高原慢性阻塞性肺疾病合并慢性肺心病低氧血症与肿瘤坏死因子系统活性及对营养不良的影响

目的探讨高原地区慢性阻塞性肺疾病（COPD）合并慢性肺心病（CCP）患者低氧血症与肿瘤坏死因子-α（TNF-α）系统活性的关系,及对营养不良的影响。方法对高原地区（海拔2260—3500m）52例COPD合并CCP低氧血症缓解期患者测定了血清TNF-α和血浆可溶性肿瘤坏死因子受体-55（sTNF—R55）、1s用力呼气容积占预计值百分比（FEV1％）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、体重（BW）、理想体重百分比（％NW）和体重指数（BMI）,并与30名年龄相似的平原健康人作对照。结果COPD合并CCP组BW、％NW、BMI、FEV,％和PaO：显著低于对照组,PaCO2、血清TNF—d和血浆sTNF-1／55显著高于对照组（均P〈0．01）。COPD合并CCP组PaO,水平与血清TNF—OL、血浆sTNF—R55水平呈显著负相关（TNF-α：r=-0．787,P〈0．01;sTNF—R55;r=-0．802,P〈0．01）,TNF—α、sTNF—R55与BMI呈显著负相关（TNF一仪：r=-0．785,P〈0．01;sTNF-R55：r=-0．791,P〈0．01）,TNF—α与sTNF—R55水平呈显著正相关（sTNF-R55;r=0．702,P〈0．01）。COPD合并CCP患者中,PaO2〈45mmHg亚组TNF-α、sTNF—R55水平显著高于Pa02≥45mmHg亚组（均P〈0．01）;BMI〈18．0kg／m^2亚组的TNF—α、sTNF—R55水平显著高于≥18．0kg／m^2亚组（均P〈0．01）;BMI〈18．0kg／m^2患者PaO2〈45mmHg亚组的TNF—α、sTNF—R55水平显著高于Pa02I〉45mmHg亚组（均P〈0．05）。结论高原COPD合并慢性肺心病全身低氧血症患者体内肿瘤坏死因子．理系统活性增强,这可能是导致本病患者发生营养不良的重要因素。     

老年慢性阻塞性肺病患者CRP、IL-1β、TNF-α水平的临床意义

目的探讨C反应蛋白（CRP）、白细胞介素-1β（IL-1β）、肿瘤坏死因子-α（TNF-α）在老年慢性阻塞性肺病（COPD）的血清表达水平及临床意义。方法分别测定58例老年健康人群（对照组）,62例老年COPD急性加重期患者（AECO-PD组）和54例老年COPD稳定期患者（COPD稳定期组）血清CRP、IL-1β、TNF-α水平。结果对照组CRP、IL-1β、TNF-α的血清浓度值明显低于AECOPD组及COPD稳定期组,COPD稳定期组CRP、IL-1β、TNF-α的血清浓度值明显低于AECOPD组,两者之间的差异具有统计学意义（P〈0.01）。结论 CRP、TNF-α、IL-1β等细胞因子在COPD的发病及急性加重中起重要作用,而且与机体的系统性炎症反应有密切关系。     

慢性阻塞性肺疾病的炎症反应与体重指数密切相关

目的探讨COPD患者局部及全身炎症反应与体重指数（BMI）的关系。方法2007年9月～2009年2月在我院就诊的稳定期COPD患者74例和健康体检者（对照组）30例。常规行肺功能、动脉血气分析及诱导痰炎症细胞分类计数,ELISA法测定血清C反应蛋白（CRP）、自细胞介素-8（IL-8）、IL_6、IL一10与肿瘤坏死因子-α（TNF-α）。分析以上各指标与BMI之间的关节。结果低体重组COPD患者诱导痰细胞总数与中性粒细胞计数明显高于正常体重组与对照组（P〈0．05）。低体重组COPD患者第一秒用力呼气量占预计值％（FEV1％）、PEV1与用力肺活量（FVC）比值及动脉血氧分压（PaO2）明显低于正常体重组（P〈0．05）,动脉血二氧化碳分压（PaC02）明显高于正常体重组（P〈0．05）。低体重组COPD患者BMI与诱导痰细胞总数、中性粒细胞数、CRP、IL-8、IL-及TNF-α呈负相关,相关系数分别为-0．515,-0．468,-0．453,-0．394,-0．462,-0．497,均P〈0．05。结论稳定期COPD患者的气道和全身炎症反应与BMI密切相关。     

