骨膜蛋白在老年慢性阻塞性肺疾病患者中的变化及与血嗜酸粒细胞和肺功能的相关性

目的观察血清骨膜蛋白在老年慢性阻塞性肺疾病(简称慢阻肺)患者中的变化及血清骨膜蛋白和血嗜酸粒细胞(EOS)、肺功能的相关性, 探讨血清骨膜蛋白能否成为观察慢阻肺患者病情变化的指标。方法病例对照研究, 纳入2018年12月至2021年5月老年慢阻肺住院患者128例为慢阻肺组, 健康体检者60例为对照组, 检测所有研究对象血清骨膜蛋白、血EOS、嗜酸粒细胞百分比(EOS%)和肺功能, 以及慢阻肺组治疗后血清骨膜蛋白, 比较慢阻肺组与对照组血清骨膜蛋白、血EOS、EOS%、肺功能第1秒用力呼气容积占预计值的百分比(FEV1%pred)的差异及慢阻肺组治疗前后骨膜蛋白的变化。将慢阻肺组患者进一步分为轻度组、中度组及重度组, 比较各组间指标的差异, 多元线性回归分析血清骨膜蛋白与血EOS、FEV1%pred的相关性, 二元Logistic回归分析血清骨膜蛋白与慢阻肺发生的相关性, 多元有序Logistic回归分析血清骨膜蛋白与慢阻肺严重程度的相关性。结果慢阻肺患者血清骨膜蛋白和血EOS、EOS%高于对照组, FEV1%pred低于对照组(均P<0.05), 慢阻肺组经治疗症状改善后血清骨膜...     

慢性阻塞性肺疾病患者抑郁情况及其影响因素研究

目的探讨慢性阻塞性肺疾病(COPD)患者抑郁情况及其影响因素。方法选取2013年3月—2016年1月在中国人民解放军第180医院呼吸内科住院部和门诊部就诊的COPD患者206例,通过电子病历系统记录其一般资料〔包括性别、年龄、吸烟史、受教育程度、体质指数(BMI)和COPD分级〕,采用肺功能仪检查患者肺功能〔包括第1秒用力呼气容积与用力肺活量比值(FEV1/FVC)和第1秒用力呼气容积占预计值百分比(FEV_1%pred)〕,采用医院焦虑抑郁量表(HAD)评估患者抑郁情况,采用多因素logistic回归分析筛选COPD患者抑郁的影响因素。结果本组患者抑郁发生率为41.3%(85/206)。抑郁患者和非抑郁患者FEV1/FVC比较,差异无统计学意义(P0.05);抑郁患者和非抑郁患者性别、年龄、有无吸烟史、受教育程度、BMI、COPD分级及FEV1%pred比较,差异均有统计学意义(P0.05)。多因素logistic回归分析结果显示,性别〔OR=0.457,95%CI(0.210,0.993)〕、年龄〔OR=0.617,95%CI(0.428,0.890)〕、受教育程度〔OR=1.455,95%CI(1.099,1.927)〕、BMI〔OR=0.492,95%CI(0.291,0.833)〕、COPD分级〔OR=1.946,95%CI(1.003,3.779)〕及FEV1%pred〔OR=2.337,95%CI(1.523,3.587)〕为COPD患者抑郁的影响因素(P0.05)。结论 COPD患者抑郁发生率较高,而性别、年龄、受教育程度、BMI、COPD分级及FEV1%pred为COPD患者抑郁的影响因素。     

