慢性阻塞性肺病患者新喋呤浓度及与病情严重程度的关系

目的:探讨新喋呤浓度与慢性阻塞性肺病(chronic obstruction pulmonary disease,COPD)患者病情严重程度的关系。方法:纳入华中科技大学同济医学院附属武汉中心医院COPD患者65例为COPD组,25名健康者为对照组,ELISA检测COPD组与对照组血清和痰液中新碟呤浓度,分析其和COPD严重程度的关系。结果:COPD组血清中新喋呤浓度高于对照组[(20.34±4.70)nmol/L vs(6.27±3.35)nmol/L,t=5.556,P=0.015];COPD组痰液中新喋呤浓度高于对照组[(32.07±8.14)nmol/L vs(4.13±2.25)nmol/L,t=7.483,P=0.005];COPD稳定期患者血清中新喋呤浓度低于COPD急性恶化期患者[(14.69±4.76)nmol/L vs(23.47±2.56)nmol/L,t=3.005,P=0.042];COPD稳定期患者痰液中新喋呤浓度低于COPD急性恶化期患者[(27.91±5.95)nmol/L vs(39.94±5.47)nmol/L,t=4.723,P=0.020]。COPD极重度患者血清和痰液新喋呤浓度高于轻、中、重度患者,血清和痰液新喋呤浓度间呈正相关(r=0.679,P<0.001)。目前吸烟者血清新碟呤浓度高于过去吸烟者和非吸烟者(F=4.972,P=0.037),目前吸烟者痰液新碟呤浓度高于过去吸烟者和非吸烟者(F=5.830,P=0.021)。结论:COPD患者血清与痰液中新蝶呤浓度与患者病情严重程度相关,且与患者吸烟状况相关。     

Inspiratory muscle strength in chronic obstructive pulmonary disease depending on disease severity

Staging criteria for COPD (chronic obstructive pulmonary disease) include symptoms and lung function parameters, but the role of reduced inspiratory muscle strength related to disease severity remains unclear. Therefore the present study tested whether inspiratory muscle strength is reduced in COPD and is related to disease severity according to GOLD (Global Initiative for Chronic Obstructive Lung Disease) criteria and assessed its clinical impact. PImax (maximal inspiratory mouth occlusion pressure), SnPna (sniff nasal pressure) and TwPmo (twitch mouth pressure) following bilateral anterior magnetic phrenic nerve stimulation were assessed in 33 COPD patients (8 GOLD(0), 6 GOLD(I), 6 GOLD(II), 7 GOLD(III) and 6 GOLD(IV)) and in 28 matched controls. Furthermore, all participants performed a standardized 6 min walking test. In comparison with controls, PImax (11.6+/-2.5 compared with 7.3+/-3.0 kPa; P<0.001), SnPna (9.7+/-2.5 compared with 6.9+/-3.3 kPa; P<0.001) and TwPmo (1.6+/-0.6 compared with 0.8+/-0.4 kPa; P<0.001) were markedly lower in COPD patients. TwPmo decreased with increasing COPD stage. TwPmo was correlated with walking distance (r=0.75; P<0.001), dyspnoea (r=-0.61; P<0.001) and blood gas values following exercise (r>0.57; P<0.001). Inspiratory muscle strength, as reliably assessed by TwPmo, decreased with increasing severity of COPD and should be considered as an important factor in rating disease severity and to reflect burden in COPD.     

慢性阻塞性肺病并发抑郁障碍相关因素分析

目的探讨慢性阻塞性肺病患者并发抑郁障碍的相关因素。方法对162例慢性阻塞性肺病患者采用抑郁自评量表与自行设计的影响心理状态因素调查表进行抑郁状况和负性精神因素与抑郁障碍关系的调查。结果49．4％的慢性阻塞性肺病患者存在不同程度的抑郁障碍,其中轻度24．1％,中度16．7％,重度8．6％。慢性阻塞性肺病并发抑郁障碍者较未并发抑郁障碍者的病程长（P〈0．01）．动脉血氧分压和肺通气功能下降,动脉血二氧化碳分压升高（P〈0．01）;抑郁程度分别与生命安全感、无法根治、运动受限、影响家庭关系、经济负担重等因素呈正相关。结论生命安全感缺乏、无法根治、运动受限、影响家庭关系、经济负担重等因素是慢性阻塞性肺病患者易并发抑郁障碍的危险因素。     

