川芎嗪联合东莨菪碱治疗慢性阻塞性肺疾病加重期的临床研究

[目的]探讨川芎嗪联合东莨菪碱佐治慢性阻塞性肺疾病加重期的疗效。[方法]对65例慢性阻塞性肺疾病患者随机分为治疗组和对照组,两组均给予常规治疗,治疗组在常规治疗基础上,加用川芎嗪和东莨菪碱,7d为1个疗程。每天检测动脉血气分析,并与对照组比较。[结果]治疗前氧分压(PaO₂)、二氧化碳分压(PaCO₂)均无显著性差异(P>0.05)。治疗7d后治疗组治疗前后PaO₂、PaCO₂比较有统计学意义,治疗后PaO₂明显高于对照组(P<0.01),PaCO₂明显降低,两组差异有显著性。[结论]应用川芎嗪和东莨菪碱治疗慢性阻塞性肺疾病有显著疗效。     

中重度稳定期慢性阻塞性肺疾病患者尿白三烯E4测定及临床意义

目的 探讨白三烯E₄在中重度稳定期慢性阻塞性肺疾病（chronic obstructive pulnonary disease,COPD）发病机制中的作用,及白三烯受体拮抗剂治疗的临床疗效。方法 将60例中重度稳定期COPD患者随机分为孟鲁司特组及常规治疗组各30例,取30例健康患者为对照组。观察3个月治疗前后各组尿白三烯E₄（uLTE₄）水平、肺功能（PFT）、短效β₂受体激动剂使用剂量、健康相关生活质量（HRQL）评分变化。同时研究第1秒时间肺活量（FEV₁）与uLTE₄、HRQL评分相关性。结果 孟鲁司特组治疗后肺功能参数用力肺活量（FVC）、第1秒钟用力呼气量（FEV₁）、1秒量占预计值的百分比（FEV₁% pre）均较治疗前明显提高（P均<0.05）,HRQL评分均明显低于治疗前（P均<0.01）,β₂受体激动剂使用剂量较治疗前显著减少（P<0.05）;治疗后孟鲁司特组uLTE₄水平显著低于治疗前（P<0.05）;常规治疗组治疗前后uLTE₄水平无明显改变,差异无统计学意义（P>0.05）。FEV₁与uLTE₄,HRQL评分均呈负相关（r分别为-0.67、-0.73,P<0.05）。结论 白三烯在慢性阻塞性肺疾病发病中可能起了重要的作用,检测尿液LTE₄水平对于了解慢性阻塞性肺疾病患者体内白三烯水平,以及评价白三烯受体拮抗剂的疗效具有一定的临床意义。孟鲁司特长期使用可改善中重度稳定期COPD患者生活质量,肺功能及减少β₂受体激动剂使用剂量。     

慢性阻塞性肺疾病合并25例肺结核的临床分析

目的探讨慢性阻塞性肺疾病合并肺结核的临床诊断及治疗特点.方法对在我院2009年12月~2011年12月间住院治疗的25例慢性阻塞性肺疾病合并肺结核患者进行回顾性分析,比较患者在治疗前后临床症状的改善情况.结果慢性阻塞性肺疾病合并肺结核症状、影像学检查不典型,25例患者经过规则治疗后,有23例明显好转,其中2例由于肺结核严重并且合并呼吸衰竭导致死亡.结论慢性阻塞性肺疾病合并肺结核在临床上常见,并且发病率较高,需要引起患者及医生的重视,做到早诊断,早治疗.     

