82例AECOPD患者肝功能异常临床处置方案初探

目的分析慢性阻塞性肺疾病急性加重（AECOPD）合并肝损害患者的临床特点、保肝治疗对其预后的影响。方法回顾性分析82例AECOPD合并肝损害者的外周血白细胞计数、中性粒细胞百分比、肝功能及动脉血气分析,并对治疗前后检验结果、住院天数、住院费用、肝功能转归和死亡率进行比较分析。结果 AECOPD患者治疗后症状、动脉血氧分压（PaO2）、外周血白细胞、中性粒细胞百分比和肝功能各参数值较治疗前均有明显改善（P〈0.01）;随pH值、PaO2、PaCO2指标的改善及感染的控制,肝功能亦逐渐恢复至正常。酸中毒时（pH〈7.35）pH值与ALT、AST结果显著负相关,PaO2与ALT、AST结果显著负相关,PaCO2与ALT、AST结果显著正相关。结论 AECOPD患者肝脏功能有明显的损害,给予抗感染等原发病治疗,肝功能可恢复正常,但常规护肝降酶治疗对转归无显著影响。     

布地格福吸入气雾剂治疗慢性阻塞性肺疾病稳定期临床疗效的影响因素分析

目的:探讨在慢性阻塞性肺疾病稳定期中影响布地格福吸入气雾剂治疗疗效的关键影响因素.方法:选取2022 年 7 月至 2023 年 10 月宁都县中医院收治的 60 例COPD稳定期患者为研究对象.患者经布地格福吸入气雾剂治疗 3 m后,按疗效分为有效组、无效组.比较两组一般资料、疾病情况和实验室指标,并通过多因素Logistic分析可能对临床疗效产生影响的因素.结果:治疗后COPD患者pH值和PaO2 水平上升,PaCO2 水平下降,差异有统计学意义(P＜0.05).60例患者纳入有效组 44 例,无效组 16 例,两组COPD分级、吸烟史、急性加重持续时间、6 分钟步行距离(6MWD)、改良英国医学会呼吸困难指数(mMRC)、COPD评估测试(CAT)评分、动脉血氧分压、动脉血二氧化碳分压比较差异有统计学意义(P＜0.05).其中吸烟史、急性加重持续时间、6MWD、mMRC评分、CAT评分、动脉血氧分压是布地格福疗效的独立影响因素.结论:使用布地格福吸入气雾剂治疗可以显著减轻稳定期COPD患者的临床症状,增强其生活质量和日常活动能力     

穴位按摩联合六字诀呼吸操应用于慢性阻塞性肺疾病 急性加重期患者中的疗效

目的 探讨穴位按摩联合六字诀呼吸操应用于慢性阻塞性肺疾病急性加重期（AECOPD）患者中的临床疗效。方法 选取2017年12月~2018年11月成都市郫都区中医医院收治的AECOPD急性加重期住院患者80例,随机分为治疗组和对照组,各40例。对照组采用常规治疗配合缩嘴呼吸及腹式呼吸锻炼,治疗组在常规治疗的基础上给予穴位按摩配合六字诀呼吸操干预,比较两组治疗前后中医证候积分、mMRC评分、SpO2、CAT评分以及FEV1/FVC的变化。结果 治疗前两组中医证候积分、mMRC评分、SpO2比较,差异无统计学意义（P＞0.05）;治疗后,治疗组中医证侯积分、mMRC评分低于对照组[（4.35±1.58）分vs（7.45±1.63）分]、[（0.45±0.50）分vs（1.23±0.48）分],SpO2高于对照组[（95.68±2.01）% vs（92.76±1.27）%],差异有统计学意义（P＜0.05）。治疗前,两组CAT评分及FEV1/FVC比较,差异无统计学意义（P＞0.05）;治疗后,治疗组CAT评分低于对照组[（21.68±3.53）分vs（24.15±3.12）分],差异有统计学意义（P＜0.05）;两组FEV1/FVC比较,差异无统计学意义（P＞0.05）。结论 穴位按摩联合六字诀呼吸操能改善慢性阻塞性肺疾病急性加重期患者中医证候,提高血氧饱和度,减轻呼吸困难,提高患者生活质量,改善预后。     

