慢性阻塞性肺疾病的免疫治疗研究进展

慢性阻塞性肺疾病（ COPD ）是一组气流受限为特征的肺部疾病,气流受限不完全可逆,呈进行性发展,是可以预防和治疗的疾病。 COPD的发病机制复杂,除吸烟、感染、大气污染等因素外,免疫调节失衡、自身免疫反应等都可导致COPD的进展［1］。目前,治疗COPD的常用药物有支气管舒张剂、糖皮质激素、磷酸二酯酶抑制剂、祛痰药、抗氧化剂等,主要治疗目的是预防和控制COPD的症状,减少急性加重的频率和严重程度,提高患者运动耐力和生活质量。近年研究发现, COPD 急性加重期（ AECOPD ）或稳定期给予免疫调节治疗,可延缓肺功能损害、减少发病次数、降低病情程度、改善或增强劳动耐量。本文就各种调节免疫药物对COPD的治疗效果作一综述。     

慢性阻塞性肺疾病中糖皮质激素抵抗的分子机制研究进展

<正>慢性阻塞性肺疾病(COPD)是一种以持续气流受限为特征的可以预防和治疗的疾病,其气流受限多呈进行性发展,与气道和肺组织对烟草烟雾等有害气体或有害颗粒的慢性炎性反应增强有关。糖皮质激素作为主要的抗炎药物,广泛地应用于COPD患者治疗中,但仍不能有效的控制炎症反应,甚至对一部分COPD患者是无效的,所以需要更有效的抗炎药物及联合治疗。在很多细胞类型中,肺部炎症及其释放的促炎症细胞因子影响糖皮质激素受体(GR)、组蛋白去乙酰化酶(HDAC) 2和表面活性蛋     

糖皮质激素在 AECOPD 中的应用研究进展

COPD 是一种临床常见疾病,其发病率高,对患者的健康和生活产生严重影响;慢性阻塞性肺疾病急性加重期(AECOPD)是 COPD 病程的重要组成部分,使患者症状加重、肺功能恶化。糖皮质激素具有强大的抗炎作用,在 AECOPD 的治疗中有较好的治疗效果,但需注意其不良反应,本文简要介绍糖皮质激素在 AECOPD 中的应用。     

糖皮质激素在慢性阻塞性肺疾病治疗中的应用

慢性阻塞性肺疾病（COPD）是由于气道及肺实质的慢性炎症导致的气流受限综合征,而这种气流受限呈进行性发展。糖皮质激素在哮喘的防治方面已经取得了显著的疗效,而慢性炎症也存在于COPD中,这为激素在COPD中的应用提供了理论基础。但糖皮质激素在治疗COPD中的应用是有争议的,关于给药的剂量、疗程、给药方式、用药指征还没有统一的标准,这些都是临床医生非常关心的问题。本文对近几年的相关研究进行了回顾,从吸入和系统应用（静脉或口服）糖皮质激素治疗COPD两个方面来介绍。     

布地奈德联合硫酸特布他林雾化吸入治疗AECOPD疗效观察

慢性阻塞性肺疾病（COPD）是以气流受限不完全可逆，并呈进行性发展为特征。COPD急性加重（AECOPD）与肺内局部炎症反应急剧加重等有关系密切。在急性加重期的药物治疗中，全球创议关于防治策略，建议短期应用糖皮质激素，由于COPD患者多为老年人，合并基础疾病多，使全身激素应用受到限制，现观察布地奈德联合硫酸特布他林局部气道雾化吸入治疗COPD急性加重期患者临床治疗效果。[第一段]     

联合吸入糖皮质激素和支气管舒张剂在COPD治疗中的应用进展

慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease, COPD）是一种以进行性,不完全可逆性气流受限为特征的呼吸系统疾病,与肺部对有害气体或有害颗粒的异常炎症反应有关,气流受限和慢性炎症是其基本病理改变。支气管舒张剂及糖皮质激素在COPD治疗中的作用已得到肯定,近年来许多学者发现支气管舒张剂和糖皮质激素可通过不同的作用机理对COPD患者发挥协同作用,     

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慢性阻塞性肺疾病(COPD)是一种以不完全可逆性气流受限为特征的可以预防和治疗的气道慢性炎症性疾病。COPD病程中,患者常因感染等因素诱发出现COPD急性加重(AECOPD)。频繁发作的急性加重可使患者生存质量下降,肺功能进一步恶化,住院率和病死率上升。本文简述AECOPD诊治进展的相     

糖皮质激素与慢性阻塞性肺疾病

慢性阻塞性肺疾病（COPD0是一种具有部分可逆因素的可流受限性疾病，其患者人数多，病死率高，且有逐步上升之趋势。 短期应用糖皮质激素治疗急性发作期患者，临床疗效肯定。但对缓解期的疗效仍有争议。部分临床研究表明，对具有哮喘样特征（糖皮质激素试验阳性）的患者，激素可缓解症状，提高生活质量。但另一部分研究表明，激素不能缓解患者肺功能下降的速度,无明显远期疗效。     

噻托溴铵治疗慢性阻塞性肺疾病的疗效

慢性阻塞性肺疾病(COPD)是一种不完全可逆的气流受限为特征的疾病,是世界上第二大非传染性疾病,每年引起270多万人死亡,其病因与肺部对有害气体或有害颗粒的异常炎症反应有关[1].药物仍是目前治疗COPD的主要手段(主要应用支气管扩张药物改善气流受限、缓解气促等对症治疗).笔者应用肺功能仪分析探讨噻托溴铵对COPD患者的治疗效果.     

