Close Association between Subclinical Atherosclerosis and Pulmonary Function in Middle-Aged Male Smokers

Aims: Cigarette smoking provokes deleterious influences on cardiovascular and pulmonary systems, although the underlying relationship has not been sufficiently investigated especially in early-stage disease. The present study investigated possible associations between subclinical atherosclerosis and pulmonary function in middle-aged male smokers.Methods: Male smokers undergoing their periodic health check-up were enrolled in this study (n = 3,775, 45 ± 8 years). Pulmonary function was evaluated using spirometry by calculating forced vital capacity (FVC) as a percentage of predicted value (FVC%-predicted), forced expiratory volume in one second (FEV1) as a percentage of predicted value (FEV1%-predicted), and the ratio of FEV1 to FVC (FEV1/FVC). Subclinical atherosclerosis was assessed based on ankle-brachial pressure index (ABI), cardio-ankle vascular index (CAVI), ultrasound examination of the carotid intima-media thickness (IMT), and presence of plaque.Results: Multivariate regression analysis showed that ABI was positively associated with FVC%-predicted and FEV1%-predicted after adjustment for confounders including smoking intensity, while CAVI or carotid IMT was inversely associated with both. Participants with chronic obstructive pulmonary disease (COPD, n = 256) showed reduced ABI and increased CAVI or carotid IMT compared with those without COPD, and participants with carotid plaque had lower pulmonary function than those without plaque. Reduced FEV1/FVC was an independent determinant of carotid plaque and decreased ABI was an independent determinant of COPD, as revealed by logistic regression analysis with the endpoint of carotid plaque presence or a diagnosis of COPD revealed.Conclusions: Middle-aged male smokers showed a close association between subclinical atherosclerosis and pulmonary function, implying that smoking induced-vascular and pulmonary damage are interacting in early-stage disease.     

老年慢性阻塞性肺疾病患者营养状况与肺通气量的关系

目的研究慢陛阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）患者营养状况与肺通气功能的关系。方法对217例患者进行以身体组成评价法（BCA）营养状况调查。根据其营养评价结果分为营养良好组和营养不良组,两组进行肺通气功能测定,观察指标包括：最大通气量（MVV）,用力肺活量（FVC）,第1秒用力呼气容积（FEV1）,最大呼气流量（PEF）。结果在调查的217例患者中,有67例患者营养状况良好,占30．87％,有150例COPD患者被评为营养不良,营养不良发生率为69．13％。营养不良组的肺通气量指标MVV％（36．21±17．36）、FVC％（75．42±19．65）、FEV1％（41．92±16．29）、PEF％（36．06±17．25）均低于营养良好组MVV％（59．25±22．61）、FVC％（93．19±15．32）、FEV1％（52．3±14．43）、PEF％（68．19±24．23）,差异有统计学意义（P〈0．05）。结论COPD患者的营养状况评价结果均不理想,而营养不良会使呼吸肌储备力量下降及呼吸肌容易疲劳,导致肺通气功能降低,所以改善COPD患者营养不良的发生,对肺通气功能恢复有重要意义。     

Lung function testing in the elderly—Can we still use FEV1/FVC<70% as a criterion of COPD?

BACKGROUND: Chronic obstructive pulmonary disease (COPD) can be diagnosed when the FEV(1)/FVC ratio is below 70%, according to global initiative for chronic obstructive lung disease (GOLD). COPD is known as a disease which is frequently under-diagnosed. However, there is a risk of over diagnosis when this diagnostic threshold is applied among the elderly. AIMS: To contribute to the discussion about the criteria for diagnosing COPD, by describing lung function and pulmonary symptoms in a population aged 60 years or more, and in particular the changes in the mean and 5% percentile of the FEV(1)/FVC ratio by increasing age. METHODS: A cross sectional population-based study was performed in the city of Troms?, Norway, in 2001-2002. Spirometry was performed in 4102 people 60 years and older (54.6% women), who also filled in a questionnaire. RESULTS: Decreased FEV(1)% predicted and FEV(1)/FVC ratio were associated with smoking, increasing age, and reported pulmonary and cardiovascular diseases. Dyspnoea and coughing were also strongly associated with smoking and reported pulmonary and cardiovascular diseases, but coughing did not become more frequent by increasing age. In never smokers aged 60-69 years the frequency of FEV(1)/FVC ratio<70% was approximately 7% compared to 16-18% in those 70 years or more (p<0.001). FEV(1)/FVC ratio<70% among never smokers aged 60-69 years was just as frequent as FEV(1)/FVC ratio <65% in never smokers older than 70 years. CONCLUSION: Adjustments of the GOLD criteria for diagnosing COPD are needed, and FEV(1)/FVC ratios down to 65% should be regarded as normal when aged 70 years and older.     