男性慢性阻塞性肺疾病炎性因子肌肉抑制素与体重指数FEV_1占预计值百分比的关系

目的研究稳定期慢性阻塞性肺疾病(慢阻肺)患者血清中炎性因子、肌肉抑制素、第一秒用力呼气容积占预计值的百分比(FEV1%pred)、体重指数(BMI)情况及相关性。方法选择2010-2012年重庆市稳定期慢阻肺男性患者及年龄相仿的健康者,用酶联免疫吸附法测定血清肿瘤坏死因子(TNF)-α、白介素(IL)-6、肌肉抑制素;肺功能仪器检测每位受试者的FEV1%pred;测定身高及体重,计算BMI。慢阻肺患者分别根据FEV1%pred及BMI分组,比较慢阻肺患者与健康受试者相关指标,探讨血清炎症因子、FEV1%预计值与肌肉抑制素的相关性。结果根据FEV1%pred及BMI分组(F组/T组)的慢阻肺组患者血清中TNF-α、IL-6及肌肉抑制素水平较对照组均有升高,除F1组/T1组外,差异有统计学意义(P0.01),肺功能越差,BMI越低,TNF-α、IL-6及肌肉抑制素水平越高(P0.05)。TNF-α、IL-6与肌肉抑制素正相关(P0.05),FEV1%pred与肌肉抑制素负相关(P0.05)。结论慢阻肺患者肺功能越差,BMI越低者,炎性因子及肌肉抑制素水平越高;炎性因子水平越高者,肌肉抑制素水平越高;肌肉抑制素水平越高者,反应肌肉萎缩越严重,肺功能越差,病情越重。炎性因子及肌肉抑制素可能成为慢阻肺患者潜在治疗的靶点。     

不同吸烟状态对正常高值血压体检人群静息心率的影响

目的研究吸烟、被动吸烟及不吸烟对正常高值血压体检人群静息心率的影响。方法2018年1月至2018年12月间,从嘉兴市第一医院健康体检人群中筛选出符合正常高值血压诊断标准者210例,其中男140例,女70例,年龄45～75岁,平均(55.58±8.51)岁。按照其吸烟状态分为不吸烟、吸烟及被动吸烟三组,测定静息心率(resting heart rate,RHR),同时运用自动生化仪测量体检者的高密度脂蛋白(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白(low-density lipoprotein cholesterol,LDL-C)、血清甘油三脂(triglyceride,TG)、总胆固醇(total cholesterol,TC)、空腹血糖(fasting blood glucose,FBG),并测量身高、体重,计算体质量指数(body mase index,BMI)。结果共入组210例,正常高值血压人群吸烟率为32.38%;吸烟组、被动吸烟组及不吸烟组BMI差异无统计学意义(P> 0.05),吸烟组TG、TC、LDL-C、HDL-C、FBG、SBP、DBP、RHR均显著高于被动吸烟组及不吸烟组(F=22.428、36.714、11.892、18.250、44.117、7.978、11.434、4.732,P <0.05);被动吸烟组与不吸烟组比较显示血清TC、HDL-C、FBG水平差异无显著性,被动吸烟组RHR水平高于不吸烟组(t=3.891,P <0.05)。多元线性回归分析RHR的影响因素结果显示,吸烟[OR=5.128,95%CI(3.522～6.432)]、被动吸烟[OR=3.573,95%CI(1.911～4.721)]、HDL-C[OR=0.586,95%CI(2.110～10.740)]、SBP[OR=0.701,95%CI(0.234～2.492)]是RHR的影响因素(P <0.05)。结论被动吸烟和吸烟的正常高值血压人群心率更快。加强戒烟教育和建议,避免暴露于被动吸烟的环境,将有利于控制正常高值血压的进展。     

稳定期慢性阻塞性肺疾病气道炎症的研究

目的 研究稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)气道炎症和肺功能、下气道细菌定植(lower airway bacterial colonization,LABC)的关系.方法 随机入选45例稳定期COPD门诊患者和28名健康志愿者,行肺功能、血常规和胸片检查.采用痰诱导方法 留取深部合格痰液,COPD患者的痰液行细菌定量培养,两组研究对象的痰液均行细胞因子检测.结果 稳定期COPD组痰液中白介素8(IL-8)、肿瘤坏死因子α(TNF-α)、IL-10、IL-19明显高于对照组(P＜0.05).第1秒用力呼气容积占预计值百分比(FEV1%pred)＜50%组痰液中IL-8、TNF-α、IL-19明显高于FEV1%pred≥50%组(P＜0.05),而IL-10在两组间比较差异无统计学意义.在本实验中LABC量≥107CFU/ml者占总人数的33.33%,主要的下气道定植菌为卡他莫拉菌、副流感嗜血杆菌、肺炎链球菌、流感嗜血杆菌等.LABC量≥107 CFU/ml组痰液中IL-8、TNF-α、IL-19明显高于LABC＜107 CFU/ml组(P＜0.05),而IL-10在两组间比较差异无统计学意义.相关性分析显示,IL-19与IL-10呈负相关,相关系数r=-0.548(P＜0.05),IL-19与IL-8、TNF-α呈正相关,相关系数分别为r=0.702(P＜0.05)、r=0.708(P＜0.05).FEV1%pred＜50%组细菌定植量明显高于FEV1%pred≥50%组(P＜0.05).FEV1%pred＜50%预计值组的吸烟指数明显高于FEV1%pred≥50%组(P＜0.05).结论 稳定期COPD患者存在气道炎症,既与LABC有关,又与吸烟有关,这种与LABC和吸烟相关的气道炎症可能是导致COPD患者肺功能进行性下降的原因.     

