慢性阻塞性肺疾病患者急性加重频率与高分辨率CT参数的相关性研究

目的 探讨不同高分辨率CT(HRCT)表型慢性阻塞性肺疾病(COPD)患者上一年急性加重次数的特点,及与HRCT参数的相关性。方法 收集COPD稳定期患者159例,对最终满足标准的72例COPD患者完成HRCT检查,并记录上一年急性加重次数。根据HRCT影像中肺气肿程度或(和)支气管管壁增厚情况进行分型,并测定PI-950和支气管管壁厚度与相邻肺动脉直径的比值。结果COPD表型分别为:无肺气肿型32例,肺气肿型40例;无支气管管壁增厚型40例,支气管管壁增厚型32例;A型32例,E型19例,M型21例。COPD患者的HRCT参数EI和支气管管壁厚度/相邻肺动脉直径比值与上一年急性加重频率均呈正相关(r=0.28,P=0.017;r=0.416,P=0.000)。HRCT表型为肺气肿型的患者平均上一年急性加重次数为(1.83±0.81)次,高于无肺气肿型\[(1.09±0.96)次,P=0.001\];支气管管壁增厚型患者急性加重次数为(1.81±0.86)次,高于无支气管管壁增厚型\[(1.25±0.95)次,P=0.011)\];A型急性加重次数为(1.09±0.96)次,低于E型及M型\[(1.63±0.761)次,(2.00±0.84)次,P=0.002\],E型与M型之间比较差异无统计学意义。结论 COPD患者PI-950及支气管管壁厚度/相邻肺动脉直径比值与上一年急性加重次数呈正相关。HRCT表型多为肺气肿型及支气管管壁增厚型的患者,且COPD急性加重频繁,而A型患者的急性加重频率较低。     

吸入激素联合治疗COPD的有效亚型及茶碱的逆转作用

目的 COPD治疗的关键是抗炎、缓解症状、延缓肺功能恶化.敏感性是影响糖皮质激素疗效的主要原因,故有必要筛选激素治疗敏感的COPD亚型并对不敏感者采取相应措施.研究发现茶碱可提高组蛋白去乙酰化酶2活性,进而改善激素的抗炎作用.因此本研究拟进一步探讨小剂量茶碱对激素不敏感的逆转作用.方法 采用高分辨率CT (high-resolution computed tomography,HRCT)对63例稳定期COPD患者行病理改变的综合评估分型,A型:无肺气肿或轻微肺气肿合并或不合并支气管管壁增厚;E型:肺气肿不合并支气管管壁增厚;M型:肺气肿合并支气管管壁增厚.各型患者分为吸入激素或联合口服茶碱治疗组.监测12周、24周治疗后患者的临床症状评分及肺功能变化.结果 各型COPD患者临床特征和肺功能检查结果存在差异.A型患者联合治疗后的临床症状评分优于E型;E型患者联合治疗后的临床症状评分显著改善;M型患者吸入激素治疗后的临床症状评分显著改善.A型患者吸入激素或联合治疗后的肺功能及改善率均高于其余2型患者;E型患者联合治疗后肺功能及改善率均高于单一吸入激素治疗.结论 HRCT分型中A型、M型可能是糖皮质激素治疗COPD的有效亚型,而联合茶碱治疗可提高激素疗效.     