肺呼吸康复治疗在慢性阻塞性肺疾病稳定期患者中的应用研究

目的分析探讨肺呼吸康复治疗在慢性阻塞性肺疾病稳定期患者中的应用效果。方法选择2018年1月至2020年3月间收治的80例慢阻肺稳定期患者,随机分为常规治疗组和肺呼吸康复治疗组。常规治疗组予以常规治疗,肺呼吸康复治疗组在常规治疗基础上,采用呼吸训练器进行吸气和呼气训练。观察比较两组患者出院随访4周后的肺功能、生活质量及运动能力。结果经4周治疗训练后,两组患者肺功能各项指标较治疗前均有显著改善(P<0.05)。肺呼吸康复治疗组患者治疗后FVC为2.43±0.61L,FEV₁为1.39±0.34L,FEV 1/FVC为57.18%±5.83%,各项指标均显著优于常规治疗组(P<0.05)。肺呼吸康复治疗组治疗后6min步行试验距离为382.52±39.06m,CAT评分为12.12±5.07分,患者治疗后运动能力及生活质量优于常规治疗组(P<0.05)。治疗后,肺呼吸康复治疗组BODE评分为3.21±0.57,优于常规治疗组,差异有统计学意义(P=0.009)。结论呼吸训练器联合常规治疗应用于肺呼吸康复治疗,可明显改善COPD稳定期患者的肺功能,改善生活质量。     

慢性阻塞性肺疾病合并肺纤维化的肺动脉压力变化及其与肺功能和生活质量关系的研究

目的探究慢性阻塞性肺疾病(COPD)合并肺纤维化患者的肺动脉压力变化及其与肺功能、生活质量的关系。方法 回顾性对比分析天津医科大学总医院2009年7月至2011年3月诊断的20例COPD合并肺纤维化及随机抽取同期30例单纯COPD患者的肺动脉收缩压、肺功能、Medieal Research Council dyspne...     

Sex differences in the relationship between metabolic syndrome and pulmonary function: the 2007 Korean National Health and Nutrition Examination Survey

Pulmonary function impairment has a connection with abdominal obesity, type 2 diabetes, and insulin resistance. Sex differences in lifestyle factors, and pulmonary structure and function may affect pulmonary function in different manners. This study focused on sex differences in the relationship of MetS and its component with pulmonary function. Among 2,614 Korean adults (1,059 men; 1,555 women), pulmonary function was measured by the percentage of predicted forced vital capacity (FVC (%)) and a ratio between forced expiratory volume in 1 second (FEV(1))/FVC. FVC (%) and FEV(1)/FVC were compared according to the presence of MetS and its components. Multiple linear regression analysis was conducted to assess the association between FVC (%), FEV(1)/FVC and clinical variables. We found sex differences in the relationship of MetS and its components with pulmonary function. FVC (%) was significantly lower in subjects with MetS than in those without MetS in both men and women, and FEV(1)/FVC was lower in subjects with MetS only in women. Among components of MetS, waist circumference, blood pressure and fasting plasma glucose, and HDL-cholesterol were independently related to FVC (%) in men, whereas waist circumference was significantly associated with FVC (%) in women. Blood pressure was found to be an independent factor of FEV(1)/FVC in men, whereas blood pressure, fasting plasma glucose and HDL-cholesterol independently determined FEV(1)/FVC in women. These findings suggest that sex-specific association between MetS and lung function measures should be considered in clinical practice.     