吸烟对40岁以上人群的肺功能的影响

目的 观察吸烟对40岁以上人群的肺功能的影响.方法 本研究前瞻性调查了2 682例居民的吸烟状况、规律合并用药情况、性别、年龄、身高、体质量等资料,并进行了肺通气功能检测.结果 随访时间2年.2 290例(85.4%)得到了有效随访,其中1 197例(52.3%)从不吸烟,467例(20.4%)曾经吸烟,626例(27.3%)现吸烟.三组人群的年龄、性别、BMI、肺功能、COPD患者例数及合并用药差异均有统计学意义.随访结果显示,肺功能FEV1、FEV1%pred、FVC、FEV1/FVC均逐年下降.经调整上述差异性变量(年龄、性别、BMI、COPD患者例数、合并用药及基线肺功能),曾吸烟组肺功能FEV1(P=0.030)、FEV1%pred(P=0.011)和FEV1/FVC(P<0.001)较从不吸烟组显著下降.现吸烟组FEV1/FVC较从不吸烟组下降快.结论 从不吸烟居民肺功能下降最慢,提倡不吸烟或尽可能早期戒烟.     

青岛市城阳区老年慢性非传染性疾病的流行病学调查

目的了解青岛市城阳区老年常住居民常见慢性非传染性疾病患病流行情况及其影响因素,为老年慢性病的干预治疗提供理论依据。方法采用多阶段分层随机抽样方法对青岛市城阳区8个街道的9 198名≥65岁常住居民进行问卷调查。结果流行病学调查发现,65~69岁年龄组参与度最高,比例为42.81%。老年慢性病非传染性疾病患病率前4位的依次为高血压(HT)6 546人(71.16%)、超重/肥胖(OW/OB)6 312人(68.62%)、血脂异常(DLP)5 996人(65.18%)和高血糖(HG)5 856人(63.66%)。多因素Logistic回归分析结果表明,慢性非传染性疾病患病风险与年龄(OR=4.547,95%CI=3.162~7.834)、吸烟(OR=3.252,95%CI=2.125~4.608)、高脂肪和低植物(OR=3.870,95%CI=3.440~4.202)、心理状态(OR=2.426,95%CI=2.030~2.880)和丧偶(OR=1.148,95%CI=1.041~1.504)呈正相关;与文化程度大专及以上(OR=0.513,95%CI=0.419~0.780)、自我保健认知度(OR=0.452,95%CI=0.310~0.762)、家庭经济收入(OR=0.956,95%CI=0.936~0.989)、身体活动水平(OR=0.845,95%CI=0.796~0.995)呈负相关。结论HT、OW/OB、DLP及HG是青岛市城阳区老年常住居民常见的慢性病,慢性病患病的影响因素为年龄、吸烟情况、戒烟、高脂肪和低植物、心理状态和丧偶;文化程度大专及以上、自我保健认知度、家庭经济收入、身体活动水平是其保护因素。     

吸烟与肺气肿肺癌

众所周知 ,吸烟可引起包括癌症在内的多种疾病 ,尤其是呼吸系统疾病 ,如慢性支气管炎、肺气肿、肺癌等 ,本文谈谈它们之间的关系。一、烟雾中的有害成份　香烟在不完全燃烧过程中产生的烟雾中含有 12 0 0多种有毒物质 ,如尼古丁、苯并芘、一氧化碳、氨氰酸、氨等。吸烟时 ,呼吸系统是首当其冲的受害器官。同时尼古丁等有害物质也可通过肺进入体内血液中 ,循环到全身各脏器 ,引起多部位癌症及心血管疾病。吸烟者周围人群也会因被动吸烟而受害。二、吸烟与慢性支气管炎、肺气肿、肺心病慢性支气管炎是气管、支气管粘膜及其周围组织的慢性炎症 …     