慢性阻塞性肺疾病大鼠肺树突细胞数量及成熟度变化与慢性炎症的关系

目的 观察香烟烟雾暴露对大鼠肺组织树突细胞数量、成熟度及肺组织慢性炎症变化的影响.方法 将30只雄性F344大鼠按随机数字表法分为香烟烟雾暴露组(暴露组)、断烟组和健康对照组(对照组),每组10只.采用香烟烟雾暴露法建立大鼠COPD模型,HE染色法检测大鼠气道炎症病理评分及肺泡平均内衬间隔,免疫组织化学ABC法观察大鼠肺组织中CD11c+、CD86+和CD8+ T细胞的分布及数量变化,流式细胞术检测CD11c+/CD86+和CD11c+/主要组织相容性复合体(MHC)Ⅱ+与CD11c+树突细胞比值.结果 暴露组和断烟组大鼠肺组织中出现COPD特征性病理改变,气道炎症病理评分[(390±33)分和(324±28)分]及肺泡平均内衬间隔[(68±11)μm和(58±9)μm]明显高于对照组[(56±13)分和(36±6)μm],差异均有统计学意义(F值分别为459.85和34.03,均P＜0.05).暴露组和断烟组大鼠CD11c+树突细胞阳性率[(1.47±0.12)%和(1.30±0.17)%]及CD86+树突细胞阳性率[(1.26±0.18)%和(1.02±0.08)%]均明显高于对照组[(0.96±0.08)%和(0.65±0.03)%],差异均有统计学意义(F值分别为6.55和30.26,均P＜0.05);暴露组和断烟组大鼠CD8+T细胞阳性率[(2.72±0.15)%和(2.35±0.23)%]均明显高于对照组[(1.39±0.11)%],差异有统计学意义(F=16.07,P＜0.05);暴露组和断烟组大鼠CD11c+/CD86+树突细胞及CD11c+/MHCⅡ+树突细胞占CD11c+树突细胞比例[(5.5±0.4)%和(4.8±0.4)%]及[(4.2±0.3)%和(3.3±0.3)%]明显低于对照组[(8.0±0.5)%和(6.1±0.5)%],差异均有统计学意义(F值分别为14.34和12.82,均P＜0.05).暴露组与断烟组上述各项指标比较,差异均无统计学意义(t值为1.10～2.11,均P＞0.05).结论 香烟烟雾暴露诱导COPD大鼠肺组织中树突细胞数量明显增加,成熟度明显下降,断烟后此趋势无明显变化,且以CD8+ T细胞浸润为主的慢性炎症反应持续存在,提示树突细胞数量变化及成熟异常可能参与了COPD慢性炎症迁延进展.

Abstract：

Objective To evaluate the changes in the number and maturation of lung tissue dendritic cells (DCs) and to assess the chronic inflammation in a cigarette smoke-induced COPD model in rats.Methods Thirty male F344 rats were randomly divided into 3 groups (n = 10):a control group, a smoke-exposure group and a smoking cessation group.Rat lung pathomorphological changes were observed by hematoxylin-eosin (HE) stain.Lung tissue CD11c+ DCs, CD85+ DCs and CD8+ T cell numbers were observed by immunohistochemisty method.Flow cytometry was used for detection of CD11c+/CD86+ DCs and CD11c+/MHCⅡ + DCs proportions.Results The airway inflammatory pathological score and the mean linear intercept (MLI) obtained from he smoke-exposure group and the smoking cessation group (390 ± 33,324 + 28 ) and[(68 ± 11 ) μm, (58 ± 9) μm]were higher than those in the control group ( 56 ± 13 ) and ( 36 ± 6 ) μm( F =459.85 and 34.03, all P ＜0.05 ).In the smoke-exposure group and the smoking cessation group, the positive rate of CD11c+ DCs[(1.47 ±0.12)%, (1.30 ±0.17)%], and the positive rate of CD86+ DCs [( 1.26 ± 0.18 ) %, ( 1.02 ± 0.08 ) %]were higher than those in the control group[( 0.96 ± 0.08 ) %,(0.65 ± 0.03 ) %]( F = 6.55 and 30.26, all P ＜ 0.05 ), but there was no significant difference between the smoke-exposure group and the smoking cessation group ( t = 1.10 and 1.47, all P ＞ 0.05 ).In the smoke-exposure group and the smoking cessation group, CD8+ T positive rate[(2.72 ±0.15)%, (2.35 ±0.23)%]was higher than that in the control group[(1.39 ±0.11)%](F = 16.07, P ＜0.05).CD11c+/CD86+ DCs and CD11c+/MHC Ⅱ+DCs percentages[(5.5 ±0.4)%, (4.8 ±0.4)%],[(4.2 ±0.4)%, (3.3±0.3 )%]decreased in the smoke-exposure group and the smoking cessation group as compared to the control group[(8.0±0.5 ) %, (6.1 ± 0.5 ) %]( F = 14.34 and 12.82, all P ＜ 0.05 ).There was no significant difference between all the above index from the smoke-exposure group and the smoking cessation group ( t = 1.10 and 2.11, all P ＞ 0.05 ).Conclusions Cigarette smoke exposure induced increased DCs transmigrated and influenced the maturation of DCs in COPD rats.Even after smoking cessation, non-specific chronic inflammation was still present, suggesting that DCs number and maturation abnormality may be involved in the chronic inflammation of COPD.     

