Chronic Obstructive Pulmonary Disease (COPD) and Vapors,Gases, Dusts,or Fumes (VGDF): A Meta-analysis

To evaluate the association between the risk of chronic obstructive pulmonary disease (COPD) and exposure to vapors, gases, dusts, or fumes (VGDF), we conducted a meta-analysis of epidemiological studies. We searched for studies investigating the relationship between COPD and occupational exposure to VGDF in the adult population. The bibliographic search was conducted in databases (PubMed and Google Scholar). Eleven studies that met predetermined inclusion criteria were included in the meta-analysis. We calculated the pooled odds ratio (OR) with its 95% confidence interval (CI) of COPD for exposure to VGDF using a random-effects model. The presence of publication bias was explored. There was moderate heterogeneity among the included studies (I² = 54.3%). In a random-effects model meta-analysis, the pooled OR for exposure to VGDF was 1.43 for COPD (95% CI: 1.19–1.73) compared with no exposure to VGDF. Publication bias was not observed in this study. Our study suggests that exposure to VGDF is associated with a higher risk of COPD. Further prospective cohort studies are needed to confirm this association.     

Exposure to occupational risk factors is associated with the severity and progression of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) results from a complex interaction between genes and the environment, and occupational exposures are an underappreciated risk factor. Until now, little research attention has been paid to the potential impact of occupational risk factor exposure on the COPD in China. The aim of this retrospective study was to analyze the role of occupational risk factor exposure on the severity and progression of COPD for exploring new prevention strategies for this disease. This study adopted a random cluster-sampling method. Five grade-A tertiary hospitals that met the inclusion criteria were selected as the survey sites, and patients with COPD hospitalized in these hospitals from January 1, 2019, to December 31, 2019, were selected as the research subjects. Data of the patients diagnosed with COPD met the Global Initiative for Chronic Obstructive Lung Disease (2019) criteria and were collected from the computerized medical record databases. Among 4082 investigated COPD patients, 1063 (26%) were found to have occupational risk factor exposure history. The top 3 industries with a large COPD case number and a history of occupational risk factor exposure ranked in the order of agriculture (including farming, forestry, animal husbandry, and fishery), manufacturing, and mining. Further multivariate logistic regression analysis indicated that when setting a low exposure level as a reference, medium and high exposure levels were correlated with the severity of COPD (odds ratio values were 2.837 and 6.201, respectively, P < .05). Linear regression analysis showed that cumulative exposure to occupational risk factors was negatively correlated with the forced expiratory volume in 1-second percentage of COPD patients, with a correlation coefficient of 0.68. Our results indicated that occupational risk factor exposure levels were related to the severity of COPD significantly. The incubation period of COPD in the exposure group was significantly shorter than that in the non-exposure group. To prevent worked-related COPD, special attention and control efforts should be taken to reduce the level of occupational risk factors such as organic dust, irritating chemicals, etc in the work environments, especially in the industries of agriculture, forestry, animal husbandry and fishery, manufacturing, and mining.     

Chromosome Pattern and Survival in Acute Non-Lymphocytic Leukaemia in Relation to Age and Occupational Exposure to Potential Mutagenic/Carcinogenic Agents

The bone marrow karyotype was investigated in 98 patients with acute non-lymphocytic leukaemia (ANLL). The patients were divided into two groups according to age. (1) 47 patients were 20–54 (median 40) years old. 21 had a history of occupational exposure to chemical solvents, insecticides, or petrol products, and 26 were considered occupationally not having been exposed to such agents. In 4 exposed patients (19%) all bone marrow cells had clonal chromosomal aberrations (designated AA), while also 4 of the non-exposed patients (15%) were AA. Thus in young ANLL patients, there was no significant association between occupational exposure to potential mutagenic/carcinogenic agents and the AA constitution of the leukaemic cells. (2) 51 patients were 55 years of age or older (median 65 years). 16 were exposed and 8 of these (50%) had the AA constitution. 35 patients were non-exposed and only 4 (11%) were AA. It is known from previous studies that the survival of ANLL patients with AA is extraordinarily short. Accordingly the overrepresentation of AA in exposed patients 55 years or older, was associated with a shorter survival than that of the non-exposed elderly patients. The results suggest that etiologic factors may influence the clinical course of ANLL, especially in elderly patients.     

