72作为临界值时,其诊断AECOPD的敏感性为88.6％,特异性为86.4％,其显著优于CRP和WBC指标.结论 外周血Th17细胞在AECOPD患者中高表达,其可作为预测COPD急性加重期的有效指标,具有一定的临床运用价值.     

Prediction of exacerbation onset in chronic obstructive pulmonary disease patients

The objective of this study was to develop an algorithm for prediction of exacerbation onset in Chronic Obstructive Pulmonary Disease (COPD) patients based on continuous self-monitoring of physiological parameters from telehome-care monitoring. 151 physiological parameters of COPD patients were monitored on a daily/weekly basis for up to 2 years. Data were segmented in 30-day periods leading up to an exacerbation (exacerbation episode) and starting from a 14-day recovery period post-exacerbation (control episode) and tested in 6 intervals to predict exacerbation onset using k-nearest neighbour (k?=?1, 3, 5). A classifier with sensitivity of 73%, specificity of 74%, positive predictive value of 69%, negative predictive value of 78% and an accuracy of 74% was achieved using data intervals consisting of 5 days. Intelligent processing of physiological recordings have potential for predicting exacerbation onset.     

Exhaled eicosanoids and biomarkers of oxidative stress in exacerbation of chronic obstructive pulmonary disease

Introduction

Eicosanoids and oxidants play an important role in inflammation, but their role in chronic obstructive pulmonary disease (COPD) is uncertain. In this study we hypothesized that levels of exhaled leukotrienes, prostaglandins and biomarkers of oxidative stress are increased in infectious exacerbations of COPD and that they decrease after antibiotic therapy.

Material and methods

Cysteinyl-leukotrienes (LTs), leukotriene B₄ (LTB₄), prostaglandin E₄, hydrogen peroxide (H₂O₂) and 8-isoprostane were measured in exhaled breath condensate (EBC) in 16 COPD patients with infectious exacerbations (mean age 64 ±12 years, 13 male) on day 1, during antibiotic therapy (days 2-4), 2-4 days after therapy and at a follow-up visit when stable (21-28 days after therapy).

Results

There was a significant fall in concentration of cys-LTs, LTB₄ and 8-isoprostane at visit 3 compared to day 1 (cys-LTs: 196.5 ±38.4 pg/ml vs. 50.1 ±8.2 pg/ml, p < 0.002; LTB₄: 153.6 ±25.5 pg/ml vs. 71.9 ±11.3 pg/ml, p < 0.05; 8-isoprostane: 121.4 ±14.6 pg/ml vs. 56.1 ±5.2 pg/ml, p < 0.03, respectively). Exhaled H₂O₂ was higher on day 1 compared to that at visits 2 and 3 (0.74 ±0.046 µM vs. 0.52 ±0.028 µM and 0.35 ±0.029 µM, p < 0.01 and p < 0.01, respectively). Exhaled PGE₂ levels did not change during exacerbations of COPD. Exhaled eicosanoids and H₂O₂ in EBC measured at the follow-up visit (stable COPD) were significantly higher compared to those from healthy subjects.

Conclusions

We conclude that eicosanoids and oxidants are increased in infectious exacerbations of COPD. They are also elevated in the airways of stable COPD patients compared to healthy subjects.     

Detection of multiple viral and bacterial infections in acute exacerbation of chronic obstructive pulmonary disease: A pilot prospective study

Few studies have evaluated the contribution of multiple virus and bacterial infections in acute exacerbation of chronic obstructive pulmonary disease. This study estimated the burden of multiple viral and bacterial respiratory infections in moderate to very severe chronic obstructive pulmonary disease patients that were prospectively followed‐up during a 12‐month pilot study. Clinical data were collected monthly and sputum was collected at the time of each acute exacerbation event. Classical culture techniques for bacteria and multiplex polymerase chain reaction (PCR) and microarray detection assays were performed to identify viral and atypical bacterial pathogens in the sputum. Overall, 51 patients were included and 45 acute exacerbation events were investigated clinically and microbiologically. Among the 45 acute exacerbation events, 44% had evidence of viral infection involving human rhinovirus (HRV) and metapneumovirus (hMPV) in 20% and 18%, respectively. Intracellular bacteria were not found in sputum by PCR. Common bacterial pathogens were identified in 42% of acute exacerbation patients, most frequently Branhamella catarrhalis, Streptococcus pneumoniae and Haemophilus influenzae. Viral or virus and bacteria co‐infections were detected in 27% of acute exacerbation events (n = 12) with HRV and hMPV involved in 92% of cases. Patients with co‐infections did not present greater clinical severity scores at exacerbation and more recurrence of acute exacerbation events at 3 and 6 months than those with single infections (P > 0.4). These results suggest that HRV and hMPV may be contributors or cofactors of AECOPD. These findings indicate that viral or virus and bacterial co‐infections do not impact significantly on the clinical severity of acute exacerbation of chronic obstructive pulmonary disease and recurrence at 3 and 6 months. J. Med. Virol. 85:866–873, 2013. © 2013 Wiley Periodicals, Inc.     

