慢性阻塞性肺疾病与肺动脉高压的研究进展

<正>慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是呼吸系统常见病,患病率居高不下,是致贫致残的重要疾病,是全球第4大死亡原因,至2020年COPD将升至全球死亡原因的第3位,成为世界疾病经济负担的第5位~([1-2])。由于COPD是一种以持续气流受限为特征的肺部疾病,随着疾病的进展,慢性炎症导致肺实质破坏和肺血管的异常而形成肺动脉高压。     

慢性阻塞性肺疾病及肺动脉高压患者的能量代谢评定

慢性阻塞性肺疾病及肺动脉高压患者的能量代谢评定马国强冀虎岗杜钧刘正大李继平张汉丰将慢性阻塞性肺疾病（ＣＯＰＤ）及并肺动脉高压（ＰＡＨ）患者基础能量消耗实际测值（ＡＢＥＥ）与Ｈａｒｒｉｓ－Ｂｅｎｅｄｉｃｔ公式预计值（ＰＢＥＥ）对照，探讨在该病时基础能量...     

慢性阻塞性肺疾病相关性肺动脉高压研究进展

肺动脉高压是慢性阻塞性肺疾病的一个重要合并症.慢性阻塞性肺疾病相关的肺动脉高压多为轻到中度且进展缓慢,香烟烟雾、炎症产物引起内皮损害,造成内皮功能失调;慢性低氧引起肺血管收缩;肺血管重塑导致管腔变小;血管膨胀性降低,阻力增加;重度肺气肿时肺-毛细血管的丧失等均与慢性阻塞性肺疾病时的肺动脉高压相关.     

辛伐他汀对慢性阻塞性肺疾病合并肺动脉高压患者的影响

目的研究辛伐他汀对慢性阻塞性肺疾病合并肺动脉高压患者疗效的影响,探讨对其肺功能以及对血浆内皮素-1、一氧化氮水平的变化。方法将50例慢性阻塞性肺疾病合并肺动脉高压门诊及住院的患者随机分为治疗组和对照组,治疗组在常规治疗的基础上使用辛伐他汀20mg,每晚一次,对照组只给予常规治疗,疗程均为6个月。治疗前后检测两组患者的肺功能,血清中内皮素-1、一氧化氮的水平。结果治疗组的总有效率为80．0％,高于对照组的52．0％,差异有统计学意义（x2=4．3672,P〈0．05）;治疗组肺功能改善较对照组更明显,血清中内皮素-1、一氧化氮的水平明显降低,与治疗前及对照组比较差异有统计学意义（t=3．2353,7．8333,5．5783,7．0613,3．1224,3．0283,2．0441,2．0281,P〈0．05）。结论辛伐他汀治疗慢性阻塞性肺疾病合并肺动脉高压患者效果可靠,能够降低一氧化氮的水平,改善肺功能及提高疗效,值得临床推广应用。     

虎杖口服液对慢性阻塞性肺疾病伴肺动脉高压患者的影响

目的 观察虎杖口服液对慢性阻塞性肺疾病伴肺动脉高压患者血流动力学、血液流变学及血气分析的影响.方法 将60例慢性阻塞性肺疾病伴肺动脉高压患者随机分为对照组(32例)和实验组(28例),对照组给予常规吸氧,抗感染、化痰、平喘等治疗,实验组在常规治疗的基础上加用虎杖口服液10 ml,2次/d,21 d为一疗程,使用一个疗程...     

扎鲁司特对慢性阻塞性肺疾病合并肺动脉高压的临床治疗研究

扎鲁司特是近年来用于治疗哮喘的一种白三烯受体拮抗剂。研究表明,白三烯受体不仅存在于气道,也存在于肺血管。庞宝森等发现,缺氧性大鼠应用扎鲁司特后肺动脉压明显下降。本研究通过观察口服扎鲁司特对慢性阻塞性肺疾病(COPD)所致肺心病的急性血流动力学、氧动力学的变化,探讨其可能的作用机制及临床应用前景。     

慢性阻塞性肺疾病患者营养状态对运动心肺功能的影响

目的：探讨营养状态对慢性阻塞性肺疾病（COPD）患运动心肺功能的影响。方法：43例COPD患分为营养不良组（15例），营养正常组（28例）和健康志愿（20名）进行负荷连续递增的运动心肺功能试验。运动行营养评价和常规肺功能检查，结果：（1）COPD营养不良组最大氧耗量（VO2max）、最大运动负荷（Wmax）、最大氧脉搏（O2pulsemax)和无氧阈（AT）低于营养正常组，两组比较差异有显性（P＜0．05）。通气氧耗（VO2／W／VE)和最大运动时的气急指数（DImax)与营养正常组比较，差异有显性（P＜0．05）。（2）COPD患理想体重百分比（IBW％）与VO2max占预计值百分比、Wmax占预计值百分比、O2pulsemax占预计值百分比，AT呈正相关（r=0.696,0.432,0.717,0.822,P均＜0．01）、与DImax,VO2/W/VE呈负相关（r=-0.450,-0.640,P均＜0．01）。结论：营养不良可以导致COPD患肌肉有氧代谢能力和运动耐力降低。     

