社区临床干预对慢性阻塞性肺疾病患者肺功能的影响

目的：探讨社区临床干预在慢性阻塞性肺疾病患者中的应用效果。方法采取非同期病例收集方式,共收集594例,其中干预组317例,对照组277例。干预组患者接受社区临床干预模式,并定期进行回访。观察两组患者COPD急性发作人数,急性发作者发作次数,干预前后肺功能变化(FEV1,FEV1%)。结果干预组1年内共96例急性发作转入上级医院治疗;对照组共158例急性发作自行到上级医院治疗,两组经统计学分析,<0.01,差异具有统计学意义。两组COPD急性发作患者发作次数比较,<0.01,差异具有统计学意义。两组患者随访一年前后肺功能(FEV1,FEV1%)组内比较比较,*=0.00(tFEV1(干预组)=18.78,tFEV1%(干预组)=57.85,tFEV1(对照组)=3.19,tFEV1%(对照组)=21.07),差异具有统计学意义。两组患者随访1年后肺功能组间比较,#P=0.00(tFEV1=13.96,tFEV1%=32.18),差异具有统计学意义。结论社区临床干预无论是对患者,还是对减轻上级医院负担而言,都具有积极的临床效应及社会效应,值得进一步推广和研究。     

运动锻炼对慢性阻塞性肺疾病患者肺康复的干预效果

慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是一种具有气流受限特征,可以预防和治疗的慢性疾病。该疾病患病率和病死率较高,且严重影响患者的生命质量,给患者家庭和社会带来沉重的经济负担。运动锻炼可以改善COPD患者的呼吸困难和疲劳状况,提高运动能力、肌肉力量和生活质量,还能减少住院率。研究表明,不同类型的运动锻炼对COPD的干预效果存在差异,如步行锻炼可以改善COPD患者的身体功能和运动耐受性,传统抗阻运动锻炼可以改善COPD患者的上下肢肌肉强度和运动能力。本文综述了不同类型的有氧运动和抗阻运动对不同病程COPD患者的干预效果,强调了运动处方个性化的重要性,并讨论了运动风险和规避方法,为慢阻肺患者的运动康复提供指导性建议。     

慢性阻塞性肺疾病患者运动能力与其体质指数及肺功能的相关性分析

目的分析慢性阻塞性肺疾病患者运动能力及其与体质指数和肺功能的相关性。方法选取2016年7月至2019年7月本院收治的102例慢性阻塞性肺疾病患者作为COPD组,同时选取同一时间段本院健康体检的100例正常者作为正常组。记录2组研究对象体质指数、肺通气功能和弥散功能,分析COPD患者运动能力与体质指数及肺功能的相关性。结果 COPD组安静状态下VO_2、VCO_2、VE、VT、VD/VT与正常组比较无差异;极量负荷时COPD组VO_2、VCO_2、VE、VT明显低于正常组,VD/VT明显高于正常组(P0.05);体质指数、FVC、FEV1、PEFR及DLco/VA与极限负荷时运动能力各指标存在显著相关性。结论慢性阻塞性肺疾病患者运动能力明显下降,重视COPD患者体质指数、肺通气功能和弥散功能障碍,对改善极量负荷时患者运动能力有重要意义。     

阿胶对慢性阻塞性肺疾病大鼠肺功能及肺组织病理损伤的影响

目的 探究阿胶(CCA)对慢性阻塞性肺疾病(COPD)大鼠肺功能及肺组织病理损伤的影响.方法 将25只大鼠随机分成对照组、模型组、阿胶(低、中、高)剂量组(1、2、4 g/kg),每组5只.采用卷烟烟雾暴露法造模,烟雾浓度为(1100±10)mg/m3,每日1次,每次90 min,连续48周.造模结束次日起,每日灌胃治...     

肺康复干预对AECOPD患者肺功能、运动耐量及心理状态的影响分析

目的 探讨肺康复干预对AECOPD患者肺功能、运动耐量及心理状态的影响,旨在提高患者生存质量水平.方法 选择2019年2月～2020年7月我院收治的120例AECOPD患者作为研究对象,根据干预方式不同将其分为对照组(予以常规干预治疗)和观察组(予以肺康复干预治疗),每组各60例.对比分析两种干预方式对AECOPD患者...     

