肺心病慢性呼吸衰竭患者脑诱发电位的研究

目的用诱发电位方法检测肺心病慢性呼吸衰竭患者在发生临床肺性脑病前脑功能的改变。方法对２８例老年肺心病慢性呼吸衰竭无肺性脑病临床表现的患者、２０例老年肺炎患者及３０例老年健康人同时进行脑干听觉、体感诱发电位（ＢＡＥＰ、ＳＥＰ）检查。结果ＢＡＥＰ异常：肺心病组２３例（８２％），肺炎组７例（３５％）；ＳＥＰ异常：肺心病组２４例（８６％），肺炎组８例（４０％）。经统计学检验，肺心病组ＢＡＥＰ、ＳＥＰ与健康组、肺炎组差异有显著性，肺炎组与健康组差异无显著性。结论肺心病慢性呼吸衰竭患者有脑干功能受损和弥漫性脑功能障碍。     

慢性阻塞性肺疾病急性加重期患者的正常甲状腺功能病态综合征

目的探讨慢性阻塞性肺疾病（COPD）急性加重期患者甲状腺激素水平的改变及病情与预后的关系。方法用放射免疫法测定36例重症COPD急性加重期患者（感染组）血浆三碘甲状腺原氨酸（T3）、甲状腺素（T4）及促甲状腺素（TSH）水平，并与正常对照组作比较，分析其临床意义。结果与对照组比较COPD急性加重期患者T3、T4均明显降低，TSH两组无差异。感染组中死亡8例，其T3、T4水平均明显低于该组中存活者。结论COPD患者中存在正常甲状腺功能病态综合征，并可作为预后不良的指标。     

B型脑钠肽对COPD急性加重期的预后价值

目的检测慢性阻塞性肺疾病（COPD）患者急性加重期血浆B型脑钠肽（BNP）水平,评价BNP在COPD急性期的预后价值。方法 122例COPD患者就诊时或入院后当天测定血浆BNP水平,统计住院期间患者机械通气和入住ICU的病例数,出院患者在1个月后复诊时再次测定血浆BNP水平。测定入住ICU、需行机械通气患者的血浆BNP水平。结果 COPD急性加重期BNP水平较缓解期增高（P〈0.01）,慢性阻塞性肺疾病全球创议（GOLD）严重程度分级越高的患者血浆BNP水平越高。在急性加重期,11例入住ICU患者的BNP水平高于其他患者（P〈0.01）,41例机械通气患者的血浆BNP水平高于其他患者（P〈0.01）。结论在COPD急性加重期的患者中监测BNP水平能预测入住ICU和机械通气的风险,可以预测疾病的严重程度。     

慢性阻塞性肺疾病急性加重期血清MMP-9、TIMP-1变化的临床意义

目的探讨慢性阻塞性肺疾病（COPD）急性加重期血清基质金属蛋白酶-9（MMP-9）、基质金属蛋白酶组织抑制剂-1（TIMP-1）变化的临床意义。方法选取COPD急性加重期患者55例（COPD组）、查体健康者20例（对照组）,根据COPD组肺功能及病情程度分为轻度组15例、中度组22例、重度组18例。采用酶联免疫吸附法检测各组血清MMP-9及TIMP-1;行肺功能通气检查,记录第1秒钟用力呼吸容积（FEV1）/用力肺活量（FVC）及FEV1占预计值的百分比（FEV1%）。分析COPD组血清MMP-9、TIMP-1水平与病情严重程度的相关性。结果 COPD组血清MMP-9、TIMP-1明显高于对照组,且随病情加重逐渐升高（P〈0.01或〈0.05）;直线相关分析显示,COPD组血清MMP-9、TIMP-1水平与FEV1%呈负相关（r分别为-0.783、-0.776,P均〈0.01）。结论血清MMP-9、TIMP-1水平与COPD病情程度相关,病情越重,MMP-9、TIMP-1越高,且与FEV1%呈负相关;提示血清MMP-9、TIMP-1变化可作为判定COPD病情严重程度的指标之一。     

还原型谷胱甘肽联合丹参治疗肺心病肝损害47例临床疗效观察

临床常见慢性阻塞性肺疾病(COPD)急性加重期并发慢性肺源性心脏病(肺心病)引起肝功能不全,病情危重,死亡率较肝功能正常的患者增高30%以上.本文采用还原型谷胱甘肽联合复方丹参注射液治疗COPD急性加重期并发慢性肺心病肝损害患者,取得较好疗效.     