年龄呼吸困难指数气流受限程度指数在慢性阻塞性肺疾病患者远期预后评估中的价值

目的 探讨年龄呼吸困难指数气流受限程度（ADO）指数在慢性阻塞性肺疾病患者病情和远期预后评估中的价值。方法 收集2016年1月至2018年12月在黄山首康医院呼吸内科住院的124例慢性阻塞性肺疾病急性加重期患者的临床资料,以入住呼吸内科时作为观察起点,以患者死亡或入住呼吸内科后180 d作为观察终点,按患者180 d转归分为死亡组（27例）与存活组（97例）。观察患者180 d转归（存活或死亡）、ADO指数与患者远期预后的相关性。结果 存活组患者的平均年龄为（70.86±7.87）岁、平均年龄评分为（2.59±0.76）分,均低于死亡组,差异无统计学意义（P>0.05）。存活组患者第1秒用力呼气容积占预计值%为（45.46±19.14）%,高于死亡组的（31.96±17.11）%,差异有统计学意义（P<0.05）。存活组患者第1秒用力呼气容积占预计值%评分、英国医学研究委员会呼吸困难评分和ADO指数分别为（1.17±0.68）分、（1.45±0.83）分和（5.23±1.38）分,均低于死亡组,差异有统计学意义（P<0.05）。患者病死率与ADO指数呈正相关（r_p=0.857,P=0.014）。ADO指数预测死亡风险的ROC曲线下面积为0.847（95% CI：0.767~0.926,P<0.001）,ADO指数为5.5时,约登指数最大,为0.565。结论 ADO指数能够较为准确地评估慢性阻塞性肺疾病患者病情的严重程度,预测患者的远期预后。     

老年慢性阻塞性肺疾病并发肺结核临床探析

目的:观察分析老年慢性阻塞性肺疾病并发肺结核的临床特点。方法:从我院收治入院的慢性阻塞性肺疾病并发肺结核的老年患者中选取60例,对其临床症状、实验室及影像学检查结果和诊治情况进行统计分析。结果:慢性阻塞性肺疾病合并肺结核患者中男性明显多于女性,其临床症状与影像学检查多不典型,多有细菌感染,结核抗体与结核菌素检测阳性率较低,经治疗后仅有1例患者因呼吸衰竭死亡,其他患者均好转出院。结论:慢性阻塞性肺疾病并发肺结核的临床症状与一般检查结果多不典型,为其诊断增加了难度,容易出现误诊与漏诊情况,但治疗效果较为理想。     

胸部DR高仟伏成像与CT成像在尘肺病诊断中的价值比较

目的 探讨DR高仟伏成像和胸部CT成像在尘肺病诊断中的差异。方法 采用随机数字表法选取2013年6月至2019年12月在合肥市第三人民医院（合肥市职业病防治院）住院的40例尘肺病患者的影像学资料，比较DR高仟伏成像和胸部CT成像对尘肺病患者及其合并症检出率的差异，并评价两种方法在尘肺病分期中的价值。结果 DR高仟伏成像和胸部CT成像对尘肺病检出的一致性较好（Kappa=0.648，P<0.001）。DR高仟伏成像对Ⅰ、Ⅱ、Ⅲ期尘肺病患者的检出率分别为73.1%（19/26）、87.5%（7/8）和100.0%（6/6），而CT成像的检出率分别为92.3%（24/26）、100.0%（8/8）和100.0%（6/6）。对于Ⅰ期尘肺者，CT的检出率明显高于DR高仟伏胸片成像（P=0.003）。CT成像对尘肺病患者肺大泡、胸膜增厚及纵隔淋巴结肿大等合并症的检出率均高于DR高仟伏成像（χ_肺大泡²=4.501，P_肺大泡=0.034，χ_胸膜增厚²=6.275，P_胸膜增厚=0.012，χ_{淋巴结肿大}²=4.507，P_{淋巴结肿大}=0.034）。结论 胸部DR高仟伏成像和CT成像对尘肺病的检出率一致，但胸部CT检查更易早期发现尘肺病患者的影像学改变及肺部合并症。     

用抗生素和糖皮质激素治疗治疗慢性阻塞性肺疾病感染

研究慢性阻塞性肺疾病(COPD)是一组以慢性不可逆的气流受限和多季节发作为特征的疾病,是由多种肺部疾病迁延所致。慢性阻塞性肺疾病(COPD)是主要包括慢性气管炎和肺气肿。研究慢性阻塞性肺疾病(COPD)是引起肺心病的主要病因,在我国由研究慢性阻塞性肺疾病(COPD)引起者约占81.8%     

急性加重期慢性阻塞性肺病的合理药物

慢性阻塞性肺疾病(COPD)是一种以气流受限为特征的疾病状态,这种气流受限通常呈进行性发展,不完全可逆,多与肺部对有害颗粒物或有害气体的异常炎症反应有关.当慢性支气管炎或(和)肺气肿患者肺功能检查出现气流受限并且不能完全可逆时,则诊断为慢性阻塞性肺疾病.     

