中度稳定期慢性阻塞性肺疾病疲劳与多维度指标的关系

目的 探讨中度稳定期慢性阻塞性肺疾病(慢阻肺)患者疲劳与营养指标、生活质量指标、炎症指标、精神情绪指标的关系。方法 采用前瞻性研究,根据一般疲劳定义,从慢阻肺患者中随机选取中度稳定期慢阻肺疲劳患者30例(疲劳组)与中度稳定期慢阻肺非疲劳患者26例(非疲劳组)。收集两组一般资料、营养指标、生活质量指标、炎症指标、精神情绪指标,并进行比较。结果 两组性别、年龄、吸烟指数等方面差异无统计学意义(均P>0.05);与非疲劳组相比,疲劳组白蛋白、血红蛋白、体重指数、第1秒用力呼气容积占预计值的百分比(percent predicted forced expiratory volume in one-second, FEV1%)、6 min步行距离(6-minute walk distance, 6MWD)均显著降低(P<0.05),慢性阻塞性肺疾病评估测试(chronic obstructive pulmonary disease assessment test, CAT)评分、C反应蛋白(C-reactive protein, CRP)、降钙素原(procalcitonin, PCT)、白细胞(WBC)计数、贝克抑郁和焦虑量表评分, 心理身体紧张松弛测试量表(PSTR)评分均较高(P<0.05)。 结论 疲劳与中度稳定期慢阻肺患者营养、生活质量、炎症、精神情绪有关,是建立慢阻肺患者多维度疲劳测量的重要部分。     

慢阻肺急性加重期患者延迟就医与家庭动力学的相关性研究

目的研究慢阻肺急性加重期患者延迟就医与家庭动力学的相关性,希望能够为慢阻肺急性加重期患者拟定护理措施提供科学依据。方法选取2017年1月-2019年12月我院240例诊断为慢阻肺急性加重期的患者为研究对象。根据患者入院就医的时间进行分组,时间≥24h的延迟就医的患者为观察组,时间<24h的及时就医患者为对照组。结果两组患者在文化水平、家庭年收入、在职状态、医疗保险和婚姻状况和APACHEⅡ评分比较(P<0.05)。观察组患者疾病观念、个性化、系统逻辑和家庭氛围得分比对照组高(P<0.05)。Pearman的相关性分析结果显示:慢阻肺急性加重期患者延迟就医时间与各个层面分数以及家庭动力总分呈现负相关性(P<0.05)。应变量为延迟就医为应变量,患者的一般资料为自变量,经Logistic回归分析结果表明:延迟就医的影响因素为文化水平、家庭动力评分、职业状态、家庭收入、婚姻状况和APACHEⅡ评分。结论慢阻肺急性加重期患者家庭动力总分与疾病观念、个性化、系统逻辑和家庭氛围得分与延迟就医时间呈现负相关性,患者延迟就医的影响因素是家庭动力学评分。     

Gait parameters,functional performance and physical activity in active and inactive Juvenile Idiopathic Arthritis

BackgroundChildren with Juvenile Idiopathic Arthritis (JIA) may adopt different movement patterns and participate in physical activity during different states of disease.Research questionWhich specific features of gait and physical function performance differ among children with active or inactive JIA compared to healthy children?MethodsForty-three children participated (14.5 ± 4.2 yrs; 60 % female). 3D-motion analysis methods were coupled with force measures from an instrumented treadmill captured gait mechanical measures. The 30-second Chair Rise Test (repetitions) and stair ascent-descent tests were performed, and the 11-point Wong-Baker face scale assessed pain after each test.ResultsCompared to healthy controls children with active and inactive JIA had worse outcomes (12–21 % slower self-selected and fast walking speeds, 28–34 % slower stair navigation times, 28 % fewer chair rise repetitions in 30 s; all p < .05). Children with active JIA had 8–13 % slower gait speeds, 4 % fewer chair rise repetitions and 14–16 % slower stair navigation times. At faster walking speed, children with active JIA had less hip joint flexion/extension excursion in the sagittal plane during the gait cycle, produced higher leg stiffness, and demonstrated greater interlimb asymmetry in GRF vertical impulse during loading than healthy children (all p < .05). The Pedi-FABS subscore of “Duration: performing athletic activity for as long as you would like without stopping” was rated lower in children with active JIA compared to controls (p < .05).ConclusionGait speed, specific load-bearing functional tasks and leg stiffness features of gait may be informative ‘functional biomarkers’ for assessing JIA burden and tracking treatment efficacy. Additional prospective studies are needed to determine how these features change over time with pain change, and understand impact on quality of life and physical activity participation.     

