慢性阻塞性肺疾病急性加重期与慢性阻塞性肺疾病并发社区获得性肺炎患者的临床对比

目的 探究慢性阻塞性肺疾病急性加重期与慢性阻塞性肺疾病并发社区获得性肺炎患者的临床对比,旨在为临床的诊断和治疗提供科学依据。方法 选取2017年3月~2018年3月于我院接受治疗的82例COPD患者为研究对象,按照随机数表法分为两组,其中观察组42例为AECOPD患者,对照组40例为COPD合并CAP患者,比较两组患者的临床症状、肺功能以及PCT、CRP水平。结果 观察组患者呼吸困难、咳脓痰、精神差、发热等临床症状的发生率均低于对照组,差异具有统计学意义（P＜0.05）。观察组患者FEV1、FVC、FEV1/FVC分别为（64.15±7.26）ml、（62.85±7.29）ml、（62.03±5.54）%,均高于对照组的（52.51±5.75）ml、（50.85±6.74）ml、（52.34±5.61）%,差异具有统计学意义（P＜0.05）。观察组患者PCT和CRP分别为（0.52±0.07）ng/L和（21.51±1.35）mg/L,均低于对照组的（0.97±0.08）ng/L和（40.05±1.57）mg/L,差异具有统计学意义（P＜0.05）。结论 AECOPD患者与COPD合并CAP患者相比,临床症状发生情况较少,肺功能较好,对患者进行相关检测,能够提高治疗效果。     

西洛司特对COPD患者炎症水平的调节作用

目的:探讨西洛司特对慢性阻塞性肺疾病(COPD)患者外周血IL-4、IL-8、TNF-α的调节作用和临床疗效.方法:70例COPD稳定期患者随机分为治疗组和对照组,每组各35例,治疗组服用西洛司特片(葛兰素史克公司)15mg bid,对照组服用安慰剂1片bid,共6个月为一疗程.结果:治疗前,两组IL-4、IL-8、T...     

两种雾化吸入方式诱发慢性阻塞性肺疾病咳嗽反射的临床观察

目的探讨治疗慢性阻塞性肺疾病（COPD）患者更好的雾化方法。方法采用随机分组自身对照研究的方法,将60例患者分为两组,A组：氧气驱动雾化吸入;B组：超声雾化吸入。每天雾化吸入2次,每次15min,连续观察7d。动态记录两组在雾化过程中咳嗽反射发生次数及发生率。结果 A组吸入过程中咳嗽发生率为3.33%,B组吸入过程中咳嗽发生率为30.00%,差异具有统计学意义（P〈0.05）。结论 COPD患者进行雾化吸入治疗,选择氧气驱动雾化吸入,能有效降低患者的不适咳嗽反射,改善通气功能。     

Artificial Intelligence and Machine Learning in Chronic Airway Diseases: Focus on Asthma and Chronic Obstructive Pulmonary Disease

Chronic airway diseases are characterized by airway inflammation, obstruction, and remodeling and show high prevalence, especially in developing countries. Among them, asthma and chronic obstructive pulmonary disease (COPD) show the highest morbidity and socioeconomic burden worldwide. Although there are extensive guidelines for the prevention, early diagnosis, and rational treatment of these lifelong diseases, their value in precision medicine is very limited. Artificial intelligence (AI) and machine learning (ML) techniques have emerged as effective methods for mining and integrating large-scale, heterogeneous medical data for clinical practice, and several AI and ML methods have recently been applied to asthma and COPD. However, very few methods have significantly contributed to clinical practice. Here, we review four aspects of AI and ML implementation in asthma and COPD to summarize existing knowledge and indicate future steps required for the safe and effective application of AI and ML tools by clinicians.     