血浆脑利钠肽检测对COPD合并慢性肺源性心脏病的诊断意义

目的探讨脑利钠肽(BNP)在不同阶段COPD合并慢性肺源性心脏病中的诊断意义。方法测定单纯COPD组(A组)、COPD合并肺心病急性加重期组(B组),COPD合并肺心病缓解期组(C组)各40例,检测各组血浆BNP水平,并对三组进行相关分析;结果 BNP值在B组高于C组,高于A组,且两两之间差异都有统计学意义。结论 BNP在区分COPD是否合并肺心病及判定肺心病发病时期具有一定的临床意义。     

慢性阻塞性肺疾病患者血清Fas／Apo-1及TNF-α与细胞凋亡的相关性研究

目的探讨慢性阻塞性肺疾病（COPD）患者血清可溶性（Fas）及（TNF-α）的变化及相关性。方法30例急性加重期和稳定期COPD患者、25例健康体检者，分别查血常规、测定肺功能，用EHSA法检测血清sFas及TNF-α浓度。结果发现COPD急性加重期组患者外周血中性粒细胞占白细胞总数百分比Neu／Leu％、sFas、TNF-α明显高于COPD稳定期组（P〈0．01，P〈0．05，P〈0．01）；COPD急性加重期组患者血清sFas、TNF-α明显高于健康对照组（P〈0．05，P〈0．01），且在急性加重期组中TNF-α与Neu／Leu％呈正相关（r=0．586，P〈0．05）。结论COPD急性加重期及稳定期sFas和TNF-α水平显著升高，提示凋亡参与了COPD的发病，可能是引起肺内炎症细胞浸润及肺实质破坏的主要原因之一。     

慢性阻塞性肺疾病患者血浆白介素17水平变化及其与白介素8、白三烯B4相关性的研究

目的观察慢性阻塞性肺疾病（COPD）急性加重期患者和急性加重期缓解患者的血浆白介素17（IL-17）、白介索8（IL-8）及白三烯B4（LTB4）含量变化。同时观察COPD患者血浆IL-17与IL8及LTB4含量的相关性。方法随机抽取COPD急性加重期患者、急性加重期缓解患者各35例，健康对照者15例，采用双抗夹心ELISA法测定三组人群血浆IL-17、IL-8、LTB4含量。结果COPD急性加重期患者血浆IL-17、IL-8及LTB4水平明显高于急性加重期缓解患者和健康对照者，差异有统计学意义（P〈0．05），COPD急性加重期缓解患者血浆IL-17、IL-8及LTB4水平亦明显高于健康对照者，差异有统计学意义（P〈0．05）。COPD急性加重期患者和急性加重期缓解患者血浆ID8、LTB4含量均与IL-17呈正相关。结论IL-17参与了COPD的炎症过程，而与IL-8、LTB4呈正相关。     

COPD患者血浆Fbg变化及临床意义

将75例慢性阻塞性肺疾病（COPD）患者分为两组，A组为未合并肺原性心脏病（肺心病）者33例，B组为合并肺心病者42例，另选查体健康者35例作为对照组，全部于稳定期和急性发作期进行血浆纤维蛋白原（Fbg）和1秒钟用力呼气容积（FEV1）占预计值％测定，并对Fbg与FEV1占预计值％进行相关性分析。发现随着COPD病情的进展，血浆Fbg水平逐渐升高COPD患者FEV1占预计值％与Fbg呈显著负相关关系。提示降低Fbg治疗可改善COPD患者病情，Fbg水平检测有助于了解患者病情及判断预后。     

C反应蛋白在慢性阻塞性肺疾病中的临床意义研究

目的观察C反应蛋白（CRP）在慢性阻塞性肺疾病（COPD）急性加重中的临床意义。方法选取56例COPD急性加重期患者,观察患者CRP水平、白细胞计数（WBC）并进行痰培养。结果 CRP的异常率为98%,明显高于WBC及痰培养的异常率;COPD Ⅰ级的患者CRP水平显著低于COPDⅡ、Ⅲ、Ⅳ级患者。COPDⅡ、Ⅲ、Ⅳ级患者中,随着气流受限程度的加重,CRP水平逐渐增高,差异有统计学意义（P均〈0.05）。结论 CRP是反映COPD急性加重期患者早期感染的敏感指标;CRP与肺功能损害程度呈正相关,能够反应疾病严重程度。     

Pulmonary diseases and heart function

The most severe cardiac sequel to lung disease is the load on the right ventricle due to pulmonary hypertension with the development of a cor pulmonale. This is characterized by hypertrophy and/or dilatation of the right ventricle because of a primary impairment of lung function and/or lung structure. The most important pathomechanisms for the development of pulmonary hypertension are vessel obliteration, mechanical lesions, primary vascular or extra-vascular inflammation and hypoxic vasoconstriction. Chronic obstructive pulmonary disease (COPD) is one of the most important reasons for chronic cor pulmonale. A further very common reason is obstructive sleep apnea syndrome, especially if combined with a COPD. In this case, the prevalence of cor pulmonale can reach 80%. The development of a chronic cor pulmonale is the most striking negative prognostic factor for these patients. Only 30% of COPD patients with cor pulmonale survive longer than 5 years, and only early detection of the disturbances to respiration which might potentially lead to cor pulmonale and their subsequent therapy are able to improve the patient's prognosis. Furthermore, pulmonary diseases may also have an impact on the left heart side in terms of an impairment of left heart function or by inducing severe arrhythmias . Thus, lung diseases may have both a significant impact on right and left heart performance.     