The Impact of Heart Failure on the Classification of COPD Severity

BackgroundPulmonary restriction—a reduction of lung volumes—is common in heart failure (HF), rendering severity grading of chronic obstructive pulmonary disease (COPD) potentially problematic in subjects with both diseases. We compared pulmonary function in patients with either HF or COPD, or the combination to assess whether grading of COPD using the Global Initiative of Chronic Obstructive Lung Disease classification is hampered in the presence of HF.Methods and ResultsIn 2 cohorts involving 591 patients with established HF and 405 with a primary care diagnosis of COPD, the presence of HF and COPD was assessed according to guidelines. HF severity was staged according to the NYHA classification system into Classes I–IV. COPD was diagnosed if the ratio of post-bronchodilator forced expiratory volume in 1 second and forced vital capacity (FEV1/FVC) was <0.70, and categorized in GOLD stages I–IV according to post-bronchodilator–predicted FEV1 levels (FEV1% ≥80%; 50–79%; 30–49%; <30%). In total, 557 patients with HF only, 108 with HF+COPD, and 194 with COPD only were studied. Patients, who had neither HF nor COPD according to definition, or HF with reversible obstruction in post-bronchodilator pulmonary function tests were excluded from this analysis (n = 137). Compared with COPD only, patients with HF plus COPD had higher levels of post-bronchodilator FEV1/FVC (median [quartiles] 0.57 [0.47–0.64] vs 0.62 [0.55–0.66] and lower total lung capacity % (115 [104–126]% vs 105 [95–117]%, P < .001) P < .001), but comparable levels of post-bronchodilator FEV1% (70 [56–84]% vs 68 [54–80]%, P = .22) and thus similar distributions of GOLD stages I–IV in both groups (24/56/19/4% vs 31/50/19/1%, P = .57). In patients with HF only, 25% exhibited pre-bronchodilator FEV1% levels of <80% (FEV1% 94 [80–108]%), despite a pre-bronchodilator FEV/FVC ratio ≥0.7 in this group. The reduction of FEV1 in patients with HF only was associated with HF severity.ConclusionsIn stable HF, FEV1 may be significantly reduced even in the absence of “real” airflow obstruction. In this situation, diagnosing COPD according to GOLD criteria (based on FEV1/FVC) still seems feasible, because both FEV1 and FVC are usually decreased to an equal extent in HF. However, classifying COPD based on FEV1 levels may overrate obstruction severity in patients with combined disease (HF plus COPD), and thus may lead to unjustified use of bronchodilators.     

慢性阻塞性肺疾病评估测试评分对预后的评估意义

目的探讨慢性阻塞性肺疾病评估测试(CAT)评分与慢性阻塞性肺疾病(COPD)患者预后因素之间的相关性,明确CAT评分对COPD患者预后评估的应用价值。方法选取2013年1月至2015年1月我院呼吸内科住院及门诊就诊的106例COPD患者为研究对象。对106例患者治疗前后进行CAT评分、6 min步行实验(6MWD)、改良英国MRC呼吸困难指数(m MRC)、BODE(B为体质量指数,O为气道阻塞程度,D为呼吸困难分数,E为运动耐力)指数、圣乔治呼吸问卷(SGRQ)评分及肺功能的测定。采用单因素线性相关分析CAT评分与患者各临床特征之间的相关性。结果随着CAT评分的升高,患者6MWD、用力呼气容积(FVC)实测值、FVC实测/预测值、一秒用力呼气容积(FEV1)实测值、FEV1实测/预测值、FEV1/FVC、呼气峰流速(PEF)实测值、PEF实测/预测值均明显降低(P0.05),而m MRC评分、BODE指数及SGRQ总评分明显升高(P0.05);患者经短期治疗后,CAT评分、BODE指数及SGRQ总评分均显著低于治疗前(P0.05),而6MWD、FEV1实测值、FEV1实测/预测值、FEV1/FVC则均显著高于治疗前(P0.05);单因素相关分析发现,治疗前CAT评分与m MRC评分(r=0.254,P=0.018)、BODE指数(r=0.426,P=0.009)及SGRQ总评分(r=0.563,P=0.007)呈显著正相关,与6MWD(r=-0.387,P=0.008)、FVC实测值(r=-0.181,P=0.023)、FVC实测/预测值(r=-0.192,P=0.021)、FEV1实测值(r=-0.201,P=0.016)、FEV1实测/预测值(r=-0.214,P=0.013)及FEV1/FVC(r=-0.223,P=0.012)呈显著负相关;治疗后CAT评分与m MRC评分(r=0.304,P=0.011)、BODE指数(r=0.382,P=0.010)及SGRQ总评分(r=0.621,P=0.004)呈显著正相关,与6MWD(r=-0.407,P=0.007)、FEV1实测值(r=-0.211,P=0.014)、FEV1实测/预测值(r=-0.228,P=0.012)及FEV1/FVC(r=-0.231,P=0.011)呈显著负相关。结论 CAT评分与COPD患者m MRC评分、BODE指数、SGRQ总评分、6MWD及肺功能指标均有较好的相关性,具有较好的预测COPD患者预后的应用价值。     