慢性阻塞性肺疾病合并肺动脉高压的发病机制研究进展

肺动脉高压(pulmonary hypertension,PH)是慢性阻塞性肺疾病(chronic obstructivepulmonary disease,COPD)的一个重要合并症.COPD合并PH是逐渐发生和进展的,最初于运动或睡眠时出现,逐渐发展为休息时即存在PH,运动、睡眠或病情恶化时进一步升高.COPD相关的PH多为轻到中度,但某些COPD患者可表现为"不成比例"的PH.香烟烟雾、炎症产物引起内皮损害,造成内皮功能失调;慢性低氧引起肺血管收缩;肺血管重构导致管腔变小,血管膨胀性降低,阻力增加;重度肺气肿时肺毛细血管的丧失等均与COPD时的PH相关.     

慢性阻塞性肺疾病并肺动脉高压的实验动物模型研究现状

借助实验动物模型研究慢性阻塞性肺疾病(COPD)并肺动脉高压形成的机制,一直是COPD研究工作中的一大热点。用于反映COPD并肺动脉高压形成的动物模型有多种,其中低氧性肺动脉高压动物模型最为常用。导致COPD并肺动脉高压形成的因素很多,在疾病发展的过程中各种细胞生长因子、炎症因子和炎症细胞同时存在,相互影响。低氧、炎症因素和基因多态性均被纳入不同模型中进行研究。用单一因素诱发的肺动脉高压模型很难复制出人类COPD并肺动脉高压的病理、生理改变。     

慢性阻塞性肺疾病和低氧性肺动脉高压诊治进展

按照最新的分类诊断标准,临床上将肺动脉高压(PH)分为5类,其中肺部疾病和(或)低氧所致的肺动脉高压属于肺动脉高压的第3类[1],相关的疾病包括慢性阻塞性肺疾病(COPD)、间质性肺疾病、其他伴有限制性和阻塞性混合型通气障碍的肺部疾病、睡眠呼吸暂停、肺泡低通气、慢性高原缺氧和肺发育异常等.我们在此探讨COPD合并肺动脉高压的临床特征及治疗进展.     

Noninvasive ventilation during exercise training improves exercise tolerance in patients with chronic obstructive pulmonary disease

PURPOSE: In patients with chronic obstructive pulmonary disease, pulmonary rehabilitation has been demonstrated to increase exercise capacity and reduce dyspnea. In the most disabled patients, the intensity of exercise during the training sessions is limited by ventilatory pump capacity. This study therefore evaluated the beneficial effect of noninvasive ventilation (NIV) support during the rehabilitation sessions on exercise tolerance. METHODS: This study included 14 patients with stabilized chronic obstructive pulmonary disease, ages 63 +/- 7 years, with a forced expiratory volume in 1 second (FEV(1)) 31.5% +/- 9.2% of predicted value. All 14 patients participated in an outpatient pulmonary rehabilitation program. Seven of the patients trained with NIV during the exercise sessions (NIV group), whereas the remaining seven patients breathed spontaneously (control group). Exercise tolerance was evaluated during an incremental exercise test and during constant work rate exercise at 75% of peak oxygen consumption (VO(2)) before and after the training program. RESULTS: The application of noninvasive ventilation increased exercise tolerance, reduced dyspnea, and prevented exercise-induced oxygen desaturation both before and after training. The pressure support was well tolerated by all the patients during the course of the training program. In the NIV group, training induced a greater improvement in peak VO(2) (18% vs 2%; P <.05) and a reduced ventilatory requirement for maximal exercise, as compared with the control group. The constant work rate exercise duration increased similarly in both groups (116% vs 81%, nonsignificant difference), and posttraining blood lactate was decreased at isotime (P <.05 in both groups), but not at the end of the exercise. CONCLUSION: In this pilot study, exercise training with noninvasive ventilation support was well tolerated and yielded further improvement in the increased exercise tolerance brought about by pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. This improved exercise tolerance is partly explained by a better ventilatory adaptation during exercise.     