Measurement of pulmonary artery to aorta ratio in computed tomography is correlated with pulmonary artery pressure in critically ill chronic obstructive pulmonary disease patients

AimChronic obstructive pulmonary disease (COPD) is one of the leading chronic diseases and a common cause of death. Identification of COPD patients at high risk for complications and mortality is of utmost importance. Computed tomography (CT) can be used to measure the ratio of the diameter of the pulmonary artery (PA) to the diameter of the aorta (A), and PA/A ratio was shown to be correlated with PA pressure (PAP). However, the prognostic value of PA size remains unclear in patients with COPD. We hypothesized that PA enlargement, as shown by a PA/A ratio greater than 1, could be associated with a higher risk of mortality in COPD patients admitted to the intensive care unit.MethodsData of patients admitted to a medical intensive care unit of a university hospital were retrospectively reviewed between January 2008 and December 2012. Patients who were identified to have a diagnosis of acute exacerbation of COPD and who had an echocardiogram and CT scan were included. Pulmonary artery to aorta ratio was calculated and patients were grouped as PA/A ≤ 1 and PA/A > 1. Comparisons were made between the groups and between patients who died and survived. Correlation analysis, survival analysis, and logistic regression analysis were done, where appropriate.ResultsOne hundred six COPD patients were enrolled. There were 40 (37.4%) patients who had a PA/A > 1. Echocardiography measured PAP was higher in the group with PA/A > 1 than in those with PA/A ≤ 1 (62.1 ± 23.2 mm Hg vs 45.3 ± 17.9 mm Hg, P = .002). Mortality rate of patients with PA/A > 1 was higher (50%) than of those patients with PA/A ≤ 1 (36.4%), although the difference did not reach a statistical significance (P = .17). Correlation was found between vmeasured PA diameter and PAP (r = 0.51, P = .001) as well as between the Acute Physiology and Chronic Health Evaluation II values and PAP (r = 0.25, P = .025).ConclusionThe PA/A ratio is an easily measured method that can be performed on thorax CT scans. Although, we failed to demonstrate a statistically significant association between higher PA/A and increased mortality, PA/A can be used as a surrogate marker to predict the pulmonary hypertension.     

Nasal symptoms, airway obstruction and disease severity in chronic obstructive pulmonary disease

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized by inflammation of the lung in association with airflow obstruction. There is increasing evidence of upper airway involvement in COPD and we have reported that this nasal inflammation is proportional to that in the lung. Given recognized relationships between lower airway inflammation and spirometric indices such as the Forced Expiratory Volume in one second (FEV(1)), we hypothesized that there may be a relationship between nasal obstruction and FEV(1) in COPD. We also sought to investigate relationships between nasal symptoms and nasal patency in COPD. METHODS: We assessed the nasal and pulmonary airways, using acoustic rhinometry and spirometry respectively, in 51 patients with COPD. RESULTS: The presence of chronic nasal symptoms in COPD was associated with reduced nasal patency (6.04 cm(2) symptoms vs. 9.55 cm(2) no symptoms, at the second minimum cross-sectional area, P = 0.049). Nasal patency in COPD was inversely proportional to pulmonary airflow obstruction, and therefore to COPD disease severity (e.g. FEV(1)% predicted vs. second minimum cross-sectional area, r = 0.36, P = 0.009). CONCLUSIONS: The degree of nasal airway obstruction in COPD reflects the impairment to pulmonary airflow, and is greater in the presence of chronic nasal symptoms. This study provides further evidence of pan-airway involvement in COPD.     

Study of peripheral muscle strength and severity indexes in individuals with chronic obstructive pulmonary disease

Background and Purpose. Individuals with chronic obstructive pulmonary disease (COPD) present reduced peripheral muscle strength, which leads to impaired mobility and increased mortality risk. However, it is not clear whether there is any relationship between muscle strength, muscle mass and the body mass index, airflow obstruction, dyspnea, exercise performance (BODE) index scale, which is considered to be the best predictor of survival for individuals with COPD. The BODE Index is a multidimensional system that measures body composition (B), airway obstruction (O), dyspnea perception (D) and the ability to exercise (E), and rates the severity of the major changes found in individuals with COPD. The objective of this study was to verify any relationship between the BODE Index, muscle mass and maximum muscle strengths of the upper limb (UL) and lower limb (LL) in subjects with moderate to very severe COPD. Methods. Twenty‐six individuals with moderate to very severe COPD were evaluated by body composition (body mass index and muscle mass), BODE Index, handgrip strength (HS) and one repetition maximum (1RM) test of the UL and LL. Results. There was a positive correlation (Pearson, p < 0.05) of peripheral muscle strength, evaluated by HS and 1RM (pectoral and triceps, round muscles and dorsal section, quadriceps), to muscle mass (0.74, 0.57, 0.74 and 0.62, respectively) and the distance walked in the six‐minute walking test (0.52, 0.50, 0.46 and 0.58, respectively), but no correlation of muscle strength was found to forced expiratory volume in one second to dyspnea or the BODE Index. Conclusion. In accordance with the results of this study, peripheral muscle strength as measured by HS and 1RM is not related to the severity indexes for COPD, unlike UL and LL muscle strength. Therefore, UL and LL measurements now have an additional importance in COPD evaluation. Copyright © 2010 John Wiley & Sons, Ltd.     