肺超声在心源性肺水肿诊疗中的应用价值

目的探讨肺超声检查在发生心力衰竭患者心源性肺水肿的诊断及治疗监测中的应用价值。方法纳入2014年7月~2015年1月临床诊断为心力衰竭患者61例为研究对象。所有患者均接受超声心动图、肺超声及胸部CT检查,比较分析肺超声与胸部CT对心源性肺水肿的诊断价值;同时,对比分析患者治疗前后肺超声检查肺部B线数量与左心室射血分数的变化,并对B线数量和左心室射血分数进行Pearson相关分析。结果CT诊断心源性肺水肿52例,肺超声诊断心源性肺水肿50例,Kappa值为0.642,两者比较差异无统计学意义(P>0.05);治疗后患者肺部B线数量与左心室射血分数较治疗前显著改善(P<0.05);相关分析表明,治疗前后B线数量与射血分数两者之间在P=0.05水平均呈显著负相关(r_治疗前=-0.907,P<0.01;r_治疗后=-0.783,P<0.01)。结论肺超声可以作为诊断心力衰竭患者心源性肺水肿的可靠辅助检查方法之一,并可用于心源性肺水肿的治疗评价,具有重要临床应用价值。     

新型冠状病毒肺炎患者6例临床特征和影像学表现

目的 总结6例新型冠状病毒肺炎（COVID-19）患者的临床特征和影像学表现，为COVID-19早期确诊和临床干预提供依据。方法 选择上海中医药大学附属第七人民医院2020年1月1日至2020年2月22日严重急性呼吸综合征冠状病毒2（SARS-CoV-2）核酸检测阳性的6例COVID-19患者，回顾性分析流行病学史、临床表现、影像学资料和实验室检查。结果 6例患者均有明确的武汉旅行或居住史，4例患者有发热，3例有咳嗽，2例有流涕、咽痛等上呼吸道症状，2例有头痛、肌肉酸痛等全身症状。6例患者胸部CT检查均可见肺部异常表现，病灶均为双侧分布，下肺病灶多于上肺，主要表现为双侧肺野外带多发磨玻璃影、实变影、“铺路石”征及不同程度纤维化。发病后较晚行胸部CT检查可见肺实变和明显纤维化。结论 COVID-19影像学具有一定的特征性表现，结合患者流行病学史、临床表现和SARS-CoV-2核酸检测能早期诊断。     

Association between socioeconomic status and chronic obstructive pulmonary disease in Jiangsu province,China: a population-based study

Background:Chronic obstructive pulmonary disease (COPD) is a common public health problem worldwide. Recent studies have reported that socioeconomic status (SES) is related to the incidence of COPD. This study aimed to investigate the association between SES and COPD among adults in Jiangsu province, China, and to determine the possible direct and indirect effects of SES on the morbidity of COPD.Methods:A cross-sectional study was conducted among adults aged 40 years and above between May and December of 2015 in Jiangsu province, China. Participants were selected using a multistage sampling approach. COPD, the outcome variable, was diagnosed by physicians based on spirometry, respiratory symptoms, and risk factors. Education, occupation, and monthly family average income (FAI) were used to separately indicate SES as the explanatory variable. Mixed-effects logistic regression models were introduced to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for examining the SES-COPD relationship. A pathway analysis was conducted to further explore the pulmonary function impairment of patients with different SES.Results:The mean age of the 2421 participants was 56.63 ± 9.62 years. The prevalence of COPD was 11.8% (95% CI: 10.5%–13.1%) among the overall sample population. After adjustment for age, gender, residence, outdoor and indoor air pollution, body weight status, cigarette smoking, and potential study area-level clustering effects, educational attainment was negatively associated with COPD prevalence in men; white collars were at lower risk (OR: 0.60, 95% CI: 0.43–0.83) of experiencing COPD than blue collars; compared with those within the lower FAI subgroup, participants in the upper (OR: 0.68, 95% CI: 0.49–0.97) tertiles were less likely to experience COPD. Such negative associations between all these three SES indicators and COPD were significant among men only. Education, FAI, and occupation had direct or indirect effects on pulmonary function including post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV₁/FVC), FEV₁, FVC, and FEV₁ percentage of predicted. Education, FAI, and occupation had indirect effects on pulmonary function indices of all participants mainly through smoking status, indoor air pollution, and outdoor air pollution. We also found that occupation could affect post-bronchodilator FEV₁/FVC through body mass index.Conclusions:Education, occupation, and FAI had an adverse relationship with COPD prevalence in Jiangsu province, China. SES has both direct and indirect associations with pulmonary function impairment. SES is of great significance for COPD morbidity. It is important that population-based COPD prevention strategies should be tailored for people with different SES.     

