老年COPD合并支气管扩张的危险因素分析

目的探讨老年慢性阻塞性肺疾病(COPD)合并支气管扩张的危险因素。 方法回顾性分析2015年6月至2018年6月我院收治的153例COPD患者病例资料。按照是否合并支气管扩张,将患者分为单纯COPD组(n＝96)和合并支气管扩张组(n＝57)。比较两组患者的一般资料、临床症状、血常规指标及红细胞沉降率(ESR)、血气分析检测指标,分析患者痰标本中细菌组成,合并支气管扩张的危险因素。 结果单纯COPD组与合并支气管扩张组患者性别、年龄、吸烟史、肺结核史及住院时间相比有明显差异(P<0.05);合并支气管扩张患者症状持续时间及伴脓痰症状人数明显高于单纯COPD组(P<0.05);单纯COPD组患者血清中血红蛋白(Hb)水平明显高于合并支气管扩张组患者,C反应蛋白(CRP)及ESR明显低于合并支气管扩张组患者(P<0.05);合并支气管扩张组患者二氧化碳分压(PaCO₂)水平明显高于单纯COPD组患者(P<0.05);合并支气管扩张组患者痰涂片铜绿假单胞菌感染例数明显高于单纯COPD组患者(P<0.05);COPD患者中,女性、有肺结核史、痰涂片有铜绿假单胞菌感染、伴脓痰症状、症状持续时间长及住院时间长是合并支气管扩张的危险因素(P<0.05)。 结论女性、住院时间长、肺结核史、痰涂片铜绿假单胞菌感染、伴脓痰症状、症状持续时间长及住院时间长的COPD患者更易患支气管扩张,是老年COPD患者合并支气管扩张的危险因素。     

老年慢性阻塞性肺疾病负面情绪与高分辨CT表型的相关性

慢性阻塞性肺疾病(COPD)患者肺实质遭到一定程度破坏,从细小支气管的破坏和扩张蔓延至整个肺部病变,本研究比较不同高分辨CT表型患者负情绪变化及生活能力. 1资料与方法 1.1 一般资料2010年3月至2012年3月我院住院治疗或门诊检查老年患者50例,均符合COPD诊断标准[1].年龄61～82[平均(78.5±9.6)]岁,病程3～21[平均(14.6±2.5)]年;患者及家属知情同意.根据HRCT表型分为A型18例(男10/女8),E型19例(男9/女10),M型13例(男4/女9),排除病理、病因特异性患者,合并其他原因肺病,包含肺结核、肺部恶性肿瘤、胸廓畸形、支气管扩张症、左心功能不全和严重心脑血管病疾病患者.     

支气管扩张症合并慢性肺源性心脏病临床特点分析

目的:分析支气管扩张症合并慢性肺源性心脏病患者的临床特点。方法:回顾首都医科大学附属北京安贞医院2013年1月至2014年12月,就诊住院的支气管扩张症急性加重患者125例,分为支气管扩张症不合并慢性肺源性心脏病组(n=62),支气管扩张症合并慢性肺源性心脏病组(n=63),比较两组患者在临床资料、超声心动图参数、急性加重期病原学、实验室检查及胸部高分辨CT等方面的差异。结果:两组患者在年龄、性别、BMI、糖尿病、结核病病史等方面,差异均无统计学意义(P0. 05)。与不合并慢性肺源性心脏病相比,支气管扩张症合并慢性肺源性心脏病患者的病程长,吸烟指数高,呼吸困难评分(mMRC)高(P0. 05),BNP水平、超声估测的肺动脉收缩压力较高(P0. 05),而超声心动图LVEF、血气分析氧分压低于不合并慢性肺源性心脏病组。急性加重病原学方面,两组差异无统计学意义(P0. 05),但病毒感染在两组急性加重病原学中均占有重要比重(10%)。两组患者胸部CT表现差异无统计学意义(P0. 05)。结论:支气管扩张症合并慢性肺源性心脏病患者较不合并患者的病程长,临床指标偏重,需要临床医生早期预警及筛查。     

