慢性阻塞性肺病患者CRR、CK-MB和BNP水平的改变及临床意义

目的 探讨血清C-反应蛋白(CRP)、磷酸肌酸激酶同工酶(CK-MB)和B型利钠肽(BNP)在慢性阻塞性肺病(COPD)急性发作期和治疗缓解期浓度变化及临床意义.方法 测定90例COPD患者急性发作期、治疗缓解期血清CRP、CK-MB和BNP水平和动脉血氧分压(PaO2),60例健康体检者血清CRP、CK-MB和BNP...     

血清降钙素原和C-反应蛋白对AECOPD细菌感染的诊断价值

目的探讨血清降钙素原(PCT)和C-反应蛋白(CRP)对慢性阻塞性肺疾病急性加重(AECOPD)细菌感染的诊断价值。方法选取70例AECOPD患者为研究对象,治疗前检测其血清PCT和CRP水平,并进行诱导痰细菌定量培养,治疗后再次进行血清PCT和CRP水平测定。以痰中的下呼吸道病原菌(PMM)浓度≥10~7CFU/ml作为诊断AECOPD细菌感染的金标准,将AECOPD患者70例分为细菌感染组39例和非细菌感染组31例。比较2组患者血清PCT和CRP水平的变化及临床意义。结果治疗前AECOPD患者PCT和CRP均显著高于治疗后(P<0.05),细菌感染组PCT水平高于非细菌感染组(P<0.05),2组CRP比较无明显差异(P>0.05)。以PCT>0.5ng/ml,CRP>10 mg/L为阳性阈值,PCT和CRP诊断AECOPD细菌感染的敏感度分别为94.9%、89.7%,特异度分别为87.1%、67.7%,PCT特异度高于CRP(P<0.05),敏感度无明显差异(P>0.05)。采用Kappa分析PCT和CRP与痰培养诊断AECOPD细菌感染的一致性,Kappa值分别为0.92、0.58,一致性均较高。结论 PCT和CRP是诊断AECOPD细菌感染较好的炎性反应指标,而PCT更具临床价值。     

NT-proBNP与慢阻肺急性加重期患者预后的相关性研究

目的分析N末端脑钠肽前体(NT-proBNP)与慢阻肺急性加重期(AECOPD)患者预后的相关性。方法回顾性分析2018年3月至2020年3月我院收治的60例AECOPD患者的临床资料,根据预后情况分为良好组(n=35)与不良组(n=25)。比较两组的NT-proBNP水平,并分析NT-proBNP与AECOPD患者预后的相关性。结果不良组入院120 h后的NTproBNP水平与入院时相比,差异无统计学意义(P>0.05);良好组入院120 h后的NT-proBNP水平较入院时显著降低(P <0.05);入院时、入院120 h后,良好组的NT-proBNP水平均低于不良组(P <0.05)。线性回归方程(Y=2.290+0.001X)提示NT-proBNP与AECOPD患者的预后密切相关(P <0.05)。ROC曲线显示,NT-proBNP预测AECOPD患者30 d不良结局的AUC为0.860,敏感度为0.960。结论 NT-proBNP水平与AECOPD患者的预后密切相关,持续性检测NT-proBNP水平可有效预测AECOPD患者的预后情况。     

COPD急性加重期和稳定期睡眠质量及其与肺功能相关性探究

目的比较慢性阻塞性肺病(COPD)患者急性加重期和稳定期的睡眠质量,并分析其与肺功能的相关性。方法选取某院收治并长期随访的稳定期和急性加重期病例资料记录完整的80例COPD患者作为研究对象,采用匹兹堡睡眠质量调查问卷(PSQI)对患者不同时期睡眠质量进行调查,并测定肺通气功能、肺换气功能指标,采用Pearson线性相关方法分析COPD患者PSQI评分和上述指标的相关性。结果 COPD患者稳定期睡眠质量、入睡时间、睡眠时间、习惯睡眠效应、催眠药物、日间功能以及感觉不适等睡眠质量维度评分均较急性加重期显著降低(P0.05);COPD患者稳定期一秒用力呼气容积(FEV_1)、二氧化碳分压(PaCO_2)水平较急性加重期显著升高(P0.05),用力肺活量(FVC)、FEV_1/FVC、PaO_2和血氧饱和度(SaO_2)水平较急性加重期显著降低(P0.05);COPD患者FEV_1和FVC与睡眠质量各个维度均无明显相关性,睡眠质量评分中睡眠质量、入睡时间、睡眠时间、习惯睡眠效应及日间功能等维度均和FEV_1/FVC、PaO_2和SaO_2存在正向相关性和Pa CO2存在负向相关性,而催眠药物和感觉不适2个维度和上述指标无明显相关性。结论COPD患者急性加重期肺功能较差,与睡眠质量差存在一定相关性。     

