慢性阻塞性肺疾病合并骨质疏松症的研究进展

慢性阻塞性肺疾病(COPD)目前仍是全球患病率、致残率、病死率高的慢性呼吸系统疾病, 常可合并多种合并症。骨质疏松症是其中之一, 是一种以低骨量和骨组织微观结构退化为特征的系统性疾病, 常导致骨强度下降, 骨折的风险随之增加, 但在临床中常被忽视。因此, 了解COPD合并骨质疏松症的危险因素、伴随疾病、诊断与治疗, 对于COPD患者具有重要意义。     

骨质疏松性椎体骨折的椎体后凸成形术治疗

骨质疏松症是以骨量减少、骨组织显微结构退化为特征,导致骨脆性增高和骨折危险性增加的全身性系统性疾病.骨质疏松性骨折中最常见的是椎体骨折.Cooper 等在回顾性研究中发现骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture, OVCF)患者的5 年生存率低于髋部骨折的患者.Kado 等学者的前瞻性研究表明OVCF 患者与同龄的对照组相比,病死率上升了23%.可以认为,病死率的增加是由于脊柱骨折后,疼痛、卧床休息、活动减少,骨量进一步丢失,再骨折的发生率显著增加而使其陷入恶性循环,最终由于脊柱严重畸形,肺功能下降导致肺炎和慢性阻塞性肺疾病等引起的.因此,迅速缓解疼痛,打断恶性循环,恢复椎体高度,尽可能矫正后凸畸形是治疗椎体骨折的关键.     

老年人慢性阻塞性肺病并发侵袋性曲霉菌感染的临床研究

侵袭性肺曲霉菌病(invasive pulmonary aspergillosis,IPA)在免疫力低下患者中发病率相对较高,对该病的诊断治疗比较困难、病死率高.随着诊断技术的提高,激素和抗生素在肺部慢性阻塞性疾病(COPD)中的广泛及某些不合理的应用以及老年人并存多种基础疾病,COPD合并曲霉菌感染逐渐受到关注.据统计约有2%的COPD患者死于IPA,而曲霉菌感染后使COPD预后更差,研究结果显示,全球COPD合并IPA病死率高达72%～95%[1-2],因此早预防、早诊断、早治疗成为降低该病病死率的关键.我们对60岁以上老年COPD合并肺部曲霉菌感染病例进行总结分析,旨在发现一些临床早期诊治的线索.     

慢性阻塞性肺病和骨质疏松

慢性阻塞性肺病(COPD)不仅是肺部疾病,而且是一种全身性疾病.骨质疏松是COPD患者的肺外表现之一.随着COPD患者病情加重,骨质疏松的发病率亦有所增加.但COPD患者发生骨质疏松的机制至今尚未完全明确.探讨COPD患者骨质疏松症的发生情况及影响因素,有助于提高对COPD发生骨质疏松的早期认识,预防骨质疏松的发生、发展,对改进COPD患者的生活质量和延长生命具有重要意义.     

慢性阻塞性肺疾病合并肺癌的研究进展

<正>慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者中肺癌的发病率和病死率逐年升高,对患者的劳动能力、生活质量及家庭经济带来严重影响,且相比单纯COPD或者肺癌更复杂、更易产生不良后果[1-2]。目前,全球COPD 40岁以上发病率已高达9%～10%。根据WHO最新数据显示,肺癌发病率占全球新发癌症的11.6%,病死率达18.4%,是中国乃至全球发病率和病死率最高的癌症。且COPD合并肺癌的发病率也在不断上升,年发病率约为16.7%[3]。因此,COPD合并肺癌的早期诊断至关重要,针对病因、发病机制及高危人群早期预防,对于该合并症的早期诊断和个体化治疗尤为重要。本文对COPD合并肺癌的     

维持性血液透析患者骨质疏松的诊治

随着血液透析技术的发展,透析患者的数量明显增加,透析患者的生活质量特别是肾性骨病所引起的骨健康问题备受关注。骨质疏松症是一种以骨量下降、骨微结构损害、骨脆性增加、易发生骨折为特征的全身性骨病。透析患者由于继发性甲状旁腺机能亢进(SHPT)、骨代谢异常、营养不良、维生素D缺乏、骨矿物质流失等原因易导致骨质疏松。随着透析患者透析龄的增加,骨质疏松的患病率呈现增高趋势,脆性骨折的致残率、病死率高,已成为影响其生活质量和生存率的重要因素。     

帕金森病合并骨质疏松的研究进展

帕金森病是慢性神经退行性疾病,患病年龄增加所致的骨量减少和疾病晚期的吞咽困难、胃肠蠕动减慢导致维生素D、钙摄入不足,使帕金森病患者更易合并骨质疏松。治疗帕金森病的药物亦可诱发甚至加重患者的骨质疏松,而骨质疏松又加重了帕金森病患者运动障碍,引起疼痛、骨折的发生。为此对帕金森病合并骨质疏松的危险因素、发病机制、预防及治疗方...     