6年间气道高反应性对重度吸烟者慢性阻塞性肺疾病发病的影响

目的探讨气道高反应性对重度吸烟者慢性阻塞性肺疾病（COPD）发病的影响。方法1996年，对456名慢性呼吸症状和重度心脑血管病的重度吸烟者（FVC≥15包／年）进行调查，询问吸烟史，测量气道反应性、第一秒用力呼气量（FEV1）、用力肺活量（FVC）。2002年对其中259人再次进行呼吸功能测量，以及COPD发病情况。结果调整年龄、性别、身高、吸烟包／年、吸烟种类（无过滤嘴、有过滤嘴、混吸）、戒烟和基线FEV1后，气道高反应性（AHR，PC20 FEV1〈8mg／ml）加快了FEV1（β=19．2ml／yr，P=0．003），FVC（β=20．6ml／yr，P=0．012）和FEV1／FVC（β=0．4％／yr，P=0．008）的1996-2002年间的下降速度。对基线无COPD者进行亚组分析发现，气道高反应性者6年后COPD发病危险显著增加，调整调整年龄、性别、身高、吸烟影年、吸烟种类（无过滤嘴、有过滤嘴、混吸）、戒烟和基线FEV1后，OR值为5．6（95％可信区间：1．1-28．2）。结论气道高反应性在吸烟引起的COPD发病过程中起着重要作用，气道反应性测定有助于吸烟易感者的早期发现。     

青年原发性高血压的危险因素研究

目的探究青年原发性高血压的危险因素。方法选取2010年3月—2015年6月在南京医科大学附属苏州医院门诊就诊及住院的青年原发性高血压病患者184例作为观察组,选取同期体检健康者200例作为对照组。收集两组受试者的临床资料,包括一般资料和实验室检查指标,并采用多因素logistic回归模型分析青年原发性高血压的危险因素。结果单因素分析结果显示,两组受试者年龄、空腹血糖、血清K+水平、血清Na+水平、血清Ca2+水平、血清丙氨酸氨基转移酶(ALT)水平、血清天冬氨酸氨基转移酶(AST)水平、血清胱抑素C(Cys-C)水平、文化程度、婚姻状况及是否有焦虑情绪比较,差异均无统计学意义(P0.05);两组受试者BMI、腰臀比、血清总胆固醇(TC)水平、血清三酰甘油(TG)水平、血清高密度脂蛋白胆固醇(HDL-C)水平、血清低密度脂蛋白胆固醇(LDL-C)水平、血尿酸(UA)水平、血肌酐(Cr)水平、性别、有无高血压家族史、是否吸烟、是否饮酒、睡眠情况、运动情况、有无高盐饮食及有无高脂饮食比较,差异有统计学意义(P0.05)。多因素logistic回归分析结果显示,BMI〔OR=20.66,95%CI(6.37,66.95)〕、TC〔OR=4.02,95%CI(2.40,6.74)〕、TG〔OR=7.83,95%CI(2.41,25.23)〕、HDL-C〔OR=3.92,95%CI(2.99,5.12)〕、LDL-C〔OR=5.36,95%CI(4.51,6.37)〕、高血压家族史〔OR=14.69,95%CI(3.88,55.59)〕、饮酒〔OR=5.96,95%CI(1.78,19.98)〕、高盐饮食〔OR=7.07,95%CI(2.13,23.43)〕是青年原发性高血压的独立危险因素(P0.05)。结论肥胖、血脂异常、遗传因素、不良生活习惯是青年原发性高血压的危险因素,应引起重视。     

Second-hand smoke exposure in Canada: Prevalence, risk factors, and association with respiratory and cardiovascular diseases

OBJECTIVES:

The aims of the present study were to estimate the prevalence of second-hand smoke exposure in Canada, to identify sociodemographic risk factors for second-hand smoke exposure, and to examine the relationship between second-hand smoke exposure and respiratory and cardiovascular diseases.

METHODS:

Data from the 2000/2001 Statistics Canada Canadian Community Health Survey (n=130,880, aged 12 years or older) were analyzed. Second-hand smoke exposure was based on self-report within the past month. The presence of chronic health conditions was also based on self-report. Because ex-smokers would be expected a priori to have poorer health than never-smokers, the analysis was stratified by previous smoking status.

