COPD患者肺动脉高压与急性加重的相关研究

目的 探讨COPD患者肺动脉高压对急性加重的预测作用.方法 收集2013至2015年因COPD急性加重入院的76例患者资料,随访8个月,记录心脏彩超所测收缩期肺动脉压(systolic pulmonary artery pressure,sPAP)、急性加重次数.结果 肺动脉压正常组和轻度肺动脉高压组间急性加重次数差异无统计学意义;中度、重度肺动脉高压组的急性加重次数均多于肺动脉压正常组、轻度肺动脉高压组,中度肺动脉高压组与重度肺动脉高压组的急性加重次数差异无统计学意义.肺动脉压力和有无急性加重发生的 ROC曲线下面积 AUC=0.786 (95% CI :0.684~0.887), P=0.000,最佳界值点为sPAP=50 mmHg,敏感度64%,特异度88.5%,阳性预测值91.2%,阴性预测值56.97%.结论 因COPD急性加重而住院的患者 sPAP>50 mmHg 可作为再次急性加重的预测因子,中重度肺动脉高压的COPD患者可发生更频繁的急性加重.     

病毒相关的慢性阻塞性肺疾病急性加重的研究进展

随着高敏感性检测手段应用的发展和普及,病毒在慢性阻塞性肺疾病急性加重(AECOPD)期间的检出率大大提高,这引起人们对病毒感染与AECOPD关系的重视.现就病毒与AECOPD的关系、病毒特异性生物标志物以及病毒相关AECOPD的临床预后三个方面进行综述.     

COPD急性加重危险因素的研究进展

COPD是呼吸系统疾病中的常见病和多发病,患病率及病死率均居高不下,近年来研究表明COPD的患病率有所增加.而COPD急性加重(acute exacerbation of chronic obstructivepulmonary disease,AECOPD)增加了医疗卫生资源的耗用,是COPD患者医药费用的首要负担,也是COPD患者的主要死因.当下临床研究的重点是对急性加重的管理,预防AECOPD尚未引起临床工作者足够重视,如何预防和减少AECOPD的发生和发展成为降低COPD患病率和病死率及减轻COPD经济负担的研究重点.本文通过研究阅读国内外相关最新研究成果,就AECOPD危险因素作出总结、探讨,阐明AECOPD相关危险因素,更好地指导临床实践,从而为AECOPD患者提供更佳的医疗服务.     

慢性阻塞性肺疾病急性加重糖皮质激素的治疗

COPD是一种可预防和治疗的疾病,以气流受限为特征病情呈进行性发展,气流受限不完全可逆,具有较高的发病率和病死率。慢性阻塞性肺疾病急性加重（acuteexacerbationofchronicobstructivepulmonarydisease,AECOPD）作为c0PD疾病病程中的一个事件,是COPD患者就诊及住院的主要原因,对患者及社会造成了庞大经济负担。糖皮质激素在AECOPD治疗中的地位已得到肯定,但仍存在许多争议的地方,如不同途径对于治疗效果的影响、激素使用中最佳剂量及使用时间的选择、不同类型激素治疗效果的差异等,仍需要进一步研究来指导合理使用糖皮质激素。     

慢性阻塞性肺疾病患者病情加重与昼夜节律的相关性

目的探讨慢性阻塞性肺疾病(简称慢阻肺)患者病情加重与昼夜节律的相关性。方法对154例慢阻肺患者随访3年,记录每位患者的一般情况和病情加重的情况,分析吸烟、年龄、性别与慢阻肺病情加重昼夜节律的相关性。结果 154例患者共出现急性加重次数1401次,觉醒型512次(36.5%),睡眠型889次(63.5%)。其中82例为睡眠型慢阻肺急性加重患者(53.2%),32例为觉醒型慢阻肺急性加重患者(20.8%),40例为弥散型慢阻肺急性加重(26.0%)。高龄(≥70岁)、吸烟和男性均较低龄(70岁)、非吸烟和女性患者更容易出现夜间病情加重(P0.05)。结论慢阻肺患者病情加重存在昼夜节律性,病情恶化更容易出现在夜间,睡眠型加重患者更为多见,尤其是吸烟、高龄男性。     

