哮喘-慢性阻塞性肺疾病重叠最新研究现状

在哮喘的基础上诱发慢性阻塞性肺疾病(COPD),或是不完全可逆的气道阻塞伴随出现逐渐增加的、可逆性的阻塞症状或者体征,称之为哮喘-COPD重叠(ACO)。本文从ACO的定义及诊断标准、发病率及相关因素、临床表型及发病机制、临床特点、预后、治疗等方面对ACO的最新研究现状进行综述,以加深对这一新型疾病的认识,同时为指导临床诊断与治疗提供帮助。     

慢性阻塞性肺疾病与心血管疾病相关性研究进展

慢性阻塞性肺疾病已被广泛认为系一种慢性炎症反应性疾病,不仅累及肺,还可引起一系列肺外效应.慢性阻塞性肺疾病与心血管疾病之间相关机制复杂,可能与全身炎症反应、血管功能障碍、氧化应激、缺氧等因素有关.本文将对二者相关性及其可能的机制方面的研究进展进行综述.     

COPD急性加重期肺炎衣原体感染的临床分析

目的　了解肺炎衣原体急性感染在 COPD急性加重期患者中的发生率及其临床特点。方法　采用固相酶联免疫吸附试验 EL ISA法测定 96例 COPD急性加重期患者血清肺炎衣原体特异性抗体 Ig G及 Ig M,同时进行痰培养 ,急性肺炎衣原体感染者分别给予阿奇霉素及左氧氟沙星治疗。结果　 COPD患者急性肺炎衣原体感染率 2 5 .0 % ,临床表现较其他 COPD患者无明显特征性 (P>0 .0 5 )。COPD患者痰细菌阳性率 5 8.3%。左氧氟沙星对肺炎衣原体急性感染的 COPD患者疗效良好。结论　 COPD急性加重期患者中肺炎衣原体急性感染率高且混合感染率多见 ,合并肺炎衣原体急性感染的 COPD患者临床表现无明显特征性。对于怀疑合并肺炎衣原体感染的COPD患者 ,新喹诺酮类药物可用作早期经验性治疗的药物。     

慢性阻塞性肺疾病与心血管疾病相关性研究进展

众所周知,慢性阻塞性肺疾病是一种常伴随有显著肺外表现的慢性炎症性疾病,心血管疾病风险增加即此类肺外表现之一。慢性阻塞性肺疾病与心血管疾病之间相关机制复杂,吸烟、衰老、缺氧、全身性炎症、氧化应激及用药等多种因素均可能参与其中。现就其潜在关联机制的研究现状予以综述。     

慢性阻塞性肺疾病与致纤维化型间质性肺疾病患者阻塞性睡眠呼吸暂停对比研究

目的探讨阻塞性睡眠呼吸暂停(OSA)与慢性呼吸系统疾病(CRDs)交互作用可能的病理生理机制,对比评价致纤维化型间质性肺疾病(ILD)和慢性阻塞性肺疾病(COPD)患者中OSA的发生情况和严重程度。方法选择2015年9月至2018年12月于中日友好医院呼吸与危重症医学科诊断的73例COPD患者和77例致纤维化型ILD患者,进行多导睡眠监测、肺功能检查和其他临床评估。OSA定义为睡眠呼吸暂停低通气指数(AHI)≥5次/h。结果不依赖于年龄、性别、体质指数(BMI)、白日嗜睡程度及并发症情况,致纤维化型ILD患者较COPD患者发生中、重度OSA更为常见(61%vs. 44%, P=0.02),程度更为严重[AHI(22.4±16.5)次/h vs.(16.8±13.2)次/h, P=0.02]。OSA的严重程度(AHI)与COPD和ILD患者的用力肺活量、肺总量及弥散功能无关。结论 OSA常见于慢性呼吸系统疾病患者,与COPD相比,致纤维化型ILD患者的OSA更为常见,程度更为严重;静态肺功能指标与慢性呼吸系统疾病患者OSA的严重程度无关。提示有必要开展ILD疾病特异性的OSA的临床研究及治疗方式探讨。     

Contribution of influenza to acute exacerbations of chronic obstructive pulmonary disease in Kashmir,India, 2010–2012

We estimate the contribution of influenza to hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in Kashmir, India. Prospective surveillance for influenza among patients hospitalized with AECOPD was conducted at a tertiary care hospital. Patients had clinical data collected and nasal/throat swabs tested for influenza viruses. Outcomes among patients with and without influenza were compared with logistic regression adjusting for age and underlying conditions. During October 2010–September 2012, 498 patients hospitalized with AECOPD were enrolled, of whom 40 (8%) had received influenza vaccine. Forty (8%) had influenza; influenza virus detection peaked in winter (January–March). Patients with influenza were more likely to die during hospitalization (adjusted OR 3·4, CI 1·0–11·4) than those without.     

