淋巴毒素A基因多态性与慢性阻塞性肺疾病并发骨质疏松的关系

目的 探讨淋巴毒素A(LTA)基因多态性与北方汉族人群慢性阻塞性肺疾病(COPD)并发症骨质疏松的关系.方法 收集2007年6-12月因COPD急性加重收住院治疗的122例COPD患者,在排除慢性肾功能不全以及甲状腺、甲状旁腺等疾病后,最后纳入101例COPD患者作为研究对象.采用双能X线骨密度测定仪测定患者的腰椎及股骨近端骨密度,根据骨密度情况将患者分为骨质疏松组(n=67)和非骨质疏松组(n=34).以PCR直接测序法检测两组患者的6个LTA基因的tSNP位点(rs2844482, rs2071590, rs2239704, rs909253, rs2229094, rs1041981)的基因型分布,用χ2检验进行Hardy-Weinberg平衡检验,用非条件logistic回归模型计算比值比及95%可信区间,比较两组的差异.结果 骨质疏松与非骨质疏松COPD患者LTA基因6个SNP位点的基因型分布频率均无显著性差异(P＞0.05).结论 LTA基因多态性与COPD并发骨质疏松可能无相关性.     

水通道蛋白-5基因多态性与中国北方汉族人群慢性阻塞性肺疾病的相关性分析

目的 探讨水通道蛋白-5(AQP5)基因多态性与中国北方汉族人群慢性阻塞性肺疾病(CORD)的遗传易感性及严重程度的关系.方法 2007年6月—2012年5月在解放军306医院呼吸科获得诊断的COPD急性加重(AECOPD)患者220例,男142例,女78例,年龄37～101(74.0±10.0)岁,选取在我院进行体检,且年龄、性别与COPD患者相匹配的285例健康人群列入对照组,男183例,女102例,年龄44～97(72.5±8.6)岁.将COPD组分为4个亚组:第1秒用力呼气容积占用力肺活量百分比(FEV1/FVC) ＜70％,第1秒用力呼气肺容积占计值百分比(FEV1％)≥80％为轻度组;50％≤FEV1％＜80％为中度组;30％≤FEV1＜50％为重度组;FEV1≤30％为极重度组,将轻度与中度合并为轻-中度组,重度与极重度合并为重度-极重度组.搜集研究对象外周血标本,采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)和SNaPshot法检测AQP5基因3个标签单核苷酸多态性(tSNP)位点(rs3736309,rs296754和rs296759)的基因型分布.采用x2检验进行Hardy-Weinberg平衡检验,用非条件logistic回归模型计算比数比(OR)及95％可信区间(CI).比较AQP5 3个tSNP基因型频率分布在健康对照组和COPD患者间的差异,以明确AQP5基因多态性与中国北方汉族人群罹患COPD的相关性.比较轻-中度与重度-极重度COPD患者AQP5基因多态性的差异,以进一步明确AQP5基因多态性与COPD严重程度的关系.结果 AQP5基因rs3736309、rs296754和rs296759位点基因型分布在COPD患者与对照组中无明显差异.但在COPD患者中,rs3736309在轻-中度与重度-极重度患者中基因型分布的差异有统计学意义(P＜0.05),提示rs3736309多态性位点可能与COPD患者气道阻塞严重程度相关.结论 AQP5基因多态性与COPD的易感性无关,但与COPD的肺功能损害严重程度有关.     

慢性阻塞性肺疾病患者正五聚蛋白-3基因单核苷酸多态性与肺曲霉菌感染关系及其影响因素分析

目的 分析慢性阻塞性肺疾病患者正五聚蛋白-3(PTX3)基因单核苷酸多态性与肺曲霉菌感染的关系及其影响因素。方法 选取自2019年1月至2023年5月南通市第二人民医院收治的159例慢性阻塞性肺疾病患者为研究对象。根据是否合并肺曲霉菌感染将患者分为肺曲霉菌感染组(n=64)与非肺曲霉菌感染组(n=95)。分析两组PTX3基因单核苷酸多态性。通过单因素分析及多因素Logistic回归分析法分析慢性阻塞性肺疾病患者肺曲霉菌感染的危险因素。结果 肺曲霉菌感染组基因型AA占比、等位基因A占比高于非肺曲霉菌感染组,差异有统计学意义(P<0.05)。多因素Logistic分析结果显示,合并糖尿病、使用抗菌药物种类>3种、抗菌药物使用时间≥14 d、近1年因慢性阻塞性肺疾病住院次数≥2次、PTX3基因rs1840680位点基因型为慢性阻塞性肺疾病患者肺曲霉菌感染的风险因素(风险比分别为2.284、2.147、2.079、2.243、2.063,P<0.05),血清白蛋白水平升高为慢性阻塞性肺疾病患者肺曲霉菌感染的保护因素(风险比分为0.407,P<0.05)。结论 慢性阻塞性...     

