慢性阻塞性肺疾病诊治进展

慢性阻塞性肺疾病(COPD)仍然是一个重要的公共卫生问题,也是病死率呈上升趋势的少数慢性疾病之一.近几年COPD发病机制、全身效应、急性发作和治疗等方面都有许多新的进展.目前COPD已被定义为可以预防、可以治疔的疾病,除了肺部病变的特点外,还伴有一些与患者疾病严重性相关的显著的肺外效应.本文从定义、诊断、病情评估和治疗...     

慢性阻塞性肺疾病呼吸衰竭的诊治进展

慢性阻塞性肺疾病(COPD)呼吸功能损害的患者,常因疲劳、气候变化而发生呼吸系统感染(通常为病毒感染伴随细菌感染),其次可因以下多种因素发生感染,如老年者易引起吸入性肺炎、自发性气胸、肺栓塞、心力衰竭、不适当的氧疗以及合并其他疾病(糖尿病、电解质紊乱、营养不良)等,使病情恶化,缺O2或伴CO2潴留加重引起呼吸衰竭发生。 据患者原呼吸功能损害的情况,可出现不同程度的临床表现。喉痒、咳嗽增加,尤为早晚加重,白色粘痰变为脓性痰、痰量增多,呼吸困难加重伴发热。严重肺气肿、肺心病、营养差的患者可无发热,仅感胸闷气急加重,无力、纳差、发绀加重。呼吸由慢而深变为浅而快,辅助呼吸肌参加运动。因缺氧、CO2潴留失代偿性酸中毒致患者精神、神志改变,亦可见下肢浮肿,球结膜充血水肿,大量出汗。体检可闻及两下肺干湿罗音增多,并有哮喘者则两肺可闻及广泛哮鸣音,血压升高。     

慢性阻塞性肺疾病

1慢性阻塞性肺疾病的定义慢性阻塞性肺疾病(COPD)是呼吸系统的一种慢性疾病,在全球患病率和死亡率呈明显上升趋势,严重影响患者的劳动能力和生活质量,由于临床上对该病名使用的不统一性,在医生和患者中造成概念模糊,也影响流行病学的调查。2001年4月美国国立心、肺、血液研究所(NHLBI)和世界卫生组织(WHO)共同发表了《慢性阻塞性肺疾病全球倡议》(GlobalInitiativeforChronicObstructiveLungDisease,GOLD)为COPD制定了新的定义。GOLD认为COPD是一种以气流受限为特征的疾病,这种气流阻塞呈进行性发展,有不少患者最终发展为慢性…     

慢性阻塞性肺疾病治疗进展

慢性阻塞性肺疾病（COPD）是一种重要的慢性呼吸系统疾病，本文综述了近年来在COPD治疗上的最新进展，包括COPD药物应用，手术治疗及氧疗等。     

慢性阻塞性肺疾病的治疗

广州陈荣昌在无创正压通气(NIPPV)治疗COPD患者急性发作的专题报告中指出,NIPPV早期应用能显著改善急性发作期COPD患者的症状和血气指标,显著降低气管插管率,如果住院患者的pH≥7·25及PaCO2>45mmHg,使用NIPPV是安全有效的。但对NIPPV应用于呼吸衰竭严重程度的时机及脱机患者使用NIPPV的特点仍有待进一步研究。泰国的Tantrakul报道,夜间使用持续气道正压通气可改善稳定期COPD患者的6m in步行距离和生活质量。广州李靖报道,细菌提取物(Bronchovaxom)的治疗对COPD的急性发作频率、持续时间和严重程度有改善作用。关于亚太…     

吸烟与慢性阻塞性肺疾病

布伦特兰博士于１９９８年５月１３日在第５１届世界卫生大会上当选为新的总干事,她宣布,上任后首先要抓控制吸烟和防治疟疾。烟草引起全球每年死亡人数达３００万。若目前对吸烟情况不加抑制,到２０２５年每年死于烟草危害者将增至１０００万。在我国,目前死于烟草危害者已达６０～７０万,到２０２５年将达２００万。烟草雾首先进入呼吸道,故呼吸系统最大程度受到危害。在工业发达国家,肺癌是吸烟造成死亡的首要疾病;而在我国,大规模、高水平的流行病学调查结果［１,２］显示,慢性阻塞性肺疾病（简称慢阻肺）是人们吸烟造成死亡…     

慢性阻塞性肺疾病的治疗研究进展

慢性阻塞性肺疾病(COPD)以不完全可逆的气流受限为特点,是小气道病变(闭塞性细支气管炎)和肺实质破坏(肺气肿)共同作用的结果.COPD的高发病率和病死率导致了巨大的经济和社会负担,而且这种负担在不断增加.目前普遍用于COPD的药物治疗如支气管扩张剂、糖皮质激素等,其疗效有一定的局限性.随着对这一疾病的深入认识,很多基于COPD发病的细胞和分子机制的研究为其临床治疗奠定了基础,本文就近年来对COPD治疗的研究进展作一综述.     