Accuracy of pulmonary function tests in predicting exercise tolerance in chronic obstructive pulmonary disease

The ability of pulmonary function tests (PFTs) to predict exercise capacity was investigated by using linear regression analysis to quantify the relationships between: (1) maximum oxygen consumption during treadmill exercise and PFT parameters; and (2) total external work performed during treadmill exercise and PFT parameters. In a group containing 11 healthy subjects, nine with mild/moderate chronic obstructive pulmonary disease (COPD) and ten with severe COPD, both maximum oxygen consumption (measured directly) and total external work (calculated indirectly from the sum of its horizontal and vertical components) correlated most strongly with indices of expiratory airflow (FEV1, FEF25-75%), less strongly with indices of ventilatory output (MVV) and resting levels of oxygen (PO2, SaO2), and weakly with indices of hyperinflation (FRC) and carbon dioxide retention (PCO2). Thus, FEV1, accounting for 56 percent and 60 percent of the observed variation in oxygen consumption and external work, respectively, can predict exercise tolerance from PFT measurements with some accuracy. If a more accurate evaluation is required, exercise testing should be prescribed.     

Predicting maximal exercise ventilation in patients with chronic obstructive pulmonary disease

Shortness of breath is a chief complaint of many individuals with cardiopulmonary diseases. Exercise testing is often used to help differentiate cardiac from pulmonary involvement. In assessing pulmonary dysfunction during exercise it is essential to know the point at which ventilatory limitation will occur. Numerous authors have presented regression equations based on the FEV1 for predicting either MVV or VEmax. Resting pulmonary function studies were obtained from 53 patients with COPD. Symptom-limited maximal exercise testing was completed on a cycle ergometer using increments of 10 watts/min. Each regression equation for predicting MVV or VEmax was then applied to the data set. Results showed that the FEV1 correlated with the measured VEmax (r = .81) as did PEF (r = .81), MVV (r = .78), IC (r = .78), DCO (r = .68), VA (r = .67), VE (r = .65) and FVC (r = .64). Single post-bronchodilator FEV1 measurements ranged from 0.56 to 1.64 L (mean 1.0 L) while VEmax ranged from 16 to 78 L/min (mean 37.69 L/min). The equation VEmax = 37.5 X FEV1 was the most robust equation found in the literature for predicting VEmax in this sample. This equation was not statistically different from the line of identity when predicted VEmax was plotted against the measured VEmax. The intercept was 0.91 with a slope of 0.98. In addition, this equation had a smaller mean square error in predicting VEmax than those of the other equations investigated.     

慢性阻塞性肺疾病运动耐力下降的机制及治疗进展

慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者的运动耐力下降与气流受限、呼吸肌疲劳、呼吸驱动调节异常、营养不良等因素有关,改善COPD患者的运动耐力,对提高患者的生活质量有重要意义。     

Relation between pulmonary ventilation parameters,exercise tolerance and quality of life in patients with chronic obstructive lung disease

Patients with chronic obstructive pulmonary disease (COPD) do usually have decreased tolerance of exercise capacity and impaired quality of life. Several studies have shown that exercise capacity is related relatively weakly to lung functions in this group of patients. The aim of the present study was to find parameter which could better reflect or predict maximal exercise capacity. 19 patients with the diagnosis COPD with mean value of forced expiratory volume in one second (FEV1) 46% predicted (range 21-79%) entering pulmonary rehabilitation program were included into the study. Enrolled patients were chosen to cover the whole range of airway obstruction severity. Post-bronchodilator static and dynamic ventilation parameters were used for evaluation and calculation. Quality of live was measured using St. George's respiratory questionnaire (SGRQ), evaluating symptoms, activity and impact of the disease with range from 0 (the best level) to 100 (the worst level). Values of FEV1 (p < 0.001) and ratio of FEV1 to vital capacity (FEV1/VC, p < 0.001) were significantly positively correlated with 6 minute walking distance (6MWD). FEV1/VC were closely related to 6MWD then FEV1. The degree of hyperinflation expressed by residual volume (RV, p < 0.005) and by ratio of residual volume to total lung capacity (RV/TLC, p < 0.001) significantly negatively correlated with 6MWD. Maximal occlusion mouth pressures (PImax, p < 0.05) were positively related to 6MWD. Total score of SGRQ correlated significantly to maximal exercise capacity. Pulmonary function tests and respiratory muscle function have important impact on exercise tolerance in patients with COPD. Tolerance of exercise capacity is significantly reflected by total score of quality of life in this group of patients.     

