噻托溴铵对轻中度慢性阻塞性肺疾病患者肺功能的影响

目的评估噻托溴铵对轻中度慢性阻塞性肺疾病（COPD）患者肺功能的影响。方法将80例轻中度COPD患者按随机数字表法分为噻托溴铵组（40例）和对照组（40例）,治疗周期为12周,两组患者均经过1周的清洗期,清洗期患者吸入0．9％氯化钠。第2～12周为治疗期,噻托溴铵组患者吸入噻托溴铵干粉胶囊（18μg／粒）,上午给药,每日1次;对照组患者则继续吸入0．9％氯化钠。分别于治疗前及治疗后第6,12周测定患者的肺功能。结果经过连续12周的治疗后,噻托溴铵组肺功能指标深吸气量、第1秒用力呼气容积和用力肺活量均得到明显改善,较治疗前分别增加了（0．43±0．15）,（0．17±0．11）和（0．41±0．14）L,而对照组上升幅度无明显改善,仅分别增加了（0．10±0．12）,（0．01±0．05）和（0．05±0．12）L,两组比较差异有统计学意义（P〈0．05）。两组不良反应发生率和COPD急性发作率比较差异无统计学意义（P〉0．05）。结论轻中度COPD患者每日1次吸入噻托溴铵（18μg）可以显著改善患者的肺功能。     

噻托溴铵对慢性阻塞性肺疾病患者肺部感染干预效果

目的探讨噻托溴铵对稳定期慢性阻塞性肺疾病(COPD)患者发生肺部感染的临床干预效果,并观察其对患者肺功能和气道重塑的影响。方法选择2012年1月-2014年3月收治的COPD肺部感染患者64例,将其随机分为对照组30例、观察组34例,对照组患者给予抗感染及常规治疗;观察组患者在对照组治疗基础上给予噻托溴铵粉雾剂治疗;评估两组患者治疗前和治疗1个月后一秒钟用力呼气量(FEV1)和一秒钟用力呼气量占用力肺活量的百分比(FEV1/FVC)等肺功能指标及生活质量。结果疗后两组FEV1和FEV1/FVC均高于治疗前、生活质量评分低于治疗前,差异有统计学意义(P<0.05);治疗后FEV1和FEV1/FVC评分观察组均高于对照组治疗后,差异有统计学意义(P<0.05);治疗后生活质量评分观察组低于对照组,差异有统计学意义(P<0.05)。结论噻托溴铵对COPD肺部感染患者干预效果明显,可以显著改善患者肺功能和气道重塑,提高患者生活质量。     

慢性阻塞性肺疾病急性加重期患者肺部感染应用噻托溴铵治疗的效果研究

目的探讨慢性阻塞性肺疾病(COPD)急性加重期患者肺部感染应用噻托溴铵治疗的效果,为临床治疗提供参考。方法随机选取2013年1月-2014年9月在医院接受治疗的慢性阻塞性肺疾病急性加重期并伴有轻、中度的肺部感染患者共80例作为研究对象,将其分为观察组和对照组各40例;对照组患者给予常规的治疗,观察组患者在此基础上联合噻托溴铵进行治疗,分析两组患者治疗效果,数据采用SPSS 18.0软件进行统计分析。结果两组患者治疗前的氧合指数(PaO2/FiO2)以及动脉血二氧化碳分压(PaCO2)水平比较差异无统计学意义,治疗后,观察组患者的氧合指数(PaO2/FiO2)明显高于对照组,而动脉血二氧化碳分压(PaCO2)明显低于对照组,两组比较差异有统计学意义(P<0.05);观察组患者治疗的总有效率达到97.5%,明显高于对照组,两组比较差异有统计学意义(P<0.05)。结论对于肺部感染的COPD急性加重期患者采用噻托溴铵进行治疗的效果显著,可以使肺功能得到显著改善,值得在临床上广泛使用并推广。     

Different patterns of chronic tissue wasting among patients with chronic obstructive pulmonary disease