慢性阻塞性肺疾病的治疗近况

慢性阻塞性肺疾病(COPD)是一种以进行性,不完全可逆的以气流受限为特征的慢性炎症性呼吸系统疾病〔1,2〕。目前普遍认为COPD以气道、肺实质和肺血管的慢性炎症为特征。另外,肺部的蛋白酶和抗蛋白酶失衡及氧化与抗氧化失衡也在COPD发病中起重要作用。气道炎症、气流受限、黏液纤毛功能障碍和气道结果的改变均导致患者肺功能下降,而以药物为主的综合治疗,是COPD的主要治疗手段,以下对其治疗情况进行综述。     

Contemporary Concise Review 2022: Chronic obstructive pulmonary disease

• International respiratory organizations now recommend using lower limit of normal and standardized residuals to diagnose airflow obstruction and COPD though using a fixed ratio <0.7 is simpler and robustly predicts important clinical outcomes.
• The most common COPD comorbidities are coronary artery calcification, emphysema and bronchiectasis. COPD patients with psychological (high anxiety and depression) and cachectic (underweight and osteoporotic) comorbidity have higher mortality and exacerbate more.
• Serum eosinophil count remains an important COPD biomarker and we have greater clarity about normal eosinophil levels in COPD and the wider population.
• Criteria for entry into COPD clinical trials continue to exclude many patients, in particular those at greater risk of exacerbation and death.
• The effect of hyperinflation on cardiac function impacts COPD mortality and is an important target for successful lung volume reduction procedures.

     

COPD合并肺间质纤维化4例报告并文献复习

目的探讨慢性阻塞性肺疾病合并肺间质纤维化(PF-COPD)的临床特点。方法报告我院PF-COPD4例,回顾性分析文献报道的PF-COPD47例,并与我院同期收治的特发性肺间质纤维化(IPF)9例及随机抽取慢性阻塞性肺疾病(COPD)40例。对比分析其临床症状、胸部体征、影像学检查、肺功能及血气分析结果。结果PF-COPD的临床表现介于两种疾病之间,肺功能检查呈混合性通气功能障碍及弥散功能下降,血气分析表现以低氧血症为主,胸部X线及CT兼具两者特点。结论PF-COPD的确存在,具有其独特的临床特点。     

Association between glycated haemoglobin and the risk of chronic obstructive pulmonary disease: A prospective cohort study in UK biobank

Aims

To investigate the association between glycated haemoglobin (HbA1c) levels and chronic obstructive pulmonary disease (COPD) incidents in the general population, and the association between HbA1c levels and mortality in patients with COPD.

Materials and Methods

We investigated the association of HbA1c levels with COPD risk in the general population in the UK Biobank, using data from 420 065 participants. Survival analysis was conducted for 18 854 patients with COPD. We used restricted cubic spline analysis to assess the dose-response relationship between HbA1c levels and COPD risk and survival. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).

Results

During a median follow-up of 12.3 years, 11 556 COPD cases were recorded. HbA1c had a non-linear relationship with COPD risk (p for non-linearity < .05). Compared with the quintile 2 (32.2-<34.3 mmol/mol), those with HbA1c levels above 38.7 mmol/mol (quintile 5) had a 22% (HR, 1.22, 95% CI: 1.15-1.30) higher risk of COPD. Compared with the HbA1c decile 2 (30.5-<32.2 mmol/mol), the HRs (95% CI) of COPD risk were 1.16 (1.03-1.30) and 1.36 (1.24-1.50) in the lowest HbA1c decile (<30.5 mmol/mol) and highest decile (≥41.0 mmol/mol), respectively. The increased COPD risk associated with HbA1c was more pronounced in younger, current smokers, passive smokers, and participants with a higher Townsend deprivation index (all p for interaction < .05). Among patients with COPD, 4569 COPD cases died (488 because of COPD) during a median follow-up of 5.4 years. Regarding COPD survival, HbA1c had a non-linear relationship with all-cause death (p for non-linearity < .05). Those with HbA1c quintile 5 (≥38.7 mmol/mol) had a 23% (HR, 1.23, 95% CI: 1.10-1.37) higher risk of all-cause death compared with the quintile 2 (32.2-<34.3 mmol/mol). Compared with the HbA1c decile 4 (33.3-<34.3 mmol/mol), those in the lowest HbA1c decile (<30.5 mmol/mol) and highest HbA1c decile (≥41.0 mmol/mol) had 22% (HR, 1.22; 95% CI: 1.01-1.47) and 28% (HR, 1.28; 95% CI: 1.11-1.48) higher risk for overall death. However, no significant association was observed between HbA1c levels and the risk of COPD-specific death.

Conclusions

Our findings indicated that lower and higher HbA1c levels were associated with a higher risk of COPD. In COPD cases, lower and higher HbA1c levels were associated with a higher COPD all-cause death risk.     