Case of benralizumab‐induced exacerbations of chronic spontaneous urticaria

The role of IL‐5 in chronic spontaneous urticarial (CSU) is unclear. It may be that benralizumab is an important bidirectional modifier of CSU; that is, blocking IL‐5 may improve CSU in some patients, but it is possible that it may worsen CSU in others.     

经鼻高流量湿化氧疗治疗AECOP D合并Ⅱ型呼吸衰竭的疗效分析

目的 研究经鼻高流量湿化氧疗治疗慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭的疗效.方法 回顾性分析四川大学华西医院2017年10月至2020年2月诊治的60例AECOPD合并Ⅱ型呼吸衰竭患者病例作为研究对象,采用非随机临床同期对照研究及患者自愿原则法分为氧疗组28例和对照组32例,其中对照组接受无创正压通...     

Effects of Asthma Medication Type on Asthma Exacerbation in a Real-World Setting

PurposeCurrently, there are multiple options for the pharmacological treatment of asthma. This study aimed to compare the effects of different asthma medications on exacerbation in a real-world setting.Materials and MethodsWe retrospectively reviewed electronic medical records of asthma patients who visited the hospital from November 1, 2016 to October 31, 2019. The number of asthma exacerbations requiring administration of systemic steroids was the primary outcome. A time-varying Cox regression analysis was used to reflect the real-world setting: variable usage times, discontinuation, and switching of medication.ResultsAmong 937 patients with asthma, 228 (24.3%) experienced asthma exacerbation during the study period. Asthma exacerbation was observed in patients using short-acting β₂-agonists (SABA) alone (50.4% vs. 28.6%, p<0.001) as well as in patients not using inhaled corticosteroids (ICS) (58.8% vs. 40.3%, p<0.001), long-acting β₂-agonists (LABA) (54.8% vs. 36.1%, p<0.001), and leukotriene receptor antagonists (71.5% vs. 50.8%, p<0.001). A time-varying Cox regression analysis of asthma exacerbations according to the duration of asthma medication showed that SABA alone increased the risk of asthma exacerbation [hazard ratio (HR), 1.834; 95% confidence interval (CI), 1.299–2.588; p=0.001], whereas ICS-LABA decreased the risk (HR, 0.733; 95% CI, 0.538–0.997; p=0.048). However, in the subgroup analysis according to medication type, specific ingredients showed no significant differences.ConclusionIn the real world, asthma medications affect asthma exacerbation variably according to the medication type.     

慢性阻塞性肺疾病急性加重合并下肢深静脉血栓的临床特征及危险因素

目的 探讨慢性阻塞性肺疾病急性加重(acute exacerbation chronic obstructive pulmonary disease, AECOPD)患者合并下肢深静脉血栓(deep venous thrombosis,DVT)的危险因素。方法 连续收集2018年10月至2019年4月首都医科大学附属北京潞河医院急诊病房收治的AECOPD患者51例,根据入院后下肢静脉彩色多普勒超声回报有无血栓的结果,分为血栓组和非血栓组,比较两组患者的基本资料、临床特征及检查结果。结果 在有无下肢水肿、肺动脉高压、平均动脉压、D-二聚体方面两组患者之间差异有统计学意义(均P＜0.05),对单因素分析结果中有意义的因素行多因素Logistic回归分析,结果显示,下肢水肿、肺动脉高压是AECOPD合并DVT的独立危险因素(P＜0.05,OR=5.215, 3.741),而平均动脉压及D-二聚体不是AECOPD合并DVT的独立危险因素(P＞0.05)。两组患者的C反应蛋白(C-reactive protein, CRP)、白细胞介素-6(interleukin-6,IL-6)、白细胞介素-8(interleukin-8,IL-8)、肿瘤坏死因子(tumor necrosis factor,TNF)、动脉血氧分压之间差异无统计学意义(P＞0.05)。结论 对AECOPD患者可通过下肢水肿情况、肺动脉高压推断发生下肢静脉血栓的可能性,进而针对性地检查、治疗,达到诊断及预防下肢深静脉血栓的效果。     