沈阳市部分社区慢性阻塞性肺疾病发病情况调查分析

目的了解沈阳社区慢性阻塞性肺疾病(COPD)的流行病学特点及相关危险因素,为COPD的社区防治提供依据。方法以整群、不等比、随机抽样方法,对2003年3月至10月沈阳市东陵区3个社区,40岁以上人群入户问卷调查及肺功能检查。结果资料完整且肺功能检查质控合格者1957例,其中男725例,女1232例。年龄平均(59.37±11.61)岁。COPD患病率为8.02%,其中男性患病率(11.59%)高于女性(5.93%)(P0.01)。60～80岁COPD患病率77.70%,明显高于其他年龄组(P0.01)。Ⅱ级患者占48.41%,明显高于其他级别(P0.01)。有咳嗽、咳痰和(或)气短者仅占31.85%。吸烟与COPD患病的OR值为6.39。吸烟率56.05%均显著高于正常人群(9.61%)(P0.01)。40岁以上COPD患病率显著高于哮喘(1.58%)和(或)COPD合并哮喘患病率(1.74%)。97.45%的患者为首次接受肺功能检查,93.63%为首次诊断为COPD。结论沈阳市社区40岁以上人群COPD患病率显著高于哮喘及COPD合并哮喘者。60～80岁为高发年龄,Ⅰ、Ⅱ级患者占大多数。COPD的发病主要与吸烟相关。COPD漏诊率高,普及肺功能检查是早期诊断的关键。     

营养风险筛查与COPD患者预后分析

目的探究营养风险对COPD患者预后的影响效果。方法对2011年上半年来我院诊疗的77名COPD患者进行分组临床试验,按意愿分成实验组与对照组两组。对照组37例,采用NRS 2002进行营养风险筛查,但并不给予临床营养支持;实验组40例,采用NRS 2002进行营养筛查,对有营养风险患者给予临床营养支持,对比分析其对患者预后的影响。结果分析显示已有营养风险的患者住院时间较无风险患者更长,并发症发生率更高,且接受营养支持可改善临床结局,住院时间及并发症发生率大幅减小,差异具有统计学意义(P<0.05)。结论营养情况对患者预后有明显影响,有必要对每一位入院患者进行营养风险筛查,并根据筛查结果,采取相应措施。     

低密度脂蛋白胆固醇累积暴露对新发急性心肌梗死影响的前瞻性队列研究

目的:探讨低密度脂蛋白胆固醇(LDL-C)累积暴露对新发急性心肌梗死(AMI)的影响。方法:以开滦研究中满足标准的观察对象组成研究队列。依据多次LDL-C测量值计算的LDL-C升高累积暴露时间及LDL-C累积暴露值(cumLDL-C)进行分组,采用log-rank检验比较不同LDL-C升高累积暴露时间组及LDL-C累积暴露值组在随访期间新发AMI累积发病率的差异,采用多因素Cox回归模型分析不同LDL-C累积暴露对新发AMI的影响,分别删除服用降脂药、降压药、降糖药人群后,重复Cox回归模型,进行敏感性分析。结果:51407例观察对象纳入研究,平均年龄(52.70±11.92)岁,其中男性39120例(75.12%),平均随访(6.84±0.89)年。LDL-C升高累积暴露0年有37941例(73.81%),累积暴露2年有9361例(18.21%),累积暴露4年有3205例(6.23%),累积暴露6年有900例(1.75%)。LDL-C升高累积暴露0年、2年、4年、6年人群的AMI累积发病率分别为0.73%、1.12%、1.50%和2.10%,差异有统计学意义(χ2=36.87,P<0.001)。经多因素Cox回归分析显示,校正其他混杂因素后,与LDL-C升高累积暴露0年相比,LDL-C升高累积暴露2年、4年、6年人群发生AMI的HR(95%CI)分别是1.28(1.00~1.63)、1.61(1.15~2.25)、2.08(1.23~3.51);与cumLDL-C第一分位组相比,cumLDL-C第二分位组、第三分位组发生AMI的HR(95%CI)分别1.19(0.91~1.55)、1.39(1.08~1.80)。增加校正2006年度单次LDL-C测量值后,与LDL-C升高累积暴露0年相比,LDL-C升高累积暴露2年、4年、6年人群发生AMI的HR(95%CI)分别是1.29(1.00~1.65)、1.64(1.13~2.38)、2.15(1.20~3.84);与cumLDL-C第一分位组相比,cumLDL-C第二分位组、第三分位组发生AMI的HR(95%CI)分别1.18(0.89~1.56)、1.37(1.01~1.86)。分别删除服用降脂药、降压药、降糖药人群后,进行敏感性分析,结果与以上主要研究结果趋势一致。结论:LDL-C的长期变化呈“累积暴露”现象,LDL-C累积暴露是AMI的危险因素,且独立于单次LDL-C测量值。     