中药治疗在慢性阻塞性肺疾病机械通气治疗中的作用研究

目的探讨中药治疗在慢性阻塞性肺疾病（COPD）并呼吸衰竭患者机械通气治疗中的影响作用。方法回顾分析125例COPD合并呼吸衰竭患者在机械通气及常规治疗过程中,据分期辨证施治结果加用中药组与未用中药组。比较两组患者呼吸力学参数,观察两组患者呼吸机相关性肺炎（VAP）的发生率、死亡率、机械通气时间、ICU住院时间、总住院时间等。结果两组机械通气呼吸参数、总的住院时间、死亡率差异无统计学意义（P〉0.05）;治疗组患者VAP发生率降低,病人机械通气时间及ICU住院时间明显缩短,与对照组比较差异有统计学意义（P〈0.05）。结论中药治疗结合常规治疗能有效降低COPD患者机械通气VAP发生率,缩短机械通气时间及ICU住院时间,但对机械通气呼吸参数、总的住院时间、死亡率无明显影响。     

早期慢性阻塞性肺疾病诊断与防治研究

慢性阻塞性肺疾病（COPD）是以持续气流受阻进行性发展为特征的一种可预防和治疗的疾病。COPD发病率、致残率较高,严重威胁人类健康安全。目前,早发现、早诊断、早治疗是我国COPD防治的重要手段。我国早期COPD病例数量大,不同患者症状存在明显差异性。研究早期COPD诊治情况,有望探索对患者进行个体化治疗的方法,进一步促进临床治疗策略的制定,提高慢性阻塞性肺疾的临床诊治研究水平。本文现就COPD早期的诊治研究进行综述,以期为临床诊治慢性阻塞性肺疾提供理论参考依据。     

双水平气道正压通气治疗慢阻肺的临床研究

目的观察双水平气道正压通气对慢性阻塞性肺疾病夜间低氧的治疗作用。方法取60例慢性阻塞性肺疾病患者,随机分成2组。对照组30例使用吸氧、抗感染等常规治疗：治疗组在常规治疗的基础上加用夜间双水平气道正压通气治疗4h,疗程为7d。分别观察2组在治疗前后低氧血症及心率失常发生率和肺动脉压力的变化。结果双水平气道正压通气组在治疗前后自身对照以及与对照组比较,夜间低氧血症及心律失常发生率和肺动脉压力的改变均有统计学意义（P〈0．05～0．01）。结论双水平气道正压通气能改善慢性阻塞性肺疾病患者的夜间低氧血症,减少心律失常的发生率,降低肺动脉压力,可作为治疗慢性阻塞性肺疾病的重要方法之一。     

基于深度学习的慢性阻塞性肺病的诊断模型研究

慢性阻塞性肺病(COPD)是一种常见的以持续气流受限为特征的慢性呼吸道疾病,具有很高的发病率和死亡率。目前临床上对COPD的诊断方式十分复杂,不仅耗时且有创或有辐射伤害,不适用于日常筛查。本研究设计了一种基于深度学习的COPD诊断模型。首先,将RespiratoryDatabase @ TR多媒体呼吸数据库中42位COPD患者的肺音数据和来自天津大学胸科医院的24位COPD患者以及37位健康受试者的临床采集肺音数据相结合,分别运用高通滤波器和基于集合经验模态分解(EEMD)及小波熵的去噪算法进行去噪处理,然后通过归一化、交叠剪切、数据扩增完成预处理过程;然后利用二阶谱分析技术提取肺音特征;最后,将特征输入到改进的19层卷积神经网络模型中,实现健康受试者与COPD患者的二分类。实验结果表明,所提出的模型能够有效诊断COPD,其准确度、敏感度、特异性、F1分数和Kappa系数分别达到了98.93%、98.47%、99.41%、98.95%和97.86%,且由于采用了双中心数据并进行了去噪处理,模型可靠性更高,具有重要的临床意义。     