BACKGROUND & AIMS: Nutritional depletion is frequently present in patients with chronic obstructive pulmonary disease, but it is unknown whether a difference exists between the two subtypes. The aim of this study was to determine whether patterns of tissue depletion were different between emphysema and chronic bronchitis patients and whether these were related to pulmonary function. METHODS: In 99 severe COPD patients and 28 healthy volunteers, body weight and composition were assessed by dual-energy X-ray absorptiometry. Patients were stratified into chronic bronchitis (n=50) and emphysema (n=49) by high-resolution computed tomography. RESULTS: Lean mass depletion was found in 37% of the emphysema patients and in 12% of the chronic bronchitis patients. The emphysema patients had lower values for body mass index than the other groups (P< 0.01), mainly due to a lower lean mass (P< 0.01) and bone mineral content (P< 0.01). Fat mass was also lower in the emphysema group compared to the chronic bronchitis group (P< 0.001). The chronic bronchitis patients had a higher fat mass (P< 0.05) and a lower bone mineral content (P< 0.01) than the healthy volunteers. CONCLUSIONS: Substantial differences in body composition were found not only between chronic obstructive pulmonary disease patients and healthy volunteers, but also between chronic bronchitis and emphysema patients.     

观察综合性肺康复疗法在慢性阻塞性肺病稳定期患者治疗中的疗效

目的采用综合性肺康复法为COPD(慢性阻塞肺病)患者进行治疗,对其稳定期的治疗效果进行观察与探讨。方法选取该院2008年1月—2011年1月收治过的符合COPD相关诊断标准的患者,共88例,将其进行随机分组,分为两组,观察组与对照组各分有患者44例,于患者的稳定期开始,进行治疗。结论进行综合性肺康复治疗在COPD患者的稳定期具有非常重要的意义。     

慢性阻塞性肺疾病患者认知障碍研究进展

摘要:目的 慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease, COPD）是以持续性、进展性的气流受限为特征的慢性支气管炎和（或）肺气肿,伴有肺和气道对有害气体或颗粒的慢性炎症反应的增加,并进而发展为复杂的多器官结构和功能障碍。它因发病率高、并发症多,现已成为严重危害国民健康的常见病,认知障碍作为并发症之一,并未得到医患双方的足够关注。本文从发生机制、影响因素、评价手段及防治策略等角度回顾近年研究成果,并对影像医学在认知评价中的价值做了初步探讨。彻底阐明发生机制,寻找特异性靶点分子是提高诊疗水平的必由之路;大力推广临床筛查才能归纳总结针对性神经心理学评价体系并完善量化评分,应用于临床,真正落实“防治结合”,而最终获益于患者。     

噻托溴铵对老午慢性阻塞性肺疾病稳定期患者肺功能及气道重塑的影响

目的探讨噻托溴铵对老年慢性阻塞性肺疾病（COPD）稳定期患者肺功能及气道重塑的影响。方法将92例老年COPD稳定期患者按随机数字表法分为治疗组（50例）和对照组（42例）,两组患者均予以COPD常规治疗,包括止咳、平喘、抗感染等治疗。治疗组在常规治疗基础上给予噻托溴铵吸入,疗程为12个月。同时选择与COPD稳定期患者年龄匹配的健康体检者40例作为健康对照组。应用高分辨率CT（HRCT）测定治疗前后气道壁厚度、气道内外径、气道腔面积等参数以评估气道重塑的程度,同时测定患者肺功能、血清炎性细胞因子[白细胞介素（IL）-8、肿瘤坏死因子（TNF）-α]水平及T淋巴细胞亚群,并与健康对照组进行比较。结果治疗组治疗后各项肺功能指标明显改善,且改善程度优于对照组,差异均有统计学意义（P〈0．05）。治疗组治疗后气道壁厚度与治疗前比较差异无统计学意义（P〉0．05）,其余气道重塑指标均较治疗前明显改善,差异有统计学意义（P〈0．05）。治疗组治疗后6min步行试验距离明显高于对照组,差异有统计学意义（P〈0．05）。两组COPD患者治疗前血清IL-8、TNF-α水平比较差异无统计学意义（P〉0．05）,治疗后两组血清IL-8、TNF-α水平均较治疗前下降（P〈0．05）,治疗组治疗后血清IL-8、TNF-α水平明显低于对照组（P〈0．05）。治疗组和对照组治疗前CD3^＋、CD4^＋、CD4^＋／CD8^＋较健康对照组明显降低,CD8^＋较健康对照组明显增高,差异有统计学意义（P〈0．05）。治疗后两组CD3^＋、CD4^＋、CD4^＋／CD8^＋升高,CD8^＋降低,与治疗前比较差异有统计学意义（P〈0．05）,并且治疗组变化更为明显（P〈0．05）。结论噻托溴铵对老年COPD稳定期患者的肺功能及气道重塑具有显著的改善作用。     

