Stress cardiomyopathy (tako-tsubo) triggered by nervous system diseases: A systematic review of the reported cases

Background

It is not clarified whether the transient, regional left ventricular dysfunction (TRLVD) associated with several neurological disorders shares the same pathophysiology with the classical tako-tsubo cardiomyopathy occurring without overt neurological disease, and whether it is appropriate to include these patients in a single stress cardiomyopathy (SCM) condition.

Methods

In February 2012, we systematically explored major electronic medical information sources to identify cases of TRLVD triggered by neurological disorders.

Results

The 81 selected papers reported a total of 124 patients, suffering from neurological disorders, in whom TRLVD occurred: 117 with central nervous system diseases, 6 with peripheral nervous system diseases and 1 with both systems involved. Most patients were females (n = 102), mean age was 63 ± 15 years, and the majority presented with an apex-involving pattern. The most common disease described was subarachnoid hemorrhage (n = 52), followed by stroke/transient ischemic attack (n = 24), and seizures (n = 18). TRLVD in neurological patients was often associated with need of inotropic support, orotracheal intubation, cerebrovascular spasm and delayed surgery.

Conclusions

TRLVD is a complication of neurological diseases, in particular in female patients in post-menopausal phase. The predilection for neurological damage at or close to the insular cortex highlights the pivotal role of sympathetic over-activation. Many other similarities with tako-tsubo support the inclusion in a single SCM category.     

代谢组学在慢性气道炎症性疾病中的研究进展

代谢组学是研究生物体被扰动后内源性代谢物变化规律的系统科学,其在慢性气道炎症性疾病如支气管哮喘、慢性阻塞性肺疾病中的应用研究成为热点,有望通过对慢性气道炎症性疾病患者的代谢轮廓分析,寻找到有意义的生物标记物并探索疾病的发病机制.本文就研究现状作一综述,并展望其发展前景.     

气道阻塞性疾病的相似与不同

世界范围内,气道阻塞性疾病的发病率逐年增加,但仍有相当部分患者的病情难以得到有效控制.其中有代表性的如支气管哮喘、COPD和支气管扩张,在流行病学及危险因素、发病机制、病理学特点、病理生理学特点、临床表现、肺功能、影像学、治疗方面有某些相似与不同之处.本文将就上述方面作一综述.     

维生素D在肺部疾病中的作用

除了维持钙盐代谢和骨骼的稳态以外,研究发现维生素D还可调控包括机体防御,炎症,免疫,损伤修复等在内的多种生理和病理生理过程。流行病学资料表明,血清低水平的维生素D与肺功能受损、炎症反应和感染性疾病相关。因此,支气管哮喘、慢性阻塞性肺疾病和肺部感染性疾病都可能与维生素D水平有关,但具体的机制尚不明确。因此,本文通过文献回顾,概述维生素D在肺部疾病,包括支气管哮喘、慢性阻塞性肺疾病、肺结核和呼吸道感染中的作用。     

维生素D在肺部疾病中的作用

除了维持钙盐代谢和骨骼的稳态以外,研究发现维生素D还可调控包括机体防御,炎症,免疫,损伤修复等在内的多种生理和病理生理过程.流行病学资料表明,血清低水平的维生素D与肺功能受损、炎症反应和感染性疾病相关.因此,支气管哮喘、慢性阻塞性肺疾病和肺部感染性疾病都可能与维生素D水平有关,但具体的机制尚不明确.因此,本文通过文献回顾,概述维生素D在肺部疾病,包括支气管哮喘、慢性阻塞件肺疾病、肺结核和呼吸道感染中的作用.     