Effects of Active Smoking on Airway and Systemic Inflammation Profiles in Patients With Chronic Obstructive Pulmonary Disease

BackgroundThe markers that characterize local and systemic inflammation in chronic obstructive pulmonary disease (COPD) remain unclear, as do their correlations with smoking status and presence of disease. The aim of this study was to assess markers of inflammation in the peripheral blood and airways of current smokers without COPD, of current smokers with COPD and of ex-smokers with COPD.MethodsIn this study, 17 current smokers with COPD (mean age: 58.2 ± 9.6 years; mean forced expiratory volume in 1 second [FEV₁]: 56.1 ± 15.9%), 35 ex-smokers with COPD (mean age: 66.3 ± 7.3 years; mean FEV₁: 47.9 ± 17.2%) and 20 current smokers without COPD (mean age: 49.1 ± 6.2 years; mean FEV₁: 106.5 ± 15.8%) were evaluated. Spirometry findings, body composition and serum/induced sputum concentrations of tumor necrosis factor α (TNF-α), interleukin (IL)-6, IL-8 and IL-10, together with serum C-reactive protein (CRP) levels, were assessed.ResultsSerum TNF-α concentration was higher in all current smokers than in ex-smokers with COPD. In current smokers without COPD, serum CRP level was lower than in ex-smokers with COPD and significantly lower than in current smokers with COPD. Sputum TNF-α concentration was higher in current and ex-smokers with COPD than in current smokers without COPD. Multiple regression analyses showed that serum TNF-α was associated with active smoking, and serum CRP and sputum TNF-α were associated with COPD diagnosis.ConclusionsSmoking is associated with higher systemic inflammation in patients with COPD. Current findings also support the hypothesis that smoking and COPD have different effects on the regulation of airway and systemic inflammatory processes.     

Obesity and depressive symptoms in elderly Koreans: Evidence for the “Jolly Fat” hypothesis from the Ansan Geriatric (AGE) Study

The current study is to examine the association between obesity and depressive symptoms and to test the validity of “Jolly Fat” hypothesis in elderly Koreans. A total of 1229 elderly (60-85 years old) Koreans selected from the Ansan Geriatric Study participated in this study. Body mass index (BMI) was calculated from the measured weights and heights of subjects. Overweight and obese were defined as BMI ≥23 and ≥25, respectively. Depressive symptoms were measured using the 30-item Korean version of the Geriatric Depression Scale (K-GDS), with a cutoff point of 18. The prevalence of depressive symptoms in elderly Korean women was higher than in men (20.9% vs. 9.2%, p < 0.001). Among elderly women, higher mean values of obesity indexes, such as weight, BMI, waist circumference, waist-hip ratio, and body fat mass, were found in normal subjects than in those with depressive symptoms. No such differences were found in elderly men. Obese elderly women were less likely to suffer from depressive symptoms compared to those with apparently normal weight (odds ratio (OR) = 0.63, 95% CI: 0.41-0.96). This inverse association was evident after adjustment for confounders, such as age, education, personal expenses, smoking, alcohol consumption, regular exercise, self-perceived health, presence of chronic disease, and cognitive function. Our data are consistent with the “Jolly Fat” hypothesis being valid only in women, but not in men, among elderly Koreans. A causal relationship between obesity and depressive symptoms should be evaluated in future studies in elderly Korean women.     

