Prophylaxis of venous thromboembolism in patients with chronic obstructive pulmonary disease

At present, almost 25% of the world population suffer from venous thromboembolism (VTE). This condition is currently regarded as a continuum of thromboembolism of pulmonary artery (TEPA) and venous thromboses including superficial venous thromboses. These diseases are not infrequently concomitant and asymptomatic. Up to 75% of the cases of venous thrombosis in the lower extremities are associated with latent TEPA and 80% of the cases of pulmonory embolism with asymptomatic venous thrombosis. The mortality rate from TEPA is estimated to be one person per 1,000. The data of autopsies indicate that 50-80% of the TEPA cases are not diagnosed at all. As many as 300 subjects of 100,000 suffer trophic ulcers in the lower extremities as a result of previous venous thrombosis. Prophylaxis is supposed to be the principal means of VTE control. Chronic lung diseases are the leading risk factors of VTE. Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality throughout the world. It is expected to become the third major cause of death by 2020. Hospitalization of COPD patients in therapeutic clinics increases the risk of VTE by 7.98 times. Prophylaxis of VTE in COPD patients may reduce the frequency of exacerbation and hospitalization and increase life expectancy.     

Plasma beta-endorphin concentrations are increased in chronic obstructive pulmonary disease patients

Objective. Since fibroblast growth factor 19 (FGF‐19) is a potent metabolic regulator that influences glucose and lipid homeostasis, our aim was to develop an ELISA assay for measuring FGF‐19 in human serum and to investigate its concentrations in healthy volunteers and patients suffering from metabolic syndrome. Material and methods. A sandwich ELISA method was developed for quantitative determination of human FGF‐19 in serum samples. Blood pressure, waist circumference, FGF‐21 serum levels, serum cholesterol, triacylglycerols, HDL‐cholesterol, LDL‐cholesterol, insulin, glucose, adiponectin, uric acid, creatinine, hs‐CRP and calculated BMI and Quicki insulin sensitivity index were measured in 153 healthy volunteers and 66 persons with metabolic syndrome. Results. Neither sex nor age influenced FGF‐19 serum concentration in the healthy volunteers. Probands with metabolic syndrome had 65?% lower FGF‐19 serum values than the healthy ones (medians 158.6 versus 242.4?ng/L; p<0.01). FGF‐19 correlated with glucose (r = ?0.35, p<0.01), HDL (r = 0.24, p = 0.045), triacylglycerols (r = ?0.19, p = 0.05) and with a number of other risk facors for metabolic syndrome (r = ?0.28, p = 0.01). When adjusted to the concentrations of triacylglycerols, BMI and glucose, and finally to all data pertinent to FGF‐19 (according to correlation analysis), our data indicate that FGF‐19 is an independent marker of metabolic syndrome. Conclusions. The present study demonstrates the analytical properties of the ELISA FGF‐19 assay and its usefulness when studying the metabolic syndrome. Serum concentrations of FGF‐19 could be new key predictors of metabolic syndrome and thereby even a new negative risk factor of atherosclerosis.     

Plasma beta-endorphin concentrations are increased in chronic obstructive pulmonary disease patients

The present study is concerned with plasma beta-endorphin and glucose tolerance in patients with chronic obstructive pulmonary disease (COPD). Plasma beta-endorphin, glucagon and insulin concentrations were measured during an oral glucose tolerance test in 20 COPD patients and in 18 age-matched healthy controls (mean age 62 years). Seven patients had a moderate COPD (group I) and seven a severe COPD (group II). The remaining six severe COPD patients received long-term oxygen therapy (group III). We found that fasting levels of beta-endorphin were significantly increased in all patient groups compared to healthy controls (p < 0.01, 0.05 and 0.005, respectively). Six of the 13 severely diseased COPD patients had impaired glucose tolerance. Plasma beta-endorphin levels decreased significantly during OGTT in the COPD patients (p < 0.05). Fasting beta-endorphin levels were higher in patients with impaired glucose tolerance than in those patients with normal OGTT (42.0 pmol/L +/- 11.4 SD versus 34.8 +/- 10.2). However, this difference was not statistically significant. In conclusion, this study showed that beta-endorphin concentrations are increased in COPD patients whether or not they receive oxygen therapy.     