上海部分城乡地区血管性痴呆的发病率及危险因素研究

目的　调查上海部分城乡地区血管性痴呆 (VaD)的发病率及相关危险因素。方法　在上海地区基线患病率调查的基础上选择 5个居委会和 4个村委会的居民作为研究对象。通过简易精神状态量表 (MMSE) ,根据文化程度划分的分界值进行初筛 ,在分界值以下的对象和正常人群中随机选择 4 %进入细查。细查项目有体格检查、详细病史记录以及成套的神经心理学测试 ,包括 :Pfeffer功能活动、Fuld物体记忆、快速物体回忆、韦氏儿童智力量表积木测验和韦氏成人智力量表数字广度、日常生活功能量表 (ADL)、HachisKi缺血量表、汉密顿抑郁量表 (HAMD)等。以精神障碍诊断和统计手册作为痴呆的诊断标准。 6个月后对所有进入细查的对象进行复查 ,根据美国神经病学、语言障碍和卒中 老年性痴呆和相关疾病学会的标准诊断阿尔茨海默病 (AD) ;根据美国国立神经病卒中研究所和瑞士神经科学研究国际协会的标准诊断VaD。结果　在实际完成初筛的 35 4 5例中 ,确诊新发痴呆病例 112例 ,其中VaD 2 8例 ,发病率是 2 .5 4 3 千人年 (标化率为 2 .4 0 3 千人年 )。VaD与年龄呈正相关 ,其OR =1.12 7(95 %CI :1.0 76～ 1.179,P =0 .0 0 0 ) ,与教育呈负相关 ,其OR =0 .6 5 4 (95 %CI:0 .4 5 1～ 0 .94 3,P =0 .0 2 3)。结论　上海部分城乡地区     

Assessment of Induced Sputum Cellularity in COPD Patients Belonging to Two Different Classes of Air Pollution Exposure

IntroductionSeveral studies have previously demonstrated that long-term exposure to outdoor pollution present airway inflammation in term of an increase of sputum neutrophils.Aim and methodsThe aim of our study was to evaluate the level of airway inflammation by induced sputum in a group of 15 non-professionally exposed population of well-characterized COPD patients, residing in urban areas with high rate of outdoor pollution, compared to a control group of 13 individuals with COPD, living in rural areas with a low pollution rate. All participants underwent spirometry and sputum induction.ResultsA statistically significant increase in the percentage of neutrophil cell count was found among the residents in urban areas compared to those living in rural regions (89.1 vs 79.0, p < 0.05)ConclusionsIn conclusion, we showed that non-professionally exposed patients with COPD residing in highly-polluted urban areas had greater airway inflammation in terms of sputum neutrophils compared to a population with very similar characteristics, living in rural areas with lower outdoor pollution. The results of this pilot study may be relevant for the long term effect of environmental outdoor pollution in vulnerable patients like those with COPD.     

Prevalence of COPD by Disease Severity in Men and Women in Northern Vietnam

The prevalence of COPD and its risk factor pattern varies between different areas of the world. The aim of this study was to investigate the prevalence of COPD by disease severity in men and women and risk factors for COPD in northern Vietnam. From all 5782 responders to a questionnaire survey, a randomly selected sample of 1500 subjects was invited to a clinical follow-up study. The methods included a structured interview using a modified GA2LEN study questionnaire for registration of symptoms and possible determinants of disease. Spirometry was performed before and after bronchodilation. The age distribution of the sample was 23–72 years. Of 684 subjects attending, 565 completed acceptable spirometric measurements. The prevalence of COPD defined by the GOLD criteria was 7.1%; in men 10.9% and in women 3.9% (p = 0.002). Of those 3.4% had a mild disease, 2.8% a moderate and 0.9% a severe disease. In ages >50 years, 23.5% of men and 6.8% of women had COPD. Among smokers aged >60 years (all men), 47.8% had COPD. None of the women with COPD had been smokers. Increasing age, smoking and male sex were the dominating risk factors, although male sex lost its significance in a multivariate setting. The prevalence of COPD among adults in northern Vietnam was 7.1% and was considerably higher among men than women. The prevalence increased considerably with age. Increasing age and smoking, the latter among men only, were the most important determinants of COPD.     

香烟烟熏对COPD大鼠血清及肺组织中CC16水平的影响

目的通过测定COPD大鼠血清及肺组织中CC16的水平,探讨烟熏在COPD形成中的作用。方法采用烟熏加气管内注入内毒素法建立大鼠COPD模型。HE染色观察大鼠肺、支气管的病理改变。ELISA法检测血清中CC16的含量。免疫组化法检测肺组织中CC16的含量变化。结果 COPD组大鼠血清及肺组织中CC16含量与对照组相比均明显降低(P<0.01);内毒素组大鼠血清及肺组织中CC16含量较对照组低,但差别无统计学差异。结论香烟烟熏造成COPD大鼠血清及肺组织中CC16的含量降低,这一改变可能是吸烟所致COPD形成的机制之一。     

Mild Cognitive Impairment: Incidence and Risk Factors: Results of the Leipzig Longitudinal Study of the Aged