白介素17在慢性阻塞性肺疾病大鼠肺组织中的表达及与气道炎症及重塑的关系

目的 探讨白介素17(IL-17)在慢性阻塞性肺疾病(COPD)大鼠气道炎症及重塑中的作用.方法 采用被动吸烟80 d来制备大鼠COPD模型.支气管肺泡灌洗计数支气管肺泡灌洗液(BALF)中细胞计数和百分比;采用半定量图像分析法测量小气道管壁和平滑肌层厚度;免疫组织化学法检测肺组织IL-17的表达;酶联免疫吸附试验法检...     

COPD稳定期患者血清IL-6、TNF-α、MMP-9水平与BODE指数的相关性研究

目的 探讨COPD稳定期患者血清IL-6、肿瘤坏死因子α(TNF-a)、基质金属蛋白酶9(MMP-9)与BODE指数(B为体质量指数、O为气流阻塞、D为呼吸困难、E为运动能力)的关系.方法 45例符合纳入标准的COPD稳定期患者作为观察组,25例体检健康者作为对照组,测定2组血清IL-6、TNF-α、MMP-9水平,评价观察组患者BODE指数.结果 与对照组相比,COPD稳定期组患者血清IL-6、TNF-α、MMP-9水平均显著高于对照组(t值分别为3.341、3.922、2.345,P值均＜0.05);COPD稳定期患者血清IL-6、TNF-α、MMP-9水平与BODE指数呈显著正相关(r值分别为0.808、0.567、0.568,P值均＜0.05).结论 COPD稳定期患者血清IL-6、TNF-α、MMP-9仍维持较高水平,且与患者BODE指数相关,可作为预测COPD患者病情的有效指标.     

老年COPD患者多种检测的临床意义

目的探讨CRP、IL-1β、TNF-α在老年COPD的水平及临床意义。方法病例选取2012.6~2013.4在我院呼吸科诊治的26例老年COPD和26例健康体检者纳入对照组,检测并比较两组血清CRP、IL-1β、TNF-α水平。结果对照组血清CRP、IL-1β、TNF-α的水平较COPD组有显著性差异(P0.05);COPD组患者FEV1/FVC%水平与IL-1β、TNF-α、CRP的水平呈显著负相关(P0.05)。结论 CRP、IL-1β、TNF-α等细胞因子在老年COPD的发病及急性加重中起重要作用,而且与机体的系统性炎症反应有密切关系。     

老年高血压病患者血清肿瘤坏死因子-α、白介素-6和C-反应蛋白水平的变化研究

目的 探讨在老年高血压病患者中,血清肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)和白细胞介素-6( IL-6)水平变化及意义.方法 24例正常血压老年人和28例老年高血压病患者,常规测量血压,抽取空腹静脉血检测其空腹血糖、血脂、血清胰岛素、IL-6、CRP和TNF-α水平.结果 与正常老年人群相比,在老年高血压者中,血清总胆固醇、三酰甘油、IL-6[(15.56±5.36)vs(26.86±2.49)μg/ml,P＜0.05]、CRP[(1.58±1.14)vs(2.29±1.42)mg/ml,P＜0.05]和TNF-α[(34.58±14.54)vs(56.82±32.14)ng/ml,P＜0.05]水平均高于正常血压人群.在老年高血压病患者中,血清CRP和TNF-α水平均与收缩压呈正相关,与舒张压无相关性.结论 老年高血压病患者中血清IL-6、CRP和TNF-α水平均增高并与收缩压呈正相关,提示高血压病与炎症密切相关.     