矽肺合并慢性阻塞性肺疾病41例临床特点分析

目的 分析矽肺合并慢性阻塞性肺疾病(COPD)的临床特点.方法 采用回顾性的方法对41例矽肺合并COPD患者的临床资料进行分析.结果 矽肺合并COPD患者呼吸困难重于单纯矽肺,矽肺合并COPD易出现低氧血症,不是所有矽肺合并慢性粉尘性支气管炎、肺气肿患者都合并COPD.结论 掌握和认识矽肺合并COPD的临床特点,早期发现、早期治疗矽肺合并COPD,对提高矽肺患者的生活质量和降低病死率有重要意义.     

骨小梁分数在风湿病并发骨质疏松管理中的应用价值

骨质疏松症是以骨强度下降、骨折风险增加为特征的骨骼疾病。风湿病是继发性骨质疏松症的常见原因之一,可显著增加患者罹患骨质疏松、脆性骨折的风险,导致疾病致残及致死率升高。风湿病患者并发骨质疏松的风险预测、早期诊断、早期干预和治疗监测均具有重要意义。目前诊断骨质疏松的金标准是骨密度值(BMD),但BMD仅反映骨量变化,不能显示骨微结构等骨质量信息。骨小梁分数(TBS)是一种基于双能X线吸收测定法(DXA)图像的新型骨微结构无创评估手段。研究表明,TBS可用于原发性及各种继发性骨质疏松症的骨质量评估,并能作为BMD和骨折风险预测工具FRAX的辅助指标,提高骨折风险预测能力。本文就TBS在风湿病并发骨质疏松领域的相关研究进行综述,提示TBS在骨质疏松识别、骨折风险评估、药物疗效监测等方面的潜在应用价值。     

骨水泥及同种异体骨条结合肱骨近端锁定钢板治疗肱骨外科颈骨折的疗效

肱骨外科颈骨折好发于老年人,以骨质疏松者多见,尤其是处于绝经后期的女性患者。在暴力作用下,骨质疏松患者不仅骨折移位明显、骨块较多,而且对于复位后远期恢复也有重要影响。因此,坚强牢靠的内固定对于肱骨外科颈骨折术后早期肩关节功能恢复意义重大〔1,2〕。本文回顾性分析我院应用骨     

Anemia in chronic obstructive pulmonary disease: A systematic review

IntroductionChronic obstructive pulmonary disease (COPD) is a type of obstructive lung disease that is characterized by poor airflow and airway inflammation. It is estimated that the global prevalence of COPD is about 13.1%. Anemia is associated with increased morbidity and hospitalization duration. In this systematic review, we investigate the association between all types of anemia and COPD progression.MethodsWe systematically searched electronic databases, including Scopus, Medline/PubMed, EMBASE, Web of Sciences (WOS), and Cochrane Library, using the following mesh-standardized keywords: (((anemia1 OR anaemia1) OR “chronic anemia disease” [Mesh] OR “CAD” OR “iron deficiency anemia” OR” IDA” OR) AND (“COPD” [Mesh] OR “chronic obstructive pulmonary disease”)) until February 2022.ResultsOverall of 11,158 studies were included. Ultimately, 59 studies were included in the analysis. The most apparent findings from the analysis were that exacerbation of COPD, increased hospitalization, and increased long-term mortality were associated with anemia. Further analysis showed that iron deficiency (ID) is a common finding in COPD and is accompanied by an increase in the systolic pulmonary artery pressure.ConclusionDespite the comfortable control of anemia, the absence of treatment can be life-threatening in patients with COPD. Our systematic results showed significant homogeneity between studies on the increased mortality rate in anemic COPD, increased hospitalization, and decreased quality of life.     

间充质干细胞移植治疗慢性阻塞性肺疾病的相关研究进展

慢性阻塞性肺疾病(COPD)是一种重要的慢性呼吸系统疾病,主要包括慢性支气管炎和肺气肿,患病人数多,病死率高,由于其缓慢进行性发展,COPD是以上调炎症过程导致诸如上皮细胞凋亡、终末肺泡间隔及肺泡外基质蛋白水解事件发生为特征,严重影响患者的劳动能力和生活质量.近来一些研究揭示,间充质干细胞对肺组织的修复和再生有重要作用...     