Pulmonary Hypertension Registry of Kerala,India (PRO-KERALA): One-year outcomes

BackgroundShort term outcomes of patients with pulmonary hypertension are not available from low and middle-income countries including India.MethodsWe conducted a prospective study of 2003 patients with pulmonary hypertension, from 50 centres (PROKERALA) in Kerala, who were followed up for one year. Pulmonary hypertension (PH) was mainly diagnosed on the basis of Doppler echocardiography. The primary outcome was a composite end-point of all-cause death and hospital admission for heart failure. All cause hospitalisation events constituted the secondary outcome.ResultsMean age of study population was 56 ± 16 years. Group 1 and Group 2 PH categories constituted 21.2% and 59% of the study population, respectively. Nearly two-thirds (65%) of the study participants had functional class II symptoms. 31% of Group 1 PH patients were on specific vasodilator drugs.In total, 83 patients (4.1%) died during the one-year follow-up period. Further, 1235 re-hospitalisation events (61.7%) were reported. In the multivariate model, baseline NYHA class III/IV (OR 1.87, 95% C.I. 1.35–2.56), use of calcium channel blockers (OR 0.18, 95% C.I. 0.04–0.77), vasodilator therapy (OR 0.5, 95% C.I. 0.28–0.87) and antiplatelet agents (OR 1.80, 95% C.I. 1.29–2.51) were associated with primary composite outcome at one-year (p < 0.05).ConclusionIn the PROKERALA registry, annual mortality rate was 4%. More than half of the patients reported re-hospitalisation events on follow up. Uptake of guideline directed therapies were suboptimal in the study population. Quality improvement programmes to improve guideline directed therapy may improve clinical outcomes of PH patients in India.     

Measurement errors in control risk regression: A comparison of correction techniques

Control risk regression is a diffuse approach for meta-analysis about the effectiveness of a treatment, relating the measure of risk with which the outcome occurs in the treated group to that in the control group. The severity of illness is a source of between-study heterogeneity that can be difficult to measure. It can be approximated by the rate of events in the control group. Since the estimate is a surrogate for the underlying risk, it is prone to measurement error. Correction methods are necessary to provide reliable inference. This article illustrates the extent of measurement error effects under different scenarios, including departures from the classical normality assumption for the control risk distribution. The performance of different measurement error corrections is examined. Attention will be paid to likelihood-based structural methods assuming a distribution for the control risk measure and to functional methods avoiding the assumption, namely, a simulation-based method and two score function methods. Advantages and limits of the approaches are evaluated through simulation. In case of large heterogeneity, structural approaches are preferable to score methods, while score methods perform better for small heterogeneity and small sample size. The simulation-based approach has a satisfactory behavior whichever the examined scenario, with no convergence issues. The methods are applied to a meta-analysis about the association between diabetes and risk of Parkinson disease. The study intends to make researchers aware of the measurement error problem occurring in control risk regression and lead them to the use of appropriate correction techniques to prevent fallacious conclusions.     

Does newborn screening improve early lung function in cystic fibrosis?

Despite evidence showing an improvement in nutritional outcomes following diagnosis by newborn screening (NBS) for cystic fibrosis (CF), the impact on pulmonary outcomes has been less clear. In this review the approaches to measurement of early lung function and knowledge gained from NBS CF cohorts will be described. Studies which have compared outcomes in those diagnosed by NBS to those diagnosed following symptomatic presentation will be presented. Compiling the evidence base used to evaluate the impact of NBS on pulmonary outcomes has been complicated by improvements in clinical management, infection control practices, as well as public health interventions (such as tobacco smoking bans in public places) that have evolved substantially over recent decades. Forced expiratory volumes have been used as the main outcome but it is important not to draw conclusions for ‘early lung function’ from tests such as spirometry alone, which lack sensitivity in early lung disease. There is, at present, insufficient evidence to draw firm conclusions about the effect of NBS on early lung function. In an era of highly effective treatments targeting the underlying molecular defect responsible for CF, future opportunities for early initiation of treatment may mean that the impact of NBS on early lung function may yet to be realised.     

系统性呼吸功能训练对哮喘-慢性阻塞性肺疾病重叠综合征患者肺功能及呼吸指标的影响

目的 探讨系统性呼吸功能训练对哮喘-慢性阻塞性肺疾病重叠综合征(asthma-COPD overlap syndrome,ACOS)患者肺功能和呼吸指标的影响。方法 选择笔者所在医院2019年5月-2020年10月收治的102例ACOS患者作为研究对象,采用随机数字表法将其分为对照组和研究组,各51例。对照组行常规护理,研究组在对照组基础上融合系统性呼吸功能训练。比较2组干预前后的肺功能指标和呼吸指标。结果 干预后,研究组的肺功能各项指标均明显优于对照组(P<0.05);气道阻力各项指标显著优于对照组(P<0.05),呼吸困难程度轻于对照组(Z=-2.996,P=0.003)。结论 对ACOS患者在护理过程中融合系统性呼吸功能训练,可明显降低患者气道阻力指标,对改善肺功能、缓解患者呼吸困难具有明显效果。