支气管哮喘与慢性阻塞性肺疾病患者气道阻力测定的临床意义

为探讨支气管哮喘与慢性阻塞性肺疾病（ＣＯＰＤ）缓解期患者气道阻力测定的临床意义，对６１例哮喘患者与７３例ＣＯＰＤ患者进行了气道阻力（Ｒａｗ）、气道传导率（Ｇａｗ）与肺通气功能测定。结果显示：哮喘缓解期患者Ｒａｗ明显增高（ｐ＜０００１），Ｇａｗ明显降低（ｐ＜０００１），用力呼气流量（Ｖ）、ＦＥＶ１％与ＭＭＥＦ正常或轻度降低，出现了Ｒａｗ－Ｖ分离现象；ＣＯＰＤ缓解期患者Ｒａｗ明显增高，Ｇａｗ明显降低，ＦＥＶ１％与ＭＭＥＦ亦相应呈现明显降低。据此作者认为，Ｒａｗ－Ｖ分离现象是哮喘患者肺功能变化的特点，可作为早期哮喘与不典型哮喘诊断的重要依据     

炎症因子与慢性阻塞性肺疾病

慢性阻塞性肺疾病(COPD)是一种具有气流受限特征的疾病,呈进行性发展,与肺部对有害气体或有害颗粒的慢性异常炎症反应有关,其发病率及病死率近年来呈增加趋势。其发病机制复杂,炎性细胞释放的多种细胞因子和炎症介质在COPD气道炎症中起重要作用,并越来越受到人们关注。现就几种炎症因子和介质与COPD的发病关系作一综述,以提高对COPD炎症状态的认识,为其治疗开创新的思路。1炎症细胞和病理COPD是以气道、肺实质和肺血管的慢性炎症为特征,在肺的不同部位有肺泡巨噬细胞、T淋巴细胞(尤其是CD8 细胞)和中性粒细胞增加。激活的炎症细胞…     

超短波辅助治疗慢性阻塞性肺疾病患者气道炎症的临床研究

目的 研究超短波对慢性阻塞性肺疾病(COPD)患者气道炎症及肺通气功能的影响并探讨其作用机理。方法 将74例急性发作期COPD患者分为超短波治疗组42例和对照组32例。超短波治疗组在常规治疗的基础上给予超短波治疗,对照组行常规治疗。两组患者均在治疗前、后分别记录其临床症状及体征,并检测血中白介素8(IL-8)、肿瘤坏死因子α(TNF-α)、粒细胞集落刺激因子(G-CSF)以及肺通气功能指标中用力肺活量(FVC)和第1秒用力呼气量(FEV_(1.0))。结果 与对照组比较,超短波治疗组治疗后其咳嗽、痰液性状、痰量及干啰音等临床症状与体征的显效好转率显著提高(P<0.05),血清IL-8、TNF-α、G-CSF均显著降低(P<0.05),FVC％pred、FEV_(1.0)％pred明显升高(P<0.05)。IL-8含量与 FEV_(1.0)呈负相关(r=-0.87,P<0.05),TNF-α含量与FEV_(1.0)呈负相关(r=-0.72,P<0.05)。结论 超短波辅助治疗COPD具有减轻气道炎症、提高肺通气功能的作用。     

支气管哮喘与慢性阻塞性肺疾病患者气道阻力测定的临床意义

目的：探讨支气管哮喘与慢性阻塞性肺疾病（COPD）患者气道阻力（Rocc）测定的临床意义。方法：选取2021年1月至2022年12月南方医科大学第三附属医院收治的108例支气管哮喘与COPD患者,根据病情类型分为支气管哮喘组（n=56）与COPD组（n=52）,再根据患者是否合并肺气肿,将支气管哮喘组、COPD组分别分为单纯支气管哮喘组（n=32）、支气管哮喘合并肺气肿组（n=24）及慢支组（n=24）、慢支合并肺气肿组（n=28）,同时选取同期50例健康体检者作为对照组。对所有受检者展开Rocc、肺功能测定,检测各组Rocc、气道传导率（Gocc）、第1秒用力呼气量（FEV1）/用力肺活量（FVC）、最大呼气流量（PEF）及最大呼气中段流量（MMEF）,并比较各组Rocc%、Gocc%、FEV1/FVC、PEF%及MMEF%。结果：支气管哮喘组、COPD组Rocc%较对照组更高,Gocc%较对照组更低（P＜0.05）;单纯支气管哮喘组FEV1/FVC、MMEF%与对照组比较相当（P＞0.05）;支气管哮喘合并肺气肿组、慢支组及慢支合并肺气肿组FEV1/FVC、MMEF%较对照组更低（P＜0.05）;单纯支气管哮喘组、慢支组PEF%与对照组比较相当（P＞0.05）;支气管哮喘合并肺气肿组、慢支合并肺气肿组的PEF%较对照组更低（P＜0.05）。结论：支气管哮喘缓解期患者Rocc升高、Gocc降低,肺功能多正常或趋于正常,存在Rocc-用力呼气流量分离现象;而COPD缓解期患者虽可出现Rocc升高、Gocc降低现象,但其肺功能明显减退,因此Rocc-用力呼气流量分离现象属于支气管哮喘患者肺功能改变的重要特征,可作为其临床诊断依据。     