炎症因子的变化在慢性阻塞性肺疾病病程发展中的应用探讨

目的观察炎症因子在慢性阻塞性肺疾病(COPD)稳定期、急性发作期的变化,探讨炎症因子对判断COPD病程进展的意义。方法本研究选取我院收治的90例COPD患者作为研究对象,同时选取同期我院体检的50例健康者作为对照组,分别对两组的血清CRP、IL-6、TNF-α、NO水平进行测定,比较COPD稳定期、急性发作期及健康者血清CRP、IL-6、TNF-α、NO的水平差异。结果 (1)COPD患者CRP、IL-6、TNF-α、NO的水平显著高于健康组(P<0.01);急性发作期患者CRP、TNF-α水平显著高于稳定期患者(P<0.01),具有统计学意义。(2)按照治疗期间肺功能状态分为a、b、c三点,a点CRP、IL-6、TNF-α、NO水平最高,b、c点依次降低,CRP、TNF-α、NO在不同时期中变化最为明显(P<0.05,P<0.01)。结论血清CRP、IL-6、TNF-α、NO水平在COPD患者显著增高,其中CRP、TNF-α、NO水平可作为评估COPD疾病进展的参考指标应用。     

血清脂质转运蛋白与慢性阻塞性肺疾病病情程度相关性分析

目的 分析血清脂质转运蛋白与慢性阻塞性肺疾病(COPD)患者病情程度的相关性。方法 选取2017年1月至2021年1月我院收治的136例COPD患者,根据病情稳定者70例为对照组和加重者66例为观察组。对比两组WBC、C反应蛋白(CRP)、中性粒细胞百分比(NEU%),血清淀粉样蛋白A(SAA)、肿瘤坏死因子-α(TNF-α)、肺泡表面活性蛋白D(SP-D)、脂质转运蛋白1(LCN-1)及脂质转运蛋白2(LCN-2),分析SAA、TNF-α、SP-D、LCN-1、LCN-2与COPD病情程度相关性。结果 观察组FEV₁/FVC、PaO₂水平低于对照组(P<0.05);观察组CRP、WBC、NEU%高于对照组(P<0.05)。观察组TNF-α、SP-D、SAA、LCN-1及LCN-2水平高于对照组(P<0.05)。经Pearson检验,SAA、TNF-α,SP-D、LCN-1、LCN-2与COPD病情程度呈正相关(P<0.05)。ROC曲线分析发现SAA、TNF-α、SP-D、LCN-1、LCN-2对COPD急性加重期有...     

高原慢性阻塞性肺疾病稳定期血清SP-D水平与肺功能及炎症因子的临床意义

目的探讨高原慢性阻塞性肺疾病(COPD)稳定期患者血清肺泡表面活性蛋白D(SP-D)的水平及与肺功能、炎症因子的临床意义。 方法收集2016年5月至2017年12月在华西医院就诊的世居高原COPD稳定期的患者150例及健康对照组67例，收集两组的临床资料包括年龄、性别、体质指数(BMI)、吸烟指数及肺功能指标，包括FEV₁(第1 s用力呼出气容积)、FEV₁%(第1 s用力呼出气容积占预计值百分比)、FEV₁/FVC%(第1 s用力呼出气容积/用力肺活量比值)，抽取静脉血测定SP-D、CRP(C反应蛋白)、IL-6(白介素6)、TNF-α(肿瘤坏死因子α)。比较两组之间及COPD稳定期的汉、藏族之间的血清SP-D、CRP、IL-6、TNF-α的浓度差异；并将血清SP-D与COPD稳定期患者的肺功能、全身炎症、CAT(COPD测试评分)、mMRC(改良英国医学研究学会呼吸困难指数)作相关性分析；作SP-D在COPD稳定期的多因素回归分析，并作SP-D在COPD稳定期的ROC分析。 结果COPD稳定组的SP-D高于对照组[(12 524±8 796)vs.(9 288±5 640 ng/L)，P<0.05]、COPD稳定组的炎症指标如CRP[0.5(2.3)比2(2.5)，P<0.05]、IL-6[2.3(2.2)vs. 1.1(1.4)，P<0.05]、TNF-α[(5.5±2.7)vs.(7.8±6.7)，P<0.05]，均显著高于对照组。COPD稳定组的SP-D与CAT、mMRC评分呈正相关(r＝0.498，P<0.05；r＝0.512，P<0.05)，与炎症因子CRP、IL-6、TNF-α的水平呈正相关(r＝0.369，P<0.05；r＝0.454，P<0.05；r＝0.529，P<0.05)，与肺功能指标FEV₁%、FEV₁/FVC%呈负相关(r＝-0.404，P<0.05；r＝-0.171，P<0.05)。对COPD稳定期患者，汉、藏族在血清SP-D及炎症因子CRP、IL-6、TNF-α之间的浓度水平均无统计学差异(P>0.05)。对SP-D在COPD稳定期的多因素回归分析，没有发现与稳定期相关的指标，均P>0.05。在ROC统计中，SP-D的阈值为9 303.5，敏感度为0.576，特异度为0.616，SP-D对诊断COPD稳定期有一定诊断价值。 结论血清SP-D升高可反应全身炎症水平，有助于评估高原COPD患者的肺功能程度及病情变化。对高原COPD病情的预测与评估有一定临床意义。     