AECOPD患者C反应蛋白检测的临床意义

目的 检测并分析AECOPD病人C反应蛋白治疗前后的变化,探讨其动态变化的临床价值.方法 选择42例AECOPD患者,检测其在治疗前及使用抗生素后10~14天的CRP水平,分析这些指标的变化情况,并分析其与白细胞总数及中性粒细胞比例的相关性.结果 在急性加重期CRP水平明显升高(57.224±54.86552 mg/L),而治疗后迅速下降(10.3976±15.1405 mg/L),其变化差异具有统计学意义,且与白细胞总数及中性粒细胞比例具有显著相关性,此外CRP与预后具有正相关,抗感染疗程及住院时间有随CRP增高而延长趋势.结论 CRP检测对COPD急性加重期感染的诊断及疗效观察、预后判定具有一定的辅助诊断意义.     

布地奈德混悬液吸人治疗慢性阻塞性肺疾病急性加重期的临床观察

目的 探讨雾化吸入布地奈德混悬液治疗慢性阻塞性肺疾病（COPD）急性加重期患者的疗效。方法 40例COPD急性加重期患者随机分成治疗组和对照组各20例，分别给予布地奈德混悬液及全身性应用糖皮质激素。观察2组治疗前后呼吸困难、肺功能、动脉血气变化及副作用的情况。结果 治疗组和对照组治疗前后的呼吸困难、肺功能、动脉血气变化均差异无显著性，雾化吸入布地奈德混悬液治疗组的副作用明显少于全身应用糖皮质激素的对照组。结论 雾化吸入布地奈德混悬液是治疗COPD急性加重期患者安全有效的方法，值得推广。     

Clinical predictors of exacerbation frequency in chronic obstructive pulmonary disease

Introduction: Reduction of exacerbation frequency plays an increasingly important role in interventions in chronic obstructive pulmonary disease (COPD). To reduce this frequency efficiently, patients at risk for frequent exacerbations need to be identified. Objective: The objective of the study was to identify predictors for frequent exacerbations from multiple domains of COPD during a stable phase of the disease. Methods: Data of multiple domains of COPD were collected from 121 patients with moderate to severe COPD. Patients were divided into infrequent (<2 exacerbations per year) and frequent (≥2 exacerbations) exacerbators. Results: St. George's Respiratory Questionnaire (SGRQ) total score and a course of oral corticosteroid within 3 months prior to the study together predicted best whether patients would be infrequent or frequent exacerbators over the course of the next year. Each unit increase in total SGRQ score was associated with a 3% higher risk of being a frequent exacerbator [odds ratio (OR) = 1.03; 95% confidence interval (CI): 1.00–1.06; P = 0.047]. Patients who received a course of oral corticosteroids in the period of 3 months prior to the study had a three‐fold increased risk of being a frequent exacerbator (OR = 3.17; 95% CI: 1.20–8.34; P = 0.02). Furthermore, we observed that a sizable number of patients switched from being a frequent to an infrequent exacerbator and vice versa. Conclusions: Health‐related quality of life and a course of oral corticosteroid in the past 3 months are the best predictors of future exacerbator status. The predictive value of the model is, however, still insufficient. Furthermore, our data suggest, in contrast to previous observations, that exacerbation frequency is not a constant feature. Please cite this paper as: Brusse‐Keizer MGJ, van der Palen J, van der Valk PDLPM, Hendrix R, Kerstjens HAM. Clinical predictors of exacerbation frequency in chronic obstructive pulmonary disease. Clin Respir J 2011; 5: 227–234.     

莫西沙星治疗慢性阻塞性肺疾病急性加重最新临床试验(MAESTRAL研究)结果解读

慢性阻塞性肺疾病(COPD)急性加重(AECOPD)是COPD自然病程中的重要事件,不但可导致肺功能进行性下降,而且还是与病死率和病残率升高、生活质量下降相关的主要因素。此外,因AE-COPD住院治疗可明显增加医疗费用。目前AECO-     