RESULTS:

Approximately 25% of never-smokers and 30% of ex-smokers self-reported recent second-hand smoke exposure. The following factors were identified as risk factors for second-hand smoke exposure: men; residences in Quebec, Atlantic Canada and the Territories; younger ages; nonimmigrant status; low education and income levels; social assistance receipt; and households without children younger than 12 years of age. After controlling for potential confounders, both never- and ex-smokers exposed to second-hand smoke had significantly higher odds of self-reporting asthma (20% to 30%) and chronic bronchitis (50%) than those not exposed to secondhand smoke. Among ex-smokers, those exposed to second-hand smoke also had significantly higher odds of self-reporting hypertension (20%) than those not exposed to second-hand smoke. No associations were observed between second-hand smoke exposure and emphysema or heart disease.

CONCLUSIONS:

Self-reported recent second-hand smoke exposure in Canada in 2000/2001 was high, and was associated with asthma, chronic bronchitis and hypertension in never- and ex-smokers. Potential causal associations and public health implications warrant additional research.     

医联体共管COPD分级诊疗模式的效果分析

目的 探讨区域医疗联合体(简称医联体)共管COPD分级诊疗模式对COPD患者的影响.方法 以2015年1月1日至2015年12月31日在北京市东城区新中街辖区内收集的COPD患者34例为对照组;以2016年1月1日至2016年12月31日在该辖区收集的COPD患者53例为试验组,对试验组实行医联体共管分级诊疗.对比分析两组的(COPD assessment test,CAT)评分、FEV1%pred、年急性发作次数、年度医疗费用.结果 研究前2组患者CAT评分、FEV1%pred及气流受限程度分布差异均无统计学意义(P>0.05).随访1年后试验组CAT评分低于对照组(P<0.05);试验组FEV1%pred明显高于对照组(P<0.05).试验组年急性发作次数、年医疗费用均明显低于对照组(P<0.05).分层分析显示试验组门诊维持治疗费用低于对照组(P<0.05),住院治疗费用2组差异无统计学意义(P>0.05).年急性加重门诊、急诊就诊率2组差异无统计学意义(P>0.05).亚组分析显示两组住院患者血气分析PO2、PCO2及FEV1%pred比较差异无统计学意义(P>0.05).结论 医联体共管分级诊疗能明显提高COPD患者的生活质量,改善气流受限程度,减低疾病风险及医疗费用.     

Lung function measures and their relationship to respiratory symptoms in 7- and 8-year-old children

Abnormal pulmonary function in childhood is a well-known risk factor for lung function impairment in adult life. It is therefore of clinical interest to recognize lower pulmonary function in childhood. We investigated the association between asthma-like respiratory symptoms and the lung function parameters FVC, FEV1, and FEF(25-75) in a population-based sample of 402 schoolchildren, aged 7 and 8 years, using linear regression analyses. Without accounting for other respiratory symptoms, wheeze, exercise-induced wheeze, chronic cough, and history of wheezy bronchitis or lower respiratory infections in early childhood were significantly associated with reduced lung function. After stepwise elimination of symptoms from the regression models, only exercise-induced wheeze (FEV1, -15%pred, FEF(25-75), -21%pred) and a history of chronic cough (FEV1, -5%pred; FEF(25-75), -11%pred) remained significant predictors of decreased lung function. After adjustment for different variability, no significant differences were seen between the effects of symptoms on the flow measurements FEV1 and FEF(25-75). We conclude that children who report exercise-induced wheeze and/or chronic cough may have a considerable deficit in lung function at early school age.     

Imaging Features of Chronic Bronchitis with Preserved Ratio and Impaired Spirometry (PRISm)

Purpose

The purpose of the study was to investigate the quantitative chest tomographic features of chronic bronchitis with preserved ratio and impaired spirometry (PRISm), including airway wall area, emphysema index, and lung capacity.

Methods

An observational, cross-sectional study of 343 patients at the Ninth Hospital of Xi’an Affiliated Hospital of Xi’an Jiaotong University between October 2014 and September 2017. The patients were divided into three groups: 77 cases of chronic bronchitis with normal lung function (forced expiratory volume in one second/forced vital capacity) (FEV1/FVC?>?70%, FEV1%pred?>?80%), 80 cases of chronic bronchitis with PRISm (FEV1/FVC?>?70%, FEV1%pred?<?80%), and 186 cases of the early chronic obstructive pulmonary disease (COPD) (FEV1/FVC?<?70%, FEV1%pred?>?50%, that is, Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade 1?+?2). We compared and analyzed the differences in imaging between the chronic bronchitis with PRISm and the other two groups.