老年COPD患者合并支气管扩张的临床特征及危险因素

目的探讨老年慢性阻塞性肺疾病(COPD)患者合并支气管扩张的临床特征及危险因素。方法回顾性分析310例老年COPD患者资料。根据胸部高分辨CT是否合并支气管扩张,分为COPD组(194例)、COPD合并支扩组(116例)。搜集病例资料,采用单因素、多因素Logistic回归模型分析COPD合并支气管扩张的危险因素。结果单因素结果显示,与COPD组相比,COPD合并支扩组气流受限严重、痰细菌分离率高、炎症反应重、体重指数(BMI)低、既往肺结核发生率及1年内曾有急性加重发生率高,差异均有统计学意义(P0.05;P0.001)。多因素Logistic回归显示,BMI18.5 kg/m~2(OR=3.569,95%CI:1.842～6.915,P0.001)、中重度气流受限(中度:OR=3.045,95%CI:1.235～7.511,P=0.016;重度:OR=3.988,95%CI:1.577～10.084,P=0.003)是COPD合并支气管扩张的危险因素。与柱状、囊柱状相比,囊状支气管扩张铜绿假单胞菌分离率高、气流受限严重,差异均有统计学意义(均P0.05)。结论 BMI18.5 kg/m~2和中重度气流受限是老年COPD患者合并支气管扩张的高危因素。     

支气管扩张症合并慢性阻塞性肺疾病急性加重患者住院死亡的相关因素

目的 回顾性分析支气管扩张症合并慢性阻塞性肺疾病急性加重(AECOPD)患者住院死亡的相关因素.方法 选取航天中心医院呼吸科2015年1月至2020年6月收治的111例支气管扩张症合并AECOPD住院患者为研究对象.根据不同预后结果将患者分为存活组与死亡组,收集2组患者的一般资料、临床表现、肺功能、实验室检查及住院时间...     

慢性阻塞性肺疾病合并支气管扩张的临床特点分析

目的探讨慢性阻塞性肺疾病(COPD)合并支气管扩张的临床特点。方法收集2012年1月至2013年12月来我院就诊的COPD和支气管扩张患者,选择同时行胸部多层螺旋CT、痰培养及肺功能检查的212例患者作为研究对象,采用回顾性方法分析其中52例被诊断为COPD合并支气管扩张患者的一般临床资料、临床特点及肺功能特点。结果在本组入选的所有COPD和支气管扩张患者中,COPD合并支气管扩张的患者占24.5%(52/212),多见于60岁以上的老年人,秋冬季节好发。既往多有肺结核、百日咳等呼吸道感染疾病及吸烟史,临床上以咳嗽、咳中等量黄脓痰为主要表现,约三分之一以上的患者伴有咯血,肺功能以中重度阻塞性通气功能障碍为主,多伴有呼吸衰竭。结论 COPD和支气管扩张在临床表现上容易混淆,根据既往病史、家族史、肺功能检查可进一步区分。早期、足量、足疗程的使用敏感抗生素,不仅能使临床症状得到迅速缓解,同时也能避免耐药菌株的产生及下呼吸道细菌的定植,延缓肺功能的下降。     

支气管扩张病因相关疾病的研究进展

支气管扩张症是各种原因引起的支气管树的病理性、永久性扩张,导致反复发生化脓性感染的气道慢性炎症.非囊性支气管扩张病因包括特发性、感染后、慢性阻塞性肺疾病( COPD)、过敏性支气管肺曲霉病( ABPA)、免疫缺陷、炎症肠病、类风湿关节炎、胃食管反流等,研究表示明确病因有可能导致13％的患者接受特殊护理[1].目前国内外...     