The electrocardiogram in chronic obstructive pulmonary disease

The electrocardiogram is often abnormal in patients who have chronic obstructive pulmonary disease. The most frequent abnormalities are a rightward P-wave axis (greater than or equal to 70 degrees) and a rightward QRS axis (greater than or equal to 90 degrees). In addition, low voltage in the limb leads, an S1S2S3 pattern, poor R-wave progression, a posterior-superior terminal QRS vector or other changes may be present. Transient atrial and ventricular dysrhythmias are common. Knowledge of the usual electrocardiographic manifestations of chronic obstructive pulmonary disease enables the clinician to recognize uncharacteristic abnormalities, which often represent the effects of superimposed illnesses or drug toxicity.     

长期家庭氧疗对慢性阻塞性肺病的影响

目的:观察长期家庭氧疗(LTOT)对慢性阻塞性肺病(COPD)患者气道壁厚度及肺功能的影响。方法:中重度COPD患者45例,随机分为家庭氧疗组(氧疗组)和对照组各20例,2组均接受常规药物治疗,氧疗组加用长期家庭氧疗。治疗前后行高分辨率螺旋CT(HRCT)扫描测试2组的气道壁厚度(WT)和气道壁相对面积值(WA%)及肺功能测试。结果:治疗2年后,对照组WT、WA%较治疗前明显增加(P<0.05),FEV1/FVC较治疗前明显降低(P<0.05),氧疗组各指标治疗前后比较差异无统计学意义。结论:长期家庭氧疗能有效改善COPD患者的气道重建及延缓患者的肺功能恶化。     

慢性阻塞性肺疾病病人长期家庭氧疗现状调查与护理

目的了解慢性阻塞性肺疾病病人长期家庭氧疗的现状。方法对2014年5月~2014年6月本科出院后愿意接受调查的97例慢性阻塞性肺疾病病人由专科护士进行电话随访调查。结果 97例病人中对氧疗相关知识不了解39例(40.2%);部分了解28例(28.9%);了解30例(30.9%)。未进行家庭氧疗的74例(76.3%),进行家庭氧疗的23例(23.7%),其中14例(14.4%)病人达到要求。结论 COPD患者对长期家庭氧疗的重要性认识不足,呼吸专科医护人员应加强对慢性阻塞性肺疾病病人氧疗相关知识的教育和指导,为病人提供支持和帮助。     

慢性阻塞性肺疾病肺康复治疗新进展

慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是全球患病率及死亡率较高的重要疾病。肺康复治疗通过肺康复计划改善患者的呼吸困难,提高运动耐力及生活质量,改善患者心理障碍及社会适应能力。本文就有关肺康复治疗进展综述如下。     

Exercise and chronic obstructive pulmonary disease

Patients with chronic obstructive pulmonary disease have abnormal respiratory mechanics, respiratory muscle function, gas exchange, and cardiovascular function during exercise. Their impaired exercise tolerance is at least partly due to altered respiratory mechanics, but factors that increase ventilation during exercise indirectly contribute to exercise limitation. Clinical exercise testing is a very important tool in the assessment of exercise capacity, assessment of factors that contribute to exercise limitation, and differential diagnosis of cardiopulmonary disease.     