Changes of hemorrheology in COPD patients with or without cor pulmonale

Parameters of hemorrheology such as whole blood viscosity, plasma viscosity, hematocrit and red blood cell electrophoretic time were measured in 34 COPD patients with or without cor pulmonale, and the pulmonary arterial pressure was simultaneously examined. The results showed that the whole blood viscosity and hematocrit in cor pulmonale group were obviously higher than COPD group which suggested the changes of hemorrheology was much obvious in patients with cor pulmonale than those in COPD patients. Meanwhile, a statistically significant correlation was obtained between whole blood viscosity and pulmonary arterial mean pressure. Thus, we suggest blood viscosity has a certain effect on the pulmonary arterial pressure.     

Lungenerkrankungen und Herzfunktion

The most severe cardiac sequel to lung disease is the load on the right ventricle due to pulmonary hypertension with the development of a cor pulmonale. This is characterized by hypertrophy and/or dilatation of the right ventricle because of a primary impairment of lung function and/or lung structure. The most important pathomechanisms for the development of pulmonary hypertension are vessel obliteration, mechanical lesions, primary vascular or extra-vascular inflammation and hypoxic vasoconstriction. Chronic obstructive pulmonary diesease (COPD) is one of the most important reasons for chronic cor pulmonale. A further very common reason is obstructive sleep apnea syndrome, especially if combined with a COPD. In this case, the prevalence of cor pulmonale can reach 80%. The development of a chronic cor pulmonale is the most striking negative prognostic factor for these patients. Only 30% of COPD patients with cor pulmonale survive longer than 5 years, and only early detection of the disturbances to respiration which might potentially lead to cor pulmonale and their subsequent therapy are able to improve the patient’s prognosis. Furthermore, pulmonary diseases may also have an impact on the left heart side in terms of an impairment of left heart function or by inducing severe arrhytmias. Thus, lung diseases may have both a significant impact on right and left heart performance.     

Pulmonary hypertension and right ventricular failure. Part IV. Chronic lung disease

In a series of articles the authors discuss literature data concerning epidemiology of pulmonary hypertension, its modern classification; peculiarities of its pathogenesis and treatment in various diseases and conditions. In the forth lecture they present literature data on prevalence of chronic cor pulmonale among patients with congestive heart failure and its value for prognosis. The authors consider peculiarities of pathogenesis of pulmonary hypertension in patients with chronic obstructive pulmonary disease (COPD) and interstitial lung diseases. Attention is paid to the fact that chronic cor pulmonale develops mainly in bronchitic type of COPD and rarely is met in patients with emphysematous type of COPD. Pathogenetic mechanisms of right ventricular failure in COPD and the role of interaction of hemodynamic, renal, and neuro-humoral factors in pathogenesis of edematous syndrome in patients with chronic cor pulmonal are presented. The article also contains discussion of possibilities and limitations of clinical and instrumental diagnostics of pulmonary hypertension and right ventricular failure in patients with COPD.     

慢性阻塞性肺疾病和肺心病患者血液动力学与循环内皮？…

目的 探讨慢性阻塞性肺疾病（ＣＯＰＤ０和肺心病时血循环内皮细胞、血液动力学的变化及意义。方法 运用右心导管检查技术和血循环内皮细胞（ＣＥＣ）分离技术，用硫巴比妥法及羟胺法测定血丙二醛（ＭＤＡ）及超氧化物歧化酶（ＳＯＤ）。结果 肺心病组肺动脉平均压［（ｍＰＡＰ）３．７６±０．７５ｋＰａ、血ＣＥＣ数量每０．９微升为１６．７０±２．６５与ＣＯＰＤ组８．４８±２．２３）比较，差异有显性（Ｐ〈０．０１），     

Measurement of right and left heart function of COPD and cor pulmonale by radionuclide ventriculography]

Non-invasive measurements of right and left ventricular ejection fraction (RVEF, LVEF) by multiple-gated equilibrium radionuclide ventriculography were performed in 19 control subjects, 55 patients with COPD and cor pulmonale, simultaneous right heart catheterizations were performed in 10 patients with cor pulmonale to determine the mean pulmonary artery pressure (mPAP), and then, the acute hemodynamic and functional effects of nifedipine were evaluated. The mean RVEFs are different significantly among the various groups. With the development of the diseases, the RVEFs reduce gradually. The mean LVEF reduces significantly in cor pulmonale patients with heart failure. The RVEF correlated negatively to mPAP (r = -0.7047, P < 0.01). After nifedipine (20mg), the RVEF and mPAP do not change significantly (P > 0.05), but the artery blood pressure reduces significantly. We conclude that the equilibrium radionuclide ventriculography may be a useful and accurate method in diagnosing early cor pulmonale and cor pulmonale with right heart failure, and nifedipine may not be a good vasodilator for pulmonary hypertension.     