A comparative study of patients with chronic obstructive pulmonary disease with and without obstructive sleep apnea syndrome

We aimed to study whether the presence of obstructive sleep apnea syndrome (OSAS) in patients with chronic obstructive pulmonary disease (COPD) led to differences in clinical picture, gas exchange during awake and sleep states and mechanical ventilation, in comparison with patients with COPD alone. We enrolled 48 COPD patients. In 26 (54.1%), OSAS was ruled out (non-OSAS COPD group) by polysomnography, and in 22 (45.8%) associated OSAS was diagnosed (OSAS COPD group). Patients in the OSAS COPD group experienced greater daytime sleepiness and less dyspnea. Body mass index was not significantly difference. The OSAS COPD group had significantly lower daytime PaO2 (66.4 +/- 10.4 mmHg in the OSAS COPD group and 75.5 +/- 11.2 mmHg in the non-OSAS COPD group; p = 0.01); there were no differences in PaCO2.Pimax in the OSAS-COPD group was 70.6 +/- 23.8 cmH2O, a level that was significantly lower than in the non-OSAS COPD group (Pimax 90.5 +/- 26.1 cmH2O; p = 0.04). Patients in the non-OSAS COPD group experienced longer periods of REM sleep. Nighttime saturation parameters were significantly different in the group with OSAS. We conclude that patients with both OSAS and COPD experience greater oximetric changes than those without OSAS, during both sleep and awake states. The deterioration of respiratory muscle pressures in such patients may play an important role in the changes. The groups also present differences in the intensity of some symptoms, such as degree of daytime sleepiness and dyspnea.     

吸入噻托溴铵对慢性阻塞性肺疾病患者运动耐量的影响

慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者呼气气流受限导致气体陷闭和肺过度充气,从而导致COPD患者特征性的临床症状.每天一次噻托溴铵18μg,通过长效的抗胆碱能作用维持24 h气道通畅,已显示出能持续减轻COPD患者呼吸困难症状,提高运动耐量和健康相关性生活质量.     

New strategies to improve exercise tolerance in chronic obstructive pulmonary disease.

Breathlessness is the most common symptom limiting exercise in patients with chronic obstructive pulmonary disease (COPD). Exercise training can improve both exercise tolerance and health status in these patients, intensity being of key importance. Nevertheless, in these patients extreme breathlessness and/or peripheral muscle fatigue may prevent patients from higher levels of intensity. In this review article the literature concerning the different ways to optimise exercise tolerance in patients with COPD, with the objective of enhancing the tolerance to higher exercise training intensity, is summarised. Continuous positive airway pressure and different modalities of noninvasive positive pressure ventilation (NPPV) may reduce breathlessness and increase exercise tolerance in these patients. Respiratory muscle unloading and reduction in intrinsic positive end-expiratory pressure have been considered among mechanisms underlying these effects. Nevertheless, the role of NPPV in pulmonary rehabilitation, if any, is still controversial. The addition of nocturnal domiciliary NPPV during a daily exercise programme in patients with severe COPD resulted in an improvement in exercise tolerance and quality of life. In patients with severe COPD application of electrical stimulation combined with active limb mobilisation significantly improved muscle strength, and interval training has been shown capable of inducing physiological training effects. Oxygen supplementation in patients who do not desaturate during exercise seems to be the most promising treatment, since it allows for higher exercise intensities and, therefore, superior training efficacy. In conclusion, further studies are needed to define the appropriate patients in order to generalise such interventions. The modalities discussed should be used as adjuncts to a well designed comprehensive respiratory rehabilitation programme.     

Effects of beta-agonists on breathlessness and exercise tolerance in patients with chronic obstructive pulmonary disease

In a single-blind placebo-controlled trial in 12 patients with advanced chronic obstructive pulmonary disease (COPD) we compared the effects of nebulized salbutamol (1 mg), clenbuterol (30 micrograms) and placebo (4 ml of normal saline) on spirometric indices (FVC, FEV1), maximal expiratory flows (Vmax50 and Vmax25), the distance walked in 6 min (6MD), assessment of breathlessness by visual analogue scale (VAS), and estimates by the patients of perceived exertion (RPE). Both clenbuterol and salbutamol produced significant increases in FEV1, FVC, Vmax50 and Vmax25. With both drugs, 6MD increased significantly (p less than 0.01) and breathlessness decreased significantly without an appreciable increase in RPE after exercise despite the extra distance covered. The absolute improvements in FEV1 and 6MD after clenbuterol were correlated (r = 0.763, p less than 0.01), but these indices were not correlated after salbutamol (r = 0.121, p greater than 0.1). The lack of correlation between the changes in 6MD and FEV1 after salbutamol might indicate that relief of airways obstruction is not the only explanation for the effects on distance walked, at least with salbutamol.