Efficacy of nutritional supplementation therapy in depleted patients with chronic obstructive pulmonary disease

OBJECTIVE: Weight loss and muscle wasting adversely affect morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD). Maintenance systemic glucocorticosteroids, prescribed in a substantial number of patients, further contribute to muscle weakness. We investigated the efficacy of oral nutritional supplementation therapy in depleted patients with COPD. METHODS: The therapy consisted of daily two to three oral liquid nutritional supplements (mean +/- standard deviation: 2812 +/- 523 kJ/24 h) incorporated into an 8-wk inpatient pulmonary rehabilitation program in 64 (49 men) depleted patients with COPD. Endpoints were body weight, fat-free mass by bioelectrical impedance analysis, respiratory and peripheral muscle function (maximal inspiratory mouth pressure and handgrip strength, respectively), exercise performance (incremental bicycle ergometry), and disease-specific health status by St. George's Respiratory Questionnaire. Forty-eight percent of the patients were treated with low-dose oral glucocorticosteroids as maintenance medication (dose equivalent to 7.6 +/- 2.5 mg of methylprednisolone per day). RESULTS: Increases in body weight (2.1 +/- 2.1 kg, P < 0.001) and fat-free mass (1.1 +/- 2.0 kg, P < 0.001) were seen. Further, maximal inspiratory mouth pressure (4 +/- 10 cm of H(2)O, P = 0.001), handgrip strength (1.2 +/- 3.1 kg, P = 0.004), and peak workload (7 +/- 11 W, P = 0.001) significantly improved. Clinically significant improvements in the items symptoms (9 +/- 16 points, P < 0.001) and impact (4 +/- 15 points, P = 0.043) of St. George's Respiratory Questionnaire were achieved. Oral glucocorticosteroid treatment significantly impaired the response to nutritional supplementation therapy with respect to maximal inspiratory mouth pressure, peak workload, and St. George's Respiratory Questionnaire symptom score. CONCLUSIONS: Nutritional supplementation therapy implemented in a pulmonary rehabilitation program was effective in depleted patients with COPD. However, oral glucocorticosteroid treatment attenuated the anabolic response to nutritional supplementation.     

Cost-effectiveness of alpha-1 antitrypsin replacement therapy in treatment of congenital chronic obstructive pulmonary disease.

BACKGROUND: Alpha 1-antitrypsin (AAT) replacement therapy is an expensive intervention ($20,000-$30,000 per patient annually) which may slow or arrest the progression of chronic obstructive pulmonary disease (COPD) in AAT-deficient patients. While FDA-approved, therapy efficacy is unknown. The costs and benefits of AAT replacement therapy were evaluated for patients with congenital COPD. METHODS: Epidemiological and disease cost data were taken from published sources. A discrete-time model of disease stage probability transition was developed to calculate the present-value expected cost of disease treatment, under a range of possible therapy efficacy and other parameter values. RESULTS: At an efficacy of 70 percent, the cost per life year saved with AAT replacement therapy would be between $28,000 and $72,000 (1990 US dollars), depending on patient age, sex, and smoking status. At 30 percent efficacy, the cost per life year saved range would be between $50,000 and $128,000. A controlled efficacy study would cost $53 million or less, if the true efficacy were 50 percent or better. CONCLUSIONS: With efficacy of 30 percent or higher, therapy cost-effectiveness would be comparable to other widely used medical interventions. The economic assessment methodology was used to evaluate both the therapeutic innovation and the value of additional clinical research.     

