Effectiveness and Safety of Inhaled Antibiotics in Patients With Chronic Obstructive Pulmonary Disease. A Multicentre Observational Study

BackgroundWe aimed to describe the effectiveness and safety of inhaled antibiotics in chronic obstructive pulmonary disease (COPD) patients, as well as the patient profile in which they are usually prescribed and the patient groups that can most benefit from this treatment.MethodsMulticentre retrospective observational cohort study in COPD patients who had received ≥1 dose of inhaled antibiotics in the last 5 years. Clinical data from the two years prior to and subsequent to the start of the treatment were compared. Primary outcome: COPD exacerbations. Secondary outcomes: side effects, symptomatology (sputum purulence, dyspnoea), microbiological profile and pathogen eradication.ResultsOf 693 COPD patients analyzed (aged 74.1; 86.3% men; mean FEV₁ = 43.7%), 71.7% had bronchiectasis and 46.6% presented chronic bronchial infection (CBI) by Pseudomonas aeruginosa (PA). After 1 year of treatment with inhaled antibiotics, there was a significant decrease in the number of exacerbations (?33.3%; P < .001), hospital admissions (?33.3%; P < .001) and hospitalization days (?26.2%; P = .003). We found no difference in effectiveness between patients with or without associated bronchiectasis. Positive patient outcomes were more pronounced in PA-eradicated patients. We found a significant reduction in daily expectoration (?33.1%; P = .024), mucopurulent/purulent sputum (?53.9%; P < .001), isolation of any potentially pathogenic microorganisms (PPM) (?16.7%; P < .001), CBI by any PPM (?37.4%; P < .001) and CBI by PA (?49.8%; P < .001). CBI by any PPM and ≥three previous exacerbations were associated with a better treatment response. 25.4% of patients presented non-severe side-effects, the most frequent of these being bronchospasm (10.5%), dyspnoea (8.8%) and cough (1.7%).ConclusionsIn COPD patients with multiple exacerbations and/or CBI by any PPM (especially PA), inhaled antibiotics appear to be an effective and safe treatment, regardless of the presence of bronchiectasis.     

支气管扩张症肺组织内降钙素表达的临床意义

目的　了解支气管扩张症肺组织降钙素 (CT)蛋白表达水平与其病变特点的关系。方法　应用免疫组化方法定量分析 4 5例支气管扩张症患者手术切除的肺组织 ,对其气道上皮内神经内分泌细胞 (NEC)计数 ,并与 19例无肺部疾患的尸检肺组织进行比较。结果　 2组均可见被染成棕红色的CT阳性细胞 ,它们分布于肺内各级支气管上皮细胞间 ,以支气管分叉处较多见。支气管扩张症组肺组织内5 0 0 0个上皮细胞中CT阳性细胞数为 (6 7.4 8± 11.0 3)个 ,非支气管扩张症组肺组织内CT阳性细胞数仅为 (5 .0 2± 1.0 0 )个 ,2组比较有非常显著性差异 (P <0 .0 0 1)。结论　支气管扩张症肺组织高水平CT表达可能与其慢性炎症改变有关 ,其局部CT表达增高可能系机体对支气管扩张病变的一种局部性代偿或调节机制。     

老年支气管扩张合并非结核分枝杆菌感染的临床特征及其危险因素

目的分析老年支气管扩张合并非结核分枝杆菌(non-tuberculous mycobacterial,NTM)的临床特征及其危险因素。方法选择2015年1月-2019年12月无锡市第五人民医院呼吸与危重症科收治的老年支气管扩张患者为研究对象,其中120例合并NTM感染患者为合并感染组,120例为单纯支气管扩张组。分析合并NTM感染患者临床症状及影像学特点,采集痰液标本进行分枝杆菌鉴定及药敏试验,单因素及多因素Logistic回归分析支气管扩张合并NTM的危险因素。结果 120例合并NTM感染患者主要症状为咳嗽咯痰、咯血;影像学检查除典型的支气管扩张影外,还伴随有斑点、斑块、条索影,同时还有部分结节影、薄壁空洞表现,并且以1~2种征象为主,多种表现混合存在;累及3个以上肺野的患者占78.33%;痰抗酸杆菌涂片阳性率为86.67%(104/120)、痰NTM-DNA检测阳性率为90.00%(108/120);Ⅲ组鸟-胞内分枝杆菌复合菌群54例占45.00%,Ⅳ组龟-脓肿分枝杆菌复合菌群58例占48.33%,其他复合菌8例占6.67%;120株NTM对一、二线抗结核药物耐药率均较高,且全耐药者达到了38.33%(46/120);吸烟史>20年、支扩累及肺叶数≥5叶、薄壁空洞、CD₄⁺<550个/ml、低蛋白血症是老年支气管扩张合并NTM感染的独立危险因素(P<0.05)。结论老年支气管扩张合并NTM感染患者临床症状及影像学表现与肺结核相似,但对抗结核药物高度耐药,临床上可根据痰抗酸杆菌涂片及NTM-DNA检测对NTM感染进行判别,同时合并NTM感染受多种因素影响。     