慢性阻塞性肺疾病急性加重的研究

慢性阻塞性肺疾病（COPD）具有很高的发病率和死亡率,而慢性阻塞性肺疾病急性加重（AECOPD）则是COPD患者就诊以及住院治疗的主要原因,也是庞大医疗费用的主要来源。本文就近年来对AECOPD的定义、病理生理、病因、治疗以及预防等的研究进展进行综述,其中一些方面已得到循证医学的证实,比如吸烟与AECOPD的关系、糖皮质激素及无创性正压通气在治疗AECOPD的作用等;但仍有一些问题尚存在争议,特别是细菌感染在AECOPD中的作用,以及抗菌治疗在AECOPD治疗中的地位,还需要更多的,设计严密的研究来证实。     

Acute exacerbation of COPD

The literature of acute exacerbation of chronic obstructive pulmonary disease (COPD) is fast expanding. This review focuses on several aspects of acute exacerbation of COPD (AECOPD) including epidemiology, diagnosis and management. COPD poses a major health and economic burden in the Asia‐Pacific region, as it does worldwide. Triggering factors of AECOPD include infectious (bacteria and viruses) and environmental (air pollution and meteorological effect) factors. Disruption in the dynamic balance between the ‘pathogens’ (viral and bacterial) and the normal bacterial communities that constitute the lung microbiome likely contributes to the risk of exacerbations. The diagnostic approach to AECOPD varies based on the clinical setting and severity of the exacerbation. After history and examination, a number of investigations may be useful, including oximetry, sputum culture, chest X‐ray and blood tests for inflammatory markers. Arterial blood gases should be considered in severe exacerbations, to characterize respiratory failure. Depending on the severity, the acute management of AECOPD involves use of bronchodilators, steroids, antibiotics, oxygen and noninvasive ventilation. Hospitalization may be required, for severe exacerbations. Nonpharmacological interventions including disease‐specific self‐management, pulmonary rehabilitation, early medical follow‐up, home visits by respiratory health workers, integrated programmes and telehealth‐assisted hospital at home have been studied during hospitalization and shortly after discharge in patients who have had a recent AECOPD. Pharmacological approaches to reducing risk of future exacerbations include long‐acting bronchodilators, inhaled steroids, mucolytics, vaccinations and long‐term macrolides. Further studies are needed to assess the cost‐effectiveness of these interventions in preventing COPD exacerbations.     

COPD急性加重危险因素的研究进展

COPD是呼吸系统疾病中的常见病和多发病,患病率及病死率均居高不下,近年来研究表明COPD的患病率有所增加.而COPD急性加重(acute exacerbation of chronic obstructivepulmonary disease,AECOPD)增加了医疗卫生资源的耗用,是COPD患者医药费用的首要负担,也是COPD患者的主要死因.当下临床研究的重点是对急性加重的管理,预防AECOPD尚未引起临床工作者足够重视,如何预防和减少AECOPD的发生和发展成为降低COPD患病率和病死率及减轻COPD经济负担的研究重点.本文通过研究阅读国内外相关最新研究成果,就AECOPD危险因素作出总结、探讨,阐明AECOPD相关危险因素,更好地指导临床实践,从而为AECOPD患者提供更佳的医疗服务.     

Prevention of acute exacerbation of chronic obstructive pulmonary disease after bronchoscopic lung volume reduction with endobronchial valves

IntroductionBronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBVs) has emerged as an important treatment method for patients with severe chronic obstructive pulmonary disease (COPD). Acute exacerbations of COPD (AECOPD) are a frequent complication following BLVR with EBV. However, there is no consensus on the prevention of AECOPD.ObjectivesOur study aims to compare the outcomes of different prophylactic measures on the occurrence of AECOPD after BLVR with EBV.MethodsWe conducted a multicenter, retrospective study of patients who underwent BLVR with EBV at six different institutions. Emphasis was directed towards the specific practices aimed at preventing AECOPD: antibiotics, steroids, antibiotics plus steroids, or no prophylaxis. Subgroups were compared, and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated.ResultsA total of 170 patients were reviewed. The rate of AECOPD was 21.2% for the full cohort. Patients who received prophylaxis had a significantly lower rate of AECOPD compared with those who did not (16.7% vs. 46.2%; p = 0.001). The rate was lowest in patients who received antibiotics alone (9.2%). There was no significant difference in the rate of AECOPD between patients who received steroids alone or antibiotics plus steroids, compared with the other subgroups. The OR for AECOPD was 4.3 (95% CI: 1.8–10.4; p = 0.001) for patients not receiving prophylaxis and 3.9 (95% CI: 1.5–10.1; p = 0.004) for prophylaxis other than antibiotics alone.ConclusionsAdministration of antibiotics after BLVR with EBV was associated with a lower rate of AECOPD. This was not observed with the use of steroids or in combination with antibiotics.     