Predictors of depressive symptoms in patients with COPD and health impact

While depression is a common co-morbid condition among patients with COPD, little is known about predictors or health impact of depression among these patients. To address these gaps in knowledge we conducted a cross-sectional survey of 207 patients with COPD cared for in a network of primary care clinics affiliated with an urban academic health center. A standardized questionnaire was used to measure demographic characteristics, smoking status, co-morbid medical conditions, current medications, self-efficacy, social support, illness intrusiveness, and self-reported health care utilization during the previous 6 months. Depressive symptoms were assessed using the Centers for Epidemiologic Studies-Depression scale. Overall, the prevalence of moderate to high levels of depressive symptoms was 60.4%. In a multivariate analysis independent predictors of depressive symptoms were being a former smoker (OR = 0.41 (95% CI 0.19-0.89)), higher self-efficacy (OR = 0.42 (0.28-0.64)), higher social support (OR = 0.72 (0.52-0.99)), and higher perceived illness intrusiveness (OR = 1.05 (1.02-1.08)). Depressive symptoms were associated with increased physician visits, emergency room visits, and hospitalizations for lung disease. In conclusion, depressive symptoms are common among patients with COPD and associated with an increase in healthcare utilization. These findings suggest that the identification of risk factors for depressive symptoms (e.g., continued smoking) may increase detection and improve management of depression and health outcomes among patients with COPD.     

PM2.5对大鼠COPD模型肺泡灌洗液IL-8、IL-17、TNF-α影响及意义

目的 初步研究BALF IL-8、IL-17、肿瘤坏死因子α(tumor necrosis tactor-α,TNF-α)在PM2.5干预下COPD大鼠(chronic obstruction pulmonary disease)模型中水平变化,研究其在COPD发病中的作用.方法 48只雄性Wistar大鼠随机分成2个组,即正常组(A组),COPD组(B组),每组24只,采用气管滴注的染毒方式,对A组、B组大鼠气管滴注无菌生理盐水及PM2.5染毒,每天染毒1次,连续3d,在最后一次染毒24 h后处死动物,分析BALF中IL-8、IL-17、TNF-α的含量.结果 ①与气管滴人生理盐水的A组相比,气管滴入PM2.5的B组BALF中IL-8浓度显著升高,差异均有统计学意义(P＜0.05);②随着大鼠染毒剂量增加,BALF中IL-8水平亦有所增加,呈正相关;③气管滴入PM2.5的B组BALF中IL 17、TNF-a水平亦有升高,高于气管滴人生理盐水A组大鼠IL-17、TNF-α水平,两组比较差异均有统计学意义(P＜0.05).结论 IL-8、IL-17、TNF α可能参与了COPD气道及系统炎症,但IL-8可能是参与COPD急性加重期发生、发展的重要炎症因子,并且在PM2.5干预下IL-8、IL-17、TNF-α相互作用贯穿与COPD的发生、发展,对评估COPD严重程度及预后具有重要的临床意义.     