β2-adrenergic receptor polymorphisms, asthma and COPD: two large population-based studies

The β(2)-adrenergic receptor (ADRB2) is an important regulator of airway smooth muscle tone. We tested the hypothesis that three functional polymorphisms in the ADRB2 gene (Thr164Ile, Gly16Arg and Gln27Glu) are associated with reduced lung function, asthma or chronic obstructive pulmonary disease (COPD). We first genotyped 8,971 individuals from the Copenhagen City Heart Study for all three polymorphisms. To validate our findings, we genotyped an additional 53,777 individuals from the Copenhagen General Population Study for the Thr164Ile polymorphism. We identified 60,910 Thr164Ile noncarriers, 1,822 heterozygotes and 16 homozygotes. In the Copenhagen City Heart Study, the Thr164Ile genotype was associated with reduced forced expiratory volume in 1 s (FEV(1)) % predicted (trend p = 0.01) and FEV(1)/forced vital capacity (FVC) (p = 0.001): Thr164Ile heterozygotes had 3% and 2% reduced FEV(1) % pred and FEV(1)/FVC, respectively, compared with noncarriers. The odds ratio for COPD in Thr164Ile heterozygotes was 1.46 (95% CI 1.05-2.02). In the Copenhagen General Population Study, the Thr164 genotype associated with reduced FEV(1) % pred (p = 0.04) and FEV(1)/FVC (p < 0.001): Thr164Ile homozygotes and heterozygotes had 7% and 1% reduced FEV(1) % pred and 6% and 1% reduced FEV(1)/FVC, respectively, compared with noncarriers. The odds ratios for COPD in Thr164Ile homozygotes and heterozygotes were 4.53 (95% CI 1.54-13.3) and 1.07 (95% CI 0.92-1.25), respectively. Our results suggest that ADRB2 Thr164Ile is associated with reduced lung function and increased risk of COPD in the general population.     

肺活量与用力肺活量差值预测慢性阻塞性肺疾病患者运动能力的研究

目的:探讨慢性阻塞性疾病(chronic obstructive pulmonary disease,COPD)患者慢肺活量(vital capacity,VC)与用力肺活量(forced vital capacity,FVC)的差值(VC-FVC)与运动能力的关系。方法:共97例COPD患者完成了常规肺功能和心肺运动试验,根据VC-FVC的结果分为两组:1组VCFVC 77例,另1组VC≤FVC 20例,比较这两组的运动反应。结果:VCFVC组的第1秒用力肺活量(FEV1)和最大摄氧量(peak VO2)均显著低于VC≤FVC组,VC-FVC与peak VO2有显著的负相关(r=-0.404,P0.001),FEV1占预计值百分比(FEV1%)与peak VO2有显著的正相关(r=0.418,P0.001),以peak VO2作为因变量进行多元逐步回归分析显示,VC-FVC、FEV1%和年龄与peak VO2相关,可解释peak VO235.9%的变化。结论:VC和FVC测定简单,其差值不仅可以反应COPD患者气体受限的程度,还可预测其运动能力。     

Chronic obstructive pulmonary disease is missed in asthmatics in specialty care in Trinidad, West Indies.

SETTING: Underdiagnosis of chronic obstructive pulmonary disease (COPD) in asthmatics attending specialty care in Trinidad, West Indies. OBJECTIVE: To determine the prevalence of COPD in diagnosed asthmatics receiving specialty respiratory care. DESIGN: In a cross-sectional study, 258 asthmatics were screened for lung function measures to examine forced expiratory volume after 1 second (FEV1), forced vital capacity (FVC) and post-bronchodilator FEV1/FVC (COPD was defined as FEV1/FVC < 70%). RESULTS: Of 165 patients evaluated (response rate 64.0%), 53 (32.1%, 95%CI 25.0-39.2) had a study diagnosis of COPD and a mean FEV1/FVC of 60.12 +/- 1.2. Proportionally, more males had COPD (50.9%) than asthma (24.1%, P < 0.001). Patients with COPD were 10 years older than asthmatics (P < 0.001). Persons with asthma who smoked were more likely to have COPD (56.0%) (OR 3.26, 95%CI 1.36-7.80, P = 0.006). In both sexes, FEV1/FVC was lower among older people (P < 0.001), with a greater effect (OR 2.75, 95%CI 1.00-7.56, P < 0.01) seen among men in this cross-sectional study. CONCLUSIONS: One third of diagnosed asthmatics in specialty care also have COPD. Lung function was lower among older persons. Early spirometric evaluation of elderly asthmatics who smoke can determine the presence of COPD and facilitate appropriate management.     