CAPS评分对急性加重期慢性阻塞性肺疾病并无创通气患者远期预后评估

目的：探讨慢性阻塞性肺疾病和支气管哮喘生理评分(the COPD and asthma physiology score, CAPS)对慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)并无创通气患者远期预后的评估效果。方法：以2014年6月至2015年10月在我院接受无创通气的AECOPD患者为观察对象,并根据其CAPS评分将其分为CAPS≥35组和CAPS<35组。比较不同CAPS评分患者出院时炎症细胞因子水平、肺功能和出院后1个月生活质量的差异。结果：CAPS≥35的患者出院时的CRP和IL-6等炎症细胞因子指标明显高于CAPS<35组患者,差异具有统计学意义(P<0.05);出院时CAPS<35的患者肺功能指标明显优于CAPS≥35组,差异具有统计学意义(P<0.05);治疗前,CAPS≥35组和CAPS<35组患者的生活质量各维度得分无明显差别,出院1个月时的调查结果显示：两组患者的生活质量均较治疗前增高,且CAPS<35组患者生活质量提高更明显(P<0.05)。结论：CAPS评分对AECOPD并无创通气患者的远期预后有较好的评估价值：CAPS评分高的患者病死率较高,预后较差。     

慢性阻塞性肺病患者心理状况及影响因素

调查慢性阻塞性肺疾病（COPD）患者心理状况和影响因素，对60例患者和60例健康者对照，应用焦虑和抑郁情绪表（HAO）对两组进行问卷调查，结果显示，患者评分显著差于健康者，年龄、病程和通气功能与患者抑郁症状和总分呈显著性相关，提示患者伴有心理障碍，重视和兼顾心理症状诊治颇有必要。     

慢性阻塞性肺疾病动物模型研究概况

慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)由基因-环境交互作用而致病,目前COPD拟临床研究大多是采用诱发性动物模型。动物选择根据实际需要以鼠、猪和灵长类动物为主。造模方法主要是将可诱发COPD的危险因素,强加于动物以诱导COPD的发生。造模时间的长短则与诱因的性质和暴露量密切相关。模型建成后主要从肺功能、肺部病理改变等方面,并采用血清炎症因子、细胞因子检测等手段对模型进行评价,但在实际操作中尚有待进一步的评估。     

Immune response in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a major public health problem because of its high prevalence, rising incidence and associated socio-economic cost. The inhalation of toxic particles and gases, mostly tobacco smoke, is the main risk factor for COPD. Yet, not all smokers are equally susceptible to these toxic effects and only a percentage of them develop the disease (so-called ‘susceptible smokers’). This, in combination with the observation that COPD shows familial aggregation, suggests that the genetic background of the smoker is a key element in the pathogenesis of the disease. On the other hand, it is well established that ‘susceptible’ smokers exhibit an enhanced inflammatory response of the lung parenchyma as compared with ‘resistant’ smokers (i.e., those who manage to maintain lung function within the normal age range despite their habit). Importantly, in COPD patients this inflammatory response does not resolve after quitting smoking, again at variance with resistant smokers. All in all, these observations suggest that the pathogenesis of COPD may involve, in some patients, an autoimmune component which contributes to the enhanced and persistent inflammatory response that characterizes the disease. Here we: i) review briefly the pathobiology of COPD; ii) present the available scientific evidence supporting a potential role for autoimmunity in COPD; iii) propose a three-step pathogenic hypothesis in the transition from smoking to COPD; and iv) discuss potential implications for the diagnosis and treatment of this frequent, growing, devastating and costly disease.     

慢性阻塞性肺疾病的全身效应

 慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease,COPD）是一种常见病、多发病,其典型表现为气流受限和气道重塑,导致肺的结构与功能的改变。由于COPD的患者多种炎症介质的激活使患者处于系统性炎症状态,使得COPD不仅仅是呼吸系统的疾病,同时还包含许多肺外表现,即全身效应。常见的全身性表现包括：骨骼肌萎缩、恶液质、骨质疏松;而慢性炎症使COPD的患者缺血性心脏病、肺动脉高压、糖尿病等疾病的患病率大大增加。