肺纤维化合并肺气肿肺功能及高分辨CT的特征

目的 探讨肺纤维化合并肺气肿(CPFE)患者临床症状、体征、肺功能和高分辨CT(HRCT)的特征;分析肺纤维化和肺气肿的程度与肺功能之间的关系.方法 前瞻性、随机临床病例对照研究.CPFE患者40例,COPD患者80例.比较两组患者一般特征及肺功能等,探讨CPFE肺纤维化和肺气肿的程度与肺功能之间的相关性.结果 40例CPFE患者,年龄(71.8±8.1)岁,男33例,有吸烟史者36例.病程6个月至15年.临床主要症状为咳嗽(34例)、呼吸困难(32例)及双下肺部爆裂音(23例).与COPD患者比较,CPFE患者PaO2降低(f=-2.016,P＜0.05).与COPD患者比较,CPFE患者FEV1％pred[(72.7±20.0)％vs (53.8±15.6)％,t=5.687,P＜0.01]和FEV1/FVC[(70.4±15.8)％vs (54.3±10.7)％,t=6.590,P＜0.01]增高,RV％ pred[(106.8±51.8)％vs(177.6±72.9)％,t=-5.484,P＜0.01]、TLC％pred[(90.1±22.5)％vs (135.4±86.2)％,t=-3.228,P＜0.01]和DL CO％ pred[(43.6±19.4)％vs (63.5±16.1)％,t=-5.900,P＜0.01]降低;VC％ pred和FVC％ pred两组之间比较差异无统计学意义(t值分别为-0.876、0.450,P值均＞0.05).CPFE患者胸部HRCT的主要表现为同时存在以双上肺野为主的肺气肿和双下肺野为主的肺间质改变.肺气肿表现为小叶中心型肺气肿(87.5％)、旁间隔型肺气肿(27.5％)、全小叶型肺气肿(10.0％)和肺大疱(35.0％).肺间质改变为网格影97.5％,磨玻璃影55.0％,蜂窝肺37.5％.调整性别、年龄和吸烟混杂因素后,肺纤维化程度与DL CO％ pred相关(P＜0.01),肺气肿严重程度与DLCO％ pred和FEV1/FVC相关(P＜0.05).结论 CPFE多发生在男性吸烟者,肺通气功能受损较轻,而弥散功能显著下降.HRCT是CPFE诊断的主要依据.HRCT显示肺纤维化和肺气肿严重者肺弥散功能更差.     

高血压患者血清骨桥蛋白水平与舒张性心力衰竭的关系

目的 探讨血清骨桥蛋白水平与舒张性心力衰竭的关系.方法 入选患者67例,其中对照组22例,单纯高血压组22例,高血压合并舒张性心力衰竭组23例.入院时测量血压,同时应用心脏彩超检测患者E峰、A峰、E/A比值、左室射血分数(LVEF)、室间隔侧二尖瓣瓣环E '(舒张早期二尖瓣环运动速度).采用ELISA法检测血清OPN水平.比较三组间血清OPN浓度的变化.结果 高血压合并舒张性心力衰竭组血清OPN浓度[(143.82±43.67) μg/L]高于对照组[(117.10 ±34.64)μg/L]及单纯高血压组[(114.53±26.55) μg,/L],差异具有统计学意义(P＜0.05).对照组与单纯高血压组血清OPN浓度差异无统计学意义(P＞0.05).高血压合并舒张性心力衰竭患者血清OPN浓度与E/E’值呈正相关.血清OPN浓度均值心功能Ⅱ级组[(107.76±36.51) μg/L]＜心功能Ⅲ级组[(143.67±16.76)μg/L]＜心功能Ⅳ级组[(180.02±37.90) μg/L],差异具有统计学意义(P＜0.05).结论 高血压合并舒张性心力衰竭患者的血清OPN浓度增高,与E/E’值呈正相关,并随心功能分级升高而增加.     