Results

Compared with the early COPD group, the PRISm group revealed significant differences in airway wall area, emphysema index, and lung capacity (P?<?0.05). Compared with the chronic bronchitis with normal lung function group, the PRISm group showed increased WA%_LUL5, decreased lung capacity, and higher mean lung density.

Conclusion

In terms of airway wall area and emphysema index, patients with chronic bronchitis with PRISm were essentially no different than those with chronic bronchitis without abnormal spirometry, whereas for symptoms, they are more like GOLD 1 and 2 patients. Our findings show that it is not yet clear whether it constitutes an intermediate stage of chronic bronchitis with normal lung function that progression to early COPD.

     

AECOPD患者呼出气冷凝液中分泌性白细胞蛋白酶抑制剂的检测及其临床意义

目的分析慢性阻塞性肺疾病急性加重期(AECOPD)患者治疗前后呼出气冷凝液(EBC)中分泌性白细胞蛋白酶抑制剂(SLPI)浓度的变化,及其与AECOPD各临床指标的相关性。方法随机选择AECOPD患者30例,正常健康者18例,采用ELISA方法检测AECOPD组治疗前后及健康对照组EBC中SLPI浓度,应用Pearson直线相关分析AECOPD组治疗前EBC中SLPI浓度与COPD临床特征、肺功能(PEF、FEV1%预计值)、血气分析、血WBC计数等指标的相关性。结果经抗感染、氧疗、解痉、激素等常规治疗7天后,AECOPD组EBC中SLPI浓度明显高于治疗前(P0.05);AECOPD组治疗前EBC中SLPI浓度与患者FEV1%预计值、痰量、呼吸困难症状密切相关(P0.05),与患者PEF、血白细胞(WBC)计数、动脉血pH值、PaO2/FiO2、PaCO2无相关性(P均0.05)。结论 AECOPD患者EBC中SLPI浓度可作为反映病情的严重程度和临床转归的指标。     

哮喘-慢性阻塞性肺疾病重叠综合征患者呼出气冷凝集液中TNF-α、IL-8、IL-10的检测水平及意义

目的检测哮喘-慢性阻塞性肺疾病重叠综合征(ACOS)患者呼出气冷凝集液(EBC)中肿瘤坏死因子α(TNF-α)、白细胞介素8(IL-8)、IL-10水平,并分析其与该疾病的关系.方法选取2016年2月至2019年3月成都市第三人民医院收治的ACOS患者105例,单纯哮喘患者109例(哮喘组),单纯COPD患者104例(COPD组),另选取同期体检的正常人100例(健康对照组).酶联免疫吸附法检测EBC中TNF-α、IL-8、IL-10水平,自动血液仪检测外周血嗜酸粒细胞比例,利用肺功能仪检测所有受试者第1秒用力呼气容积(FEV1)、用力肺活量(FVC).结果ACOS组、哮喘组、COPD组患者血清IgE水平、外周血嗜酸粒细胞显著高于健康对照组(t=13.594、23.188、3.595;20.886、26.966、20.036,P值均<0.05).ACOS组EBC中TNF-α、IL-8水平显著高于COPD组、哮喘组、健康对照组(t=11.999、13.157、26.807;6.961、7.741、32.496,P值均<0.05),IL-10水平、FEV1%pred显著低于哮喘组、COPD组、健康对照组(t=7.566、9.568、40.129;t=11.539、14.339、28.837,P值均<0.05),FEV1/FVC值显著低于健康对照组(t=16.756,P<0.05);COPD组、哮喘组EBC中TNF-α水平、IL-8水平显著高于健康对照组(t=14.892、14.057;25.544、25.146,P值均<0.05),IL-10水平、FEV1%pred、FEV1/FVC值显著低于健康对照组(t=32.562、31.045;t=17.372、14.939;13.752、16.341,P值均<0.05);哮喘组和COPD组TNF-α、IL-8、IL-10水平、FEV1%pred、FEV1/FVC值比较差异无统计学意义(t=1.015、0.697、1.909、2.658、2.457,P值均>0.05).Pearson检验结果显示,ACOS患者EBC中TNF-α、IL-8水平与FEV1%pred、FEV1/FVC呈负相关(r=-0.463、-0.504;-0.447、-0.476,P值均<0.05);IL-10水平与FEV1%pred、FEV1/FVC呈正相关(r=0.429、0.474,P值均<0.05);Logistic回归分析结果显示,血清IgE水平升高、EBC中TNF-α、IL-8水平升高是ACOS的危险因素(P<0.05),EBC中IL-10水平升高是ACOS的保护因素(P<0.05).结论EBC中TNF-α、IL-8、IL-10水平可能具有潜在的鉴别ACOS生物标志价值.     