骨质疏松与慢性阻塞性呼吸系统疾病

目的:分析慢性阻塞性呼吸系统疾病继发骨质疏松的病因及发病途径,为其预防及治疗提供理论依据。资料来源:应用计算机检索Medline,Pubmed和Ovid数据库1990-01/2006-06有关慢性阻塞性呼吸系统疾病和骨质疏松关系的文章。检索词为“COPD or chronic obstructive pulmonary disease,osteoporosis,pathogenesis,treatment”,限定文章语言种类为English。同时计算机检索中国期刊全文数据库(CNKI)1990-01/2006-06有关慢性阻塞性呼吸系统疾病和骨质疏松关系的文章,检索词为“慢性阻塞性肺病,骨质疏松,发病机制,治疗”,限定文章语言种类为中文。资料选择:对资料进行初审,筛除非随机的研究。纳入标准:①随机对照临床研究。②前后对照临床研究。排除标准:①重复性研究。②综述文献。资料提炼:共收集到45篇有关慢性阻塞性呼吸系统疾病和骨质疏松症关系的文章,其中36篇符合纳入标准。资料综合:36篇文献中包括27个随机对照临床研究和9个前后对照临床研究,提示慢性阻塞性呼吸系统疾病继发骨质疏松症的病因主要是吸烟、户外运动减少、缺氧与营养不良、激素作用及一些相关的细胞因子和蛋白酶,对其治疗除了积极治疗慢性阻塞性呼吸系统疾病外,还应减少香烟的吸入,适当加强户外运动,增加营养,对于严重者可适当给予治疗骨质疏松的中西医药物。结论:对于慢性阻塞性呼吸系统疾病继发骨质疏松,要定期进行骨密度等测定,及时发现,及早治疗,防止其发生和发展,将有利于提高老年肺病患者的生活质量。     

Genes and chronic obstructive pulmonary disease

Although much remains to be done, recent advances and the advent of new methodologies are promising and should yield increased understanding of the genetic and epigenetic mechanisms influencing the pathogenesis of COPD, both related and unrelated to severe AAT deficiency. Such understanding should ultimately be translated into novel approaches to prevent, diagnose, and treat COPD.     

Comorbidity in chronic obstructive pulmonary disease

AIM: To investigate comorbidity in chronic obstructive pulmonary disease (COPD) and its contribution to lethality of patients with pulmonary disease. MATERIAL AND METHODS: Case histories of 125 COPD and 54 osteoarthritis (OA) patients matched by sex and age have been analysed retrospectively. Mean comorbidity index (CI) in COPD patients was two times higher than in OA patients (p < 0.001). RESULTS: The CI rose with growing severity of a COPD course (p < 0.01). Follow-up of 77 COPD patients for 3-5 years distinguished a group of patients with unfavorable outcomes. In lethal outcomes CI-3 points occurred significantly more frequently (p < 0.001). A significant correlation exists between CI and time from the moment of CI estimation to the patient's death (r = -0.54; p < 0.05). Thus, CI can be used in clinical practice as a simple method of risk of death for COPD patients. A rise of CI over 3 scores indicates a high risk of a COPD patient's death which should be considered in management of COPD patients.     

Apoptosis in chronic obstructive pulmonary disease

Although the major sites of airflow limitation in patients with COPD are most likely the peripheral airways, lesions in both the peripheral airways and the lung parenchyma contribute to chronic airflow limitations. Abnormalities in the lung parenchyma is recognized as emphysema characterized by air space enlargement and alveolar destruction. The mechanism responsible for the development of emphysema was thought to be protease/antiprotease imbalance and oxidative stress. A very recent study shows that alveolar cell apoptosis causes lung destruction and emphysematous changes. Thus, apoptosis may play a significant role in the development of emphysema.     

慢性阻塞性肺疾病患者家庭肺康复的效果评价

目的 应用meta分析方法,评价以家庭为基础的肺康复能否改善慢性阻塞性肺疾病(COPD)患者的运动耐力和生活质量。方法 在Pubmed、Embase、CochraneCentralRegisterofControlledTrials及CBMDisc中检索COPD患者接受家庭肺康复的随机对照试验(RCTs),并对结果进行meta分析。结果 共有15项RCTs符合文献纳入标准。其家庭肺康复组患者康复锻炼前后6分钟步行距离(6MWD)的改变量显著大于常规治疗组,2组间的差值为59.03m(50.23m,67.83m),具有统计学意义。慢性呼吸道疾病问卷(CRDQ)的呼吸困难、疲倦及情绪状态项目评分,合并后的组间差值分别为0.78(0.24,1.32)、1.12(0.54,1.70)及1.05(0.51,1.60),2组间的差异具有统计学意义。结论 家庭肺康复可以提高COPD患者的运动耐力,改善患者的呼吸困难、疲倦症状及情绪状态。