吸烟对不同性别AECOPD患者气道炎症影响

目的 通过比较不同性别COPD急性发作期(AECOPD)患者的肺功能、血清细胞因子差异,研究性别差异对COPD患者气道炎症的影响.方法 将AECOPD患者分为四组,其中1组为既往无吸烟史男性,2组为吸烟指数>200支年男性,3组为既往无吸烟史女性,4组为吸烟指数>200支年女性,每组25例.检测所有患者入院时肺功能、血浆IL-8、TNF-α值.结果 非吸烟男性和女性血清炎症因子IL-8、TNF-α和肺功能比较无显著性差异(P>0.05),而在长期吸烟患者中,男性和女性患者的炎症因子、肺功能与无吸烟男性和女性比较均有显著性差异(P<0.05),同时吸烟女性与吸烟男性比较炎症因子更高(P<0.05)和肺功能更差(P<0.05).结论 吸烟的COPD女性患者在急性发作期炎症因子释放高于不吸烟女性及吸烟男性.     

稳定期慢性阻塞性肺疾病气道炎症的研究

目的 研究稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)气道炎症和肺功能、下气道细菌定植(lower airway bacterial colonization,LABC)的关系.方法 随机入选45例稳定期COPD门诊患者和28名健康志愿者,行肺功能、血常规和胸片检查.采用痰诱导方法 留取深部合格痰液,COPD患者的痰液行细菌定量培养,两组研究对象的痰液均行细胞因子检测.结果 稳定期COPD组痰液中白介素8(IL-8)、肿瘤坏死因子α(TNF-α)、IL-10、IL-19明显高于对照组(P＜0.05).第1秒用力呼气容积占预计值百分比(FEV1%pred)＜50%组痰液中IL-8、TNF-α、IL-19明显高于FEV1%pred≥50%组(P＜0.05),而IL-10在两组间比较差异无统计学意义.在本实验中LABC量≥107CFU/ml者占总人数的33.33%,主要的下气道定植菌为卡他莫拉菌、副流感嗜血杆菌、肺炎链球菌、流感嗜血杆菌等.LABC量≥107 CFU/ml组痰液中IL-8、TNF-α、IL-19明显高于LABC＜107 CFU/ml组(P＜0.05),而IL-10在两组间比较差异无统计学意义.相关性分析显示,IL-19与IL-10呈负相关,相关系数r=-0.548(P＜0.05),IL-19与IL-8、TNF-α呈正相关,相关系数分别为r=0.702(P＜0.05)、r=0.708(P＜0.05).FEV1%pred＜50%组细菌定植量明显高于FEV1%pred≥50%组(P＜0.05).FEV1%pred＜50%预计值组的吸烟指数明显高于FEV1%pred≥50%组(P＜0.05).结论 稳定期COPD患者存在气道炎症,既与LABC有关,又与吸烟有关,这种与LABC和吸烟相关的气道炎症可能是导致COPD患者肺功能进行性下降的原因.     

COPD治疗期间呼出气冷凝液中细胞因子的变化及意义

目的探讨COPD患者治疗期间呼出气冷凝液(EBC)细胞因子水平的变化及与肺功能相关性。方法入选稳定期COPD组24例,健康对照组18例。治疗前及治疗2周、4周、12周收集EBC并检测其LTB4、TNF-α、IL-13水平,并行肺功能检查。结果治疗前COPD组EBC中LTB4、TNF-α、IL-13水平高于对照组,治疗2周后均下降,治疗4周LTB4进一步下降(P0.05),且至12周保持低水平;而TNF-α、IL-13在治疗后2周至12周水平未见明显变化;治疗前后肺功能比较差异有统计学意义(P0.05);治疗前FEV1%与LTB4呈负相关关系(r=-0.574,P=0.003)。结论 LTB4、TNF-α可能参与COPD发病机制,可作为治疗期间观察疗效及监测病情指标。     