慢性重度心力衰竭患者血B型利钠肽浓度正常的临床意义探讨

目的 探讨慢性重度心力衰竭(心衰)患者出现血B型利钠肽(B-type natriuretic peptide,BNP)浓度正常的临床意义.方法 采用前瞻性对照研究的方法观察心功能Ⅲ～Ⅳ级的慢性重度心衰患者57例.血BNP浓度正常的13例患者为研究组(A组),血BNP浓度明显升高的44例为对照组(B组),分析两组患者的临床特点,判定血BNP浓度正常对于慢性重度心衰患者的意义.结果 两组患者的基线情况差异无统计学意义.A组的左室舒张末期内径大于B组[(70.56±4.33)mm与(63.73±3.75)mm,P＜0.05];A组的左室射血分数小于B组[(24.16±2.50)%与(28.49±2.63)%,P＜0.05].A组中能耐受美托洛尔的人数比例少于B组[(7/13)与(39/44),P＜0.05],耐受剂量低于B组[(12.5±6.25)mg/d与(24.20±11.22)mg/d,P＜0.05].两组血BNP浓度在稳定期各时间段无明显改变,但在慢性心衰急性发作与缓解后,A组无显著性改变[(74.03±11.18)ng/L与(71.38±11.68)ng/L,P＞0.05],而B组改变明显[(962.73±165.00)ng/L与(876.24±167.70)ng/L,P＜0.05].随访中,A组病死率高于B组(11/13与6/44,P＜0.05).Logistic多因素回归分析显示:血BNP降低为预测重度慢性心衰患者心原性死亡的独立危险因素(OR值45.488,95%可信区间5.322～388.791),P＜0.05.结论 慢性重度心衰患者出现血BNP浓度正常提示BNP分泌机制的耗竭和心脏功能的进一步恶化.     

脑钠肽与超声心动图评价老年糖尿病并存高血压患者左心室舒张功能的研究

目的 探讨老年糖尿病并存高血压患者左心室功能的变化与脑钠肽(BNP)水平的关系. 方法 128例2型糖尿病患者按是否并存高血压分组,其中不伴高血压组63例,伴高血压组65例,对照组为62例健康查体者.测定各组BNP浓度.常规超声测定左心室结构指标,计算左心室质量指数(LVMI),脉冲多普勒测量二尖瓣口舒张早期血流速度(E)、舒张晚期血流速度(A),计算E/A值.定量组织多普勒技术(QTVI)测量左心室壁二尖瓣环6个位点(侧壁和后间隔、前壁和下壁、前间隔和后壁)处的舒张早期峰值运动速度(Em)和舒张晚期峰值运动速度(Am).计算6个位点平均Em、Am(MEm、MAm)和E/MEm比值. 结果 糖尿病不伴高血压组、伴高血压组LVMI[分别为(91.6±17.3)g/m2、(116.7±20.5)g/m2]、E/MEm(10.3±1.8和12.5±1.4)及BNP浓度[(47.7±29.4)ng/L、(105.7±32.5)ng/L]较对照组[分别为(78.7±19.5)g/m2、8.9±1.6、(20.8±11.63)ng/L]升高,差异有统计学意义(F值分别为11.54、13.83和9.75,P均＜0.05);不伴高血压组、伴高血压组MEm[《6.7±1.0)cm/s、(5.4±0.9)cm/s]较对照组[(5.4±0.9)cm/s]降低,差异有统计学意义(F=11.26,P＜0.05).糖尿病患者BNP浓度与E/A、MEm值呈负相关(r值分别为-0.42、-0.51,均P＜0.01),与LVMI和E/MEm值呈正相关(r值分别为0.48、0.58,均P＜0.01). 结论 糖尿病患者左心室舒张功能降低,并存高血压患者左心室舒张功能障碍更为严重.联合血浆BNP浓度和超声指标有助于准确评估老年糖尿病患者左心室舒张功能.     