Enfermedad pulmonar obstructiva crónica y osteoporosis

Osteoporosis is one of the systemic effects associated with chronic obstructive pulmonary disease (COPD). Risk factors for bone loss include smoking, skeletal muscle weakness, low bone mass index (BMI), vitamin D deficiency, glucocorticoid use, hypogonadism and systemic inflammation. The most important clinical feature is vertebral fracture, due to its significant morbidity and mortality. The treatment of osteoporosis includes calcium and vitamin D, bisphosphonates, anabolic agents and pulmonary rehabilitation. Prospective studies are required to determine the prevalence of osteoporosis in COPD and to identify which patients are at high risk for osteoporotic fracture. The development of new drugs to control systemic inflammation may contribute to specific treatments for osteoporosis in COPD.     

慢性阻塞性肺疾病急性加重与呼吸道病毒感染的研究进展

慢性阻塞性肺疾病(COPD)是一种呼吸道常见的炎症性疾病,是全世界发病率和病死率较高的疾病之一。慢性阻塞性肺疾病急性加重(AECOPD)是其过程中的重要事件,常导致患者生活质量下降,病死率升高。呼吸道病毒感染与AECOPD密切相关。AECOPD的患者病毒感染具有多样性、季节性及地域性等特点。呼吸道病毒感染可通过活化炎症细胞及介质,参与免疫反应使COPD加重。各种各样的病毒感染对AECOPD的影响及机制可能不同,需要进一步研究。     

The impact of chronic obstructive pulmonary disease in patients hospitalized for worsening heart failure with reduced ejection fraction: an analysis of the EVEREST Trial

BackgroundChronic obstructive pulmonary disease (COPD) is prevalent in heart failure (HF) patients, yet these patients are poorly characterized. We aimed to describe the characteristics and outcomes of patients with systolic dysfunction and COPD in a contemporary HF randomized trial.Methods and ResultsEVEREST investigated 4,133 patients hospitalized with worsening HF and an ejection fraction (EF) ≤40%. We analyzed the characteristics and outcomes (all-cause mortality and cardiovascular mortality/HF hospitalization) of patients according to baseline COPD status. COPD was present in 10% (n = 416) of patients. Patients with COPD had a higher prevalence of comorbidities and were less likely to receive a β-blocker, angiotensin-converting enzyme inhibitor, or aldosterone antagonist. On univariate analysis, COPD was associated with increased all-cause mortality (HR 1.41, 95% CI 1.18–1.67) and cardiovascular mortality/HF hospitalization (HR 1.29, 95% CI 1.11–1.49). After adjusting for potential confounders, the risk associated with COPD remained increased, but was not statistically significant.ConclusionThe presence of COPD in HF patients is associated with an increased burden of comorbidities, lower use of HF therapies, and a trend toward worse outcomes. These findings provide a starting point for prospective investigations of the treatment of HF comorbidities to reduce the high postdischarge event rates.     

Bronchodilators in COPD: Impact of ��-agonists and anticholinergics on severe exacerbations and mortality

This review summarizes the long-term clinical outcomes associated with β-agonist and anticholinergic bronchodilator use in patients with chronic obstructive pulmonary disease (COPD). Pooled data from randomized placebo-controlled trials of at least three months duration were used to evaluate the risk for COPD hospitalizations, respiratory mortality, and total mortality. The results show that anticholinergic use is associated with a 30% reduction in COPD hospitalizations, a 70% reduction in respiratory mortality, and without a significant effect on total mortality. In contrast, β-agonist use had no effect on COPD hospitalizations and was associated with a two-fold increased risk for respiratory death compared with placebo. When the two bronchodilators were directly compared with each other, β-agonists were associated with a two-fold increased risk for COPD hospitalization and a five-fold increased risk for total mortality compared with anticholinergics. When β-agonists were added to either anticholinergic use or inhaled corticosteroid use alone, there was no significant improvement in any long-term clinical outcome. These results indicate that anticholinergics should be the bronchodilator of choice in COPD, while β-agonists may be associated with poorer disease control.     