Bronchodilator therapy for chronic obstructive pulmonary disease

Abstract Chronic obstructive pulmonary disease (COPD) is a heterogeneous group of diseases characterized by cough, sputum production, dyspnoea, airflow limitation and bronchial hyperreactivity. The airflow limitation declines progressively and is irreversible or partially reversible. Bronchodilator therapy is prescribed to relieve the symptoms, reverse airway obstruction and hopefully slow the rate of disease progression and decelerate the decline in pulmonary function. During acute exacerbation, inhalation of β2-agonists remain the therapy of choice. The usefulness of anticholinergic inhalation in acute attacks is investigated in order to determine if a higher dose and more frequent administration have same benefit as β2-agonists inhalation. Theophylline is usually given orally as a sustained release formulation for chronic maintenance therapy. Some patients may benefit from theophylline infusion during an acute phase when appropriately used; however, sympathomimetic agents fail to produce adequate bronchodilation. During interim periods of stability, inhalation of ipratropium bromide has increased in popularity as a regular long-term bronchodilator therapy. Although ipratropium and β2-agonists are equally efficacious when the dosage is adequate enough, a combination of both provides a rapid onset of action of the adrenergic agents and a prolonged action of the anticholinergic. Furthermore, this combination can be given in a reduced dose, thereby avoiding side-effects. Inhalation techniques can influence the efficacy of bronchodilator therapy. For severe dyspnoeic patients or patients with poor technique of co-ordination with metered-dose inhaler (MDI), attachment of a spacer to the MDI or using a nebulizer will overcome these difficulties. Bronchodilator therapy can not prevent the development of COPD or slow down the decline of pulmonary function, other interventions should be included in a comprehensive management programme.     

Management of chronic obstructive pulmonary disease in Australia after the publication of national guidelines

Background: Information on the management of chronic obstructive pulmonary disease (COPD) in Australia, especially the extent of adherence to the COPD‐X Plan, is sparse. Aim: To evaluate COPD patient adherence to treatment recommendations and healthcare provider adherence to the COPD‐X Plan. Methods: Cross‐sectional study of patients admitted to a secondary care hospital with an acute exacerbation of COPD over a 6‐month period. Data were collected from patient interviews and medical notes. Results: Participants (n= 45) aged 72 ± 11.5 years (mean ± SD) had a mean FEV₁ % predicted 52.2 ± 18.7. At the time 11 (24.4%) patients continued to smoke; 25 (55.6%) had never participated in a pulmonary rehabilitation programme; and 23 (51.1%) self‐reported poor adherence to some COPD medications. Inhaler technique was deemed suboptimal in 25 (55.6%) patients. Only 11 (24.4%) patients had received any instructions from their doctor regarding management of exacerbations. The use of medications not supported by the COPD‐X guidelines were: long‐term prednisolone (11, 24.4%) and prophylactic antibiotics (3, 6.7%). Conclusion: Management of COPD in Australia by both patients and providers remains suboptimal despite the publication and wide dissemination of the COPD‐X Plan, suggesting the need to intensify both patient and provider education in COPD management.     

AECOPD住院病人合并症状况调查

目的了解慢性阻塞性肺疾病急性加重期（AECOPD）住院病人中合并疾病的情况。方法系统回顾我科2002年10月至2007年3月1274例AECOPD住院病人,统计各级AECOPD存在合并症例数和各个单病种罹患率。结果1274例病人中有合并症的687例（53．9％）,无合并症的587例（46．1％）。这些合并疾病计68种,最常见的合并症是冠心病204例（16．0％）,高血压133例（10．4％）,糖尿病44例（3．5％）,活动性肺结核38例（3．O％）。结论合并症在AECOPD住院病人中是高发的,应引起我们的重视。     

慢性阻塞性肺疾病急性加重的病因调查

目的了解慢性阻塞性肺疾病急性加重期（AECOPD）急性加重因素。方法系统回顾我科2002年10月1日至2007年3月31日1274例AECOPD住院病人，逐例统计并核实各级COPD急性加重的因素。结果1274例病人急性加重因素计有34种。其中，单纯肺／支气管感染者490例（占38．5％），单纯心衰者138例（10．8％），肺／支气管感染和心衰同时存在的218例（17．0％），总的肺／支气管感染和总心衰分别是706例（55．4％）和354例（27．8％）。分级越重，心衰和感染发生率越高（P〈0．01）。前十位诱因尚有：水电解质代谢紊乱32例（2．5％）、气胸29例（2．3％）、胸水27例（2．1％）、心律失常29例（2．3％）、药源性16例（1．3％）等。结论AECOPD诱因很多，肺／支气管感染和心衰是最多见的诱发因素。     