慢性阻塞性肺疾病患者的认知缺陷

目的:探讨稳定期慢性阻塞性肺疾病tients with COPD(chronic obstructive pulmonary disease,COPD)患者的认知功能,明确其认知功能的变化及认知功能损害的相关因素。方法:选择稳定期COPD患者37例进行血气参数及肺功能测定,选择同期北京市城区健康居民40例为对照组,两组年龄、性别及受教育程度无显著性差异(P>0.05),均采用扩充痴呆量表(Expansive Scale of Dementia,ESD)进行认知功能评价。根据动脉血氧分压值(PaO2)及FEV1占预测值百分比将患者分组。结果:COPD组ESD总分及学习、记忆、计算、结构等四项分测验评分均明显低于对照组(总平均分相差16分,208.1±17.6/224.3±10.6,t=5.19,P<0.001,四项分测验均值相差3-5分,差异均有统计学意义)。PaO2<60mmHgCOPD组ESD总分及学习、记忆力和计算力等三项分测验评分明显低于PaO2≥60mmHgCOPD组(总平均分相差12分,199.4±12.1/211.8±18.4,t=2.05,P=0.048,其他分测验也相差2-5分,其中学习项相差最多22.9±6.8/18.0±2.3,t=2.35,P=0.025)。FEV1占预测值百分比<50%COPD组与FEV1占预测值百分比≥50%COPD组ESD总分分别为205.7±18.1及211.5±16.7,两组评分差异无统计学意义。回归分析显示,PaO2及受教育程度与影响COPD患者ESD评分,两者的标化回归系数分别为0.425和0.245(均P<0.01)。结论:稳定期COPD患者ESD评分明显低于正常对照组,主要表现在学习、记忆、计算、结构等方面。ESD评分主要影响因素为受教育程度及PaO。     

慢性阻塞性肺疾病药物治疗研究

慢性阻塞性肺疾病（COPD）是一种最常见的慢性气道疾病,其起病较为缓慢、病程较长、病情迁延难愈,在早期没有自觉症状。伴随着病情的不断发展,可出现终身不愈的慢性咳嗽,并在气道、肺血管、肺实质内出现炎症应激反应,也会并发慢性呼吸衰竭、自发性气胸、慢性肺源性心脏病等疾病,严重影响患者正常工作与生活质量。目前,临床针对COPD的治疗仍以药物为主,药物治疗的目标在于改善临床症状、提高生活质量,延缓或减弱肺功能减退,预防和治疗并发症,提高存活率,避免或减少用药副作用。因此,寻求合适的药物治疗方案来满足COPD患者的临床治疗需求对于改善患者预后具有十分重要意义。本文通过对COPD致病机制、药物治疗方案作一综述,旨在为临床治疗该疾病提供参考依据。     

No Significant Detectable Anti-infection Effects of Aspirin and Statins in Chronic Obstructive Pulmonary Disease

Background: Past studies have shown that aspirin and statins decrease the rate and severity of exacerbation, the rate of hospitalization, and mortality in chronic obstructive pulmonary disease (COPD). Although these studies are relatively new, there is evidence that new therapeutic strategies could prevent exacerbation of COPD.Trial design: This article examines retrospectively the possibility of using aspirin and statins to prevent exacerbation and infection in patients with COPD.Methods: All patients with COPD were identified from hospital charts in the Department of Internal Medicine, Saarland University Medical Center, Germany, between 2004 and 2014.Results: The study examined 514 medical reports and secured a study population of 300 with COPD. The mean age was 69 ± 10 years (206 men, 68.7%, 95% CI, 63.4‒73.9; 94 women, 31.3%, 95% CI, 26.1‒36.6). The study results did not show a causal relationship between aspirin and statins and prevention of exacerbation and infection in patients with COPD.Conclusion: In contrast, in this study, the exacerbation and infection rates increased under medication with aspirin and statins (p = 0.008).     

慢性阻塞性肺疾病发病机制的研究

慢性阻塞性肺疾病（COPD）在全球的发病率不断地上升,在我国发病率以及死亡率也居高不下,临床对于COPD的研究有很多,包括预防、诊断以及治疗等方面,很大程度上提高了人们对于COPD的认知。但是,目前对于COPD的发病机制尚无明确定论,公认的主要为炎症、蛋白酶-抗蛋白酶失衡以及氧化-抗氧化失衡这三种学说,但是近几年来,研究者在这三种发病机制有了更深的研究,也发现了新的可能的发病机制,本文将对此进行阐述,为COPD的诊治提供理论参考。     

Modified Yupingfeng Formula for the Treatment of Stable Chronic Obstructive Pulmonary Disease: A Systematic Review of Randomized Controlled Trials

Background

Chronic obstructive pulmonary disease (COPD), is a very common disease of respiratory system. An increasing number of clinical trials on Yupingfeng formula in the management of stable COPD have been performed. However, the evidence base for it remains unknown. This review aims at assessing the efficacy, and safety of modified Yupingfeng formula in the treatment of stable COPD through a systematic review of all available randomized controlled trials.