胃食管反流病与呼吸系统疾病的相关性研究进展

胃食管反流病典型表现为胃灼热感、反酸,但很多患者以食管外症状为主要表现或唯一表现。食管外症状以呼吸系统症状多见,并且此类患者往往生活质量受到严重影响甚至威胁生命,但就诊率低,误诊率高。一方面由于临床医师和患者对此病认识不足,另一方面目前缺乏有效的、有循证依据的大样本前瞻性研究来证实胃食管反流与呼吸系统疾病之间的相关关系。二者的相关性及联系的具体机制尚不清晰,本文结合近年来国内外针对二者相关性的研究现状,对胃食管反流病与呼吸系统疾病的相关性的研究进展展开叙述。     

MicroRNA在气道炎症性疾病中的研究进展

微小RNA(microRNA)是一类长约22nt的内源性非编码小RNA,microRNA与靶mRNA特定碱基结合引起靶mRNA的降解或抑制其翻译,进而调控基因转录后的表达.近年来的一些研究表明microRNA与肺的发育、炎症反应和以慢性阻塞性肺疾病、哮喘为代表的气道炎症性疾病密切相关,现就microRNA在该领域的研究进展作一综述.     

A Respiratory Therapist-Directed Protocol for Managing Inpatients with Asthma and COPD Incorporating a Long-Acting Bronchodilator

This prospective study was designed to determine whether incorporating formoterol into a standardized respiratory therapist-directed protocol for administering bronchodilators to hospitalized patients with obstructive airway disease would reduce health care resource use and provide a safety advantage. All patients admitted to Washington Hospital Center with asthma and chronic obstructive pulmonary disease (CODP) are administered bronchodilators under a standardized respiratory therapist-directed protocol. Formoterol was the primary bronchodilator for the intervention period from January through March 2002, with levalbuterol, albuterol, and ipratropium available as needed. Results for the intervention period were compared against two historical control periods. From January through March 2000, the bronchodilators in the protocol were albuterol and ipratropium, and from January through March 2001 levalbuterol, albuterol, and ipratropium were available. Health care resource use was determined by the number of bronchodilator treatments administered per admission. Costs (adjusted to 2002 dollars) for supplies, therapist time, and drugs were calculated for the three time periods. Adverse events related to bronchodilator administration were recorded in a standardized manner for all three time periods. Bronchodilator treatments per admission, respiratory therapist visits per admission, and time spent per admission, and cost per bronchodilator treatment significantly decreased in 2002. Significantly fewer adverse events related to bronchodilator treatments were reported in 2002 than 2000. The addition of formoterol to a respiratory therapist-directed protocol for administering bronchodilators reduced health care resource use and adverse events for patients with asthma and COPD.     

A program for the prevention of lung diseases

The pathogenesis, morbidity, mortality, and economic impact of chronic obstructive pulmonary disease (COPD) are similar to those of coronary heart disease. But in contrast to cardiologists pulmonologists have not yet developed and tested worldwide preventive strategies. Based on a research pneumobile in the FRG, the Institute for Preventive Medicine in Graz has developed a Pneumobile for general use. The program is aimed at all groups that can contribute to the prevention of COPD. This means the lay public, physicians, health-care providers, and politicians, and especially the media. To date about 10,500 people from all social levels have been tested in the pneumobile; 8% underwent a lysis test. The Pneumobile was stationed at heavily frequented locations in urban and rural centers. About 10 times as many people got a close look, and 100–1000 times as many heard of the Pneumobile and were made aware of the problem of COPD.     

肺微生物组学在常见肺部疾病中的作用研究进展

肺微生物组学的研究是近年来肺部疾病研究领域的热点,并有多篇研究在国际重要的学术期刊上发表.他们旨在研究肺部微生物的组成、多样性及其与人类健康和疾病的相关性,尤其是与慢性肺部疾病的相关性.本文就肺微生物组学在常见肺部疾病中的作用和最新的研究进展进行了综述,希望能为临床和科研带来帮助.     