外周血嗜酸粒细胞、CK-MB及cTnT表达与慢阻肺患者心肌损伤的相关性分析

目的:研究外周血嗜酸粒细胞、CK-MB 及 cTnT 表达与慢阻肺患者心肌损伤的相关性.方法:选取2019 年 6 月-2022 年 6 月我院收治的 94 例慢阻肺患者作为研究对象.根据患者是否存在心肌损伤分为心肌损伤组(n=41)和无心肌损伤组(n=53).对比两组外周血嗜酸粒细胞、CK-MB及cTnT表达.对比两组一般资料.采用logistic回归分析影响导致慢阻肺患者心肌损伤的相关危险因素.结果:相比无心肌损伤组,心肌受损组外周血嗜酸粒细胞、CK-MB及cTnT显著更高(P＜0.05);两组者在COPD病程、存在高血压、存在糖尿病、无创机械通气时间、PaO2、PaCO2、CRP方面,差异具有统计学意义(P＜0.05);外周血嗜酸粒细胞、CK-MB、cTnT、COPD病程、存在高血压、存在糖尿病、无创机械通气时间、PaO2、PaCO2、CRP是慢阻肺患者合并心肌损伤的独立危险因素.结论:慢阻肺患者出现心肌损伤与患者的外周血嗜酸粒细胞、CK-MB、cTnT、COPD 病程、存在高血压、存在糖尿病、无创机械通气时间、Pa O2、PaCO2、CRP 有关.     

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。     

无创正压通气在慢性阻塞性肺疾病急性加重期治疗中的应用

目的：探讨无创正压通气在慢性阻塞性肺疾病（COPD）急性加重期的治疗作用。方法：48例COPD急性加重期患者随机分为两组。对照组22例行常规治疗;治疗组26例除常规治疗外,同时采用双水平无创正压通气（BiPAP）治疗。结果：治疗组无创正压通气治疗3h、24h的动脉血气分析示,PH、PaCO2及PaO2值较治疗前有明显改善（P〈0．05）。治疗组住院时间较对照组短（P〈0．05）,治愈率较对照组高（P〈0．05）,气管插管率和住院死亡率较对照组低。结论：使用BiPAP呼吸机行无创正压通气,其方法简便、有效、并发症少,对COPD急性加重期患者早期应用,可缩短患者住院时间、降低死亡率、提高痊愈率。     

无创呼吸机治疗慢性呼吸衰竭80例疗效分析

目的：探究无创呼吸机治疗COPD合并I 型呼吸衰竭的临床疗效。方法回顾性分析我院收治COPD并I 型呼吸衰竭80例患者的临床资料。结果观察组患者PaO2、SpO2明显提高,PaCO2明显降低,pH值明显改善,差异均具有统计学意义,<0.05;对照组患者的动脉血气pH值、PaO2、PaCO2、SpO2指标变化不大,差异无统计学意义,>0.05。结论无创呼吸机治疗COPD并I 型呼吸衰竭,可有效改善患者呼吸功能,疗效确切,值得临床推广应用。     

多索茶碱治疗慢性阻塞性肺疾病急性加重期患者的临床疗效

目的 探讨多索茶碱治疗慢性阻塞性肺疾病（COPD）急性加重期患者的临床疗效。方法 选取2017年9月~2018年8月我院收治的COPD急性加重期患者50例,随机分为观察组及对照组,各25例。对照组给予患者吸氧、抗感染、化痰及解痉平喘等治疗,观察组在对照组基础上加用多索茶碱0.3 g静滴治疗,比较两组动脉血气、CAT评分、临床疗效有效率。结果 治疗后,两组pH比较,差异无统计学意义（P＞0.05）;观察组PaO2高于对照组,PaCO2低于对照组,差异有统计学意义（P＜0.05）。观察组CAT评分低于对照组[（17.68±2.77）分 vs（19.76±2.60）分],差异有统计学意义（P＜0.05）。观察组总有效率为88.00%,高于对照组的76.00%,差异有统计学意义（P＜0.05）。结论 多索茶碱治疗COPD急性加重期患者的临床治疗效果较好,患者的各项症状均得到缓解,值得临床使用。     