中医药干预慢性阻塞性肺疾病气道炎症及重塑的研究进展

慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease,COPD）是一种常见的呼吸系统疾病,气道炎症及气道重塑在COPD发病过程中扮演着一个重要角色。近年来运用中医药防治COPD气道炎症及气道重塑效果显著,能减轻气道炎症,延缓气道重塑过程。该文对近年来国内外有关COPD气道炎症及重塑的文献进行了回顾,对中医药治疗COPD气道炎症及气道重塑的机制进行综述。     

慢性阻塞性肺疾病患者炎症反应与营养不良的相关性研究

目的探讨慢性阻塞性肺疾病(COPD)炎症反应与营养不良的相关性。方法选取BMI<18.5 kg/m2的COPD患者为观察组,18.5 kg/m2≤BMI<24 kg/m2的患者为对照组。采用诱导痰方法检查痰细胞的总数以及中性粒细胞、巨噬细胞、嗜酸粒细胞、淋巴细胞所占比例;采用酶联免疫吸附法(ELISA)测定血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)的水平;分析BMI与各炎症指标的相关性。结果观察组痰细胞总数和中性粒细胞所占比例显著高于对照组(P<0.01);观察组CRP、IL-6、IL-8、TNF-α水平明显高于对照组(P<0.01);观察组BMI与痰细胞总数(r=-0.493,P=0.004)、中性粒细胞百分比(r=-0.504,P=0.003)以及系统炎症指标CRP(r=-0.481,P=0.007)、IL-6(r=-0.423,P=0.015)、IL-8(r=-0.397,P=0.041)、TNF-α(r=-0.422,P=0.016)水平呈显著负相关。结论气道和系统炎症反应均与COPD患者的营养不良密切相关。     

慢性阻塞性肺疾病急性发作期细胞因子检测的意义

目的：探讨白细胞介素－８（ＩＬ－８）和α－肿瘤坏死因子（ＴＮＦ－α）在慢性阻塞性肺疾病（ＣＯＰＤ）气道炎症中的作用。方法：采用酶联免疫吸附法（ＥＬＩＳＡ）检测１０例ＣＯＰＤ急性发作期和１０例正常对照组痰及血清的ＩＬ－８和ＴＮＦ－α水平。结果ＬＣＯＰＤ患者痰ＩＬ－８水平（１９８２．２４±９０１．０７）ｎｇ／Ｌ均显著高于正常人痰ＩＬ－８（７６８．６０±５７０．１４）ｎｇ／Ｌ和ＴＮＦ－α水平（２３．９０     

重新识别慢性阻塞性肺疾病与支气管哮喘

慢性阻塞性肺疾病 (ＣＯＰＤ)是具有气流阻塞特征的慢性支气管炎或 (和 )肺气肿。过去 ,很多不同种类的呼吸系统疾病 ,如它们表现为一慢性进行性过程 ,则常被列为ＣＯＰＤ。近年来 ,随着人们对疾病病理生理研究水平的不断提高以及对疾病预后认识的增加 ,目前认为图 1所示仅阴影部分才属于ＣＯＰＤ范畴。〔1〕图 1 ＣＯＰＤ的范畴　　支气管哮喘是以不同程度的可逆性气流受限为特征的气道炎性综合征 ,通常伴有气道高反应性 ,临床上表现为反复发作的喘息、呼吸困难、胸闷和咳嗽。如仅由此看 ,ＣＯＰＤ与哮喘的鉴别诊断似乎很明确。然而 ,在临…     