Asthma–COPD overlap syndrome (ACOS): A diagnostic challenge

Asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is characterized by persistent airflow limitation with several features usually associated with asthma and several features usually associated with COPD. ACOS may be a special phenotype of a spectrum of chronic obstructive airway diseases, in which asthma and COPD are at the two opposite ends. The prevalence of ACOS varies considerably due to differing criteria being applied for diagnosis. Patients with ACOS utilize a large proportion of medical resources. They are associated with more frequent adverse outcomes than those with asthma or COPD alone. ACOS is currently a diagnostic challenge for physicians because there are no specific biomarkers to differentiate ACOS from asthma or COPD. The approach to diagnosing ACOS depends on the population from which the patient originated. The management of ACOS should be individualized to ensure the most effective treatment with minimal side effects. In this paper, we review the diagnostic criteria of ACOS used in previous studies, propose practical approaches to diagnosing and managing ACOS and raise some research questions related to ACOS.     

自噬与慢性阻塞性肺疾病

自噬现象是一个广泛存在于真核细胞中的生命过程,最早于1962年由Ashford和Porter发现的.近年来,随着对自噬作用研究的深入,发现自噬在多种疾病中都扮演着十分重要的角色.慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)逐渐成为一个不容忽视的公共健康问题,据世界卫生组织/世界银行研究推测,截至2020年该病将成为全球经济负担的第五大疾病.但是,COPD的发病机制尚不明确,随着自噬现象及其与COPD的关系研究进一步深入,为COPD的防治寻找新的治疗策略.因此,该文着重讨论自噬在COPD发病机制中的作用及其在COPD中的临床运用价值.     

慢性阻塞性肺疾病的治疗研究进展

慢性阻塞性肺疾病(COPD)以不完全可逆的气流受限为特点,是小气道病变(闭塞性细支气管炎)和肺实质破坏(肺气肿)共同作用的结果.COPD的高发病率和病死率导致了巨大的经济和社会负担,而且这种负担在不断增加.目前普遍用于COPD的药物治疗如支气管扩张剂、糖皮质激素等,其疗效有一定的局限性.随着对这一疾病的深入认识,很多基于COPD发病的细胞和分子机制的研究为其临床治疗奠定了基础,本文就近年来对COPD治疗的研究进展作一综述.     

慢性阻塞性肺疾病的免疫治疗进展

目前慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)治疗仍以糖皮质激素,支气管扩张剂,以及其他全身并发症的对症治疗为主,但其均不能减缓COPD进行性发展.随着对发病机制的深入研究发现,COPD肺内T细胞异常激活,CD4~+/CD8~+比值倒置,并出现各种针对气道内皮抗体,即使去除各种诱因后,病变仍持续存在,同时COPD患者多合并免疫功能下降和(或)其他自身免疫性疾病,提示了免疫机制在该病发病及进展中的作用.现就COPD的免疫治疗作一综述.     

Role of N-acetylcysteine in the management of COPD

The importance of the underlying local and systemic oxidative stress and inflammation in chronic obstructive pulmonary disease (COPD) has long been established. In view of the lack of therapy that might inhibit the progress of the disease, there is an urgent need for a successful therapeutic approach that, through affecting the pathological processes, will influence the subsequent issues in COPD management such as lung function, airway clearance, dyspnoea, exacerbation, and quality of life. N-acetylcysteine (NAC) is a mucolytic and antioxidant drug that may also influence several inflammatory pathways. It provides the sulfhydryl groups and acts both as a precursor of reduced glutathione and as a direct reactive oxygen species (ROS) scavenger, hence regulating the redox status in the cells. The changed redox status may, in turn, influence the inflammation-controlling pathways. Moreover, as a mucolytic drug, it may, by means of decreasing viscosity of the sputum, clean the bronchi leading to a decrease in dyspnoea and improved lung function. Nevertheless, as successful as it is in the in vitro studies and in vivo studies with high dosage, its actions at the dosages used in COPD management are debatable. It seems to influence exacerbation rate and limit the number of hospitalization days, however, with little or no influence on the lung function parameters. Despite these considerations and in view of the present lack of effective therapies to inhibit disease progression in COPD, NAC and its derivatives with their multiple molecular modes of action remain promising medication once doses and route of administration are optimized.     

Validation of a novel device to objectively measure adherence to long-term oxygen therapy

Rationale

We have developed a novel oxygen adherence monitor that objectively measures patient use of long-term oxygen therapy. The monitor attaches to the oxygen source and detects whether or not the patient is wearing the nasal cannula.

Objective

The study’s purpose was to validate the monitor’s performance in patients with chronic obstructive pulmonary disease during wakefulness and sleep.