血清可溶性尿激酶型纤溶酶原激活物受体对老年慢性阻塞性肺疾病急性加重期临床诊断的意义

目的探讨血清可溶性尿激酶型纤溶酶原激活物受体对老年慢性阻塞性肺疾病急性加重期(AECOPD)的诊断价值。方法选取本院2015年1月至2018年6月收治的老年慢性阻塞性肺疾病(COPD)患者158例,其中AECOPD患者(急性组)93例,COPD稳定期患者(稳定组)65例;同时选取同期健康体检老年人群79例作为对照组。检测血清可溶性尿激酶型纤溶酶原激活物受体(suPAR)、降钙素原(PCT)和C反应蛋白(CRP)水平、肺功能及CAT评分;同时分析suPAR、PCT、CRP水平与肺功能和CAT评分的相关性,并应用受试者工作曲线(ROC)评分suPAR、PCT、CRP水平对老年慢性阻塞性肺疾病急性加重期的诊断价值。结果急性组和稳定组血清suPAR、CRP、PCT水平高于对照组( P <0.05);稳定组血清suPAR、CRP、PCT水平和CAT评分低于急性组( P <0.05)。急性组和稳定组FEV1%pred和FEV1/FVC水平低于对照组( P <0.05);稳定组FEV1%pred和FEV1/FVC水平高于急性组( P <0.05)。血清suPAR、PCT和CRP水平与FEV1%pred和FEV1/FVC呈负相关( P <0.05),与CAT评分呈正相关( P <0.05)。ROC曲线分析显示,血清suPAR对COPD急性加重期的诊断价值优于PCT和CRP。结论老年COPD急性加重期患者血清suPAR水平明显上升,与肺功能指标密切相关,可作为诊断老年COPD急性加重期的标志物。     

胸部物理治疗联合纤维支气管镜灌洗对肺结核的效果

目的:探讨胸部物理治疗（CPT）联合纤维支气管镜（FB）灌洗对肺结核（PTB）患者的应用效果。方法:125例PTB患者根据随机数字表法分为对照组62例和观察组63例,对照组行常规治疗,观察组在其基础上行CPT联合FB灌洗。比较两组治疗7 d后排痰效果和治疗24 h后日排痰量;治疗前和治疗24 h后呼吸频率（RR）、血氧饱和度（SpO2）、气道峰压（PIP）、平均动脉压（MAP）、血氧分压（PaO2）、二氧化碳分压（PaCO2）、氧合指数（OI）。结果:与对照组比较,观察组排痰总有效率、日排痰量显著升高,差异有统计学意义（P<0.05）;与治疗前比较,治疗后两组RR、PIP、MAP、PaCO2显著降低,SpO2、PaO2、OI显著升高,观察组变化幅度显著大于对照组（P<0.05）。结论:CPT联合FB灌洗对PTB患者有较好的应用效果,能够有效改善排痰效果和呼吸功能。     

Noninvasive intermittent positive pressure ventilation in treatment of chronic respiratory disease exacerbation

Noninvasive intermittent positive pressure ventilation (NIPPV) via nasal mask became a routine method of treatment of severe exacerbations of chronic respiratory failure. The aim of the study was to apply NIPPV in patients with COPD admitted to hospital due to exacerbation of the disease who on standard treatment developed progressing respiratory acidosis (pH < 7.30). Fourteen COPD patients were treated with NIPPV. Arterial blood gases at the beginning of treatment were: PaO2 41 +/- 9 mmHg, PaCO2 = 87 +/- 17 mmHg, pH = 7.30 +/- 0.05. In 10 patients NIPPV applied quasi continuously resulted in clinical improvement and an amelioration of arterial blood gases. PaO2 rose from 41 +/- 9 mmHg to 56 +/- 12 mmHg, PaCO2 fell from 85 +/- 17 to 57 +/- 9 mmHg and pH rose from 7.30 +/- 0.05 to 7.41 +/- 0.04. In 4 patients NIPPV did not prevent further progression of respiratory acidosis. They were intubated and mechanically ventilated. Three patients survived and were discharged home. One patient died from septic shock. We conclude that NIPPV is an effective method to treat respiratory acidosis developing during exacerbation of severe COPD.     