慢性阻塞性肺疾病患者年龄及体质量指数与肺功能的关系

目的：揭示慢性阻塞性肺疾病发作期患者体质量指数（body mass index,BMI）、年龄与肺功能的关系。方法：选择慢性阻塞性肺疾病患者,测量其体质量及身高并检测其肺功能。比较营养不良组（BMI＜18.5）、正常组（18.5≤BMI＜24）、超重组（24≤BMI＜28）、肥胖组（BMI≥28）患者肺功能之间的关系;同时将患者分为老年组（年龄≥65岁）和非老年组（年龄≤64岁）,同样方法比较这两组患者的肺功能状态;检测BMI和年龄与肺功能之间的相关性。结果：营养不良组和正常组、超重组、肥胖组相比,第1秒用力呼气量占预计值的百分比（forced expiratory volume in on second, FEV1%）均存在统计学意义（P＜0.01）;正常组和超重组、肥胖组相比,FEV1%差异无统计学意义（P＞0.05）;超重组和肥胖组相比,差异无统计学意义（P＞0.05）。营养不良组与超重组、肥胖组相比,FEV1/用力肺活量（forced vital capacity, FVC）的比值差异均存在统计学意义（P＜0.01）;正常组和超重组、肥胖组相比,FEV1/FVC的差异有统计学意义（P＜0.05）。FEV1%老年组与非老年组相比,差异有统计学意义（P＞0.05）,而FEV1/FVC老年组与非老年组相比,差异有统计学意义（P＜0.05）;FEV1%和BMI呈正相关（r=0.22, P＜0.01）、FEV1/FVC和BMI呈正相关（r=0.29,P＜0.01）,年龄和FEV1%无显著相关性（r=-0.12,P＞0.05）,而年龄和FEV1/FVC呈负相关（r=-0.17, P＜0.05）。结论：慢性阻塞性肺疾病患者FEV1/FVC与患者的体质量指数和年龄均存在相关性,而体质量指数对FEV1%的影响不及对FEV1/FVC的影响,年龄对FEV1%的影响不大。     

慢性阻塞性肺疾病急性加重期与慢性阻塞性肺疾病并发社区获得性肺炎患者的临床对比

目的 探究慢性阻塞性肺疾病急性加重期与慢性阻塞性肺疾病并发社区获得性肺炎患者的临床对比,旨在为临床的诊断和治疗提供科学依据。方法 选取2017年3月~2018年3月于我院接受治疗的82例COPD患者为研究对象,按照随机数表法分为两组,其中观察组42例为AECOPD患者,对照组40例为COPD合并CAP患者,比较两组患者的临床症状、肺功能以及PCT、CRP水平。结果 观察组患者呼吸困难、咳脓痰、精神差、发热等临床症状的发生率均低于对照组,差异具有统计学意义（P＜0.05）。观察组患者FEV1、FVC、FEV1/FVC分别为（64.15±7.26）ml、（62.85±7.29）ml、（62.03±5.54）%,均高于对照组的（52.51±5.75）ml、（50.85±6.74）ml、（52.34±5.61）%,差异具有统计学意义（P＜0.05）。观察组患者PCT和CRP分别为（0.52±0.07）ng/L和（21.51±1.35）mg/L,均低于对照组的（0.97±0.08）ng/L和（40.05±1.57）mg/L,差异具有统计学意义（P＜0.05）。结论 AECOPD患者与COPD合并CAP患者相比,临床症状发生情况较少,肺功能较好,对患者进行相关检测,能够提高治疗效果。     