COPD患者血清IL-4、IL-8、TNF-α、CC16水平变化与气道炎症损伤的探讨

目的通过检测慢性阻塞性肺疾病急性发作期(AECOPD)患者血清中白细胞介素(IL)及TNF-α、CC16的水平变化,评价咳喘合剂的临床疗效及探讨COPD的作用机理。方法采用随机对照的方法选择94例COPD患者,其中中药复方治疗组(50例)及西药治疗组(44例),中药复方组给予口服咳喘合剂,西药组给予口服头孢类抗生素,余两组治疗方案相同。对AE-COPD及缓解期患者进行血清中IL-4、IL-8、TNF-α、CC16浓度检测。结果(1)AECOPD患者血清中IL-4、IL-8、TNF-α急性期较缓解期增高(P0.05);CC16浓度较COPD缓解期(P0.05)降低,(2)随着病情的严重分级,患者血清中IL-4、IL-8、TNF-α含量增多,CC16含量减少,(3)中药治疗组较西药组血清中IL-4、IL-8、TNF-α比较无差异(P0.05),(4)中药治疗组较西药治疗组CC16含量有差异,(P0.05)。结论AECOPD患者血清中IL-4、IL-8及TNF-α浓度升高,CC16浓度降低,可作为AECOPD气道炎症损伤的指标;咳喘合剂可以在临床广泛推广。     

老年脓毒症患者细胞因子和皮质醇水平与预后的关系

目的探讨老年脓毒症患者细胞因子和糖皮质激素水平及其与脓毒症预后的关系。方法用ELISA和放射免疫的方法检测42例老年脓毒症患者治疗前和治疗1周后血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)、皮质醇(Cor)和促肾上腺皮质激素(ACTH)水平,同时以30例健康老年人为对照组。结果老年脓毒症患者IL-6、TNF-α和ACTH较对照组明显升高,Cor和IL-10与对照组比较无明显差异。治疗1周后,15例患者死亡,死亡组ACTHI、L-6、TNF-α水平较存活组明显增高,而CorI、L-10水平降低。结论治疗1周后,伴血清高炎症细胞因子和低Cor及IL-10的老年脓毒症患者预后较差。     

Independent contribution of overweight/obesity and physical inactivity to lower health-related quality of life in community-dwelling older subjects

The study examined the association of nutritional status, obesity and physical activity (PA) with health-related quality of life (HRQL) in the elderly, and whether this relationship persists after controlling for confounders attributable to comorbidities, functional status and cognitive function. A total of 300 community-dwelling persons (177 women and 123 men) between 66 and 79 years of age were randomly chosen from all inhabitants of one district of the city of Lodz (Poland). HRQL was assessed with the Euroqol 5D questionnaire. PA was assessed by two questionnaires: the Seven Day Recall PA Questionnaire and the Stanford Usual Activity Questionnaire. Comorbidities, nutritional state (Mini Nutritional Assessment questionnaire - MNA), physical disability, cognitive function and psychological state were also assessed. In bivariate relationships body mass index (BMI), waist-to-hip ratio (WHR) and the percentage of body fat were negatively related to several HRQL scores both in women and men. Similarly, many HRQL scores were positively related to PA indices in both genders. In multivariate relationships, after adjustments for age, gender, smoking status, number of medications taken, comorbidities and geriatric physical and cognitive function, BMI predicted lower mobility while the percentage of body fat independently contributed to more frequent pain/discomfort and anxiety/depression problems. An adequate MNA added to a higher usual activity score, while a higher Stanford Moderate PA Index predicted better overall perceived health state. These results indicate that excess body fatness and sedentary lifestyle have, together with several functional and medical comorbidities, an independent contribution to inferior HRQL in community dwelling older subjects.