慢性阻塞性肺疾病合并支气管扩张危险因素分析

目的探讨慢性阻塞性肺疾病(COPD)合并支气管扩张患者的临床特点及危险因素。方法收集河南省人民医院呼吸内科2016年1月至2018年5月住院诊断为中度以上COPD患者173例,其中69例患者行胸部高分辨率CT(HRCT)检查诊断合并支气管扩张,作为病例组;另104例患者行HRCT检查未合并支气管扩张(对照组)。整理两组患者首诊时病例资料,如性别、年龄、吸烟史、吸烟年限、慢阻肺评估测试问卷(CAT)评分、GOLD分级、慢性呼吸道症状(咳嗽、咳痰、呼吸困难)出现时间、既往肺结核史、既往糖尿病史、血糖、血红蛋白(Hb)、总蛋白(TP)、痰培养细菌学结果等。分析慢性阻塞性肺疾病合并支气管扩张患者的临床特点,评估易合并支气管扩张的相关因素。结果慢性阻塞性肺疾病合并支气管扩张占39.9%,大多为男性(P=0.017),有吸烟史(P=0.037),吸烟年限更长(P=0.035),CAT评分更高(P=0.002),GOLD分级更重(P=0.031),慢性呼吸道症状时间更长(P=0.001),既往有结核病史(P=0.044),既往有糖尿病史(P=0.003),血糖更高(P=0.003);多因素logistic回归分析显示与COPD合并支气管扩张的危险因素有男性(OR 2.427,95%CI 1.126~5.231,P=0.024)、CAT分(OR 1.476,95%CI 1.031~2.113,P=0.034)、慢性呼吸道症状时间(OR 3.502,95%CI 1.619~7.575,P=0.001)、既往糖尿病史(OR 4.182,95%CI 1.407~12.427,P=0.010)。结论慢性阻塞性肺疾病患者为男性、CAT评分越高、慢性呼吸道症状时间持续越长、既往有结核病史和糖尿病史时易合并支气管扩张,应得到重视,尽早明确诊断给予治疗。     

铜绿假单胞菌致下呼吸道感染的药敏分析

目的探讨下呼吸道铜绿假单胞菌（PA）感染的药敏情况，供临床用药参考。方法对82例3次痰培养为PA的慢性阻塞性肺疾病（COPD）、支气管扩张症及呼吸机相关性肺炎（VAP）患者进行药敏分析。结果VAP耐药率最高，COPD、支气管扩张症相似；敏感性较高的药物依次为头孢哌酮-舒巴坦、哌拉西林-他唑巴坦、阿米卡星、美洛培南及亚胺培南。结论下呼吸道感染PA耐药率高，且VAP高于COPD及支气管扩张症。     

老年慢性阻塞性肺疾病骨质代谢临床分析

慢性阻塞性肺疾病 (COPD)患者骨质代谢异常 ,导致骨质疏松 ,其病因多种 ,国内外已有报道。为进一步探讨其发病情况和发病机制 ,并为临床提供治疗依据 ,我们对 97例COPD患者进行了骨质代谢指标及骨密度测定。1　对象和方法1 1　 对象　COPD急性发作期住院患者 97例 ,均符合中华医学会呼吸学会 1997年制定的“慢性阻塞性肺疾病的诊治规范”中的诊断标准。病程 5～ 40年 ,男 67例 ,女 3 0例 ,平均年龄60 .5 2± 12 .99岁。 97例中慢性支气管炎 89例 ,支气管哮喘 6例 ,支气管扩张症 2例 ,其中合并肺心病 3 6例 ,均排除其他疾病对骨质代谢的…     

An Epidemiological Overview of Chronic Obstructive Pulmonary Disease: What Can Real-Life Data Tell Us about Disease Management?

ABSTRACT

Chronic obstructive pulmonary disease (COPD) is a common condition, associated with increasing age and smoking exposure. COPD is a leading cause of morbidity, mortality and health care expenditure worldwide; yet, only 10–15% of all cases are identified medically. Alpha-1-antitrypsin deficiency (AATD) is responsible for about 1% of COPD cases but is also largely under-recognised, leading to diagnostic delay and missed treatment opportunities in patients who remain undetected. New evidence has recently highlighted the extent of overlap between COPD and bronchiectasis and the implications of comorbidity on clinical course and mortality. COPD with comorbid bronchiectasis deserves to be given research priority. This article overviews the epidemiology of COPD and examines the implications of overlap between COPD and AATD and between COPD and bronchiectasis.     