肺癌及慢性阻塞性肺疾病患者的血管紧张素转换酶基因多态性

目的;主要观察肺癌、慢性阻塞性肺疾病、慢性肺心病及正常人血管紧张素转换酶基因多态性(ACEGP)的变化及与血清血管紧张素转换酶(sACE)水平的关系.方法:ACEGP测定采用PCR,sACE采用紫外分光光度法测定.结果:正常人和肺心病组Ⅰ型基因占优势(分别为57.9%和60.7%),而肺癌组和慢喘支组D型占优势(分别为61.8%和59.5%).肺癌组I/D和Ⅰ等位基因频率均明显低于正常组(P<0.01).而D/D和D等位基因频率明显高于正常组.慢喘支组Ⅰ等位基因频率(40.5%)明显低于正常组(57.9%),但其所有指标均与肺癌组无明显差异.肺心病组I等位基因频率(60.7%)显著高于肺癌组(38.2%).各组疾病sACE变化与基因型变化不尽相同.肺心病组各基因频率虽与正常组无明显差异,但各型中sACE值却明显低于正常组.肺癌组、慢喘支组与正常组三组间基因型虽有所不同,但sACE值却无明显差异.正常组与三组疾病均以D/D型sACE值最高,I/I型最低,尤以正常组和肺心病组差异最显著.结论:肺癌、慢喘支发病与ACEGP的D/D型明显有关,而正常人和肺心病以Ⅰ型基因占优势.ACEGP与sACE D/D型>I/I型,但sACE值还受其他因素的影响.     

一氧化氮与慢性阻塞性肺疾病

对内皮依赖性舒张作用和内皮依赖性舒张因子(EDRF)的早期观察始于80年代初,1980年Furch-gott和Zawadzki首先证实用乙酰胆碱诱发的血管扩张作用有赖于内皮的存在,并证实这种效应是由一种稳定的激素因子中介的,以后这种激素因子被称为内皮细胞衍化舒张因子(EDRF)。至80年代末生物学界证实了EDRF的本质就是一氧化氮(NO),而且发现NO具有重要的生理功能,包括舒张血管、支气管平滑肌、调节血压及局部脏器血流量,防止血小板粘附聚集、介导细胞免疫和参与神经冲动的传导管,从此有关NO的临床研究进入了一     

慢性阻塞性肺疾病的护理干预

目的：通过对慢性阻塞性肺病患者实施系统有效的护理,降低其发病的频率,减轻发病的程度,从而提高其生存质量。方法：对患者实施系统护理干预如进行心理护理、呼吸功能锻炼、合理氧疗、有效排痰、适当运动、营养指导、健康教育等。结果：通过对117例慢性阻塞性肺疾病患者进行系统有效的护理,112例患者咳嗽、咳痰、气喘症状明显改善,在未进行氧疗时SPO2可达95%,有效率95.7%。结论：对慢性阻塞性肺疾病患者进行系统的护理干预,可延缓疾病发展,能改善症状,提高生存质量。     

慢性阻塞性肺疾病的CT应用进展

慢性阻塞性肺疾病(COPD)是一种可防可治的常见病,临床常规应用肺功能检查评估患者是否有气流受限.CT不作为COPD诊断和治疗的常规推荐方法,但随着发展,其在评估COPD患者肺部异常改变、并发症及肺功能方面具有优势.从4个方面对COPD的CT应用进展进行综述.     

慢性阻塞性肺疾病研究新进展

慢性阻塞性肺疾病是威胁全人类健康的重大疾病，2001年美国制定了《慢性阻塞性肺疾病全球倡仪》得到各国的积极响应。中国也正式发表了《中国慢性阻塞性肺疾病诊治指南》。许多研究表明，吸烟是慢性阻塞性肺疾病的重要危险因素。抗胆碱能药是治疗慢性阻塞性肺疾病的一线用药，与茶碱、β2受体激动剂合用有协同作用。激素只是在某些病人中选择应用。     

慢性阻塞性肺疾病患者的营养支持治疗

21世纪是人类老龄化时代,慢性阻塞性肺疾患(COPD)作为老年人常见病、多发病,随着增龄其病程和治疗也会随之发生变化。据统计,此类疾病中约60％患者的体重低于理想值,其中,肺气肿、肺心病尤为突出,呈蛋白-热量营养不良状态。因此,营养支持治疗也将成为COPD治疗的重要手段,并日益受到人们的重视,本文就此问题综述如下。     