心肺运动试验在慢性阻塞性肺疾病中的应用

目的：探讨心肺运动试验在慢性阻塞性肺疾病中的应用意义。方法对我院收治的46例慢性阻塞性肺疾病患者(COPD组)和46例健康志愿者(对照组)进行心肺运动试验,比较两组在心肺运动试验后的心、肺功能指标。结果 COPD组患者的心功能指标Wmax、VO2max、VO2max/kg、VO2/HR max、SpO2、AT均显著低于对照组患者,<0.05;心肺运动试验中COPD组患者的肺功能指标VEmax、VTmax、VCO2max均显著低于对照组患者,<0.05;BFmax、VE/VO2AT、VE/VCO2 AT均显著高于对照组患者,<0.05。结论心肺功能试验能全面的反映慢性阻塞性肺疾病患者的疾病状况,对疾病的治疗和预后起到客观的评估作用。     

慢性阻塞性肺疾病患者和吸烟肺功能正常者体内HIF-1α表达及意义

目的探讨低氧诱导因子-1α(HIF-1α)在慢性阻塞性肺疾病(COPD)患者和吸烟肺功能正常者肺组织和血清中表达及其临床意义。方法肺组织标本取自手术治疗的周围型肺癌患者,共32例,检测术前肺功能,将其分为吸烟COPD稳定期组(COPD组,n=10),吸烟肺功能正常组(n=12),不吸烟肺功能正常组(n=10)。术前清晨空腹取血清,术后取癌旁肺组织,ELISA检测血清和肺组织匀浆HIF-1α含量,免疫组织化学方法检测肺组织HIF-1α的表达,并分析HIF-1α表达水平与肺功能指标的相关关系。结果 COPD稳定期组、吸烟肺功能正常组、不吸烟肺功能正常组患者血清HIF-1α含量分别为(73.25±6.12)pg/mL、(60.30±8.00)pg/mL、(47.03±8.43)pg/mL;吸烟肺功能正常组和COPD组明显高于不吸烟肺功能正常组(P0.01),COPD组明显高于吸烟肺功能正常组(P0.01)。COPD稳定期组、吸烟肺功能正常组、不吸烟肺功能正常组患者肺组织匀浆HIF-1α含量分别为(2.04±0.24)pg/μg、(1.67±0.34)pg/μg、(1.12±0.33)pg/μg;吸烟肺功能正常组和COPD组明显高于不吸烟肺功能正常组(P0.01),COPD组明显高于吸烟肺功能正常组(P0.01)。HIF-1α广泛表达于COPD组肺泡和气道上皮细胞、肺小动脉壁的炎症细胞以及巨噬细胞中。血清和肺组织匀浆中HIF-1α含量均与第1秒用力呼气容积与用力肺活量比(FEV1/FVC)、第1秒钟用力呼气容积占预计值百分比(FEV1%pred)呈显著负相关。结论 COPD患者和吸烟肺功能正常者肺组织和血清HIF-1α的表达增加,与气流受限有关。     

Plasma inflammatory biomarkers response to aerobic versus resisted exercise training for chronic obstructive pulmonary disease patients

BackgroundChronic obstructive pulmonary disease (COPD) is a main risk for morbidity, associated with alterations in systemic inflammation. Recent studies proved that morbidity and mortality of COPD is related to systemic inflammation as it contributes to the pathogenesis of atherosclerosis and cardiovascular disease. However, increase of inflammatory cytokines adversely affects quality of life, alteration in ventilatory and skeletal muscles functions. Moreover, exercise training has many beneficial effects in correction of the adverse effects of COPD.ObjectiveThis study aimed to compare the response of inflammatory cytokines of COPD to aerobic versus resisted exercises.ResultsThe mean values of TNF-α, Il-2, IL-4, IL-6 and CRP were significantly decreased in both groups. Also; there was a significant difference between both groups at the end of the study with more reduction in patients who received aerobic exercise training.ConclusionAerobic exercise is more appropriate than resisted exercise training in modulating inflammatory cytokines level in patients with chronic obstructive pulmonary disease.     