Establishment and pathological study of models of chronic obstructive pulmonary disease by SO_2 inhalation method

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肺结核病史者第一秒用力呼气容积的结果分析

目的 通过测定第一秒用力呼气容积（ FEV1 ）,分析肺结核病史者的肺功能特点.方法 对潍坊市部分农村地区40 岁以上的居民进行问卷调查、胸片和肺通气功能检测,取资料完整的1052例进行分析.结果 肺结核病史者的FVC%,FEV1%,FEV1/FVC,吸入支气管舒张剂后FEV1%改善及FEV1/FVC等指标均低于非肺结核病史者,差异均有统计学意义.有慢性气流受限不可逆的肺结核病史者吸入支气管舒张剂后FEV1%改善及FEV1/FVC等指标均显著低于无肺结核病史的COPD者,FEV1/FVC指标无明显差异.有吸烟史肺结核病史者吸入支气管舒张剂后FEV1%改善及FEV1/FVC等指标均低于无吸烟史的肺结核病史者,仅FEV1/FVC差异有统计学意义.结论 肺结核病史者的第一秒呼气容积各项指标均较无肺结核病史者差.与COPD者比较,慢性气流受限不可逆的肺结核病史者的气道阻力及受限程度较高,对支气管舒张剂的反应性较差;吸烟使气流受限不可逆的风险性增高.     

肌肉生长抑制蛋白预测肺动脉高压风险的分析

目的 探讨肌肉生长抑制蛋白预测慢性阻塞性肺疾病（COPD）所致肺动脉高压风险性所发挥的作用,为临床进一步诊疗提供参考依据。方法 选取2013年9月~2015年9月在笔者医院首次就诊的COPD且无肺动脉高压的患者189例作为研究对象,记录其年龄、BMI、PH、PaO₂、PaCO₂、C反应蛋白、CV/TLC、FEV₁/FVC、血BNP值、血SUA值、肌肉生长抑制蛋白、FEV₁占预计值%、RVD、RAD、左心室射血分数、右心室变化分数等指标。所有患者的随访期为2年,单因素分析影响慢阻肺患者预后的因素;COX回归模型进一步分析差异具有统计学意义的指标对COPD患者预后影响的程度; ROC曲线分析血BNP值和肌肉生长抑制蛋白水平在预测COPD患者肺动脉高压风险性的敏感度和特异性。结果 单因素分析提示,患者CV/TLC、FEV₁/FVC、血BNP值、血SUA值、肌肉生长抑制蛋白、FEV₁占预计值%、右房横径、右心室变化分数均能影响患者预后情况,差异有统计学意义（P<0.05）。COX回归结果提示患者的患者的血BNP值（P=0.021）、肌肉生长抑制蛋白（P=0.017）是影响PH风险的独立影响因素,且肌肉生长抑制蛋白影响程度明显高于血BNP值（RR=2.893 vs RR=2.415）;ROC曲线下肌肉生长抑制蛋白值的AUC为0.797,（95%可信区间为0.708~0.886）,其敏感度和特异性分别为76.8%、71.2%;血BNP值的AUC为0.752,（95%可信区间为0.657~0.847）,敏感度和特异性分别为72.1%、66.3%; 结论 肌肉生长抑制蛋白水平在评估COPD患者肺动脉高压风险方面表现出较好的预测能力,有望作为COPD患者的常规评估指标,为临床指导治疗提供依据。     