慢性阻塞性肺疾病合并肺动脉高压炎性介质研究

目的探讨高迁移率族蛋白B1(HMGB1)、肿瘤坏死因子α(TNF-a)及白介素6(IL-6)血清表达水平与慢性阻塞性疾病(COPD)及COPD所致的肺动脉高压的相关性。方法选取自2015年1月至2016年5月收治的COPD患者96例为研究对象,根据患者患病情况将其分为单纯COPD组(A组,n=56)及COPD合并肺动脉高压组(B组,n=40)。另选取20例健康研究对象作为健康组。采用第1秒用力呼气容积(FEV1)占预计值百分比(FEV1%)、FEV1/用力肺活量百分比(FEV1/FVC%)评价各组研究对象的肺功能;用超声心动图测定肺动脉压力;采用酶联免疫吸附试验检测各组研究对象血清HMGB1、TNF-a、IL-6水平并进行比较,分析血清HMGB1、TNF-a、IL-6水平与肺功能、肺动脉压力的相关性。结果 B组肺动脉压明显高于A组和健康组,组间比较,差异均有统计学意义(P <0. 05); B组的FEV1%及FEV1/FVC%均低于A组和健康组,且A组低于健康组,组间比较,差异均有统计学意义(P <0. 05)。B组的HMGB1、TNF-a及IL-6均高于A组、健康组,且A组上述指标均高于健康组,组间比较,差异均有统计学意义(P <0. 05)。相关性分析结果显示,HMGB1、TNF-a、IL-6与肺动脉压呈正相关,与FEVI%、FEV1/FVC%呈负相关。HMGB1与TNF-a、IL-6呈正相关。结论 HMGB1、TNF-a、IL-6介导了COPD全身炎症反应,这些细胞因子在COPD、肺动脉高压的发生、发展过程起重要作用。     

慢性阻塞性肺疾病的早期诊断

慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）是一种严重影响人类健康的疾病,且其发病率逐年上升,而COPD的早期诊断可能对于防止疾病进一步恶化及随后众多并发症的出现具有重要意义。因此,为探讨COPD早期诊断的方法及其意义,作者综合分析近几年关于COPD早期诊断的国内外文献,为日后人们认识、诊断和治疗COPD提供新思路。     

Imaging phenotypes of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. COPD is defined by irreversible airflow obstruction. It is a heterogeneous disease affecting the airways and/or the parenchyma with different severity during the course of the disease. These different aspects of COPD can be addressed by imaging using a combination of morphological and functional techniques. Computed tomography (CT) is the technique of choice for morphological imaging of the lung parenchyma and airways. This morphological information is to be accomplished by functional information about ventilation and perfusion, mainly provided by magnetic resonance imaging (MRI). The comprehensive diagnostic possibilities of CT complemented by MRI will allow for a more sensitive detection, phenotype-driven characterization, and dedicated therapy monitoring of the disease.     

New modalities of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Pulmonary rehabilitation has been shown to be an important part of the management of patients with chronic obstructive pulmonary disease (COPD). Exercise training is the corner stone of a comprehensive, multidisciplinary pulmonary rehabilitation in COPD and has been shown to improve health-related quality of life and exercise capacity. Nevertheless, not every COPD patient responds well to pulmonary rehabilitation.Future trials should focus on new additions to conventional pulmonary rehabilitation programmes to optimise its effects on health-related quality of life, exercise capacity, body composition and muscle function in patients with COPD. Therefore, a patient-tailored approach is inevitable. Advantages and disadvantages of new modalities of pulmonary rehabilitation will be outlined in detail, including the following: endurance training and long-acting bronchodilatators; endurance training and technical modalities (inspiratory pressure support and inspiratory muscle training); interval training; resistance training; transcutaneous neuromuscular electrical stimulation; and exercise training and supplements (oxygen, oral creatine, anabolic steroids and polyunsaturated fatty acids).Based on well defined baseline characteristics, patients should most probably be individually selected. At present, these new modalities of pulmonary rehabilitation have been shown to improve body composition, skeletal muscle function and sometimes also exercise capacity. However, the translation to an improved health-related quality of life is mostly lacking, and cost effectiveness and long-term effects have not been studied. Moreover, future trials should study the effects of pulmonary rehabilitation in elderly patients with restrictive pulmonary diseases.     

Athletic training in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a common and very debilitating disease in the United States. COPD is characterized by plugging of airways with secretions, impaired airway integrity with airway collapse with effort, bronchospasm, frequent infections, destruction of alveolar tissue, and ventilation-to-perfusion inequality. This results in abnormalities in pulmonary mechanics and respiratory gas exchange, all of which make hyperventilation much less effective. However, research has shown that the pulmonary patient can improve work capacity in an exercise training program. Training also alleviates the severe emotional problems of anxiety, depression, and social isolation frequently present in COPD sufferers. Even the lowest level patient can frequently improve in a training program, and guidelines for the implementation of such a therapeutic regimen are provided.     

Correlation of the perfusion scintigram with pulmonary functions in chronic obstructive pulmonary disease]

We carried out ventilation-perfusion scintigraphy and pulmonary function tests in 21 patients with chronic obstructive pulmonary disease. We used 99mTc-macroaggregate for perfusion scintigram and 133Xe gas for ventilation scintigram. We added the radioactivities of rebreathing phase and made lung volume image using computer. Regions of interest (ROIs) were derived from radioactivities in each image. ROIs on lung volume image included each whole lung and those on perfusion image included the areas which had relatively high radioactivity. We counted the area of ROIs on lung volume (L) and perfusion (P) images. Then we used the ratio of perfusion to lung volume (P/L) as a parameter of pulmonary perfusion. P/L had the significant correlations with the vital capacity, the actual FEV1.0, arterial oxygen partial pressure, diffusing capacity, RV/TLC and peak flow rate. These results suggested that P/L was a useful parameter of pulmonary perfusion in chronic obstructive pulmonary disease.