N-乙酰半胱氨酸辅助治疗慢性阻塞性肺疾病急性加重期的疗效分析

目的探讨N-乙酰半胱氨酸(NAC)辅助治疗慢性阻塞性肺疾病急性加重期(AECOPD)的临床疗效。方法选择150例AECOPD患者,随机分为治疗组和对照组,每组75例,2组患者均予控制性氧疗、抗感染、支气管扩张剂、糖皮质激素、营养等基础治疗。治疗组在上述治疗基础上加用N-乙酰半胱氨酸胶囊口服,3次/d,共2周。观察2组患者治疗前后临床疗效、肺功能、动脉血气分析指标等相关因素的改善情况、C反应蛋白(CRP)正常率及不良反应发生情况。结果治疗组与对照组有效率分别为93.33%和70.67%;治疗组在一定程度上有效增加肺活量(VC)和1 s用力呼气容积与用力肺活量比值(FEV1/FVC%)(P0.05),降低二氧化碳分压(Pa CO2)、提高氧分压(Pa O2)(P0.05),CRP正常率明显提高(P0.05),并未见严重不良反应发生。结论 N-乙酰半胱氨酸辅助治疗AECOPD患者临床疗效确切,可显著提高患者生存质量。     

: Short-term effects of exposure to particulate matter on hospital admissions for asthma and chronic obstructive pulmonary disease

We investigated the effects of particulate matter (PM) factors on hospitalization rates for asthma and chronic obstructive pulmonary disease (COPD).We obtained data on pollutants—PM₁₀, PM_2.5—in Seoul, South Korea. We also investigated data for asthma and COPD exacerbation that required hospitalization from 2006 to 2016. We used a time-stratified case-crossover design and generalized additive models with log transformation to assess adjusted risk, and conditional logistic regression was performed to analyze these data.Our study showed that PM₁₀ and PM_2.5, on different best lag days, were associated with increased risks of COPD or asthma hospitalization. The odds ratios (ORs) for each per-unit increase in PM₁₀ and PM_2.5 were higher in patients with male asthma (PM₁₀: OR, 1.012; 95% confidence interval [CI], 1.008–1.016 and PM_2.5: OR, 1.015; 95% CI, 1008–1.023), preschool asthma (PM₁₀: OR, 1.015; 95% CI, 1.006–1.015 and PM_2.5: OR, 1.015; 95% CI, 1.009–1.024), male COPD (PM₁₀: OR, 1.012; 95% CI, 1.005–1.019 and PM_2.5: OR, 1.013; 95% CI, 1.000–1.026), and senior COPD (PM₁₀: OR, 1.016; 95% CI, 1.008–1.024 and PM_2.5: OR, 1.022; 95% CI, 1.007–1.036).Increasing PM levels increased hospitalizations for asthma and COPD. Additionally, the consequences may be different according to age and sex, and PM_2.5 may have a more significant effect on airway disease patients than PM₁₀.     

慢性阻塞性肺疾病频发加重表型患者危险因素分析

目的 分析导致慢性阻塞性肺疾病频发急性加重表型患者,频发加重的可能危险因素.方法收集2016年01月至2017年01月在上海交通大学医学院附属新华医院崇明分院呼吸科住院患者中被诊断为慢阻肺急性加重期的患者,根据患者急性加重发作频率,纳入51例频发急性加重表型患者并随访1年,观察1年内再次频发加重的患者比例及临床特征,采...     

感染在慢性阻塞性肺疾病急性加重期的作用

慢性阻塞性肺疾病（COPD）具有很高的发病率和病死率,而慢性阻塞性肺疾病急性加重（AECOPD）则是COPD患者就诊以及住院治疗的主要原因,它不仅会加快病程的进展,使肺功能出现急剧下降,还会增加疾病相关病死率。所以,积极治疗AECOPD对于延缓COPD的病程、降低病死率非常重要。正确的治疗是建立在对病因学充分认识基础上的,感染因素是AECOPD最重要的原因,相关的研究也是COPD以及AECOPD研究的重点,目前已经充分认识到了这一因素的重要性,相关治疗措施已应用于临床。但是仍有一些尚待明确的问题,尤其是在细菌感染方面。本文结合近年来众多相关文献,对感染原因引起的AECOPD作一综述。