人类真核延伸因子1A2对胰腺癌细胞侵袭、转移能力的影响

目的 探讨外源性人类真核延伸因子(EEF)1A2基因导入人胰腺癌SW1990细胞株后.细胞侵袭转移能力的改变.方法 应用腺病毒载体将EEF1A2基因导入人胰腺癌SW1990细胞中,采用划痕实验、Transwell小室、细胞粘附实验检测转染前后细胞运动、侵袭、转移及粘附能力的改变.结果 Ad5/F35-EEF1A2转染后继续培养48 h的SW1990细胞,可见预期大小的特异性条带.实验组24 h后细胞迁移率为(74.43±2.12)%,与阴性对照组和空白对照组比较差异有统计学意义[(44.08±5.92)%和(48.09±3.54)%,P＜0.05].实验组48 h后穿膜细胞数为(65.42±8.24)个,与阴性对照组和空白对照组相比差异有统计学意义[(20.10±5.82)个和(23.25±5.23)个,P＜0.05].实验组48 h后穿膜细胞数为(61.30±5.68)个,与阴性对照组和空白对照组相比差异有统计学意义[(32.04±3.60)个和(32.33±2.51)个,P＜0.05],且对Ⅰ型、Ⅱ型、Ⅳ型胶原、纤维结合蛋白、粘蛋白的粘附力增强(P＜0.05).结论 腺病毒介导的EEF1A2高表达能明显增强胰腺癌SW1990细胞的运动、侵袭、转移及粘附能力.提示EEF1A2可能通过改变胰腺癌细胞的生物学特性影响胰腺癌的发生发展.     

氟对大鼠骨代谢的影响

目的 观察氟对大鼠骨代谢的影响,探讨氟骨症的发病机制.方法 Wistar雄性大鼠80只,体质量80～100 g.将大鼠按体质量随机分为4组:对照组(饮用自来水),低剂量组(NaF,50 mg/L),中剂量组(NaF,100 mg/L),高剂量组(NaF,150 mg/L),每组20只.饲养12周,乙醚麻醉处死大鼠,观察大鼠氟斑牙发生率;股动脉取血,放射免疫法测定血清骨钙素(BGP)、甲状旁腺激素(PTH)、降钙素(CT);比色法测定血清碱性磷酸酶(ALP)、酸性磷酸酶(ACP).结果大鼠氟斑牙检出率组间比较差异有统计学意义(x2=82.81,P＜0.01);其中低(80%,16/20)、中(100%,20/20)、高剂量组(100%,20/20)与对照组(0,0/20)比较差异有统计学意义(x2值分别为22.67、40.00、40.00,P均＜0.01).大鼠血清BGP、PTH、CT组间比较差异有统计学意义(F值分别为38.614、20.778、3.023,P＜0.01或＜0.05);但ALP、ACP组问比较差异无统计学意义(F值分别0.609、2.895,P均＞0.05).血清BGP:低、中、高剂量组[(19.60±12.79)、(33.41±10.81)、(39.46±9.51)mg/L]高于对照组[(7.35±3.22)mg/L,P均＜0.01],中、高剂量组高于低剂量组(P均＜0.01);血清PTH:低、中、高剂量组[(72.27±25.38)、(67.80±12.01)、(106.52±36.37)pmol/L]高于对照组[(47.08±9.22)pmol/L,P均＜0.01],高剂量组高于低、中剂量组(P均＜0.01);血清CT:中、高剂量组[(13.39±2.07)、(15.05±4.77)pmol/L]低于对照组[(26.06±28.31)pmol/L,P均＜0.05],也低于低剂量组[(24.49±14.10)pmol/L,P＜0.05].结论氟影响大鼠的骨代谢,BGP、PTH、CT在氟骨症发病中起着重要的作用.     