OBECTIVES: To provide information on age‐ and sex‐specific incidence rates of mild cognitive impairment (MCI) and risk factors for incident MCI. DESIGN: Prospective longitudinal cohort. SETTING: Leipzig Longitudinal Study of the Aged, a population‐based German study of the epidemiology of dementia and mild cognitive impairment. PARTICIPANTS: At baseline, 1,692 subjects aged 75 and older were included in the sample. MEASUREMENTS: Trained psychologists and physicians conducted structured clinical interviews including neuropsychological assessment and questions about sociodemographics, familial history of dementia, activities of daily living, subjective memory impairment, and lifestyle (alcohol consumption, smoking) at participants' homes. Structured third‐party interviews were conducted with proxies. Incidence was calculated according to the person‐years‐at‐risk method. Cox proportional hazards models were used to examine the association between risk factors and incident MCI. RESULTS: During an 8‐year follow‐up period, 26.4% (n=137) of the 519 study participants (population at risk) were identified as incident MCI cases (person‐years=1,791.1). The overall incidence rate of MCI was 76.5 (95% confidence interval=64.7–90.4) per 1,000 person‐years. Older age, subjective memory impairment, impairment in instrumental activities of daily living, and antecedent lower cognitive performance were found to be significantly associated with the development of future MCI. CONCLUSION: MCI is highly incident in the elderly population. For the purpose of early detection of dementia, subjective memory impairment should be taken seriously as a possible prestage of MCI.     

The Frequency of Chronic Rhinosinusitis/Nasal Polyp in COPD and Its Effect on the Severity of COPD

This study aimed to investigate the effect of chronic rhinosinusitis/nasal polyposis on the severity of COPD and to find out whether the ‘united airway disease’ hypothesis is valid for COPD. The study enrolled 90 patients diagnosed and staged according to criteria of an international guideline for diagnosis and management of COPD. The patients in stages I and II were classified as Group 1 and the patients in stages III and IV as Group 2. All the patients were questioned about the presence of major and minor criteria of sinusitis, underwent paranasal sinus computed tomography (PNS-CT) scans, and answered a questionnaire based on a quality of life test for sinusitis (SNOT-20). Sinusitis was present in 48 (53%) patients according to criteria of major and minor symptoms, and in 58 (64%) patients according to Lund-Mackay scoring system of PNS-CT. There was no significant difference in CT score between Group 1 and Group 2 (2.3 ± 0.5 vs. 2.1 ± 0.4, p > 0.05). However, the frequency of minor symptoms was greater in Group 2. SNOT-20 score was significantly higher in Group 2 than in Group 1 (28.7 ± 1.7 and 22.2 ± 1.9, respectively, p = 0.014). A significant correlation was determined between Lund-Mackay and SNOT-20 scores. The presence of CRS should be assessed in COPD patients, especially in those with severe disease. Further research is needed to disclose possible common immunopathological mechanisms in the pathogeneses of COPD and CRS.     

The influence of hospitalizations due to exacerbations or spontaneous pneumothoraxes on the quality of life,mental function and symptoms of depression and anxiety in patients with COPD or asthma

Background: Patients with bronchial asthma or chronic obstructive pulmonary disease (COPD) frequently have a low quality of life (QoL) in addition to depression symptoms. The aim of this study was to compare the QoL, depression symptoms, mental function and anxiety in patients with asthma or COPD exacerbations or spontaneous pneumothoraxes (SP) to patients with stable disease. Materials and methods: Patients with a confirmed diagnosis of severe (III degree) bronchial asthma or COPD were included in this study. Prospective observations of asthma or COPD exacerbations or SP were performed over a three-year period. QoL was assessed using St. George’s Respiratory Questionnaire (SGRQ). In addition, the AQ20 questionnaire (AQ20), the Hospital Anxiety and Depression Scale (HADS) and the Mini-Mental State Examination (MMSE) were administered. Results: A total of 233 patients (112 with asthma and 121 with COPD; mean age 57.9?±?11.9 years) were included in the study. Patients with COPD or asthma had a low QoL as estimated by the SGRQ (mean?±?SD: 27.5?±?12.9 and 25.1?±?10.2 for asthma and COPD, respectively). Asthma exacerbations, COPD exacerbations or SP requiring hospitalization were associated with lower SGRQ scores over the three-year observation period (41.5?±?11.7, 57.9?±?14.3 and 65.3?±?11.4, respectively). The mean MMSE score significantly decreased after an asthma exacerbation compared to the baseline (29.9?±?2.1 versus 27.2?±?3.1; p?p?p?Conclusion: Low QoL and mental impairment were observed in patients with asthma and COPD. In addition, the QoL significantly decreased following hospitalizations due to exacerbations or SP.