Effects of training at mild exercise intensities on quadriceps muscle energy metabolism in patients with chronic obstructive pulmonary disease

Aim: To study the effects of physical training at mild intensities on skeletal muscle energy metabolism in eight patients with chronic obstructive pulmonary disease (COPD) and eight paired healthy sedentary subjects. Methods: Energy metabolism of patients and controls vastus lateralis muscle was studied before and after 3 months of cycling training at mild exercises intensities. Results: The total amount of work accomplished was about 4059 ± 336 kJ in patients with COPD and 7531 ± 1693 kJ in control subjects. This work corresponds to a mechanical power set at 65.2 ± 7.5% of the maximum power for patients with COPD and 52 ± 3.3% of the maximum power in control group. Despite this low level of exercise intensities, we observed an improvement in mitochondrial oxidative phosphorylation through the creatine kinase system revealed by the increased apparent K_m for ADP (from 105.5 ± 16.1 to 176.9 ± 26.5 μm , P < 0.05 in the COPD group and from 126.9 ± 16.8 to 177.7 ± 17.0, P > 0.05 in the control group). Meanwhile, maximal mechanical and metabolic power increased significantly from 83.1 ± 7.1 to 91.3 ± 7.4 Watts (P < 0.05) and from 16 ± 0.8 to 18.7 ± 0.98 mL O₂ kg^?1 min^?1 (P < 0.05) only in the COPD group. Conclusion: This study shows that physical training at mild intensity is able to induce comparable changes in skeletal muscles oxidative energy metabolism in patients with COPD and sedentary healthy subjects, but different changes of maximal mechanical and metabolic power.     

Leukotriene pathway inhibitors in asthma and chronic obstructive pulmonary disease

Leukotrienes can be generated from a wide variety of cells including mast cells and eosinophils. The biological properties of these products include bronchial smooth muscle contraction, stimulation of mucous production, enhancement of vascular permeability, and recruitment of eosinophils. These properties can contribute significantly to the pathobiology of asthma. Recently, zafirlukast and montelukast, and zileuton, leukotriene D₄ receptor antagonists and 5-lipoxygenase inhibitors, respectively, have been developed and are available for treating asthma. Studies have found these compounds modify bronchospasm with exercise, the pulmonary reaction to aspirin in sensitive subjects, and the airway response to inhaled antigen. Furthermore, in patients with chronic asthma, leukotriene modifiers improve airflow obstruction, decrease the need for rescue medication, and diminish symptoms. Moreover, these drugs can prevent asthma exacerbations. However, there is little evidence that these medications have potent anti-inflammatory activity. Nonetheless, leukotriene modifiers represent new, and effective, therapeutics in the treatment of asthma; at present, the positioning of these products in relationship to inhaled corticosteroids, for example, in the treatment of asthma has not been fully defined but will emerge with further study and use in the clinic setting.     

慢性阻塞性肺疾病大鼠肺组织中肺表面活性物质蛋白-C表达下降

目的探讨肺表面活性物质蛋白-C(SP-C)在慢性阻塞性肺疾病(COPD)大鼠肺组织中的作用。方法将大鼠随机分为对照组、香烟烟雾暴露组、脂多糖组和COPD组,每组10只。测定各组大鼠的PaO_2和PaCO_2的水平;透射电镜观察肺组织的细胞微观结构;ELISA检测支气管肺泡灌洗液(BALF)和肺组织SP-C蛋白;RT-q PCR检测肺组织SP-C mRNA的表达。结果与其他组相比,COPD大鼠的PaO_2最低,而PaCO_2最高;肺泡Ⅱ型上皮细胞表面微绒毛明显减少(P<0.01);BALF和肺组织中SP-C蛋白表达下降(P<0.01);肺组织中的SP-C mRNA表达下降(P<0.01)。结论 SP-C在COPD大鼠肺组织中表达下调,这种下调可能引起肺通气和肺换气功能障碍。     

慢性阻塞性肺病患者心理状况及影响因素

调查慢性阻塞性肺疾病（COPD）患者心理状况和影响因素，对60例患者和60例健康者对照，应用焦虑和抑郁情绪表（HAO）对两组进行问卷调查，结果显示，患者评分显著差于健康者，年龄、病程和通气功能与患者抑郁症状和总分呈显著性相关，提示患者伴有心理障碍，重视和兼顾心理症状诊治颇有必要。     