呼出气一氧化氮测定在COPD频繁急性加重表型患者中的临床意义

目的 探讨中央和外周气道呼出气一氧化氮(FeNO)在慢性阻塞性肺病(COPD)频繁急性加重表型患者中的临床意义。方法 收集2019年1月至2021年6月安徽医科大学第四附属医院呼吸与危重症医学科收治的90例COPD患者作为研究对象,在一年内因急性加重次数≥2次的患者纳入频繁急性加重组(n=23),急性加重次数≤1次的患者纳入非频繁急性加重组(n=67)。测定两组中央气道一氧化氮(FeNO₅₀)浓度和外周气道呼出气一氧化氮(FeNO₂₀₀)浓度、肺泡气一氧化氮(CaNO)浓度并收集白细胞计数、血嗜酸粒细胞百分比、血清总免疫球蛋白E(IgE)、慢性阻塞性肺疾病评估测试(CAT)评分及肺功能等相关指标,对进行对比分析。结果 COPD频繁急性加重组FeNO₂₀₀、CaNO、C反应蛋白(CRP)、血清总IgE、CAT评分均高于非频繁急性加重组,第一秒用力呼气容积占预计值百分比(FEV1%)低于非频繁急性加重组(P＜0.05)。在COPD急性加重患者中,FeNO₂₀₀、CaNO与FEV1%呈负相关(r=-0.305、-0.439,P＜0.05),与血清总IgE呈正相关(r=0.523、0.514,P＜0.05),其中CaNO还与CRP呈正相关(r=0.321,P=0.023)。结论 COPD频繁急性加重表型患者中央和外周FeNO浓度存在差异,FeNO₂₀₀、CaNO均可作为COPD患者外周小气道炎症指标。     

Establishment and pathological study of models of chronic ob structive pulmonary disease by SO2 inhalation method

Objective To establish rat models of chronic obstructive pulmonary disease (COPD) and study the pathological characteristics of airflow obstruction.
Method SO₂ inhalation method was used to establish rat models. After exposure to SO₂ for 7 weeks, peak expiratory flow (PEF), peak inspiratory flow (PIF), intratracheal pressure (IP) and IP slope in rat were measured by Maclab data recording and analysis system. Experimental rats with PEF less than 80% of the mean of the normal rats were classified as airflow obstructed, while those with PEF greater than 80% of mean of normal rats were non-obstructed. Pathological changes in airway and lung tissue were compared between these two groups.
Result In experimental animals, PEF was significantly decreased (P<0.005) and IP slope increased (P<0.001) as compared with normal rats. Epithelial damage, goblet cell hyperplasia and inflammatory cell infiltration in cartilaginous bronchi were more remarkable in experimental rats with airflow obstruction than those without airflow obstruction (P<0.001, <0 .01, <0.001, respectively). Furthermore, pathological changes in airway lumen, epithelium and airway wall in membranous and respiratory bronchioles were more marked in experimental rats with airflow obstruction than those without airflow obstruction (P<0.001 or P<0.05). There was a negative correlation between PEF values and epithelial hyperplasia, goblet cell hyperplasia, inflammatory cell infiltration, smooth muscle hyperplasia and mucous plug in membranous and respiratory bronchioles (P<0.001 or P<0. 05).
Conclusion SO₂ inhalation may cause chronic bronchitis with airflow obstruction, i.e. COPD in rats. COPD was induced in 64% (16 of 25) of the experimental group rats.     

A dangerous combination: tuberculosis and chronic obstructive pulmonary disease

Both chronic obstructive pulmonary disease (COPD) and pulmonary tuberculosis are leading causes of morbidity and mortality,and therefore the most important challenges to public health in China.A large,populationbased survey showed that the prevalence of COPD was 8.2％ (men,12.4％;women,5.1％) in adults 40 years of age or older,1 and even higher in Chinese rural areas where biomass fuels are the main sources of energy for cooking,heating,and other household needs in poorly ventilated dwellings.2 Under-diagnosis and under-treatment of COPD in these areas was another serious concern.2 It is also notable that pulmonary tuberculosis is highly prevalent in rural areas,which may share common risk factors with COPD.A systemic review by Lin et al3 showed that smoking was also an independent risk factor for tuberculosis and suggested a positive association between indoor air pollution and the disease.Cigarette smoking is the leading risk factor for COPD,but the prevalence of COPD in non-smokers is as high as 6.6％,and it is estimated that 25％-45％ COPD patients are neversmokers.4 Biomass fuel and occupational exposure are two major risk factors in never-smokers,and accumulating evidence suggests that tuberculosis is another significant risk factor for COPD.Facing the colliding epidemics of tuberculosis,tobacco smoking and COPD in developing countries,5 it is of urgent need to address the impact of tuberculosis on COPD,as well as the risk of tuberculosis in COPD patients.     