脉冲震荡法对慢性阻塞性肺疾病严重程度评估的临床意义

目的 通过对COPD稳定期患者进行脉冲震荡法(IOS)及常规肺功能FEV1％pred和FEV1/FVC测定,探讨IOS对COPD严重程度评估的临床意义.方法 收集2014年7月至2015年6月于山西大医院确诊为COPD稳定期的患者214例,根据GOLD(2011版)联合评估的方法将其分为A、B、C和D4组.选同期体检人员41例作为健康对照组,分别进行IOS(Z5、R5、R20、R5-R20、X5、Fres)及常规肺功能(FEV1％pred、FEV1/FVC)检测.结果 ①COPD组男164例,女50例,平均年龄(63.6±9.5)岁;其中A组48例、B组68例、C组55例、D组43例.健康对照组男26例,女15例,平均年龄(54.6±10.4)岁.2组性别及平均年龄差异无统计学意义.②COPD组IOS中Z5、R5、R20和R5-R20分别为(0.70±0.30)、(0.62±0.25)、(0.36±0.12)和(0.26±0.18) kPa·L-1·s-1,Fres为(28.71±9.07) Hz及常规肺功能中FEV1％ pred和FEV1/FVC分别为(50.83±21.91)％和(51.57±11.29)％均较健康对照组显著增高(P值均＜0.05).X5为(-0.31±0.19) kPa·L-1·s-1,较健康对照组显著减低(P＜0.05).③COPD患者A、B、C和D4组IOS中Z5、R5、R5-R20和Fres呈上升趋势,X5呈下降趋势.A、B、C3组间比较差异均有统计学意义(P值均＜0.05).④COPD患者IOS中Z5、R5、R5-R20和Fres与FEV1％pred均呈显著负相关(P值均＜0.05),其中Fres与FEV1％pred相关性最大(r=-0.599);X5与FEV1％pred呈显著正相关(P＜0.05).COPD患者A、B、C和D4组IOS中各指标与FEV1％pred相关性逐渐降低.A、B、C3组间比较差异均有统计学意义(P值均＜0.05).结论 IOS测定能较好地反映不同组别COPD患者气道阻力的变化,可更好地评估COPD患者疾病严重程度,尤其适用于老年患者.     

Evaluation of spirometric and pulmonary haemodynamic parameters in patients with COPD

In this study we aimed to asses the association between the spirometric test which is known to be an indicator of severity of the disease and pulmonary artery pressure, in patient chronic obstructive pulmonary disease (COPD). Study population consisted of 51 patients with COPD. Severity of the disease was graded by the criteria of European Respiratory Society; mildly obstructive 5 patients (FEV1 > 70%), moderately obstructive 10 (FEV1= 50-69%), severely obstructive 36 patients (FEV1 < 50%). Measurement of pulmonary artery pressure was performed bt microcatheterisation method. Statistical analysis was performed between two groups; group I consisted of mildly and moderately obstructive patients, and group II severely obstructive patients. Pulmonary artery pressure of the group II patients was significantly higher than that of group I patients (27 +/- 4 mmHg vs 22 +/- 1.6 mmHg, respectively p< 0.001). There were also statistically significant difference between group I and group II in respect to FEV1% (63 +/- 7 vs 28 +/- 9 respectively p< 0.001), FEV1 L (1.84 +/- 0.46 vs 0.89 +/- 0.36 respectively p< 0.001), FEV1/FVC (71 +/- 10 vs 53 +/- 11 respectively p< 0.001), FVC% (73 +/- 8 vs 47 +/- 10 respectively p< 0.001), and MMF% (38 +/- 13 vs 15 +/- 6 respectively p< 0.001). Pulmonary artery pressure and diameter of right descending pulmonary artery on chest X-ray of the patients were negatively correlated with FEV1%, FEV1 L, FVC and MMF (p< 0.001 for all). We have shown pulmonary artery pressure of the patients with COPD was negatively correlated with the spirometric parameters such as FEV1%, FEV1 L, FVC and MMF. So FEV1 < 50% can be used as an indicator of increased pulmonary artery pressure in patients with COPD.     