稳定期慢性阻塞性肺疾病患者护理健康教育效果评价

目的 评价护理健康教育对稳定期慢性阻塞性肺疾病（COPD）患者肺功能及生活质量的影响。方法 将确诊为COPD稳定期的84例患者根据自愿原则随机分为护理健康教育组（A组，n=46）和对照组（B组，n=38），分析干预前及干预后1年FEV1、FEV％预计值、FEV1／FVC及生活质量评分（SGRQ评分）。结果1年后A组FEV1、FEV％预计值、FEV1／FVC下降明显减少．生活质量指数有明显提高，其规律服药率、戒烟率与B组比较，差异均有显著性意义（P均〈0．05）。结论 系统护理健康教育对延缓稳定期COPD患者肺功能下降、提高患者生活质量有明显作用。     

Pharmacological therapy of chronic obstructive pulmonary disease

None of the available drugs for chronic obstructive pulmonary disease is able to reduce the progressive decline in lung function which is the hallmark of this disease. Smoking cessation is the only intervention that has been shown so far to reduce disease progression. The current pharmacological therapy for chronic obstructive pulmonary disease is largely symptomatic and is based on bronchodilators including selective beta2-adrenoceptor agonists (short- and long-acting), anticholinergics, theophylline, or a combination of these drugs. Due to the lack of efficacy, side effects at high doses, and high costs, glucocorticoids should not be used routinely for management of stable chronic obstructive pulmonary disease, although they are effective for exacerbations. New pharmacological strategies for chronic obstructive pulmonary disease are needed because the current management is inadequate.     

噻托溴铵粉雾剂治疗慢性阻塞性肺气肿的疗效分析

目的探讨噻托溴铵粉雾剂治疗慢性阻塞性肺气肿的临床疗效。方法对照组60例患者均给予爱全乐(异丙托溴铵气雾剂)雾化治疗;研究组60例患者均给予名思力华(噻托溴铵粉雾剂)雾化治疗。结果研究组治疗后FEV1和FEV1/FVC值明显高于对照组,且研究组FEV1改善率明显优于对照组(P﹤0.05)。研究组治疗后生活质量评分明显高于对照组,数据经统计学比较差异有统计学意义(P﹤0.05)。两组并发症发生率经统计学比较差异无统计学意义(P﹥0.05)。结论噻托溴铵粉雾剂治疗慢性阻塞性肺气肿具有较好的临床疗效和安全性,能够有效改善和提高患者的生活质量。     

Circulating ghrelin in patients with chronic obstructive pulmonary disease

OBJECTIVE: Unexplained weight loss is common in patients with chronic obstructive pulmonary disease (COPD). Because ghrelin plays an important role in energy homeostasis, this study investigated the plasma level of ghrelin in COPD. METHODS: Plasma ghrelin levels and levels of leptin, tumor necrosis factor-alpha, and C-reactive protein were measured in 29 patients with COPD and 17 healthy controls. Body composition was assessed with bioelectrical impedance analysis. RESULTS: Body mass index and percentage of body fat were lower in patients who had COPD than in healthy controls. Plasma ghrelin and leptin concentrations were significantly lower in patients who had COPD than in healthy controls (ghrelin: 0.25+/-0.22 ng/mL versus 0.43+/-0.24 ng/mL, P=0.013; leptin: 1.77+/-0.70 ng/mL versus 2.85+/-0.96 ng/mL, P=0.000). In contrast, tumor necrosis factor-alpha and C-reactive protein were significantly higher in those with COPD than in controls. Plasma ghrelin (log transformed) was positively correlated with body mass index and percentage of body fat in patients with COPD but negatively correlated in control subjects. Plasma ghrelin was negatively correlated with tumor necrosis factor-alpha and C-reactive protein in COPD. CONCLUSION: Plasma ghrelin level was decreased in COPD and this is different from other weight-loss diseases. These data suggest that decreased ghrelin and other factors may contribute to alterations in metabolic status during inflammatory stress in this disease.     