辽宁省肺功能检查普及情况及COPD 患者对肺功能检查认知情况的调查分析

 目的了解肺功能检查（PFT）在辽宁省的普及情况及慢性阻塞性肺疾病（COPD）患者对肺功能检查的认知情况。方
法对辽宁省内129 家二级及以上综合性医院肺功能检查的普及情况电话及直接问卷调查。对206 例COPD患者进行肺功能
检查认知状况横断面调查。结果开展肺功能检查的医院占总数的51.2豫，肺功能检查在三级医院中的普及率高于二级医院，
分别为79.4%和24.2%。在206 例COPD患者中曾诊断过COPD 者53 例（25.73%），既往做过肺功能者100 例（48.5%）。在诊断
过慢性支气管炎的患者中曾被诊断为COPD 者仅33.8%，其确诊COPD 的时间是在慢性支气管炎诊断后的（11.79±10.96）年，且
诊断COPD 时多数患者已为Ⅲ、Ⅳ级。结论辽宁省肺功能检查的普及率偏低，尤其是二级综合性医院。慢性支气管炎患者进
行肺功能检查的比率低，COPD 的确诊时间晚。     

成都地区COPD患病危险因素的城乡对比研究

目的 对比分析成都地区城市和农村慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）患病情况及其危险因素差异。方法 采取整群随机抽样方法,于2010年2～12月选取成都市城市和农村共4个社区,对被选人群中所有40～70岁居民进行问卷调查、体格检查和便携式肺功能检查。对气流受限者使用支气管扩张剂后再次测定一秒钟用力呼气量／用力肺活量（FEV1/FVC）小于70%者确诊为COPD。结果 在1931个样本人群中1579人完成了调查表和肺功能检查,应答率81.77%。成都地区COPD总患病率8.35%,城市患病率7.69%低于农村12.37%（\P\P\P\P<0.05）。多因素分析显示,吸烟量、文化程度、年龄和BMI是男性COPD危险因素。厨房烹饪燃料用煤、经济收入和BMI是女性COPD危险因素。结论 成都地区COPD患病率高,农村高于城市,主要危险因素有吸烟量、厨房烹饪燃料、BMI。     

Effect of physical training on fat-free mass in patients with chronic obstructive pulmonary disease (COPD)

Background Weight loss and depletion of fat-free mass are common problems in patients with chronic obstructive pulmonary disease (COPD) and are related to muscular weakness and exercise intolerance. Physical training of COPD patients has good effect on exercise tolerance and quality of life. The aim of this study was to examine factors that affect change in fat-free mass after physical training, in patients with COPD.Patients Patients were examined before and after a 4-month exercise period. Weight and height were measured, and bioelectrical impedance was performed. Fat-free mass (FFM) was calculated, by a three-compartment model, and fat-free mass index (FFMI) was calculated as FFM kg/m² and body mass index (BMI) as kg/m². A symptom-limited ramp ergometer test and 12-minute walk test (12MWT) were performed. Dyspnoea score of daily activities was determined by Chronic Respiratory Disease Questionnaire (CRDQ). Blood was taken for analyses of C-reactive protein (CRP) and fibrinogen. Patients with a BMI <21 kg/m² were given nutritional support during the training period.Results A total of 27 patients completed the training (64 years, FEV₁ 31% of predicted). Patients with low FFMI gained 1.2 kg, whereas those with normal FFMI lost 0.7 kg (p = 0.04). In multivariate analyses high age (p = 0.03), low FEV₁ (p = 0.02), and a high level of dyspnoea (p = 0.01) at baseline were found to be negative predictors for increase in FFM.Conclusions Difficulties in increasing the fat-free mass in COPD patients by physical training seem to be associated with dyspnoea in daily life and impaired lung function (FEV₁).