COPD与肺癌发病的相关性

目的：研究COPD与肺癌发病的相关性。方法收集2010年11月至2013年11月我院收治的门诊或住院患者210例肺癌患者作为实验组,同时选取在玉林市红十字会医院体检中心体检的非癌健康人226例作为对照组,观察2组研究对象个人呼吸系统疾病史、家族呼吸系统疾病史与肺癌之间的关系,同时观察2组中吸烟患者和不吸烟患者的 COPD 发生率。结果呼吸系统疾病中肺炎、哮喘与肺癌的发生无显著关系(P 值均>0.05);伴有 COPD、支气管炎、肺气肿、肺结核的患者,发生肺癌的风险显著增高(P 值均<0.05),其中 COPD 与肺癌发生的关联性最强(OR =2.73)。具有COPD及肺癌家族史的人群,发生肺癌的风险显著增加(P<0.05)。吸烟患者中实验组COPD的发生率显著高于对照组(χ2=5.482,P<0.05);实验组未吸烟患者中实验组 COPD的发生率显著高于对照组(χ2=5.901,P<0.05)。结论患有COPD病史及有 COPD家族史的患者,发生肺癌的风险增加,且COPD患者无论是否吸烟,COPD仍然会导致肺癌发生的风险性增加。     

A community-based, time-matched, case-control study of respiratory viruses and exacerbations of COPD

Respiratory viruses are associated with severe acute exacerbations of chronic obstructive pulmonary disease (COPD) in hospitalized patients. However, exacerbations are increasingly managed in the community, where the role of viruses is unclear. In community exacerbations, the causal association between viruses and exacerbation maybe confounded by random fluctuations in the prevalence of circulating respiratory viruses. Therefore, to determine whether viral respiratory tract infections are causally associated with community exacerbations, a time-matched case-control study was performed. Ninety-two subjects (mean age 72 yrs), with moderate to severe COPD, (mean FEV(1) 40% predicted), were enrolled. Nasopharyngeal swabs for viral multiplex polymerase chain reaction and atypical pneumonia serology were obtained at exacerbation onset. Control samples were collected in synchrony, from a randomly selected stable patient drawn from the same cohort. In 99 weeks of surveillance, there were 148 exacerbations. Odds of viral isolation were 11 times higher in cases, than their time-matched controls (34 discordant case-control pairs; in 31 pairs only the case had virus and in three pairs only control). Picornavirus (26), influenza A (3), parainfluenza 1,2,3 (2), respiratory syncytial virus (1), and adenovirus (1) were detected in cases while adenovirus (1) and picornavirus (2) were detected in controls. In patients with moderate or severe COPD the presence of a virus in upper airway secretions is strongly associated with the development of COPD exacerbations. These data support the causative role of viruses in triggering COPD exacerbations in the community.     

COPD合并急性呼衰患者从有创机械通气过渡至无创通气效果观察及时机探讨

目的　探讨慢性阻塞性肺疾病 (COPD)合并急性呼吸衰竭 (呼衰 )患者从有创机械通气过渡至无创通气的效果及时机。方法　将 2 8例 COPD合并急性呼吸衰竭且实施有创机械通气的患者当肺部感染基本控制时随机分为两组 ,各 14例。A组继续行有创通气 ,B组拔除气管插管改为面罩无创机械通气。观察两组呼吸机相关肺炎 (VAP)例数、病死例数、机械通气时间、住呼吸监护室 (RICU)时间。结果　 A组与 B组发生 VAP的例数分别为 8例和 1例 (P <0 .0 5 ) ;死亡例数分别为 2例和 1例 (P >0 .0 5 ) ;总机械通气时间分别为 (2 1± 9)天和 (11± 5 )天(P <0 .0 5 ) ;住 RICU时间分别为 (2 5± 10 )天和 (16± 7)天 (P <0 .0 5 )。结论　 COPD合并急性呼吸衰竭机械通气患者当肺部感染基本控制时改用无创通气可以降低 VAP发生率 ,缩短机械通气时间和住 RICU时间。     

生存质量量表在呼吸系统疾病中的应用

生存质量是一种自我感受,涉及到社会和心理多方面的因素.严重肺部疾病及合并症会使患者的生存质量受到影响,因此评定患者生存质量对疾病的变化及治疗有指导意义.目前应用于呼吸系统疾病的生存质量量表众多,它们有着各自的特点及评估侧重点,如何根据临床目的进行恰当的选择,是临床工作中遇到的重要问题.     