国产噻托溴铵粉雾剂与沙美特罗替卡松治疗COPD的肺功能观察

目的分析国产噻托溴铵粉雾剂与沙美特罗替卡松治疗COPD的肺功能变化。方法选取48例门诊Ⅱ级中度COPD患者,男28例,女20例,其中单一吸入国产噻托溴铵粉雾剂(天晴速乐,18μg)14例,单一吸入沙美特罗替卡松(舒利迭,50/250μg)34例。用药前、用药后第4周、第8周记录肺功能。结果所有入选患者在用药4周及8周后肺功能均较前改善,噻托溴铵组的第4周FEV1增加值为133.5±11.8 ml,第8周为68.8±22.0 ml,第4周FVC增加值为151.1±55.8 ml,第8周为55.9±19.6 ml;沙美特罗替卡松组第4周FEV1增加值100.6±24.0 ml,第8周为60.1±17.6 ml,第4周FVC增加值为137.5±41.3 ml,第8周为55±22.4 ml。两组FEV1、FVC增加值无统计学差异。结论国产噻托溴铵粉雾剂与沙美特罗替卡松均可在短期内改善COPD患者肺功能,两组各自的FEV1、FVC增加值差异无统计学意义,噻托溴铵组患者依从性逊于沙美特罗替卡松组。     

慢性阻塞性肺疾病稳定期门诊治疗的临床研究

目的研究COPD稳定期的不同治疗方案。方法将90例COPD患者随机分为3组：舒利迭组（吸入沙美特罗氟替卡松50／250μg每天2次）、联合用药组（口服茶碱缓释片0．1g每天2次＋吸入丙酸氟替昔松125μg每天2次）及对照组（按需使用硫酸沙丁胺醇气雾剂）,随访1年,观察1年后的肺功能（FEV1、FVC、FEV1％pred、FEV1/FVC和FEF25—75％）,6分钟步行距离（6 minuteswalkingdistance,6MWD）和1年中急性加重的次数。结果治疗后舒利迭组和联合用药组的FEV1、FVC、FEV1％pred、FEV1／FVC、FEF25—75％和6MWD分别与对照组及治疗前比较均有改善（P值均〈0．05）;治疗后舒利迭组比联合用药组FVC和FEF2575％改善更明显（分别为2．41±0．61和2．11±0．47,44．9±10．1和35．4±8．8。P值均〈0．05）。结论舒利迭（50／250μg）、联合用药（口服茶碱缓释片＋丙酸氟替卡松气雾剂）对稳定期COPD患者疗效肯定,前者对FVC和FEF25—75％的改善较后者强。     

舒利迭改善COPD合并尘肺病患者肺功能研究

目的研究舒利迭对COPD合并尘肺病患者肺功能影响的机制。方法选择我院肺功能Ⅱ～Ⅲ组稳定期COPD合并尘肺病和COPD患者各28例,给予舒利迭吸入治疗4周,检测治疗前后两组FEV1、FVC、FEV1%和FEV1/FVC等指标,比较两组肺功能改善程度。结果两组治疗后FEV1、FVC、FEV1%和FEV1/FVC均较治疗前显著提高(P<0.05)。治疗后COPD合并尘肺病组的FEV1%低于COPD组(P<0.05);两组FEV1/FVC差异无显著性(P>0.05)。结论舒利迭吸入治疗能显著改善COPD患者和COPD合并尘肺患者的肺功能,但合并尘肺病使舒利迭对COPD患者的疗效减弱。     

慢性阻塞性肺疾病患者血清抵抗素和瘦素水平及其与营养状况的关系

目的探讨慢性阻塞性肺疾病(COPD)患者血清抵抗素、瘦素水平及其与营养状况的关系。方法用酶联免疫吸附测定(ELISA)和放射免疫法检测57例稳定期COPD患者和31名健康对照者血清抵抗素、瘦素水平,分析相关因素。结果COPD患者血清抵抗素、瘦素水平[(2·1±1·2)、(0·65±0·41)μg/L]与对照组[(3·6±2·3)、(1·03±0·71)μg/L]比较差异均有统计学意义(P均<0·01)。COPD营养不良患者抵抗素、瘦素水平[(1·7±0·7)、(0·43±0·16)μg/L]显著低于非营养不良患者[(2·2±1·2)、(0·73±0·48)μg/L,P均<0·05]。COPD患者抵抗素与瘦素、第一秒用力呼气容积(FEV1)及FEV1/用力肺活量(FVC)显著正相关(r=0.426~0.531,P均<0·01),瘦素与体重指数(BMI)、胸围、腹围、抵抗素及FEV1/FVC显著正相关(r=0.371~0.580,P均<0·01)。结论COPD稳定期患者血清抵抗素、瘦素水平下降,合并营养不良时下降更显著。     

Spirometric thresholds for diagnosing COPD: 0.70 or LLN, pre- or post-dilator values?