Left heart function in chronic obstructive lung disease

Summary In patients with varying degrees of chronic obstructive pulmonary disease (COPD), simultaneous measurements of central hemodynamics and left ventricular radionuclide ventriculograms at rest and during exercise were made. In 21 of these patients, satisfactory echocardiograms could be performed. In seven of the patients, arterial blood pressure at rest was increased. Decreased compliance of the left ventricle was thought to be present in patients with COPD and additional arterial hypertension. The left ventricular ejection fraction (LVEF) at rest was in the high normal range in all patients. During exercise, no further increase was observed. This pattern of LVEF response seems to be typical in patients with COPD. Because the highest values were observed in the more severe COPD and right ventricular hypertrophy, it is unlikely that an impairment of left ventricular function is caused by COPD. In five of 27 patients, an abnormal decrease of LVEF and regional hypokinesis occurred during exercise, thus suggesting additional coronary heart disease. The fact that at least 30% of the patients with COPD suffered from arterial hypertension and 20% of the patients exhibited unexpected ischemia detected by regional hypokinesis in RNV during exercise, but not in the ECG, may be of practical relevance. Coronary angiography was not indicated because most of these patients were over 65 and the factor limiting the working capacity was ventilatory impairment and not angina pectoris, in all patients. For this reason, a diagnostic uncertainty remains with regard to additional coronary heart disease in the older patients with advanced chronic obstructive pulmonary disease.Lung Function Parameters VC (1) inspiratory vital capacity - FEV1 (1) forced exspiratory volume in 1 sec - Raw (cmH20/l/s) airways resistance - RV/TLC (%) residual volume/total lung capacity - paO₂ (mm Hg) O₂ partial pressure Hemodynamic Parameters CI (1/min/sqm) cardiac index - SVI (ml/sqm) stroke volume index - PAP (mm Hg) pulmonary artery mean pressure - PwP (mm Hg) pulmonary capillary wedge pressure - RRs (mm Hg) systolic arterial pressure - RRd (mm Hg) diastolic arterial pressure (at the time of catheterization) - RR(WHO) (mm Hg) mean values measured at different days (at least 3 values). Parameters Derived from Combined Radionuclide Ventriculography and Central Hemodynamics LVEF (%) left ventricular ejection fraction - LVESVI (ml/sqm) left ventricular endsystolic volume index - P/V (mm Hg/ml/sqm) peak systolic pressure/endsystolic volume index - PFR (1/sec) peak filling rate: endsystolic volume/sec Echocardiographic Parameters RV d wth (mm) right ventricular enddiastolic wall thickness - LV d wth (mm) left ventricular enddiastolic wall thickness In honor to Prof. W.E. Adam's 60th birthday     

慢性阻塞性肺疾病稳定期患者应用远程康复效果的Meta分析

文题释义：肺康复：指对有症状、日常生活能力下降的慢性呼吸系统疾病患者采取的多学科综合干预措施,是慢性肺部疾病的一项非药物治疗措施,其目标是缓解症状和降低未来急性加重的发生风险。远程康复：是以多媒体技术为基础,通过计算机和网络技术手段,与大型医院的医疗技术相结合,提供远距离在线康复医疗信息和技术服务。背景：由于行动不便,缺乏交通和旅行费用,使慢性阻塞性肺疾病稳定期患者难以获得以中心为基础的肺康复服务,而远程康复技术使这些患者获得肺康复的机会。目的：分析远程康复在慢性阻塞性肺疾病稳定期患者肺康复中的应用效果。方法：以 “远程”“康复”“慢性阻塞性肺疾病”和“telerehabilitation”“Chronicobstructive pulmonary disease”等为中、英文检索词,从PubMed、The Cochrane library和中国知网等数据库中检索文献,根据纳入和排除标准独立筛选文献、提取数据,并行文献质量评价。运用RevMan5.3软件对数据进行荟萃分析。结果与结论：共纳入21篇RCT研究,共3 033例慢性阻塞性肺疾病稳定期患者。Meta分析结果显示：干预组与对照组比较,第1秒用力呼气容量/用力肺活量比值显著升高[MD=5.11,95%CI(4.05,6.17),Z=9.49,P < 0.00001]和CAT评分明显降低[MD=-3.54,95%CI(-5.61,-1.46),Z=3.34,P=0.000 8],差异均有显著性意义(P < 0.05)。干预组与对照组比较,6 min步行距离、第1秒用力呼气容量/预计值%、mMRC评分和SGRQ得分,差异均无显著性意义(P > 0.05)。结果表明,远程康复为慢性阻塞性肺疾病稳定期患者提供了一种新的肺康复方式,能促进患者疾病康复和加强自我管理能力。ORCID: 0000-0003-4506-8394(丁美祝)中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Pulmonary involvement in type 1 Gaucher disease: functional and exercise findings in patients with and without clinical interstitial lung disease