支气管扩张感染加重的病原学及药敏分析

目的：为了解本地区支扩感染加重需住院患者的病原学及药敏情况,指导临床治疗。方法：用纤支镜取深部痰作培养和药敏以及血清ＩｇＧ测定。结果：７４例深部痰培养６０例阳性,阳性率为８１．１％,最常见的病原菌为假单孢菌属; ７２例患者有 ５３例 ＩｇＧ降低,平均值为 ６． ５±１． ２ｇ／Ｌ。结果：患者免疫功能低下和革兰氏阴性杆菌特别是铜绿假单抱杆菌感染是引起支扩感染加重住院的主要因素。在抗菌药物应用时宜选用对假单孢菌有效的药物。     

肺段支气管剔除治疗支气管扩张症的疗效观察

目的观察肺段支气管剔除治疗支气管扩张症的疗效。方法对我院30例支气管扩张症患者采用肺段支气管剔除术进行治疗。结果共剔除肺段支气管64支。术中失血量300～600ml,平均380ml,手术当天胸腔引流量350～550ml,无手术死亡病例。胸腔引流管术后第3～5天拔除。术后胸部X线片示肺膨胀良好,无残腔。术后1例出现肺不张,经纤维支气管镜吸痰后肺复张。住院2～3周均痊愈出院。随访6个月,患者症状消失,复查血气分析检查均正常,胸部X线片示肺膨胀良好,未发现残腔、积液。无1例复发。结论只要掌握好手术条件,采用肺段支气管剔除术代替肺段切除术治疗支气管扩张症是可行的,手术方法简单,不仅切除了病变支气管,出血少,减少了术后并发症,克服了以往术式的不足。值得临床推广。     

Estudio de los mecanismos implicados en la génesis y evolución del asma (proyecto MEGA): creación y seguimiento a largo plazo de una cohorte de pacientes asmáticos

The general aim of this study is to create a cohort of asthma patients with varying grades of severity in order to gain greater insight into the mechanisms underlying the genesis and course of this disease.The specific objectives focus on various studies, including imaging, lung function, inflammation, and bronchial hyperresponsiveness, to determine the relevant events that characterize the asthma population, the long-term parameters that can determine changes in the severity of patients, and the treatments that influence disease progression. The study will also seek to identify the causes of exacerbations and how this affects the course of the disease.Patients will be contacted via the outpatient clinics of the 8 participating institutions under the auspices of the Spanish Respiratory Diseases Networking System (CIBER). In the inclusion visit, a standardized clinical history will be obtained, a clinical examination, including blood pressure, body mass index, complete respiratory function tests, and FENO will be performed, and the Asthma Control Test (ACT), Morisky-Green test, Asthma Quality of Life Questionnaire (Mini AQLQ), the Sino-Nasal Outcome Test 22 (SNOT-22), and the Hospital Anxiety and Depression scale (HADS) will be administered. A specific electronic database has been designed for data collection. Exhaled breath condensate, urine and blood samples will also be collected. Non-specific bronchial hyperresponsiveness testing with methacholine will be performed and an induced sputum sample will be collected at the beginning of the study and every 24 months. A skin prick test for airborne allergens and a chest CT will be performed at the beginning of the study and repeated every 5 years.     