MSCT诊断慢性阻塞性肺疾病合并慢性肺源性心脏病

目的 比较不同严重程度慢性阻塞性肺疾病（COPD）及COPD合并慢性肺源性心脏病患者右心室功能,评价MSCT诊断COPD合并慢性肺源性心脏病的价值。方法 对53例COPD患者（轻中度组13例、重度组22例及合并慢性肺源性心脏病组18例）和36名健康志愿者（对照组）行肺功能和MSCT检查。记录肺功能和右心室功能参数。比较各组右心室功能差异,分析COPD患者肺功能与右心室功能的相关性。分别绘制右心室每搏输出量（SV）、射血分数（EF）的ROC曲线,评价MSCT在COPD合并慢性肺源性心脏病中的诊断价值。以预试验确定的右心室SV<48 ml或EF<40%作为诊断慢性肺源性心脏病的标准,计算诊断敏感度和特异度。结果 4组间右心室舒张末容积（EDV）、EDV/体质量指数（BMI）、SV、SV/BMI及EF差异有统计学意义（P均<0.05）,而收缩末容积（ESV）及ESV/BMI差异无统计学意义（P均>0.05）。COPD患者右心室SV/BMI、EF与第1秒用力呼气容积（FEV1）（r=0.321、0.296,P=0.019、0.031）、第1秒用力呼气容积/用力肺活量（FEV1/FVC）（r=0.305、0.280,P=0.026、0.043）及FEV1占预计值百分比（FEV1%_pred;r=0.457、0.351,P=0.001、0.001）均呈正相关。分别绘制右心室EF、SV ROC曲线,AUC分别为0.973、0.930（P均<0.001）,MSCT诊断慢性肺源性心脏病的敏感度分别为77.77%、77.77%,特异度分别为98.59%、88.63%。结论 COPD患者在未达到慢性肺源性心脏病诊断标准前右心室功能已出现减退,且其肺功能与右心室功能呈正相关。MSCT能早期发现COPD患者右心室功能不全,且对于诊断慢性肺源性心脏病具有重要价值。     

慢性阻塞性肺疾病合并肺间质纤维化的临床研究

目的研究慢性阻塞性肺疾病（COPD）合并肺间质纤维化的临床特点及意义,并探讨其临床诊断要点.方法对近8年来临床确诊的36例COPD合并肺间质纤维化病例进行临床与影像学的回顾性分析研究,其中肺气肿合并肺纤维化11例,肺心病合并肺纤维化25例.结果 COPD合并肺间质纤维化的临床表现多数界于上述两种病变之间,胸部X线及CT兼具二者特点,肺纤维化病变在肺心病组多见.结论 COPD合并肺间质纤维化具有其独特的临床与影像学特征,其中临床症状及胸片是诊断的重要线索,高分辨率CT是临床确诊的最佳方法.     

Diagnosis of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease affects more than 26 million adults in the United States. Family physicians provide care for most of these patients. Cigarette smoking is the leading risk factor for chronic obstructive pulmonary disease, although other risk factors, including occupational and environmental exposures, account for up to one in six cases. Patients presenting with chronic cough, increased sputum production, or progressive dyspnea should be evaluated for the disease. Asthma is the disease most often confused with chronic obstructive pulmonary disease. The diagnosis of chronic obstructive pulmonary disease is based on clinical suspicion and spirometry confirmation. A forced expiratory volume in one second/forced vital capacity ratio that is less than 70 percent, and that is incompletely reversible with the administration of an inhaled bronchodilator, suggests chronic obstructive pulmonary disease. Disease severity is classified by symptomatology and spirometry. Joint guidelines from the American Thoracic Society and the European Respiratory Society recommend a single quantitative test for alpha1-antitrypsin deficiency in patients diagnosed with chronic obstructive pulmonary disease who remain symptomatic despite bronchodilator therapy. Other advanced testing is usually not necessary.     