Inflammatory endotypes in COPD

Chronic obstructive pulmonary disease (COPD) is a major global health problem that is poorly treated by current therapies as it has proved difficult to treat the underlying inflammation, which is largely corticosteroid‐resistant in most patients. Although rare genetic endotypes of COPD have been recognized, despite the clinical heterogeneity of COPD, it has proved difficult to identify distinct inflammatory endotypes. Most patients have increased neutrophils and macrophages in sputum, reflecting the increased secretion of neutrophil and monocyte chemotactic mediators in the lungs. However, some patients also have increased eosinophils in sputum and this may be reflected by increased blood eosinophils. Increased blood and sputum eosinophils are associated with more frequent exacerbations and predict a good response to corticosteroids in reducing and treating acute exacerbations. Eosinophilic COPD may represent an overlap with asthma but the mechanism of eosinophilia is uncertain as, although an increase in sputum IL‐5 has been detected, anti‐IL‐5 therapies are not effective in preventing exacerbations. More research is needed to link inflammatory endotypes to clinical manifestations and outcomes in COPD and in particular to predict response to precision medicines.     

Acute exacerbations of asthma: epidemiology, biology and the exacerbation-prone phenotype

Asthma is a highly prevalent chronic respiratory disease affecting 300 million people world-wide. A significant fraction of the cost and morbidity of asthma derives from acute care for asthma exacerbations. In the United States alone, there are approximately 15 million outpatient visits, 2 million emergency room visits, and 500 000 hospitalizations each year for management of acute asthma. Common respiratory viruses, especially rhinoviruses, cause the majority of exacerbations in children and adults. Infection of airway epithelial cells with rhinovirus causes the release of pro-inflammatory cytokines and chemokines, as well as recruitment of inflammatory cells, particularly neutrophils, lymphocytes, and eosinophils. The host response to viral infection is likely to influence susceptibility to asthma exacerbation. Having had at least one exacerbation is an important risk factor for recurrent exacerbations suggesting an 'exacerbation-prone' subset of asthmatics. Factors underlying the 'exacerbation-prone' phenotype are incompletely understood but include extrinsic factors: cigarette smoking, medication non-compliance, psychosocial factors, and co-morbidities such as gastroesophageal reflux disease, rhinosinusitis, obesity, and intolerance to non-steroidal anti-inflammatory medications; as well as intrinsic factors such as deficient epithelial cell production of the anti-viral type I interferons (IFN-α and IFN-β). A better understanding of the biologic mechanisms of host susceptibility to recurrent exacerbations will be important for developing more effective preventions and treatments aimed at reducing the significant cost and morbidity associated with this important global health problem.     

Neutrophil CD64 as a Marker of Bacterial Infection in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are responsible for most mortality in patients with chronic obstructive pulmonary disease (COPD) and are caused mainly by bacterial infection. We analyzed and compared neutrophil CD64 expression (using the ratio of CD64 level in neutrophils to that in lymphocytes as an index), serum C-reactive protein (CRP), procalcitonin (PCT) levels, white blood cell (WBC) count, and neutrophil percentage among healthy subjects and patients with stable COPD or AECOPD. Compared with patients with COPD and healthy subjects, patients with AECOPD demonstrated significantly increased CD64 index, CRP, PCT, WBC count, and neutrophil percentage. Interestingly, CD64 index and PCT were both significantly higher in patients with AECOPD with positive bacterial sputum culture than those with negative culture. Furthermore, CD64 index and PCT were positively correlated in AECOPD, and there was also correlation between CD64 index and CRP, WBC, and neutrophil percentage. These data suggest that CD64 index is a relevant marker of bacterial infection in AECOPD. We divided patients with AECOPD into CD64-guided group and conventional treatment group. In CD64-guided group, clinicians prescribed antibiotics based on CD64 index; while in the conventional treatment group, clinicians relied on experience and clinical symptoms to determine the necessity for antibiotics. We found that the efficacy of antibiotic treatment in CD64-guided group was significantly improved compared with the conventional treatment group, including reduction of hospital stays and cost and shortened antibiotic treatment duration. Thus, the CD64 index has important diagnostic and therapeutic implications for antibiotic treatment of patients with AECOPD.     