哮喘慢性阻塞性肺疾病重叠综合征的临床特点

人们逐渐认识到哮喘和慢性阻塞性肺疾病(COPD)是一种异质性疾病,就其临床表现,疾病进展和对治疗的反应而言,具有极大的个体差异性。哮喘慢性阻塞性肺疾病重叠综合征(ACOS)的引入可能会更好的体现其临床特点。目前进行的研究一般都是基于症状来诊断ACOS,不完全可逆气流受限,支气管扩张试验阳性,气道高反应,嗜酸粒细胞炎症,过敏性疾病的历史,和烟雾暴露是ACOS的重要组成部分。迄今为止进行的研究用不同的标准来定义ACOS,总的来说,ACOS综合征被定义为两种临床表型:哮喘-ACOS和COPD-ACOS。每个表型都有一个不同的潜在的病理生理、临床特点和预后。ACOS的治疗应根据表型定制。然而,ACOS仍处于初级阶段,并需做出很大的改进。     

慢性阻塞性肺疾病的气道炎症及治疗新进展

目前,慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)居全球死亡原因的第4位[1],是世界慢性病防治重点之一。在COPD气道炎症中,中性粒细胞、肺泡巨噬细胞(alveolar macrophage,AM)等炎症细胞渗出增加,并释放白介素6(interleukin-6,IL-6)、白介素8(interleukin-8,IL-8)、白三烯     

Distinguishing chronic obstructive pulmonary disease from asthma

Asthma and chronic obstructive pulmonary disease (COPD) are the most common chronic respiratory diseases in the UK. Good management of both diseases results in better symptom control and improved quality of life for the patient, but will rely on all members of the primary healthcare team sharing the aims of management as well as helping to implement those goals. The two diseases share many clinical features and similar drugs can be used to treat them both. However there are important clinical differences which help to distinguish them from each other. The management of the two diseases differs in drug regimens and in the long-term aims of management. This article clarifies the important features that distinguish asthma from COPD and which allow patients to receive the best specific management.     

The cytokine network in asthma and chronic obstructive pulmonary disease

Asthma and chronic obstructive pulmonary disease (COPD) are very common inflammatory diseases of the airways. They both cause airway narrowing and are increasing in incidence throughout the world, imposing enormous burdens on health care. Cytokines play a key role in orchestrating the chronic inflammation and structural changes of the respiratory tract in both asthma and COPD and have become important targets for the development of new therapeutic strategies in these diseases.     

热-磁-振疗法对慢性阻塞性肺疾病患者气道炎症的影响

目的观察热-磁-振疗法对慢性阻塞性肺疾病（COPD）患者气道炎症的影响，并探讨其作用机制。 方法将78例急性发作期COPD患者分为治疗组40例和对照组38例。对照组行常规治疗，治疗组在常规治疗的基础上给予热-磁-振治疗，每日1次，每次30 min。2组患者均在治疗前、后分别记录其临床症状及体征，并检测血清中肿瘤坏死因子α（TNF-α）、白介素6（IL-6）、白介素8（IL-8）、白介素13（IL-13）以及肺通气功能［1秒钟用力呼气容积占预计值百分比（FEV1.0%）和1秒钟用力呼气容积/用力肺活量百分比（FEV1.0/FVC）］。 结果治疗组治疗后其咳嗽、痰液性状、痰量及干啰音等临床症状与体征的改善明显优于对照组（P<0.05或P<0.01），TNF-α、IL-6、IL-8、IL-13均显著降低（P<0.05或P<0.01）,FEV1.0%、FEV1.0/FVC明显升高，其中治疗后FEV1.0%、FEV1.0/FVC（%）的改善治疗组优于对照组（P<0.01）。相关分析表明，TNF-α、IL-6、IL-8、IL-13均与FEV1.0%呈负相关（P<0.01）。 结论热-磁-振疗法治疗COPD具有调节炎性细胞因子分泌，减轻气道炎症，提高肺通气功能的作用。     