The effect of biomass fuel exposure on the prevalence of asthma in adults in India – review of current evidence

Introduction: The combustion of biomass fuels is a major source of respiratory disease among individuals in the developing world. Over two million people world-wide rely on biomass fuels to supply their household energy needs with an estimated 1.6 million deaths annually being attributable to biomass smoke exposure. As a developing country, India relies heavily on the use of solid fuels as a source of energy. These materials supply 75% of the country’s domestic energy need and are attributed as the cause of over 600?000 deaths annually. Diseases such as chronic bronchitis and acute lower respiratory tract infections are strongly correlated to biomass smoke exposure. While not as strongly correlated, accumulating evidence suggests that asthma prevalence may be related to solid fuel smoke. Methods: This review examines the current literature linking biomass smoke exposure to the reporting of asthma symptoms. A PubMed search was performed using key terms biomass, asthma, India and respiratory disease. Preference was given to recent articles that surveyed the adult population within India. Results: The reviewed articles showed an increased odds ratio for reporting a diagnosis of asthma or symptoms consistent with asthma following biomass smoke exposure. While the literature supports a strong association between household air pollution and the development of chronic bronchitis and acute lower respiratory tract infections in India, this review establishes a more firm relationship between reported asthma symptoms and biomass smoke exposure. Conclusion: The exposure to biomass fuel smoke results in respiratory diseases in developing countries. Among these diseases, asthma appears to be a preventable pulmonary pathology that is associated with household air pollution. Measures to reduce exposure may decrease the burden of disease which could help advance social and economic progress in these nations. Further research and out-reach efforts are needed to reduce the total burden of lung diseases, including asthma, across the developing world. This reduction could save millions of dollars annually and lower morbidity and mortality in the affected populations.     

Bronchial reactivity to cigarette smoke; relation to lung function, respiratory symptoms, serum-immunoglobulin E and blood eosinophil and leukocyte counts

STUDY OBJECTIVES: The aim of the study was to investigate the relationship between the immediate bronchial response to inhaled cigarette smoke [cigarette smoke bronchial reactivity (CBR)] and lung function, respiratory symptoms and markers of allergy and inflammation. DESIGN, PARTICIPANTS AND MEASUREMENTS: This cross-sectional study included 98 smokers. Their lung function and reversibility to inhaled terbutaline was measured. Their clinical history was obtained, an allergological examination was done, and bronchial reactivity to methacholine and inhaled cigarette smoke was measured. Questionnaires about respiratory symptoms, smoking history and drug usage were completed and a blood sample was obtained. Participants were divided into three groups: with asthma, chronic bronchitis and persons without asthma or chronic bronchitis (the respiratory healthy). RESULTS: Forced expiratory volume in 1sec (FEV1) residuals were independently related to the % fall in FEV1 after 12 cigarette smoke inhalations (DFEV%) in all participants (P<001), in asthmatic smokers (P<0.01) and in smokers with chronic bronchitis (P<0.05). In smokers with asthma and chronic bronchitis FEV1 residuals explained 51% and 13% of the variation in DFEV%, respectively, but only 8% (P<0.05) and 1% (N.S.) of the variation in the methacholine bronchial reactivity. In the total population the presence of wheeze (P<0.01), attacks of breathlessness (P<0.05) and daily expectoration (P<0.001) were related to higher DFEV% readings. Serum immunonoglobulin (ES-IgE) was independently related to DFEV% in all participants (P<0.01), in smokers with chronic bronchitis (P<0.01) and in the respiratory healthy (0.05相似文献