团体认知行为疗法对老年慢性阻塞性肺疾病患者的干预效果研究

目的探讨团体认知行为疗法对老年慢性阻塞性肺疾病(COPD)患者焦虑、抑郁、自我效能及生活质量的干预效果.方法采用方便抽样的方法,选取2017年9月至2018年9月山西省某三级甲等医院呼吸与危重症医学科收治的276例老年COPD患者为研究对象,按入院时间将患者分为实验组(n=132)和对照组(n=144),对照组接受常规护理和健康教育,实验组在常规护理基础上增加团体认知行为干预,在干预前、干预后、干预后1个月使用抑郁自评量表、焦虑自评量表、一般自我效能量表、生活质量量表评价干预效果.结果干预前两组患者焦虑自评量表、抑郁自评量表、一般自我效能量表及生活质量量表评分差异均无统计学意义(P>0.05);干预后、干预后1个月两组患者焦虑自评量表、抑郁自评量表、生活质量量表、一般自我效能量表评分均优于干预前,且差异均具有统计学意义(P<0.05).结论团体认知行为疗法可缓解老年COPD患者的焦虑、抑郁症状,提升自我效能感,改善其生活质量.本研究为老年COPD患者心理护理方法的改进提供了科学依据,同时为其他慢病人群的护理管理和健康教育提供参考.     

Diaphragm dysfunction in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterised by alterations in the airways and lung parenchyma resulting in an increased respiratory workload. Besides an increased load and hyperinflation of the thorax, additional factors, such as systemic inflammation, oxidative stress, hypoxia and loss of muscle mass, further have a negative influence on diaphragm contractility. The diaphragm seems to adapt only partly to the altered circumstances to which it is exposed. As a consequence, several morphological, biochemical and functional alterations occur in the diaphragm, resulting in diaphragm dysfunction. In an appropriately selected group of patients, the function of the diaphragm can be improved by respiratory muscle training, oral nutritional therapy or hormonal interventions.     

吸入噻托溴铵联合舒利迭治疗稳定期中重度慢性阻塞性肺疾病的临床观察

目的研究吸入噻托溴铵联合舒利迭在稳定期中重度慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)治疗中的应用价值。方法选取2013年1月—2015年1月收治的稳定期中重度COPD患者116例作为研究对象,随机分为对照组和研究组各58例。对照组患者在常规治疗基础上给予舒利迭吸入治疗,1吸/次,2次/d。研究组患者在对照组基础上加用噻托溴铵吸入治疗,1支/次,1次/d。两组均治疗3个月。观察并比较患者临床疗效及肺功能、血气分析、英国医学研究委员会呼吸困难量表评分(modified British medical research council dyspnea scale,MMRC)、6分钟步行试验(6 minute walking test,6MWT)结果。计量资料采用t检验,计数资料采用χ2检验,P0.05为差异有统计学意义。结果研究组总有效率为91.38%,明显高于对照组的70.69%,差异有统计学意义(P0.05)。治疗后,研究组患者FVC、FEV1、FEV1%分别为(3.32±0.41)、(2.25±0.32)L、(67.23±8.03)%,均明显高于对照组的(2.86±0.23)、(1.77±0.21)L、(56.73±6.42)%,差异均有统计学意义(均P0.05)。研究组Pa O2为(74.23±4.19)mm Hg(1 mm Hg=0.133 k Pa),明显高于对照组的(65.63±3.23)mm Hg,研究组PaCO_2为(43.12±2.19)mm Hg,明显低于对照组的(48.62±2.42)mm Hg,差异均有统计学意义(均P0.05)。研究组MMRC评分为(1.33±0.31)分,明显低于对照组的(1.82±0.41)分,研究组6MWT为(432.52±33.28)m,明显长于对照组的(390.23±24.38)m,差异均有统计学意义(均P0.05)。结论在稳定期中重度COPD治疗中,噻托溴铵联合舒利迭吸入治疗可提高治疗效果,改善患者肺功能,提高血氧分压,提高患者日常生活质量,值得推广。     

Altered interorgan response to feeding in patients with chronic obstructive pulmonary disease