慢性阻塞性肺疾病急性加重的发病机制

慢性阻塞性肺疾病急性加重（AECOPD）导致肺功能迅速下降。其发生机制仍不十分清楚,先后经历了黏液嵌塞假说、气道高反应学说、感染学说、细菌负荷周值理论和肺组织损伤加剧等认识过程,目前认为可能是多种因素综合作用的结果,其中一种或多种因素可能是发生AECOPD的触发因素。因此,深入了解该病机制有助于延缓甚至或阻断COPD进程。     

病毒相关的慢性阻塞性肺疾病急性加重的研究进展

随着高敏感性检测手段应用的发展和普及,病毒在慢性阻塞性肺疾病急性加重(AECOPD)期间的检出率大大提高,这引起人们对病毒感染与AECOPD关系的重视.现就病毒与AECOPD的关系、病毒特异性生物标志物以及病毒相关AECOPD的临床预后三个方面进行综述.     

单核细胞、大血小板对慢性阻塞性肺疾病急性加重期合并肺栓塞的临床意义

慢性阻塞性肺疾病急性加重期(AECOPD)可导致呼吸功能急剧恶化,慢性阻塞性肺疾病相关性死亡多发生于急性加重期。慢性阻塞性肺疾病患者尤其是AECOPD患者中肺栓塞的患病率较高。肺栓塞与AECOPD有着相似的临床表现,通过症状、体征和简单的实验室检查难以鉴别,导致了CT肺动脉造影的过度使用。近年来,许多学者研究发现单核细胞、血小板特别是大血小板与血管内外的炎症反应、血栓形成有着千丝万缕的联系。     

细菌感染与慢性阻塞性肺疾病急性加重

细菌感染作为慢性阻塞性肺疾病急性加重(acute exacerabation of chronic obstructivepulmonary disease,AECOPD)的一个重要原因,已经得到大部分学者的肯定.但是关于细菌感染如何促使AECOPD,不同学者提出了阈值假说、新致病菌株学说、病原体与宿主相互作用假说.从而指导了AECOPD中抗生素的应用.     

Remote daily real-time monitoring in patients with COPD – A feasibility study using a novel device

New technologies have allowed remote real-time electronic recording of symptoms and spirometry. The feasibility of utilising this technology in COPD patients has not been investigated.This is a feasibility study. The primary objective is to determine whether the use of an electronic diary with a portable spirometer can be performed by COPD patients with a moderate to severe disease. Secondary objectives are to investigate the value of this method in early detection of acute exacerbations of COPD (AECOPD).In this 6-month study, 18 patients recorded daily their symptom score and spirometry. Data was sent on real time. AECOPD which was defined according to pre-set criteria were noted. Spirometry values and scores for health-related quality of life were compared between the start and the end of the study. Hospitalisation rate due to AECOPD was compared with a parallel period in the previous year.On average, patients were able to record 77% of their total study days. The system detected 73% of AECOPD. In further 27% of AECOPD patients sought treatment although the change in symptoms did not meet AECOPD definition. The number of COPD-related hospitalisations significantly reduced compared to the previous year. There was a significant increase in FEV₁ and FVC from the start to the end of the study.The remote monitoring device used in this study can be used in COPD patients. AECOPD was detected early in the majority of cases. Hospitalisation rate due to AECOPD was reduced and FEV₁ and FVC values increased during the study.     

COPD急性加重期肺炎衣原体感染的临床分析

目的　了解肺炎衣原体急性感染在 COPD急性加重期患者中的发生率及其临床特点。方法　采用固相酶联免疫吸附试验 EL ISA法测定 96例 COPD急性加重期患者血清肺炎衣原体特异性抗体 Ig G及 Ig M,同时进行痰培养 ,急性肺炎衣原体感染者分别给予阿奇霉素及左氧氟沙星治疗。结果　 COPD患者急性肺炎衣原体感染率 2 5 .0 % ,临床表现较其他 COPD患者无明显特征性 (P>0 .0 5 )。COPD患者痰细菌阳性率 5 8.3%。左氧氟沙星对肺炎衣原体急性感染的 COPD患者疗效良好。结论　 COPD急性加重期患者中肺炎衣原体急性感染率高且混合感染率多见 ,合并肺炎衣原体急性感染的 COPD患者临床表现无明显特征性。对于怀疑合并肺炎衣原体感染的COPD患者 ,新喹诺酮类药物可用作早期经验性治疗的药物。