Socioeconomic circumstances and incidence of chronic obstructive pulmonary disease (COPD) in an urban population in Sweden

The association between socioeconomic circumstances and incidence of chronic obstructive pulmonary disease (COPD) was investigated in an urban population in Sweden. The study included all 40–89 year-old inhabitants in Malmö, Sweden (N?=?117,479) without previous hospitalization due to COPD, who were followed over 14 years for COPD related hospital admissions. The Malmö Preventive Project (MPP) cohort (n?=?27,358) with information on biological and lifestyle factors was also used to study the association between socioeconomic circumstances and COPD. The Swedish hospital discharge register was used to record incidence of COPD hospitalizations. A total of 2,877 individuals (47.5% men) were discharged from hospital with COPD as the primary diagnosis during follow-up in Malmö. Low annual income (hazard ratio (HR): 2.23; 95%CI: 1.97–2.53, P?P?P?P?1, BMI, age and sex. However, socioeconomic circumstances were not associated with COPD in analyses restricted to never smokers. Low socioeconomic circumstances were associated with an increased risk of COPD after adjustments for biological and lifestyle risk factors including smoking status. However, this relationship was not significant in those who never smoked.     

A nationwide cohort study of the risk of chronic obstructive pulmonary disease in coeliac disease

Abstract. Ludvigsson JF, Inghammar M, Ekberg M, Egesten A (Örebro University Hospital, Örebro; Karolinska Institutet, Stockholm; and Lund University, Skåne University Hospital, Lund, Sweden). A nationwide cohort study of the risk of chronic obstructive pulmonary disease in coeliac disease. J Intern Med 2012; 271 : 481–489. Objective. Chronic obstructive pulmonary disease (COPD) continues to be an important cause of morbidity, mortality and healthcare costs in the western world. Although smoking is an important trigger of COPD, other factors such as chronic inflammation and malnutrition are known to influence its development. Because coeliac disease (CD) is characterized both by dysregulated inflammation and malnutrition, the possibility of an association between CD and COPD was investigated. Methods. Through biopsy data from all Swedish pathology departments, we identified 10 990 individuals with CD who were biopsied between 1987 and 2008 (Marsh 3: villous atrophy). As controls, 54 129 reference individuals matched for age, sex, county and calendar year of first biopsy were selected. Cox regression analysis was then performed to estimate hazard ratios (HRs) for having a diagnosis of COPD according to the Swedish Patient Register. Results. During follow‐up, 380 individuals with CD (3.5%) and 1391 (2.6%) controls had an incident diagnosis of COPD, which corresponds to an HR of 1.24 (95% CI: 1.10–1.38) and an excess risk of COPD of 79/100 000 person‐years in CD. The risk increase remained 5 years after biopsy (HR = 1.17; 95% CI: 1.00–1.37). Risk estimates did not change with adjustment for type 1 diabetes, thyroid disease, rheumatoid arthritis, country of birth or level of education. Men with CD were at a higher risk of COPD (HR = 1.39; 95% CI: 1.18–1.62) than women with CD (HR = 1.11; 95% CI: 0.94–1.30). Of note, CD was also associated with COPD before CD diagnosis (odds ratio = 1.22; 95% CI: 1.02–1.46). Conclusion. Patients with CD seem to be at a moderately increased risk of COPD both before and after CD diagnosis.     

老年慢性阻塞性肺疾病并肺诺卡菌感染9例临床分析

目的探讨老年慢性阻塞性肺疾病并肺诺卡菌感染患者的临床特征、影像学特点及治疗转归,提高该病的早期诊断及治疗水平。方法回顾性分析我院2014.1-2018.12收治的9例慢性阻塞性肺疾病并肺诺卡菌感染老年患者的临床资料,并进行文献复习。结果9例中男性6例,女性3例,年龄65~83岁,平均年龄73.78±6.14岁;6例长期吸入糖皮质激素,4例合并2型糖尿病;常见症状有发热、咳痰和气短,可伴咯血。常见胸部CT表现为结节、肿块影、支气管扩张、肺实变伴空洞及磨玻璃影。血气分析表现为不同程度的呼吸衰竭,5例患者应用机械通气治疗。经支气管肺泡灌洗液确诊5例,痰培养确诊3例,经皮肺穿刺活检确诊1例。确诊后分别应用磺胺甲噁唑/甲氧苄啶、米诺环素、美罗培南、利奈唑胺、头孢哌酮舒巴坦、莫西沙星、依替米星、伏立康唑等抗菌药物联合治疗,3例患者死亡,6例患者好转出院。结论慢性阻塞性肺疾病合并肺诺卡菌感染在老年患者常为多重复杂混合感染,常见的症状为发热及咳痰,容易合并严重呼吸衰竭,病情进展快,因临床症状不典型,易漏诊及延误诊断,死亡率高。针对肺诺卡菌感染的一线治疗以磺胺甲基异恶唑为主的联合治疗,应尽早足量、足疗程,以改善患者的预后。