Materials and Methods

Literature retrieval was conducted using four English databases (CENTRAL, PubMed, EMBASE, and ISI Web of Science), and four Chinese databases (CBM, CNKI, VIP, and WANFANG), from respective inception to January 2013, and supplemented with a manual search. Review authors independently extracted the trial data, and assessed the quality of each trial. Methodological quality was assessed by Cochrane risk of bias and Jadad''s scale. The following outcomes were evaluated: (1) lung function; (2) 6-minute walk distance (6MWD); (3) effective rate; (4) serum levels of IgA, IgG and IgE; and (5) adverse events. Data were analyzed using STATA 12.0 software.

Results

A total of nine studies involving 660, stable COPD patients were identified. Patients from all studies included in this review were randomized to receive Yupingfeng formula combined with Western medications in comparison with Western medications. In general, the methodological quality of the included trials was poor. The results of this systematic review indicates that, compared with Western medications alone, the use of Yupingfeng formula, if combined with Western medications could significantly improve FEV₁ (WMD = 0.30L; 95%CI: 0.19, 0.42), FEV₁/FVC ratio (SMD = 0.69; 95%CI: 0.48, 0.91), 6MWD (WMD = 31.73m; 95% CI: 19.29, 44.17), and effective rate (RR = 1.24; 95% CI: 1.10, 1.41), and increase the serum levels of IgA (WMD = 0.25; 95%CI: 0.16, 0.34) and IgG (WMD = 1.10; 95%CI: 0.53, 1.68), but no difference was found in the serum IgE levels (WMD = 0.47; 95%CI: −0.32, 1.27) between the two groups. No serious adverse events were reported.

Conclusions

Within the limitations of this systematic review, we may conclude that compared with Western medications alone, Yupingfeng formula, when combined with Western medications can provide more benefits for patients with stable COPD, without any serious adverse reactions being identified. However, these benefits need to be further confirmed through high-quality prospective placebo-controlled trials that should be strictly conducted in accordance with methodological principles and procedures.     

血液流变学用于估测慢性阻塞性肺疾病肺动脉高压的可行性

通过对８９例慢性阻塞性肺疾病（ＣＯＰＤ）患者肺动脉顺应性（Ｃｐａ）、肺动脉平均压（ＰＡＭＰ）测定和血液流变学的同步研究，获得三个回归方程式，①ＰＡＭＰ＝０．４２５＋０．３５２·ηｂ（Ｈ）；②ＰＡＭＰ＝１．８５７＋０．０７３·ηｂ（Ｌ）；③ＰＡＭＰ＝０．３４９＋０．４５·ＩＲ，并扩大验证４８例。提示肺动脉压力、肺动脉顺应性与血液粘度、红细胞刚性指数有一定的相关性，且能估算群体ＰＡＭＰ，但对个体不能精确计算。     

Relationship of Vitamin D Binding Protein Polymorphisms and Lung Function in Korean Chronic Obstructive Pulmonary Disease

Purpose

Multiple genetic factors are associated with chronic obstructive pulmonary disease (COPD). The association of gene encoding vitamin D binding protein (VDBP, GC) with COPD has been controversial. We sought to investigate the types of GC variants in the Korean population and determine the association of GC variants with COPD and lung function in the Korean population.

Materials and Methods

The study cohort consisted of 203 COPD patients and 157 control subjects. GC variants were genotyped by the restriction fragment-length polymorphism method. Repeated measures of lung function data were analyzed using a linear mixed model including sex, age, height, and pack-years of smoking to investigate the association of GC genetic factors and lung function.

Results

GC1F variant was most frequently observed in COPD (46.1%) and controls (42.0%). GC1S variant (29.0% vs. 21.4%; p=0.020) and genotype 1S-1S (8.3% vs. 3.4%; p=0.047) were more commonly detected in control than COPD. According to linear mixed model analysis including controls and COPD, subjects with genotype 1S-1S had 0.427 L higher forced expiratory volume in 1 second (FEV₁) than those with other genotypes (p=0.029). However, interaction between the genotype and smoking pack-year was found to be particularly significant among subjects with genotype 1S-1S; FEV₁ decreased by 0.014 L per smoking pack-year (p=0.001).