支气管扩张症合并感染患者血清人分泌型磷脂酶A2-X表达情况及其与炎性指标的相关性研究

背景　支气管扩张症是呼吸系统常见病、多发病，感染是引起支气管扩张症的最常见原因。人分泌型磷脂酶A2-X（sPLA2-X）在炎性反应中发挥重要作用，并可促进炎性反应的发生、发展，而支气管扩张症合并感染患者血清sPLA2-X表达情况及其与重要炎性指标如降钙素原（PCT）、C反应蛋白（CRP）、诱导型一氧化氮合酶（iNOS）、白介素（IL）-6、IL-17、IL-33是否存在相关性尚未见相关报道。目的　研究支气管扩张症合并感染患者血清sPLA2-X表达情况及其与炎性指标--PCT、CRP、iNOS、IL-6、IL-17、IL-33的相关性，并进一步研究血清sPLA2-X对支气管扩张症合并感染的影响。方法　选取2017年2月-2019年1月在贵州省人民医院呼吸与危重症医学科住院治疗的支气管扩张症合并感染患者47例为病例组，选取同期在贵州省人民医院健康体检中心体检的健康志愿者21例为健康对照组。收集研究对象一般资料，分别检测健康对照组体检当天、观察组治疗前（入院当天）与治疗后（出院前1天）血清sPLA2-X、白细胞计数、PCT、CRP、iNOS、IL-6、IL-17、IL-33。比较两组治疗前后观察指标，分析病例组治疗前血清sPLA2-X与PCT、CRP、iNOS、IL-6、IL-17、IL-33的相关性。结果　病例组治疗前血清sPLA2-X、白细胞计数、PCT、CRP、iNOS、IL-6、IL-17、IL-33均高于健康对照组（P<0.05）；病例组治疗后血清sPLA2-X、PCT、CRP、iNOS、IL-17均高于健康对照组（P<0.05）；两组治疗后白细胞计数、IL-6、IL-33比较，差异无统计学意义（P>0.05）。病例组治疗后血清sPLA2-X、白细胞计数、PCT、CRP、iNOS、IL-6、IL-17、IL-33均低于本组治疗前（P<0.05）。病例组治疗前血清sPLA2-X与PCT、CRP、iNOS、IL-6、IL-17、IL-33均呈正相关（r=0.526 2、 0.640 1、0.550 7、0.516 8、0.609 9、0.357 4，P值均<0.01）。结论　支气管扩张症合并感染患者血清sPLA2-X升高，且其与PCT、CRP、iNOS、IL-6、IL-7、IL-33呈正相关，表明血清sPLA2-X与支气管扩张症合并感染有重要的关联，血清sPLA2-X可作为评估支气管扩张症合并感染的参考指标。     

噻托溴铵粉吸入剂治疗148例支气管扩张症的效果评定

目的观察噻托溴铵粉吸入剂应用于临床治疗支气管扩张症的效果。方法选取我院治疗的148例支气管扩张症患者,随机分为观察组和对比组,对比组给予常规的支气管扩张症治疗;观察组在进行常规治疗的同时给予噻托溴铵粉吸入剂进行治疗。结果治疗后观察组和对比组的BODE指数和临床症状均有改善,但观察组优于对比组,P0.05,差异具有统计学意义。结论使用噻托溴铵粉吸入剂治疗支气管扩张症疗效显著。     

厄多司坦对老年支气管扩张症及黏液分泌过多的疗效分析

目的：探讨厄多司坦治疗患有支气管扩张症及黏液分泌过多的临床效果分析。方法：抽取80例在本院就诊的患有支气管扩张症及黏液分泌过多的老年患者,将其随机分为A、B两组各40例。A组患者采用胸部物理治疗;B组患者在A组基础上采用厄多司坦进行治疗。结果：两组患者在治疗后的VAS评分、MP、MVP、呼吸肌力、用力肺活量、第1秒用力呼气量均较治疗前有明显的改善,差异有统计学意义（P〈0.05）;B组患者上述指标的改善程度明显高于A组,差异有统计学意义（P〈0.05）。结论：采用厄多司坦对患有支气管扩张症及黏液分泌过多的老年患者进行治疗的临床效果十分明显,不会造成特殊的严重的并发症和不良反应现象,可以做为今后临床对该类患者进行治疗的首选方法,值得进一步使用和推广。