Characteristics of COPD phenotypes classified according to the findings of HRCT

The present study was performed to clarify the clinical characteristics of chronic obstructive pulmonary disease (COPD) patients classified into phenotypes according to the dominancy of emphysema and the presence of bronchial wall thickening evaluated by chest high-resolution computed tomography (HRCT). Eighty-five patients with stable COPD (FEV1 < or = 80%) were examined by chest HRCT. Emphysematous changes and bronchial wall thickening were evaluated visually, and COPD patients were classified into three phenotypes: absence of emphysema, with little emphysema with or without bronchial wall thickening (A phenotype), emphysema without bronchial wall thickening (E phenotype), and emphysema with bronchial wall thickening phenotype (M phenotype). Clinical characteristics were compared among the three phenotypes. The A phenotype group showed a higher prevalence of subjects who had never smoked and patients with wheezing, higher values of body mass index (BMI) and DLco, milder lung hyperinflation, and greater reversibility of airflow limitation responsive to inhaled beta2-agonist as compared with the other phenotypes. The degree of emphysema was significantly associated with Brinkman index, lower BMI, decrease in DLco, lower FEV1/FVC. The presence of bronchial wall thickening in A- and M- phenotype was significantly associated with reversibility responsive to treatment with inhaled corticosteroid and sputum eosinophilia. These findings suggest that the morphological phenotypes of COPD show several clinical characteristics and different responsiveness to treatment with bronchodilators and inhaled corticosteroids.     

慢性阻塞性肺疾病患者影像学表型的临床治疗及疗效探究

目的探讨慢性阻塞性肺疾病(COPD)患者影像学表型个体化治疗的临床效果。方法按照2012年慢性阻塞性肺疾病全球倡议[1],选取符合C、D组稳定期COPD患者75例,收集入组者胸部高分辨率CT资料,将患者分为A型、E型、M型三型,分别予布地奈德福莫特罗粉吸入剂,布地奈德/福莫特罗粉吸入剂(160μg/4.5μg,2次/d)治疗。分别于用药前,用药3个月后测定:肺功能指标(FEV1、RV/TCL、FEV1%Pre);检测C反应蛋白(CRP),并做COPD评估测试问卷(CAT评分)评价。结论 A型、E型、M型经ICS+LABA治疗后,A型对ICS+LABA反应优于M和E型,M型的患者对ICS+LABA的反应优于E型。A型、M型对激素的反应优于E型。提示E型患者的病情较重、生活质量差、肺通气明显减退,单一支气管扩张剂改善患者疗效不佳,对于E型患者需要更大剂量或多种作用途径药物联合治疗。     

Clinical analysis of chronic obstructive pulmonary disease phenotypes classified using high-resolution computed tomography

OBJECTIVE AND BACKGROUND: The present study was performed to clarify the clinical characteristics of patients with COPD classified into phenotypes according to the dominancy of emphysema and the presence of bronchial wall thickening (BWT) evaluated by chest high-resolution CT. METHODS: A total of 172 patients with stable COPD (FEV1<80%) were examined by chest high-resolution CT. Emphysematous changes and BWT were evaluated visually, and COPD patients were classified into three phenotypes: absence of emphysema, with little emphysema with or without BWT (A phenotype), emphysema without BWT (E phenotype) and emphysema with BWT phenotype (M phenotype). The clinical characteristics were compared among the three phenotypes. RESULTS: The A phenotype showed a higher prevalence of those who had never smoked and patients with wheezing both on exertion and at rest, higher values of BMI and diffusing capacity for carbon mononide (DLCO), milder lung hyperinflation, and greater reversibility of airflow limitation responsive to beta2-agonist as compared with the E phenotype. The M phenotype showed a higher prevalence of patients complaining of a large amount of sputum, productive cough and wheezing, higher rate of exacerbation or hospitalization and greater reversibility of airflow limitation responsive to beta2-agonist as compared with the E phenotype. CONCLUSIONS: These findings suggest that the morphological phenotypes of COPD show several clinical characteristics and different responsiveness to bronchodilators.     

肺功能状态和呼吸困难问卷用于慢性阻塞性肺疾病患者的信度与效度研究

目的 评价中文版肺功能状态和呼吸困难问卷(PFSDQ)修订版用于COPD患者的信度和效度.方法 于2009年4-9月在北京市2家医院呼吸科门诊选取COPD稳定期患者61例,其中男52例,女9例;年龄51～80岁,平均(66±7)岁.用PFSDQ修订版和修订的英国医学委员会呼吸困难量表(MMRC量表)评估其呼吸困难及功能情况,并于同日或1周内进行检测肺功能和6 min步行试验.PFSDQ修订版包括活动受限程度、活动后呼吸困难和活动后疲乏3个维度.结果 PFSDQ修订版中活动受限、活动后呼吸困难和活动后疲乏3个维度的克龙巴赫α系数分别为0.84、0.85和0.89,与6 min步行距离、FEV_1、FEV_1/FVC、FEV_1占预计值%、MMRC测评的呼吸困难程度和BODE指数均有显著相关性(r值为-0.27～0.66,均P＜0.01).上述3个维度在病情严重程度不同的患者中进行两两比较,差异均有统计学意义(χ~2值为7.35～15.21,P＜0.05和P＜0.01).结论 中文版PFSDQ修订版在61例COPD患者中使用具有良好的信度和效度,适用于我国COPD患者.     