Evaluation of the multimorbidity network and its relationship with clinical phenotypes in chronic obstructive pulmonary disease: The GALAXIA study

BackgroundChronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition, in which taking into consideration clinical phenotypes and multimorbidity is relevant to disease management. Network analysis, a procedure designed to study complex systems, allows to represent connections between the distinct features found in COPD.MethodsNetwork analysis was applied to a cohort of patients with COPD in order to explore the degree of connectivity between different diseases, taking into account the presence of two phenotypic traits commonly used to categorize patients in clinical practice: chronic bronchitis (CB⁺/CB⁻) and the history of previous severe exacerbations (Ex⁺/Ex⁻). The strength of association between diseases was quantified using the correlation coefficient Phi (ɸ).ResultsA total of 1726 patients were included, and 91 possible links between 14 diseases were established. Although the four phenotypically defined groups presented a similar underlying comorbidity pattern, with special relevance for cardiovascular diseases and/or risk factors, classifying patients according to the presence or absence of CB implied differences between groups in network density (mean ɸ: 0.098 in the CB⁻ group and 0.050 in the CB⁺ group). In contrast, between‐group differences in network density were small and of questionable significance when classifying patients according to prior exacerbation history (mean ɸ: 0.082 among Ex⁻ subjects and 0.072 in the Ex⁺ group). The degree of connectivity of any given disease with the rest of the network also varied depending on the selected phenotypic trait. The classification of patients according to the CB⁻/CB⁺ groups revealed significant differences between groups in the degree of conectivity between comorbidities. On the other side, grouping the patients according to the Ex⁻/Ex⁺ trait did not disclose differences in connectivity between network nodes (diseases).ConclusionsThe multimorbidity network of a patient with COPD differs according to the underlying clinical characteristics, suggesting that the connections linking comorbidities between them vary for different phenotypes and that the clinical heterogeneity of COPD could influence the expression of latent multimorbidity. Network analysis has the potential to delve into the interactions between COPD clinical traits and comorbidities and is a promising tool to investigate possible specific biological pathways that modulate multimorbidity patterns.     

Prevention of acute exacerbation of chronic obstructive pulmonary disease after bronchoscopic lung volume reduction with endobronchial valves

IntroductionBronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBVs) has emerged as an important treatment method for patients with severe chronic obstructive pulmonary disease (COPD). Acute exacerbations of COPD (AECOPD) are a frequent complication following BLVR with EBV. However, there is no consensus on the prevention of AECOPD.ObjectivesOur study aims to compare the outcomes of different prophylactic measures on the occurrence of AECOPD after BLVR with EBV.MethodsWe conducted a multicenter, retrospective study of patients who underwent BLVR with EBV at six different institutions. Emphasis was directed towards the specific practices aimed at preventing AECOPD: antibiotics, steroids, antibiotics plus steroids, or no prophylaxis. Subgroups were compared, and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated.ResultsA total of 170 patients were reviewed. The rate of AECOPD was 21.2% for the full cohort. Patients who received prophylaxis had a significantly lower rate of AECOPD compared with those who did not (16.7% vs. 46.2%; p = 0.001). The rate was lowest in patients who received antibiotics alone (9.2%). There was no significant difference in the rate of AECOPD between patients who received steroids alone or antibiotics plus steroids, compared with the other subgroups. The OR for AECOPD was 4.3 (95% CI: 1.8–10.4; p = 0.001) for patients not receiving prophylaxis and 3.9 (95% CI: 1.5–10.1; p = 0.004) for prophylaxis other than antibiotics alone.ConclusionsAdministration of antibiotics after BLVR with EBV was associated with a lower rate of AECOPD. This was not observed with the use of steroids or in combination with antibiotics.