血小板与慢性阻塞性肺病

慢性阻塞性肺病加重时，存在看血小板活化；活化的血小板及释放的多种物质增强凝血活性，损伤内皮细胞，激活炎性细胞等多种途径加重慢性阻塞性肺病。     

慢性阻塞性肺病社区呼吸康复的研究

为探索社区能为慢性阻塞性肺病患者进行呼吸康复提供的帮助.我社区卫生服务中心与所辖街道居委联系免费为患者提供呼吸康复的场地,组织患者每天进行太极拳锻练,锻练时配合腹式呼吸及缩唇呼吸,从而提高患者长期坚持呼吸康复的比率,其后复查发现实验组发病率明显减少,患者肺功能明显改善.     

慢性阻塞性肺病排痰护理体会

慢性阻塞性肺疾病简称“慢阻肺”（COPD），就是人们常说的慢性支气管炎和肺气肿，主要症状为长时间咳嗽、咳痰以及气短。据世界卫生组织估计，慢阻肺在全球疾病死亡原因当中，次于心脏病、脑血管病和急性肺部感染，与艾滋病一起并列第4位。     

老年慢性阻塞性肺病患者细胞免疫功能变化的研究

比较了 89例老年COPD患者与 91例非COPD患者的细胞免疫功能的情况 ,发现老年COPD患者的淋巴细胞数CD4 /CD8 的比值、CD4 细胞比例较对照组显著降低 ,NK细胞比例和CD8 细胞比例较对照组显著增高 .说明老年COPD患者存在细胞免疫功能异常 ,而CD8 T淋巴细胞免疫反应增强 ,可能是COPD的发病机制之一 .     

老年慢性阻塞性肺病患者细胞免疫功能变化的研究

比较了89例老年COPD患者与91例非COPD患者的细胞免疫功能的情况,发现老年COPD患者的淋巴细胞数CD4+/CD8+的比值、CD4+细胞比例较对照组显著降低,NK细胞比例和CD8+细胞比例较对照组显著增高.说明老年COPD患者存在细胞免疫功能异常,而CD8+T淋巴细胞免疫反应增强,可能是COPD的发病机制之一.     

42例慢性阻塞性肺病的临床分析

目的 探讨慢性阻塞性肺病的临床表现及治疗效果.方法 回顾性分析我院2010年住院的42例慢性阻塞性肺病患者的临床病例资料,对其临床表现、治疗方法和治疗效果进行分析.结果 治疗后显效27例(64.3%),有效12例(28.6%),无效3例(7.1%),总有效率为92.9%.结论 根据慢性阻塞性肺病临床症状,避免诱发因素的接触,应用支气管扩张剂治疗,取得显著的效果.     

社区慢性阻塞性肺病患者的心理状况分析

笔者对我中心所辖社区内的慢性阻塞性肺病患者的心理状况进行调查,并与同区内其它人群的心理状况进行比较.发现其心理障碍发病率高达60.1%,远高于普通人群的24.76%.把慢性阻塞性肺病组受试者心理状况影响因素的多因素逐步回归分析,以婚姻,家庭结构,医疗报销,经济状况等项目作为自变量,心理健康(HAD积分)作为应变量进行多元逐步回归分析,获生活质量线性回归方程.提示慢性阻塞性肺病患者的心理状况除与病情有联系还与众多因素密切相关.     

慢性阻塞性肺病并发气胸临床分析

目的：探讨慢性阻塞性肺病(COPD)并发气胸患者临床诊断及治疗方法。方法将120例COPD并发气胸患者随机分为观察组及对照组各60例,对照组患者给予常规性抗感染及吸氧治疗,观察组在常规治疗基础行胸腔闭式引流。结果观察组总有效率91.67豫高于对照组71.67豫,差异有统计学意义(<0.05)。观察组治疗后6MVD高于对照组(<0.05),而BODE指数、SGRQ评分低于对照组(<0.05)。结论胸腔闭式引流能有效提高COPD并发气胸患者肺功能,改善患者治疗效果,降低患者病死率,有利于患者预后。     

慢性阻塞性肺病患者膈神经传导测定

目的:初步研究慢性阻塞性肺病患者(COPD)肺功能及膈神经传导(PNC),并探讨二者之间的关系。方法:对22例患者进行肺功能及膈神经运动传导。以14例因其它原因就诊并无呼吸系统疾患的患者作为对照。肺功能检测主要指标包括:第一秒用力肺活量(FEV1),第一秒用力肺活量与预计值的百分比(FEV1%)、用力肺活量(FVC)、一秒率(FEV1/FVC%)。PNC检测方法是在胸锁乳突肌后缘中点用力电刺激膈神经,于过剑突的截面与腋前线的连线记录膈肌复合动作电位(dCMAP),测量其波幅及潜伏期。结果:1、COPD患者肺功能各项指标FEV1、FEV1%、FVC、FEV1/FVC%分别为0.68±0.54、27.8±18.6、1.44±0.74、50.2±19.6,均为异常,与对照组相比有显著性差异。2、两组PNC潜伏期比较,差异无统计学意义;dCMAP波幅比较,差异有统计学意义。即COPD患者的膈神经传导波幅明显减低。结论:COPD患者膈神经动作电位波幅降低,可能与肺功能减退、膈肌疲劳有一定关系,通过PNC检测可能为肺功能异常者提供膈肌功能障碍的信息。     

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。     

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。     

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.     

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。     

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.     

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。     

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。     

Severity Staging of Chronic Obstructive Pulmonary Disease: Differences in Pre- and Post-Bronchodilator Spirometry

Purpose

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for chronic obstructive pulmonary disease (COPD) uses the post-bronchodilator spirometry for diagnosis and severity staging. We evaluated differences in the severity classification of COPD, based on pre- and post-bronchodilator spirometry.

Materials and Methods

From 2000 to 2004, 207 COPD patients who underwent spirometry before and after inhalation of 400 µg of fenoterol were analyzed. A responder to the bronchodilator test (BDT) was defined by the American Thoracic Society (ATS) as an increase in forced expiratory volume in one second (FEV₁) or forced vital capacity ≥ 12% and ≥ 200 mL, and by the European Respiratory Society (ERS) as an increase in FEV₁ ≥ 10% of the predicted value. COPD severity was classified according to the 2008 GOLD guidelines.

Results

For the entire study population, the FEV₁ increased by 11.8 ± 12.5% of baseline after BDT and 41.1% and 27.1% of subjects were classified as responders using the ATS and ERS criteria, respectively. Based on pre-BDT spirometry, 55, 85, 58, and 9 patients were classified as Stage I-IV COPD, respectively. Sixty-seven (32.4%) patients changed severity staging after BDT, including 20.0%, 28.2%, 44.8%, and 66.7% of pre-BDT patients Stages I through IV, respectively. More ATS or ERS BDT-responders had a change in severity staging than non-responders (52.9% vs. 18.9% and 62.5% vs. 21.2%, both p < 0.001).

Conclusion

Our data suggest that the severity staging of COPD using pre-BDT spirometry might lead to significant differences as compared to staging, based on post-BDT spirometry, as recommended by the current GOLD guidelines.     

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。