慢性阻塞性肺疾病"临界呼吸衰竭"的研究

目的提出并解释由慢性阻塞性支气管炎导致的慢性阻塞性肺疾病(COPD)老年患者病情发展的一个特定阶段“临界呼吸衰竭”。方法将该人群样本同未到达“临界呼吸衰竭”的COPD老年患者和老年正常对照组受试者做比较,研究其血气指标、静息呼吸驱动、气道阻力与顺应性、白介素4、γ干扰素以及它们之间的相互作用及其作用强度。结果已达到“临界呼吸衰竭”的COPD老年患者较之未到达“临界呼吸衰竭”的COPD老年患者和老年正常对照组受试者在血气指标、静息呼吸驱动、气道阻力与顺应性、白介素4和γ干扰素方面均会导致病情进一步恶化,表明“临界呼吸衰竭”这一定义具有一定的临床指导意义。结论对“临界呼吸衰竭”这一阶段的人群应在其发展至呼吸衰竭以前及时给予适当干预。如吸氧、应用气道扩张药物、改善气道顺应性以及免疫治疗和抗感染治疗等。     

Prevalence of asthma and chronic obstructive pulmonary disease in Aboriginal and non-Aboriginal populations: A systematic review and meta-analysis of epidemiological studies

BACKGROUND:

Asthma and chronic obstructive pulmonary disease (COPD) have considerable potential for inequities in diagnosis and treatment, thereby affecting vulnerable groups.

OBJECTIVE:

To evaluate differences in asthma and COPD prevalence between adult Aboriginal and non-Aboriginal populations.

METHODS:

MEDLINE, EMBASE, specialized databases and the grey literature up to October 2011 were searched to identify epidemiological studies comparing asthma and COPD prevalence between Aboriginal and non-Aboriginal adult populations. Prevalence ORs (PORs) and 95% CIs were calculated in a random-effects meta-analysis.

RESULTS:

Of 132 studies, eight contained relevant data. Aboriginal populations included Native Americans, Canadian Aboriginals, Australian Aboriginals and New Zealand Maori. Overall, Aboriginals were more likely to report having asthma than non-Aboriginals (POR 1.41 [95% CI 1.23 to 1.60]), particularly among Canadian Aboriginals (POR 1.80 [95% CI 1.68 to 1.93]), Native Americans (POR 1.41 [95% CI 1.13 to 1.76]) and Maori (POR 1.64 [95% CI 1.40 to 1.91]). Australian Aboriginals were less likely to report asthma (POR 0.49 [95% CI 0.28 to 0.86]). Sex differences in asthma prevalence between Aboriginals and their non-Aboriginal counterparts were not identified. One study compared COPD prevalence between Native and non-Native Americans, with similar rates in both groups (POR 1.08 [95% CI 0.81 to 1.44]).

CONCLUSIONS:

Differences in asthma prevalence between Aboriginal and non-Aboriginal populations exist in a variety of countries. Studies comparing COPD prevalence between Aboriginal and non-Aboriginal populations are scarce. Further investigation is needed to identify and account for factors associated with respiratory health inequalities among Aboriginal peoples.     

Biomarkers in airway diseases

The inherent limitations of spirometry and clinical history have prompted clinicians and scientists to search for surrogate markers of airway diseases. Although few biomarkers have been widely accepted into the clinical armamentarium, the authors explore three sources of biomarkers that have shown promise as indicators of disease severity and treatment response. In asthma, exhaled nitric oxide measurements can predict steroid responsiveness and sputum eosinophil counts have been used to titrate anti-inflammatory therapies. In chronic obstructive pulmonary disease, inflammatory plasma biomarkers, such as fibrinogen, club cell secretory protein-16 and surfactant protein D, can denote greater severity and predict the risk of exacerbations. While the multitude of disease phenotypes in respiratory medicine make biomarker development especially challenging, these three may soon play key roles in the diagnosis and management of airway diseases.     

人音猬因子相互作用蛋白基因与肺部疾病

人音猬因子相互作用蛋白基因编码一组跨膜糖蛋白——人音猬因子相互作用蛋白,其主要功能是负反馈调节抑制Hh信号通路活性.该基因与Hh信号通路在胚胎发育、细胞分化、肿瘤形成等有关,参与了各系统疾病的发生发展.本文就其与一些肺部疾病的关系作一综述.