FEV1、FEV1/FVC对COPD气流阻塞的判断价值

为探讨1秒钟用力呼气容积(FEV_1)及FEV_1与用力肺活量(FVC)的比值(FEV_1/FVC)对慢性阻塞性肺疾病(COPD)气流阻塞的判断价值,我们对129例COPD患者的肺功能进行了检测。现报告如下。     

FEV1/FVC and FEV1 for the assessment of chronic airflow obstruction in prevalence studies: Do prediction equations need revision?

Little is known on the long-term validity of reference equations used in the calculation of FEV(1) and FEV(1)/FVC predicted values. This survey assessed the prevalence of chronic airflow obstruction in a population-based sample and how it is influenced by: (i) the definition of airflow obstruction; and (ii) equations used to calculate predicted values. Subjects aged 45 or more were recruited in health prevention centers, performed spirometry and fulfilled a standardized ECRHS-derived questionnaire. Previously diagnosed cases and risk factors were identified. Prevalence of airflow obstruction was calculated using: (i) ATS-GOLD definition (FEV(1)/FVC<0.70); and (ii) ERS definition (FEV(1)/FVC相似文献   

Predictive Value of sGaw,FEF25 − 75, and FEV1 for Development of Asthma after a Negative Methacholine Challenge Test

Background. A 20% change in forced expiratory volume in 1 second (FEV₁) during methacholine challenge testing (MCT) is a reliable marker of asthma. When the FEV₁ decrease is < 20%, there is controversy whether other changes in flows and conductance may be useful. We conducted this study to determine whether changes in sGaw, FEF_{25 ? 75}, and FEV₁ in a negative MCT could predict future occurrence of asthma over a 3-year period. Methods. A total of 100 consecutive patients with clinical suspicion of asthma but who had a negative MCT per ATS FEV₁ criteria (< 20% FEV₁ decline at 16 mg/mL of methacholine) performed by the 5-breath dosimeter method were analyzed. Two pulmonary fellows, blinded to MCT results, reviewed the patients' medical records. Patients were classified into one of three categories: asthmatic, unclear, and not asthmatic. Decreases in sGaw, FEF_{25 ? 75}, and FEV₁ in the five groups were then retrieved. Analysis of variance (ANOVA) was used for data analysis. Results. Of 100 patients, 23 were excluded owing to lack of a 3-year follow-up. After complete data review, the number of patients (n) in each group was as follows: asthmatic (n = 15), unclear (n = 7), and not asthmatic (n = 55). sGaw and FEF_{25 ? 75} decreases from the negative MCT could not predict asthma; however, decreases in FEV₁ were associated with future asthma occurrence (sGaw p = 0.21, FEF25-75 p = 0.07, FEV₁ p = 0.0009). Forty-three percent of the patients who had a 10% to 20% decline in FEV₁ eventually developed asthma. Conclusion. Up to 20% of patients who have symptoms suggestive of asthma but a negative MCT can still develop asthma. Declines in sGaw and FEF_{25 ? 75} in a negative MCT appear to have no clinical significance. A decrease in FEV₁, especially 10% to 20%, is associated with the diagnosis of future asthma.     

FEV1%与FEV1/FVC作为COPD气流阻塞判定指标的比较研究

目的　对FEV1%与FEV1/FVC作为COPD气流阻塞判断标准进行比较分析。方法　对 15 8例慢性支气管炎和肺气肿患者 ,34例限制性通气功能障碍疾病的患者及 34例正常人的肺功能进行前瞻性的分析研究。结果　作为COPD气流阻塞判断指标 ,FEV1%与FEV1/FVC呈高度直线正相关 (P <0 0 1) ,FEV1/FVC敏感性高 ,漏诊率低。作为分级标准 ,两者的百分比并不一致 ,FEV1/FVC受FEV1与FVC下降的不一致影响 ,与FEV1%比较 ,中度略有上升 ,重度则明显增高。结论　在确定有无气流阻塞诊断COPD时 ,FEV1/FVC较好 ,在气流阻塞程度分级时 ,FEV1%较好     

COPD患者PEFR与FEV1相关性分析

慢性阻塞性肺部疾病(COPD)的主要特征是气道阻塞.FEV1(第一秒用力呼气容积)被公认为是评定通气功能的最佳指标.但是,在COPD患者急性加重期,部分病人对完成FEV1测定比较困难.PEFR(最大呼气流率峰值)常被用于哮喘患者气道阻塞程度的考核指标[1].我们对80例COPD患者进行了PEFR和FEV1的测定,以分析COPD患者PEFR与FEV1的关系. 对象与方法本院呼吸内科门诊和病房COPD患者80例(男女各半),平均年龄63.3±10.6岁.采用电子肺量计和峰速仪对上述对象进行PEFR和FEV1测定,以上海地区肺功能正常值为依据计算其实测值占予计值百分比,并分析两者的相关性.     