Conclusion

This study suggested that GC polymorphism might be associated with lung function and risk of COPD in Korean population. GC1S variant and genotype 1S-1S were more frequently observed in control than in COPD. Moreover, GC1S variant was more common in non-decliners than in rapid decliners among COPD.     

脑卒中伴慢性阻塞性肺疾病患者应用ACEI对并发吸入性肺炎的影响

目的观察合并高血压的脑卒中并发稳定期慢性阻塞性肺疾病患者应用血管紧张素转换酶抑制剂（ACEI）类降压药对其预防吸入性肺炎的影响。方法将120例合并高血压非昏迷且年龄≥60岁的脑卒中伴稳定期慢性阻塞性肺疾病患者分为ACEI组和对照组,ACEI组患者应用ACEI类降压药（卡托普利）治疗,对照组应用其它类型的降压药,观察两组在住院期间吸入性肺炎等并发症的发生情况。结果在住院期间ACEI组有4例患者（6．7％）并发吸入性肺炎,而对照组有13例患者（21．7％）合并吸入性肺炎,两组相比差异有统计学意义（P〈0．05）。ACEI组有11例（18．3％）患者出现不同程度咳嗽,其中4例因持续性干咳而停药。ACEI组住院期间患者死亡率为3．3％,而对照组患者死亡率为5％,两组差异无统计学意义。结论预防性应用ACEI类降压药．可降低合并高血压非昏迷老年脑卒中伴稳定期慢性阻塞性肺疾病患者并发吸入性肺炎的发生率。     

异丙托溴铵雾化吸入治疗慢阻肺急性加重期的临床疗效

目的 探讨沙丁胺醇与布地奈德联合异丙托溴铵雾化吸入治疗慢阻肺急性加重期的临床疗效。方法 选取2017年7月~2019年4月我院收治的慢阻肺急性加重期患者94例,根据随机数字表法分为观察组和对照组,每组47例。对照组给予沙丁胺醇与布地奈德雾化吸入治疗,观察组在对照组基础上加用异丙托溴铵雾化吸入治疗,比较两组临床疗效、不良反应总发生率及治疗前后肺功能指标变化情况（FEV1%、FEV1和FVC）。结果 观察组总有效率为91.49%,高于对照组的74.47%,差异有统计学意义（P＜0.05）。观察组不良反应总发生率为12.76%,低于对照组的14.89%,但差异无统计学意义（P＞0.05）。治疗后,观察组FEV1%、FEV1和FVC均高于对照组[（70.61±14.74）% vs（61.24±13.42）%]、[（2.25±0.77）L vs（1.94±0.63）L]、[（3.46±0.98）L vs（3.07±0.91）L],差异有统计学意义（P＜0.05）。结论 沙丁胺醇与布地奈德联合异丙托溴铵雾化吸入治疗慢阻肺急性加重期患者疗效显著,有助于改善患者临床症状及肺部通气功能,减少用药后不良反应发生几率,安全性高。     

Evaluation of Quality of Life with the Chronic Obstructive Pulmonary Disease Assessment Test in Chronic Obstructive Pulmonary Disease and the Effect of Dyspnea on Disease-Specific Quality of Life in These Patients

Purpose

The chronic obstructive pulmonary disease (COPD) assessment test (CAT) was recently introduced for use in assessing disease-specific quality of life and follow-up of patients with COPD. The purpose of this study was to evaluate the effect of the dyspnea on disease-specific quality of life detected by CAT score in patients with COPD.

Materials and Methods

In this study, 90 stable patients with COPD as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria were included. The level of dyspnea was assessed with the Medical Research Council (MRC) dyspnea scale, and disease-specific quality of life was assessed with CAT score.

Results

The mean±SD age was 68.5±10.9 (range 41-97) years. A significant relationship was established between CAT score, MRC dyspnea scale score and GOLD stage in patients with COPD. There was also a positive correlation between dyspnea scale scores and GOLD stage in the patients (p<0.001), as well as positive correlation between CAT score and dyspnea scale score (p<0.001). CAT score showed a significant correlation with hospitalization and exacerbations (p<0.05).

Conclusion

Dyspnea is an important symptom that may impact quality of life in patients with COPD. CAT was shown to be a simple, fast and intelligible measurement of disease-specific quality of life, and was correlated with levels of dyspnea in patients with COPD.