噻托溴铵对慢性阻塞性肺疾病患者肺功能和气道炎症的改善作用

目的观察噻托溴铵吸入剂对稳定期慢性阻塞性肺疾病(COPD)患者不同分型肺功能及气道炎症的改善作用。方法选取67例COPD稳定期患者为研究对象,行肺功能检查,按诱导痰嗜酸细胞计数结果分为:A组:支气管舒张试验阴性且痰液嗜酸粒细胞计数≥3%;B组:中性粒细胞明显升高,且痰液嗜酸粒细胞计数3%。两组均给予噻托溴铵吸入剂(思力华)18μg/次,1次/d,连用6周;6周后再复查肺功能,同时再取诱导痰行细胞分析及测定LTB4的含量。结果 6周后,A、B两组FEV1较基线值分别升高(0.13±0.10)L,(0.04±0.05)L;FVC分别高(0.16±0.24)L,(0.03±0.05)L,两组相比差异有统计学意义(P0.05);A组在治疗前后LTB4治疗水平变化不大,差异无统计学意义(P0.05),B组在治疗前后LTB4较前下降,治疗前后差异有统计学意义(P0.05)。结论吸入噻托溴铵能可改善稳定期COPD患者的肺功能,减轻以中性粒细胞浸润为主的COPD患者的气道炎症。     

The myocardial condition in chronic obstructive pulmonary disease and bronchial asthma

The purpose of the study was to assess the influence of structural and functional changes in the myocardium of the right and left ventricle (RVand LV) on the development of ischemia and arrhythmia in chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA). The subjects of the study were 156 patients with either persistent BA (81 patients) or COPD (75 patients). Patients with decompensated cor pulmonale were excluded. ECG, 24-hour ECG monitoring, and echocardioscopy were performed. The study found that the occurrence of supraventricular and ventricular extrasystoles (SVES and VES) in patients with mild COPD or BA depended on the condition of RV diastolic function and on LV diastolic function and myocardial ischemia as well in COPD. In moderate BA the processes of myocardial remodeling correlate with myocardial ischemia, RV dysfunction and increased pulmonary arterial pressure (PAP), as well as with lipid dismetabolism. The appearance of SVES in patients with severe BA is connected with interventricular septal hypertrophy, LV dysfunction, and increased PAP, while VEC appear due to myocardial ischemia and hypercholesterolemia. In severe COPD the occurrence of SVES and VES does not depend on structural and functional changes in the myocardium, while myocardial ischemia is connected with LV hypertrophy. In BA ischemia depends on the development of RV and LV diastolic dysfunction, as well as hypercholesterolemia.     

Monoclonal antibodies for asthma and chronic obstructive pulmonary disease

Introduction: In asthma and chronic obstructive pulmonary disease (COPD), the inflammation in the airways cannot always be controlled with conventional therapies, such as inhaled corticosteroids. Addition of more specific anti-inflammatory therapies, such as monoclonal antibodies, against inflammation pathways might improve the disease outcome.

Areas covered: This review individually discusses the major inflammation pathways and their potential blocking monoclonal antibodies in asthma and COPD.

Expert opinion: The current use of omalizumab in asthma provides a good example on the potential therapeutic role of monoclonal antibodies in both asthma and COPD. There are many other monoclonal antibodies which are currently investigated as possible therapies in these diseases. The identification of the disease subsets in which such antibodies might exert the maximum benefit opens the door for personalized medicine and for targeted biological therapy in asthma and COPD.     

Ventilation of patients with asthma and chronic obstructive pulmonary disease

Ventilatory intervention is often life-saving when patients with asthma or chronic obstructive pulmonary disease (COPD) experience acute respiratory compromise. Although both noninvasive and invasive ventilation methods may be viable initial choices, which is better depends upon the severity of illness, the rapidity of response, coexisting disease, and capacity of the medical environment. In addition, noninvasive ventilation often relieves dyspnea and hypoxemia in patients with stable severe COPD. On the basis of current evidence, the general principles of ventilatory management common to patients with acutely exacerbated asthma/COPD are these: noninvasive ventilation is suitable for a relatively simple condition, but invasive ventilation is usually required in patients with more complex or more severe disease. It is crucial to provide controlled hypoventilation, longer expiratory time, and titrated extrinsic positive end-expiratory pressure to avoid dynamic hyperinflation and its attendant consequences. Controlled sedation helps achieve synchrony of triggering, power, and breath timing between patient and ventilator. When feasible, noninvasive ventilation often facilitates the weaning of ventilator-dependent patients with COPD and shortens the patient's stay in the intensive care unit.