Exhaled Nitric Oxide and Exercise-Induced Bronchospasm Assessed by FEV1, FEF25 − 75% in Childhood Asthma

The relationship between exhaled nitric oxide (eNO) and bronchial hyperresponsiveness (BHR) should be clarified. The aim of this study was to determine the relationship between eNO and exercise-induced bronchospasm (EIB) by estimation of the each lung parameter in asthmatic children who performed a bicycle ergometer exercise test. Twenty children with asthma were recruited. eNO concentration was examined by the recommended online method. To evaluate BHR, an exercise stress test was performed on a bicycle ergometer. The mean baseline eNO value was significantly correlated with the mean maximum % fall in forced expiratory volume in 1 second (FEV₁), forced expiratory flow between 25% and 75% (FEF25-75%) after exercise (r = 0.53, r = 0.65, respectively). eNO in the EIB-positive group was significantly higher than that in the EIB-negative group by assessing FEV₁, FEF_25?75% (p < 0.005, p = 0.005). We demonstrated that the most important lung parameter assessed the occurrence of EIB by a bicycle ergometer exercise test was not only FEV₁ but FEF_25?75%, which significantly correlated with eNO. This suggests that not only FEV₁ but FEF_25?75% can be used to evaluate the correlations between BHR (EIB) and airway inflammation (eNO) in asthmatic children. A low eNO is useful for a negative predictor for EIB.     

利用LMS法建立全年龄段FEV1正常参考值

目的探讨一种建立肺功能全年龄段的正常参考值的方法。方法利用LMS法对4个中心共12829名正常健康人FEV1建立全年龄段正常参考值曲线和正常值下限,并对该模型进行评价。结果FEV1与身高、年龄之间存在密切关联,在校正身高影响之后,FEV1在全年龄段与年龄呈非线性关系,而且变异随着年龄变化而变化。LMS方法考虑个体间变异,适用于不服从正态分布的偏峰数据,而且还可以校正身高等其他因素的影响,计算得到的不同年龄的正常参考值最低下限更符合实际。结论LMS法是一种建立全年龄肺功能正常参考值的有效统计方法。     

Hypophosphatemia and refeeding: a corrective or a preventive attitude?

Hypophosphatemia is a rare but potentially lethal complication of the refeeding of cachectic patients. Up until now a careful monitoring of the serum phosphor level was recommended and the deficit was corrected as needed. Illustrated by two case reports we propose the use of a preventive schedule in patients with a normal renal function. We show that preventively treated patients do not develop hypophosphatemia and thereby avoid serious complications such as sudden death. In the presence of normal kidney function we propose to administer phosphor at 2 x 10 mmol/day orally or between 10 and 30 mmol IV depending on the initial phosphor levels. Further treatment is then adapted to measured levels. In the presence of kidney malfunction we propose to keep the corrective schedule.     

Periodontitis and diabetes—a complex relationship

Periodontitis is a common problem in patients with diabetes. The interrelation between diabetes mellitus and inflammatory periodontal disease has been intensively studied for more than 50 years. The relationship between these 2 maladies appears bidirectional—insofar that the presence of one condition tends to promote the other, and that the meticulous management of either may assist treatment of the other. Inflammation plays an important role in this interrelation, orchestrating both the periodontal disease and diabetes mellitus pathogeny and complications. Conversely, periodontal infection can seriously impair metabolic control of some diabetic patients. Moreover, treatment of periodontal disease and reduction of oral signs of inflammation may have a beneficial effect on diabetes. This review examines the relationships that exist between periodontal diseases and diabetes mellitus, with a focus on potential common pathophysiologic pathways including those associated with inflammation, altered host responses and insulin resistance     

Iron and pregnancy—a delicate balance

The review focuses on iron balance during pregnancy and postpartum in the Western affluent societies. Iron status and body iron can be monitored using serum ferritin, haemoglobin, serum soluble transferrin receptors (sTfR) and the sTfR/ferritin ratio. Requirements for absorbed iron increase during pregnancy from 0.8 mg/day in the first trimester to 7.5 mg/day in the third trimester. Average requirement during the entire gestation is ~4.4 mg/day. Intestinal iron absorption increases during pregnancy, but women with ample body iron reserves have lower absorption than those with depleted reserves, so increased absorption is, in part, due to progressive iron depletion. Apparently, women do not change dietary habits when they become pregnant. Non-pregnant Scandinavian women have a median dietary iron intake of ~9 mg/day, i.e. more than 90% of the women have an intake below the recommended ~18 mg/day. Non-pregnant women have a low iron status, 42% have serum ferritin levels ≤30 μg/l, i.e. small or depleted iron reserves and 2–4% have iron deficiency anaemia; only 14–20% have ferritin levels >70 μg/l corresponding to body iron of ≥500 mg. The association between high haemoglobin during gestation and a low birth weight of the newborns is caused by inappropriate haemodilution. In placebo-controlled studies on healthy pregnant women, there is no relationship between the women’s haemoglobin and birth weight of the newborns and no increased frequency of preeclampsia in women taking iron supplements.     

Is there a difference between a chief of cardiology and a chief of medicine?

The job of Chief of Medicine demands considerably more administrative effort than the Chief of Cardiology. However, one can still maintain a significant presence in cardiology as a Chief of Medicine. Each job has its own merits, joys, and irritations.