Three-month Treatment Response and Exacerbation in Chronic Obstructive Pulmonary Disease

The aim of this study was to investigate relationships between acute exacerbation and Forced Expiratory Volume 1 second (FEV₁) improvement after treatment with combined long-acting beta-agonist (LABA) and inhaled corticosteroid (ICS) in patients with chronic obstructive pulmonary disease (COPD). A total of 137 COPD patients were classified as responders or nonresponders according to FEV₁ improvement after 3 months of LABA/ICS treatment in fourteen referral hospitals in Korea. Exacerbation occurrence in these two subgroups was compared over a period of 1 yr. Eighty of the 137 COPD patients (58.4%) were classified as responders and 57 (41.6%) as nonresponders. Acute exacerbations occurred in 25 patients (31.3%) in the responder group and in 26 patients (45.6%) in the nonresponder group (P=0.086). FEV₁ improvement after LABA/ICS treatment was a significant prognostic factor for fewer acute exacerbations in a multivariate Cox proportional hazard model adjusted for age, sex, FEV₁, smoking history, 6 min walk distance, body mass index, exacerbation history in the previous year, and dyspnea scale.Three-month treatment response to LABA/ICS might be a prognostic factor for the occurrence of acute exacerbation in COPD patients.

Graphical Abstract

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Chlamydia pneumoniae Infection in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Analysis of 250 Hospitalizations

Two hundred fifty hospitalizations were included in a serologically based prospective study to assess the role of Chlamydia pneumoniae in episodes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and the percentage of COPD patients chronically infected with this pathogen. Chlamydia pneumoniae-specific IgG, IgA and IgM antibody titers were determined using a commercial kit with the microimmunofluorescence method. A significantly higher geometric mean titer in the COPD patients compared to the control group was found for IgG (P<0.00001) and IgA (P<0.000001). The serological criterion for chronic Chlamydia pneumoniae infection (IgG ≥128 concomitant with IgA ≥64) was positive in 73 (33.3%) COPD patients compared with 7 (7%) controls (P=0.000001). No difference was found in any serological parameter when the study population was divided by severity of COPD. When the serological profiles were compared between the first and second of 31 pairs of hospitalizations, 7 of the 62 (11.3%) hospitalizations showed evidence of acute infection with Chlamydia pneumoniae around one of the episodes of AECOPD. It is concluded that compared with the control group, the COPD patients had a significantly higher prevalence of chronic Chlamydia pneumoniae infection. In the COPD group, there was no correlation between the severity of the disease and the rate of chronic Chlamydia pneumoniae infection. In a substantial percentage of AECOPD cases, there is serological evidence of acute Chlamydia pneumoniae infection around the time of the exacerbation. The clinical and pathophysiologic implications of these findings should be clarified by further studies. Electronic Publication     

Exacerbations of chronic obstructive pulmonary disease and chronic mucus hypersecretion

Chronic obstructive pulmonary disease (COPD) exacerbations are an important cause of the considerable morbidity and mortality found in COPD. COPD exacerbations increase with increasing severity of COPD, and some patients are prone to frequent exacerbations leading to hospital admission and readmission. These frequent exacerbations may have considerable impact on quality of life and activities of daily living. Factors that increase the risk for COPD exacerbations are associated with increased airway inflammation caused by common pollutants and bacterial and/or viral infections. These inflammatory responses cause mucus hypersecretion and, thereby, airway obstruction and associated exacerbations. While chronic mucus hypersecretion is a significant risk factor for frequent and severe exacerbations, patients with chronic mucus hypersecretion have a lower rate of relapse after initial treatment for acute exacerbation. The benefit of antibiotics for treatment of COPD exacerbations is small but significant. While the mechanisms of actions are not clear, mucolytic agents reduce the number of days of disability in subjects with exacerbations. Reducing mucous cell numbers in small airways could be a useful way to reduce chronic mucus hypersecretion. Our studies suggest that programmed cell death is crucial in the resolution of metaplastic mucous cells, and understanding these mechanisms may provide novel therapies to reduce the risk of COPD exacerbations.