Tomographic and functional findings in severe COPD: comparison between the wood smoke-related and smoking-related disease

OBJECTIVE:

Wood smoke exposure is a risk factor for COPD. For a given degree of airway obstruction, the reduction in DLCO is smaller in individuals with wood smoke-related COPD than in those with smoking-related COPD, suggesting that there is less emphysema in the former. The objective of this study was to compare HRCT findings between women with wood smoke-related COPD and women with smoking-related COPD.

METHODS:

Twenty-two women with severe COPD (FEV₁/FVC ratio < 70% and FEV₁ < 50%) were divided into two groups: those with wood smoke-related COPD (n = 12) and those with smoking-related COPD (n = 10). The two groups were compared regarding emphysema scores and airway involvement (as determined by HRCT); and functional abnormalities-spirometry results, DLCO, alveolar volume (VA), the DLCO/VA ratio, lung volumes, and specific airway resistance (sRaw).

RESULTS:

There were no significant differences between the two groups in terms of FEV₁, sRaw, or lung hyperinflation. Decreases in DLCO and in the DLCO/VA ratio were greater in the smoking-related COPD group subjects, who also had higher emphysema scores, in comparison with the wood smoke-related COPD group subjects. In the wood smoke-related COPD group, HRCT scans showed no significant emphysema, the main findings being peribronchial thickening, bronchial dilation, and subsegmental atelectasis.

CONCLUSIONS:

Female patients with severe wood smoke-related COPD do not appear to develop emphysema, although they do show severe airway involvement. The reduction in DLCO and VA, with a normal DLCO/VA ratio, is probably due to severe bronchial obstruction and incomplete mixing of inspired gas during the determination of single-breath DLCO.     

阿奇霉素治疗不同CT表型稳定期COPD患者的临床研究

目的:研究阿奇霉素维持治疗对不同高分辨率CT(HRCT)表型稳定期慢性阻塞性肺疾病(COPD)患者急性加重频次、肺功能的影响。方法:本研究为前瞻性、随机、双盲、安慰剂对照、单中心临床试验。选取2013年5月至2018年5月于河北中石油中心医院呼吸与危重症医学科住院或门诊治疗好转的COPD稳定期患者110例进行研究。11...     

Clinical Significance of Radiologic Characterizations in COPD

ABSTRACT

COPD is a heterogeneous disorder with clinical assessment becoming increasingly multidimensional. We hypothesized HRCT phenotype would strongly influence clinical outcomes including health status, exacerbation frequency, and BODE. COPD subjects were characterized via the SF-12, SGRQ, MMRC, physiologic testing, and standardized volumetric chest HRCT. Visual semi-quantitative estimation of bronchial wall thickness (VBT) and automated quantification of emphysema percent and bronchial wall thickness were generated. Multivariate modeling compared emphysema severity and airway abnormality with clinical outcome measures. Poisson models were used to analyze exacerbation frequency. SGRQ and SF-12 physical component scores were influenced by FEV₁% predicted, emphysema percent, and VBT. VBT scores > 2 (scale 0–48) were associated with increased exacerbation frequency (p = 0.009) in the preceding year adjusting for age, gender, emphysema percent, smoking history and FEV₁% predicted, although this effect was attenuated by age. Emphysema percent correlated with total BODE score in unadjusted (r = 0.73; p < 0.0001) and adjusted (p < 0.0001) analyses and with BODE individual components. HRCT provides unique COPD phenotyping information. Radiographic quantification of emphysema and bronchial thickness are independently associated with SGRQ and physical component score of the SF-12. Bronchial thickness but not emphysema is associated with exacerbation frequency, whereas emphysema is a stronger predictor of BODE and its systemic components MMRC, 6MWT, and BMI. Future research should clarify whether CT parameters complement BODE score in influencing survival.     