COPD: a multifactorial systemic disease

Chronic obstructive pulmonary disease (COPD) has traditionally been considered a disease of the lungs secondary to cigarette smoking and characterized by airflow obstruction due to abnormalities of both airway (bronchitis) and lung parenchyma (emphysema). It is now well known that COPD is associated with significant systemic abnormalities, such as renal and hormonal abnormalities, malnutrition, muscle wasting, osteoporosis, and anemia. However, it is still unclear whether they represent consequences of the pulmonary disorder, or whether COPD should be considered as a systemic disease. These systemic abnormalities have been attributed to an increased level of systemic inflammation. Chronic inflammation, however, may not be the only cause of the systemic effects of COPD. Recent data from humans and animal models support the view that emphysema may be a vascular disease. Other studies have highlighted the role of repair failure, bone marrow abnormality, genetic and epigenetic factors, immunological disorders and infections as potential causes of COPD systemic manifestations. Based on this new evidence, it is reasonable to consider COPD, and emphysema in particular, as 'a disease with a significant systemic component' if not a 'systemic disease' per se. The aim of this review is to give an overview of the most relevant and innovative hypothesis about the extrapulmonary manifestations of COPD.     

Chronic obstructive pulmonary disease: a chronic systemic inflammatory disease

Chronic obstructive pulmonary disease (COPD) is characterized by chronic inflammation in both the airways causing airway obstruction and the lung tissues causing emphysema. The disease is induced by inhalation of noxious gasses and particulate matter resulting in a chronic persistent inflammatory response in the lung, and the extent of the inflammatory reaction correlates with the severity of the disease. This chronic inflammatory response in the lung is also associated with a significant systemic inflammatory response with downstream adverse clinical health effects. The systemic response in COPD is associated with mortality, specifically cardiovascular mortality. This review describes the nature of the systemic inflammatory response in COPD and the clinical manifestations associated with the systemic response, with a focus on the potential mechanisms for these adverse health effects.     

Exploratory study of the ‘weekend effect’ for acute medical admissions to public hospitals in Queensland,Australia

Aims: To determine whether in‐hospital deaths of patients admitted through emergency departments with acute exacerbations of chronic obstructive pulmonary disease (COPD), acute myocardial infarction, intracerebral haemorrhage and acute hip fracture are increased by weekend versus weekday admission (the ‘weekend effect’). Methods: We performed a retrospective analysis of statewide administrative data from public hospitals in Queensland, Australia, during the 2002/2003–2006/2007 financial years. The primary outcome was 30‐day in‐hospital mortality. The secondary outcome of 2‐day in‐hospital mortality helped determine whether increased mortality of weekend admissions was closely linked to weekend medical care. Results: During the study period, there were 30 522 COPD, 17 910 acute myocardial infarction, 4183 acute hip fracture and 1781 intracerebral haemorrhage admissions. There was no significant weekend effect on 30‐day in‐hospital mortality for COPD (adjusted risk ratio = 0.92, 95% CI: 0.81–1.04, P= 0.222), intracerebral haemorrhage (adjusted risk ratio = 1.01, 95% CI: 0.86–1.16, P= 0.935) or acute hip fracture (adjusted risk ratio = 0.78, 95% CI: 0.54–1.03, P= 0.13). There was a significant weekend effect for acute myocardial infarction (adjusted risk ratio = 1.15, 95% CI: 1.03–1.26, P= 0.007). Two‐day in‐hospital mortality showed similar results. Conclusion: This is the first Australian study on the ‘weekend effect’ (in a cohort other than neonates), and the first study worldwide to assess specifically the weekend effect among COPD patients. Observed patterns were consistent with overseas research. There was a significant weekend effect for myocardial infarction. Further research is needed to determine whether location (e.g. rural), clinical (e.g. disease severity) and service provision factors (e.g. access to invasive procedures) influence the weekend effect for acute medical conditions in Australia.     

Beta-blocker use in patients with chronic obstructive pulmonary disease: A systematic review: A systematic review of βB in COPD

Beta-blockers (βB) are a frequently used class of medications. Although βB have many indications, those related to cardiovascular disease are among the most common and important. However, in patients with chronic obstructive pulmonary disease (COPD), βB are used less often due to concerns about an unfavorable impact on respiratory morbidity and mortality. We performed a systematic review to assess the safety of βB in patients with COPD. We included a total of 2 randomized controlled trials and 28 observational studies. The majority found statistically significant reductions in mortality. The two higher quality observational studies reported increased mortality with βB. The risk of COPD exacerbations was reduced in about half of the studies. Nonetheless, there were significant biases that confounded the results. The highest quality RCT found a significant increase in severe and very severe COPD exacerbations with βB use. In conclusion, data on the safety of βB in patients with COPD are conflicting. However, given higher quality evidence showed harm with their use, βB should be prescribed with caution in patients with COPD, including patients with cardiac indication for βB.