Genetics of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a complex disease that results from the interaction of multiple genetic and environmental factors. Different approaches have been used to identify the genetic factors: genome-wide linkage study, gene expression profiling, candidate gene association study, and genome-wide association study. Although many genes responsible for susceptibility to COPD have been reported, most of them have not been replicated in other study populations. Difficulty in replication is attributed to the genetic and phenotypic heterogeneity of the disease as well as the small influence of each gene on the development of the disease. A more precise definition is required for the characterization of different COPD phenotypes such as emphysema and small airway disease. A combination of several approaches using the improved phenotypes will lead to detection of novel susceptibility genes and new therapeutic targets.     

Therapy of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is one of the commonest causes of morbidity and mortality in the world, and is increasing in prevalence. Current therapies are not very effective, and no current treatment prevents the relentless progression of airflow limitation that characterizes this disease. Smoking cessation is the only strategy that reduces this decline in lung function, and although bupropion is the most effective aid to quitting, more effective treatments of nicotine addiction are needed. The mainstay of treatment is bronchodilators for symptom relief, and inhaled anticholinergics and beta(2)-agonists are useful by reducing hyperinflation of the lungs. A new once-daily inhaled anticholinergic is the most effective bronchodilator, but long-acting inhaled beta(2)-agonists are also useful. Theophylline is used as an additional bronchodilator in more severe patients, and may have some anti-inflammatory action. In contrast, inhaled corticosteroids are poorly effective and do not reduce disease progression, although recent studies with combination inhalers (corticosteroid + long-acting beta(2)-agonist) have shown better effects. Long-term oxygen therapy is needed by patients with pulmonary hypertension and right heart failure. There is a pressing need to develop new classes of therapy, and several new drugs are current in development, including interleukin-8 antagonists, phosphodiesterase-4 inhibitors, protease inhibitors, and antioxidants.     

慢性阻塞性肺疾患的康复

近年来 ,随着发病率和致残率的不断升高 ,慢性阻塞性肺疾患已成为中国及一些西方发达国家前 5位的死亡原因。慢性阻塞性肺疾患 (ｃｈｒｏｎｉｃｏｂｓｔｒｕｃｔｉｖｅｐｕｌ ｍｏｎａｒｙｄｉｓｅａｓｅ ,ＣＯＰＤ)的主要症状之一是呼吸困难 ,因此而引起的并发症是致残的主要原因。肺康复的主要内容即是针对ＣＯＰＤ的。根据我国 6 0 0 0多万人口的普查 ,不同地区ＣＯＰＤ的发病率最低为 0 .6 %,最高为 4 .3%,严重地影响了人民群众的健康。康复训练和治疗对于预防ＣＯＰＤ发展为慢性肺源性心脏病和右心衰竭 ,改善患者的健康状况、提高患者…     

Fatigue in patients with chronic obstructive pulmonary disease

BACKGROUND: Fatigue is a frequently occurring symptom in patients with chronic obstructive pulmonary disease (COPD). Despite this, relatively few studies have objectively assessed patients' perceptions of fatigue and the impact of perceived fatigue on their everyday lives. OBJECTIVE: The purpose of this study was to describe the prevalence, duration and severity of fatigue among patients with COPD and the impact of perceived fatigue on cognitive, physical and psychosocial functioning in comparison with controls. METHOD: The Fatigue Impact Scale, including physical, psychosocial and cognitive dimension and structured questions about the frequency, duration, and severity of fatigue was mailed to 44 outpatients with COPD and 88 randomly selected age- and sex-matched controls. In total 36 patients and 37 controls completed the questionnaire. RESULTS: Almost half of the patients (47.2%), reported fatigue every day during the preceding month compared with 13.5% of the control group (P < 0.001). The duration of fatigue was more than 6 hours in 52.7% of the patients and 44.4% reported that fatigue was either the worst or one of the worst symptoms they had, compared with 18.9% (P < 0.001) and 10.8% (P < 0.01) in the control group. The patients reported a significantly greater impact of fatigue on cognitive, physical and psychosocial functioning compared with the control group (P < 0.001). CONCLUSION: These findings indicate that fatigue is a highly prevalent symptom, which impacts on patients' functional condition and needs to be professionally assessed and managed.