Methods

Ten adult males with stable chronic obstructive pulmonary disease (mean ± SD FEV₁ 37.7 ± 14.9% of predicted) on long-term continuous oxygen therapy were tested in a sleep laboratory over a 12–13 hour period that included an overnight polysomnogram.

Measurements

The monitor’s measurements were obtained at 4-minute intervals and compared to actual oxygen use determined by review of time-synchronized video recordings.

Main results

The monitor made 1504/1888 (79.7%) correct detections (unprocessed data) across all participants: 957/1,118 (85.6%) correct detections during wakefulness and 546/770 (70.9%) during sleep. All errors were false negatives, ie, the monitor failed to detect that the participant was actually wearing the cannula. Application of a majority-vote filter to the raw data improved overall detection accuracy to 84.9%.

Conclusions

The results demonstrate the monitor’s ability to objectively measure whether or not men with chronic obstructive pulmonary disease are receiving their oxygen treatment. The ability to objectively measure oxygen delivery, rather than oxygen expended, may help improve the management of patients on long-term oxygen therapy.     

microRNA在COPD中的研究进展

microRNA 是一种短的内源性单链非编码 RNA 分子,主要在转录后水平通过与靶mRNA互补配对的方式抑制 mRNA的翻译或直接降解靶 mRNA.多于1000多种 microRNA存在于人体的基因组中,并调控大于60%基因的表达.许多研究证明,microRNA在 COPD中表达谱的改变影响疾病的自然病程和病理生理过程.因此,microRNA 成为 COPD 诊断和治疗的研究热点.现对microRNA在COPD中的作用机制、表达及 microRNA与COPD严重程度的关系作一综述.     

慢性阻塞性肺疾病稳定期的治疗进展

慢性阻塞性肺疾病是临床上常见的疾病之一,其发病率和病死率逐年升高,是一种不可逆转且进行性加重的呼吸系统疾病.本文综述慢性阻塞性肺疾病治疗的新进展.     

慢性阻塞性肺疾病急性加重糖皮质激素的治疗

COPD是一种可预防和治疗的疾病,以气流受限为特征病情呈进行性发展,气流受限不完全可逆,具有较高的发病率和病死率。慢性阻塞性肺疾病急性加重（acuteexacerbationofchronicobstructivepulmonarydisease,AECOPD）作为c0PD疾病病程中的一个事件,是COPD患者就诊及住院的主要原因,对患者及社会造成了庞大经济负担。糖皮质激素在AECOPD治疗中的地位已得到肯定,但仍存在许多争议的地方,如不同途径对于治疗效果的影响、激素使用中最佳剂量及使用时间的选择、不同类型激素治疗效果的差异等,仍需要进一步研究来指导合理使用糖皮质激素。     

几种细胞因子在慢性阻塞性肺疾病形成机制中的相关研究

慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是一种严重的慢性呼吸系统疾病,它在呼吸内科住院患者总数中所占的比例相当高,病死率也很高,是导致世界范围内的巨大经济和社会负担的主要原因.COPD的发病机制非常复杂,近年来,细胞因子在其形成机制中的研究越来越受到关注,本文就几种细胞因子在COPD形成机制中的作用作一简要慨述.     

茶碱在慢性阻塞性肺疾病中的地位和作用

茶碱类支气管舒张药价格便宜、使用方便,但治疗剂量与中毒剂量接近限制了其临床应用,近年研究表明小剂量茶碱除具有支气管舒张作用外,还具有抗炎和免疫调节作用,为茶碱在慢性阻塞性肺疾病的治疗提供了新的理论依据.     

菲得欣治疗慢性阻塞性肺疾病急性发作的疗效观察

目的探讨菲得欣(氨溴索注射液)在慢性阻塞性肺疾病(chron ic obstructive pu lm onary d isease,COPD)急性发作中的治疗作用。方法COPD急性加重期患者60例,对照组(30例)仅给予抗生素及解痉平喘药物治疗,治疗组(30例)除上述治疗外,还给予菲得欣50m g ivgtt q12h,连用7天。比较治疗后第4、8日时两组的症状评分,并判定疗效。结果两组在治疗第4、8天时症状均较治疗前有所好转,治疗组症状在第4、8日较对照组改善明显(P<0.05)。结论菲得欣可有效改善COPD急性加重期患者的症状,改善睡眠质量,是有效辅助治疗药物之一。     

N-乙酰半胱氨酸在慢性阻塞性肺疾病中的作用机制

慢性阻塞性肺疾病（COPD）是一种以进行性发展的不完全可逆的气流受限为特征的慢性疾病，是一种常见的呼吸系统疾病，近年来有初步的研究表明N-乙酰半胱氨酸（NAC）能预防气道的炎症，减轻COPD患者的症状，延缓病情的发展，本文对其作用机制作一探讨。