Structural and functional co-conspirators in chronic obstructive pulmonary disease exacerbations

Chronic obstructive pulmonary disease (COPD) exacerbations have a major impact on patients with COPD, yet they are complex events that are associated with a number of triggers and affected by the underlying disease process. A number of conditions can mimic the symptoms of an exacerbation and require evaluation. Airway and systemic inflammatory changes at exacerbation are modulated by infective factors (viruses and bacteria) and lead to the pathophysiologic effects seen at exacerbations with increase in airflow obstruction. Although bacteria or viruses can be isolated at exacerbation, often these organisms act in combination and lead to greater inflammatory changes and more severe exacerbation. Underlying structural changes such as radiologic changes of bronchiectasis that can be found in COPD can also modulate exacerbation severity and contribute to morbidity associated with exacerbations.     

Peptic Ulceration in Patients with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is frequently accompanied by peptic ulceration. Recent studies strongly suggest that the major cause is hypersecretion of gastric juice induced by hypoxemia or hypercapnia. To determine the incidence of peptic ulcers in COPD, we surveyed 267 patients with COPD seen at our hospital as inpatients or outpatients between 1984 and 1988. There were 90 patients with pulmonary emphysema, 93 with chronic bronchitis, and 84 with bronchiectasis. The prevalence of gastric ulcer in the patients with COPD was 23 out of the 267 patients (8.6%) surveyed. These included 13 patients with pulmonary emphysema, 6 with chronic bronchitis, and 4 with bronchiectasis. One-half of the patients with pulmonary emphysema had hypoxemia and hypercapnia: These observations suggest it is necessary to improve the abnormal blood gas concentration in patients with COPD in order to promote the healing of the peptic ulcer.     

Effects of pulmonary rehabilitation in bronchiectasis: A retrospective study

There is limited information about the benefits of pulmonary rehabilitation (PR) in patients with bronchiectasis. This study aimed to evaluate the effects of an out-patient PR program in patients with a primary diagnosis of bronchiectasis and to compare them with a matched COPD group who completed the same PR program. A retrospective review was conducted of patients with bronchiectasis or COPD who completed 6 to 8 weeks of PR at two tertiary institutions. The outcome measures were the 6-minute walk distance (6MWD) and Chronic Respiratory Disease Questionnaire (CRQ). Ninety-five patients with bronchiectasis completed the PR (48 male; FEV(1) 63 [24] % predicted; age 67 [10] years). Significant improvements in 6MWD (mean change 53.4 m, 95% CI 45.0 to 61.7) and CRQ total score (mean change 14.0 units, 95% CI 11.3 to 16.7) were observed immediately following PR. In patients with complete follow-up (n = 37), these improvements remained significantly higher than baseline at 12 months (20.5 m, 95% CI 1.4 to 39.5 for 6MWD; 12.1 points, 95% CI 5.7 to 18.4 for CRQ total score). The time trend and changes in the 6MWD and CRQ scores were not significantly different between the bronchiectasis and the COPD groups (all p > 0.05). This study supports the inclusion of patients with bronchiectasis in existing PR programs. Further prospective RCTs are warranted to substantiate these findings.     

Does coexistence with bronchiectasis influence intensive care unit outcome in patients with chronic obstructive pulmonary disease?

BACKGROUND: Bronchiectasis is associated with chronic obstructive pulmonary disease (COPD) in 30% to 50% of patients. This study evaluated whether association with bronchiectasis has any influence on morbidity and mortality in patients with COPD during their intensive care unit (ICU) stay. METHODS: The study was conducted at a respiratory ICU of a university hospital, and 93 mechanically ventilated patients with COPD were studied. Twenty-nine (31%) of 93 patients with COPD also had bronchiectasis. Patients with bronchiectasis had more frequent hospitalizations, more severe airflow limitation, and higher pulmonary artery pressure than patients without bronchiectasis. Duration of ICU (27+/-32 days [median: 14]; 16+/-16 days [median: 9]; P=.01) and hospital stays (44+/-44 days [median: 24.5]; 28+/-26 days (median: 20); P=.046) in patients with bronchiectasis were significantly longer than in patients without bronchiectasis, respectively. Bronchiectasis was an independent predictor for ICU stay longer than 10 days (odds ratio: 5, 95% confidence interval: 1.02-21, P=.043). The development rate of ventilator-associated pneumonia, especially with Pseudomonas aeruginosa, was significantly higher in patients with bronchiectasis (P=.034). Despite these prolonged durations, bronchiectasis did not increase mortality in this study population (P=.865). RESULTS: These results suggest that the coexistence of bronchiectasis in patients with COPD may increase the duration of ICU stay and hospitalization but does not influence the mortality.     