BACKGROUND: Previously, we reported increased values for whole-body protein turnover in patients with chronic obstructive pulmonary disease (COPD) in the postabsorptive state. OBJECTIVE: The objective was to investigate whether intake of a carbohydrate-protein meal influences whole-body protein turnover differently in COPD patients and control subjects. DESIGN: Eight normal-weight patients with moderate COPD and 8 healthy control subjects were examined in the postabsorptive state and after 2 h of repeatedly ingesting a maltodextrin casein-based protein meal (0.02 g x kg body wt(-1) x 20 min(-1)). Combined simultaneous, continuous, intravenous infusion of L-[ring-2H5]-phenylalanine and L-[ring-2H2]-tyrosine tracer and oral repeated ingestion of 1-13C-phenylalanine were performed to measure whole-body protein synthesis (WbPS) and first-pass splanchnic extraction of phenylalanine. Endogenous rate of appearance of phenylalanine as the measure of whole-body protein breakdown (WbPB) and netWbPS was calculated as WbPS--WbPB. Arterialized venous blood was sampled for amino acid enrichment and concentration analyses. RESULTS: Feeding induced an increase in WbPS and a reduction in WbPB. The reduction in WbPB was larger in the COPD group than in the control group (P < 0.05) and was related to the lower splanchnic extraction of phenylalanine in the patients. Consequently, netWbPS increased more after feeding in the COPD group than in the control group (P < 0.05). CONCLUSION: Feeding induces more protein anabolism in normal-weight patients with moderate COPD than in healthy control subjects. This is probably because these COPD patients are characterized by an adaptive interorgan response to feeding to prevent or delay weight loss at this disease stage.     

噻托溴铵和布地奈德/福莫特罗治疗慢性阻塞性肺疾病的疗效与安全性研究

目的 观察联合吸入噻托溴铵和布地奈德/福莫特罗治疗慢性阻塞性肺疾病(COPD),对减少COPD急性发作、改善患者肺功能和健康状况的效果.方法 86例COPD患者按照随机数字表法分为三组,联合治疗组29例:吸入布地奈德/福莫特罗粉吸入剂160 μg/4.5μg,每日2次,并且吸入噻托溴铵干粉胶囊18 μg,每日1次;布地奈德/福莫特罗组29例(160 μg/4.5μg,每日2次);噻托溴铵组28例(18 μg,每日1次),疗程为3个月.结果 三组患者试验后肺功能、临床症状和健康状况均有显著改善,联合治疗组第1秒用力呼气容积为(1.24±0.18)L,较试验前提高了11.7%,且明显高于其他两组,差异有统计学意义(P<0.01);联合治疗组使用缓解药次数及急性发作次数较其他两组明显减少,差异有统计学意义(P<0.01);联合治疗组St.George呼吸疾病问卷(SGRQ)评分为(35.6±13.9)分,明显低于其他两组,差异有统计学意义(P<0.01).三组间不良事件发生率差异无统计学意义(P>0.05).结论 联合吸入噻托溴铵和布地奈德/福莫特罗治疗COPD,可以控制患者的临床症状并改善肺功能,疗效优于单药治疗,不良反应未增加.     

运动锻炼配合噻托溴铵、沙美特罗/替卡松联合吸入治疗慢性阻塞性肺疾病稳定期疗效分析

目的 观察运动锻炼配合噻托溴铵、沙美特罗/替卡松吸入对慢性阻塞性肺疾病(COPD)稳定期的疗效.方法 将COPD稳定期Ⅲ～Ⅳ级患者60例依据随机数字表法分为对照组(药物)和试验组(药物+锻炼),对照组联合吸入噻托溴铵粉雾剂及沙美特罗/替卡松干粉剂,试验组在药物治疗同时配合运动锻炼(缩唇呼吸和踏阶梯运动),疗程均为8周;治疗前后以第1秒用力呼气容积(FEV1)、FEV1占预计值百分比(FEV1%)、FEV1/用力肺活量(FVC)、MRC评分、日常生活活动能力(ADL)评分、6min步行距离(6MWD)等指标评价疗效.结果 试验组、对照组治疗前后组内各指标比较差异均有统计学意义(P<0.01);治疗后试验组、对照组FEV1[(1.41±0.25)L比(1.28±0.23)L]、FEV1%[(53.76±11.17)%比(46.27±8.85)%]、FEV1/FVC[(62.12±10.78)%比(55.76±8.57)%]、MRC评分[(1.56±1.16)分比(2.29±1.13)分]、ADL评分[(5.51±0.18)分比(4.47±0.13)分]、6MWD[(342.7±19.7)m比(280.6±17.8)m]比较差异有统计学意义(p<0.05).结论 配合运动锻炼能显著改进噻托溴铵、沙美特罗/替卡松联合吸入对COPD稳定期患者的疗效.