COPD合并肺心病患者的心电图与超声心动图特征比较分析

目的比较慢性阻塞性肺疾病(COPD)合并肺心病患者的心电图与超声心动图特征。 方法回顾性分析我院COPD合并慢性肺源性心脏病患者48例(观察组),无心血管疾病的COPD患者32例(对照组),统计分析入组患者的超声心动图和心电图特征,并比较两种检查对肺心病的诊断价值。 结果2组患者在年龄、性别、病程和吸烟史方面均无统计学差异(P>0.05)。对照组患者心电图异常为房性早搏为(18.75%),右束支传导阻滞、顺钟向转位、肢体导联低电压均为(6.24%),右心室肥大(3.12%),肺型P波、电轴右偏、室上速均未发现;观察组患者心电图异常为房性早搏(33.33%)、电轴右偏(29.64%)、右束支传导阻滞(22.91%)、肢体导联低电压(22.92%)、肺型P波(14.58%)、顺钟向转位(10.41%)、室上速(8.30%),观察组患者心电图异常的发生率均较对照组患者显著的增高(P<0.05)。超声心动图检查显示观察组RA和RV值较对照组亦有显著的增加(P<0.05)。分析发现心电图对肺心病的检出率为54.17%,超声心动图检出率为85.42%,显著高于心电图(P<0.05)。 结论心电图和超声心动图是检测心脏疾病的重要手段,各有优缺点,医生在临床工作中可根据患者病情,同时结合心电图和超声心动图结果,早期发现并诊断COPD发生肺心病,以提高肺心病的诊疗水平。     

The interaction of some active and immunological factors in blood in the development of chronic cor pulmonale]

Fourteen experimental indices were determined in 26 patients of chronic cor pulmonale due to COPD and in 32 healthy nonsmokers. It was found that elastase, TXB2, ATII, 5-HT, IgE, CTC and Ach were significantly higher whereas 6-keto -PGF1 alpha, C4 and cAMP lower in the blood from the patients. The roles played by these factors in the development of chronic cor pulmonale were discussed.     

COPD合并慢性肺源性心脏病与否的肺功能对比分析

目的 通过对单纯COPD与肺心病患者的肺功能进行对比分析,了解COPD合并肺心病与否时的肺功能改变.方法 对所有入选的COPD患者进行肺功能和心脏超声检查,COPD患者GOLD分级为Ⅱ～Ⅳ级.根据有无肺心病将入选患者分为单纯COPD组和COPD合并肺心病组.单纯COPD组37例;COPD合并肺心病组31例.结果 COPD合并肺心病组DLCO% pred显著低于单纯COPD组(P<0.05);两组间FEV1% pred、FVC% pred、FEV1/FVC、RV% pred、TLC% pred、RV/TLC和共振频率无显著差异(P＞0.05).结论 COPD合并肺心病患者较单纯COPD患者肺弥散功能的损害更为显著.     

Chronic obstructive pulmonary disease and the early stage of cor pulmonale: A perspective in treatment with pulmonary arterial hypertension-approved drugs

Cor pulmonale is right ventricular hypertrophy and/or dilation caused by pulmonary hypertension (PH) due to diseases affecting the lung function and structure. Recently, the definition of PH was revised from a mean pulmonary arterial pressure (mPAP) >25 mmHg to an mPAP >20 mmHg based on the Nice statement; this might expedite the detection of cor pulmonale. However, the only treatment for cor pulmonale for the past 3 decades has been to maintain the lung function and oxygen saturation.Chronic obstructive pulmonary disease (COPD) is the leading cause of cor pulmonale. Cor pulmonale in COPD is generally known to occur due to loss of vascular bed and chronic hypoxic pulmonary vasoconstriction (HPV) due to alveolar wall destruction. However, a recent study suggested that in some patients with COPD, the pulmonary vascular alterations include components that are primary lesions of the pulmonary artery. These alterations may be similar to the remodeling that occurs in pulmonary arterial hypertension (PAH). Although, there is no evidence supporting the treatment of COPD patients with PH using drugs approved for PAH, such drugs may be effective in the treatment of a selected group of COPD patients, whose disease includes PAH-like vascular components.To distinguish these patients, it is necessary to understand the histopathology of COPD and renew our understanding of the concept of cor pulmonale, which treats the heart and lung as a single unit. Herein, we review the recent histopathological concepts of COPD with respect to the progression of cor pulmonale.