Role of macrolide therapy in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability worldwide. The Global Burden of Disease study has concluded that COPD will become the third leading cause of death worldwide by 2020, and will increase its ranking of disability-adjusted life years lost from 12th to 5th. Acute exacerbations of COPD (AECOPD) are associated with impaired quality of life and pulmonary function. More frequent or severe AECOPDs have been associated with especially markedly impaired quality of life and a greater longitudinal loss of pulmonary function. COPD and AECOPDs are characterized by an augmented inflammatory response. Macrolide antibiotics are macrocyclical lactones that provide adequate coverage for the most frequently identified pathogens in AECOPD and have been generally included in published guidelines for AECOPD management. In addition, they exert broad-ranging, immunomodulatory effects both in vitro and in vivo, as well as diverse actions that suppress microbial virulence factors. Macrolide antibiotics have been used to successfully treat a number of chronic, inflammatory lung disorders including diffuse panbronchiolitis, asthma, noncystic fibrosis associated bronchiectasis, and cystic fibrosis. Data in COPD patients have been limited and contradictory but the majority hint to a potential clinical and biological effect. Additional, prospective, controlled data are required to define any potential treatment effect, the nature of this effect, and the role of bronchiectasis, baseline colonization, and other cormorbidities.     

Management of COPD in Asia: A position statement of the Asian Pacific Society of Respirology

Chronic obstructive pulmonary disease (COPD) is a major disease in Asia. However, how to manage specifically Asian COPD patients has not been proposed. Awareness of COPD is very low and underdiagnosis/undertreatment is common in Asian countries. Low utilization of pulmonary function test and inhalers is also a problem. Moreover, high smoking prevalence and air pollution are barriers to managing Asian patients with COPD. The relatively low body mass index of Asian patients with COPD can increase their risk for experiencing adverse effects from COPD drugs. Physicians should consider the unique features of Asian populations with COPD such as the high prevalence rates of bronchiectasis and tuberculosis‐destroyed lungs, biomass smoke exposure and parasitic infection.     

慢性阻塞性肺疾病表型与急性加重相关性的研究进展

COPD是一种异质性明显的疾病.目前COPD大体分为8个表型:临床表型、生理表型、影像学表型、COPD频发急性加重表型、全身炎症表型、合并症表型、多维指数测评表型和ACOS表型.COPD急性加重(AECOPD)是影响疾病发病率、病死率、生活质量、医疗费用的最主要因素.本文就COPD各种表型与AECOPD之间相关性的研究进展进行总结.     

Bronchiectasis, exacerbation indices, and inflammation in chronic obstructive pulmonary disease

Relationships between high-resolution computed tomography (HRCT) findings in chronic obstructive pulmonary disease (COPD) and bacterial colonization, airway inflammation, or exacerbation indices are unknown. Fifty-four patients with COPD (mean [SD]: age, 69 [7] years; FEV(1), 0.96 [0.33] L; FEV(1) [percent predicted], 38.1 [13.9]%; FEV(1)/forced vital capacity [percent predicted], 40.9 [11.8]%; arterial partial pressure of oxygen, 8.77 [1.11] kPa; history of smoking, 50.5 [33.5] smoking pack-years) underwent HRCT scans of the chest to quantify the presence and extent of bronchiectasis or emphysema. Exacerbation indices were determined from diary cards over 2 years. Quantitative sputum bacteriology and cytokine measurements were performed. Twenty-seven of 54 patients (50%) had bronchiectasis on HRCT, most frequently in the lower lobes (18 of 54, 33.3%). Patients with bronchiectasis had higher levels of airway inflammatory cytokines (p = 0.001). Lower lobe bronchiectasis was associated with lower airway bacterial colonization (p = 0.004), higher sputum interleukin-8 levels (p = 0.001), and longer symptom recovery time at exacerbation (p = 0.001). No relationship was seen between exacerbation frequency and HRCT changes. Evidence of moderate lower lobe bronchiectasis on HRCT is common in COPD and is associated with more severe COPD exacerbations, lower airway bacterial colonization, and increased sputum inflammatory markers.