慢性阻塞性肺疾病急性加重期患者血浆选择素相关蛋白水平的观察

目的 探讨整合素相关蛋白CD_(47)和P-选择素在COPD发病中的作用.方法 病例来自2008年10月至2009年3月在遵义医学院附属医院呼吸一科住院的COPD患者35例,其中男26例,女9例;年龄55～84岁,平均(65±7)岁.未经任何治疗时为急性加重期(AECOPD)组,经过抗感染、解痉平喘、祛痰、吸氧和支持等治疗,达到临床缓解时为稳定期组.同期体检的健康志愿者加名为对照组,其中男14名,女6名;年龄45～80岁,平均(59±7)岁.采用流式细胞术检测所有研究对象外周血浆中CD_(47)和P-选择素水平,并检测血小板计数.采用SNK-q检验和Pearson回归分析进行相关性分析.结果 AECOPD组CD_(47)阳性率为(93±4)%,明显高于稳定期组的(72±11)%和对照组的(67±10)%,差异均有统计学意义(q值分别为11.26和13.32,均P＜0.01),稳定期组与对照组的差异无统计学意义(q=1.73,P＞0.05);AECOPD组P-选择素阳性率为[(35±11)%],明显高于稳定期组[(12±8)%]和对照组[(10±4)%],差异均有统计学意义(q值分别为9.93和12.19,均P＜.0.05),稳定期组也明显高于对照组,差异有统计学意义(q=1.90,P＜0.05);AECOPD组血小板计数为(188±56)×10~9/L,与稳定期组的(213±57)×10~9/L和对照组的(204±51)×10~9/L比较,差异无统计学意义(F=1.74,P＞0.05);AECOPD组CD_(47)与P-选择素呈正相关(r=0.77,P＜0.01),稳定期及对照组CD_(47)与P-选择素均无相关性(r值分别为-0.04和-0.15,均P＞0.05).结论 CD_(47)和P-选择素作为血小板活化标志物,在AECOPD时明显增高,表明AECOPD存在血小板活化,提示血小板作为一种炎性细胞参与AECOPD发病,可能以其活化形式发挥重要作用.CD_(47)和P-选择素可作为判断AECOPD严重程度及血小板活化程度的指标.     

慢性阻塞性肺疾病患者深吸气量与生命质量的关系

目的 探讨COPD患者深吸气量等肺功能指标与生命质量的关系.方法 2006年1月至2007年3月北京大学第三医院门诊的COPD稳定期患者62例,其中男55例,女7例;年龄43～79岁,平均年龄(66±8)岁.均进行肺容量、肺通气功能和小气道功能检查,并经圣乔治呼吸问卷(SGRQ)评分,采用Pearson直线相关分析SGRQ的分值与总分、SGRQ评分与肺功能指标之间的相关性.结果 62例COPD稳定期患者的SGRQ总分为(43±17)分,其中呼吸症状分值为(54±23)分,活动受限分值为(54±19)分,疾病影响分值为(33±20)分;肺功能检查结果中FEV_1占预计值%为(43±13)%,FEV_1/FVC为(52±11)%,残气量占预计值%为(194±50)%,残气量/肺总量为(166±31)%,深吸气量占预计值%为(74±21)%.深吸气量占预计值%、残气量占预计值%、残气量/肺总量、FEV,占预计值%、FEV./FVC、呼气峰流量、用力呼出50%肺活量时呼气流量(FEF_(50%))、用力呼出25%肺活量时呼气流量(FE_(25%))和最大呼气中段流量(MMEF)与SGRQ总分均呈负相关,其中通气功能指标的相关系数为-0.336～-0.479,小气道功能指标的相关系数为-0.368～-0.411,而深吸气量占预计值%和SGRQ的3个能区分值和总分相关性最好,相关系数为-0.418～-0.521,均P＜0.05.SGRQ的3个能区分值中呼吸症状和肺功能无显著相关性.结论 肺功能检查中肺容量测定、肺通气功能和小气道功能均与COPD患者的生命质量相关,深吸气量占预计值%和FEV_1占预计值%应联合作为临床评价COPD患者的客观指标.