In absence of a gold standard for chronic obstructive pulmonary disease (COPD) it remains difficult to compare the true diagnostic characteristics of the forced expiratory volume in 1 second to the forced vital capacity (FEV(1)/FVC) <0.70 and < lower limit of normal (LLN). COPD is a clinical diagnosis, based on symptoms signs and lung function results combined, and an expert panel assessment would be an adequate reference standard. We compared the diagnostic properties of FEV(1)/FVC 50, consulting for persistent cough, but without physician-diagnosed COPD, were prospectively enrolled. All underwent extensive history taking, physical examination, spirometry and diffusion testing. An expert panel, including a board certified respiratory physician, assessed all diagnostic information to determine the presence or absence of COPD and served as reference standard. Then, 104 participants were diagnosed with COPD by the panel. The reproducibility of the panel diagnosis was high (kappa of 0.94). Sensitivity estimates of <0.70 were significantly higher than that of 相似文献   

MK-0633, a potent 5-lipoxygenase inhibitor, in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is associated with neutrophil-mediated inflammation, a potential target for treatment in COPD. We evaluated MK-0633, a 5-lipoxygenase inhibitor in patients with COPD. This was a 12 week, randomized, double-blind, multicenter study comparing MK-0633 100 mg and placebo in patients 40-75 years of age (N = 266) with COPD, post-β-agonist forced expiratory volume in 1 s (FEV(1)) 25%-75% predicted, and an FEV(1)/forced vital capacity ratio (FVC) ≤ 70%. Long-acting inhaled bronchodilators were permitted for approximately 50% of patients. The primary efficacy endpoint was the change from baseline in pre-dose (trough) FEV(1) measured over the last 2 weeks of the 12 week treatment period. The change in FEV(1) over the last 2 weeks of the 12 weeks treatment period compared to baseline was 0.015 L for MK-0633 and 0.0002 for placebo (p = 0.556). For COPD Global Evaluation, 75.4% of patients receiving MK-0633 reported feeling better vs. 59.8% of patients receiving placebo (p = 0.032). There were no other significant differences between treatments. MK-0633 was well-tolerated and comparable to placebo. The 5-LO inhibitor MK-0633 was not significantly more effective than placebo in improving FEV(1) from baseline in patients with COPD, although more patients reported feeling improved with MK-0633. Clinicaltrials.gov identifier: NCT00418613.     

Downregulation of lung mitochondrial prohibitin in COPD

Prohibitins (PHB1 and PHB2) are versatile proteins located at the inner mitochondrial membrane, maintaining normal mitochondrial function and morphology. They interact with the NADH dehydrogenase protein complex, which is essential for oxidoreductase activity within cells. However, their expression in lung epithelium, especially in smokers and patients with inflammatory lung diseases associated with increased oxidative stress, such as COPD, is unknown. Lung tissue specimens from 45 male subjects were studied: 20 COPD patients [age: 65.7?±?5.8 years, smoking: 84.6?±?33.6 pack-years, FEV(1) (%pred.): 58.7?±?14.6, FEV(1)/FVC (%): 63.8?±?9.4], 15 non-COPD smokers [age: 59.0?±?12.1 years, smoking: 52.5?±?20.8 pack-years, FEV(1) (%pred.): 85.5?±?14.2, FEV(1)/FVC (%): 78.5?±?4.7] and 10 non-smokers. Quantitative real-time PCR experiments were carried out for PHB1 and PHB2, using β-actin as internal control. Non-COPD smokers exhibited lower PHB1 mRNA levels when compared to non-smokers (0.55?±?0.06 vs. 0.90?±?0.06, P?=?0.043), while PHB1 expression was even further decreased in COPD patients (0.32?±?0.02), a statistically significant finding vs. both non-COPD smokers (P?=?0.040) and non-smokers (P?相似文献