Pulmonary disease is a well-known complication of Type 1 Gaucher disease (GD), although its incidence is not well established and its severity varies. The purpose of this study was to determine the frequency and extent of pulmonary involvement in patients with GD. Pulmonary involvement was assessed by history, physical examination and chest radiograph in 150 consecutive patients with Type 1 GD presenting at a specialized center for genetic diseases. Five patients were noted to have clinical evidence of pulmonary involvement. Full pulmonary function tests were performed in these five patients and in an additional 13 patients randomly selected from the remaining 145. Many of the 18 patients also underwent radionuclide body imaging with 67 Gallium citrate and 111Indium-tagged leucocyte scans, as well as incremental cardiorespiratory exercise tests. Lung biopsies were available in two patients with lung disease, and a second examination of lung tissue was performed in one of these two patients post-mortem. Clinical lung disease was detected in five patients. All five had dyspnea, diffuse infiltrates, restrictive impairment and low single breath CO diffusing capacity (DLCOSB). Two of these patients underwent exercise testing and showed abnormalities consistent with lung disease (ventilatory limitation, excessive ventilation and increased dead space) as well as decreased VO2 max. and anaerobic threshold (AT). In contrast, in the other 13 patients, physical examination, chest radiographs and pulmonary function were normal (except for a low DLCOSB in one patient). Responses on exercise testing (performed in six of the 13 patients) were consistent with a circulatory impairment (decreased VO2 max. and AT). Our study found that <5% of patients with Type 1 GD have clinical interstitial lung disease. In addition, we found that some patients, without evident lung involvement, may experience limitations in physical exertion and are easily fatigued; this is attributable to impaired circulation.     

Preoperative pulmonary rehabilitation in patients with non-small cell lung cancer and chronic obstructive pulmonary disease

Introduction

The aim of this study was to assess the effects of preoperative pulmonary rehabilitation (PPR) on preoperative clinical status changes in patients with chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer (NSCLC), and net effects of PPR and cancer resection on residual pulmonary function and functional capacity.

Material and methods

This prospective single group study included 83 COPD patients (62 ±8 years, 85% males, FEV₁ = 1844 ±618 ml, Tiffeneau index = 54 ±9%) with NSCLC, on 2–4-week PPR, before resection. Pulmonary function, and functional and symptom status were evaluated by spirometry, 6-minute walking distance (6MWD) and Borg scale, on admission, after PPR and after surgery.

Results

Following PPR significant improvement was registered in the majority of spirometry parameters (FEV₁ by 374 ml, p < 0.001; VLC by 407 ml, p < 0.001; FEF₅₀ by 3%, p = 0.003), 6MWD (for 56 m, p < 0.001) and dyspnoeal symptoms (by 1.0 Borg unit, p < 0.001). A positive correlation was identified between preoperative increments of FEV₁ and 6MWD (r _s = 0.503, p = 0.001). Negative correlations were found between basal FEV₁ and its percentage increment (r _s = –0.479, p = 0.001) and between basal 6MWD and its percentage change (r _s = –0.603, p < 0.001) during PPR. Compared to basal values, after resection a significant reduction of most spirometry parameters and 6MWD were recorded, while Tiffeneau index, FEF₂₅ and dyspnoea severity remained stable (p = NS).

Conclusions

Preoperative pulmonary rehabilitation significantly enhances clinical status of COPD patients before NSCLC resection. Preoperative increase of exercise tolerance was the result of pulmonary function improvement during PPR. The beneficial effects of PPR were most emphasized in patients with initially the worst pulmonary function and the weakest functional capacity.