Multidrug-Resistant Tuberculosis in Patients with Chronic Obstructive Pulmonary Disease in China

Background

Relatively little is known about the specific relationship and impact from chronic obstructive pulmonary disease (COPD) on multidrug-resistant tuberculsosis (MDR-TB).

Methods

We conducted a retrospective study included patients aged ≥40 years with a confirmed pulmonary TB at three tertiary hospitals (Shandong, China) between January 2011 and October 2014. Univariable and multivariable analyses were performed to identify the relationship of MDR-TB and COPD.

Results

A total of 2164 patients aged ≥ 40 years with available results of drug susceptibility test (DST) and medical records were screened for this study: 268 patients with discharge diagnosis of COPD and 1896 patients without COPD. Overall, 14.2% of patients with COPD and 8.5% patients without COPD were MDR-TB. The rate of MDR-TB were significantly higher in patients with COPD (P<0.05). Migrant (odds ratios (OR) 1.32, 95% confidence interval (CI) 1.02–1.72), previous anti-TB treatment (OR 4.58, 95% CI 1.69–12.42), cavity (OR 2.33, 95% CI 1.14–4.75), and GOLD stage (OR 1.86, 95% CI 1.01–2.93) were the independent predictors for MDR-TB among patients with COPD.

Conclusions

MDR-TB occurs more frequently in patients with underlying COPD, especially those with being migrant, previous anti-TB therapy, cavity and severe airway obstruction.     

Epicardial Adipose Tissue in Patients with Chronic Obstructive Pulmonary Disease

Rationale

Epicardial Adipose Tissue (EAT) volume as determined by chest computed tomography (CT) is an independent marker of cardiovascular events in the general population. COPD patients have an increased risk of cardiovascular disease, however nothing is known about the EAT volume in this population.

Objectives

To assess EAT volume in COPD and explore its association with clinical and physiological variables of disease severity.

Methods

We measured EAT using low-dose CT in 171 stable COPD patients and 70 controls matched by age, smoking history and BMI. We determined blood pressure, cholesterol, glucose and HbA1c levels, microalbuminuria, lung function, BODE index, co-morbidity index and coronary artery calcium score (CAC). EAT volume were compared between groups. Uni and multivariate analyses explored the relationship between EAT volume and the COPD related variables.

Results

COPD patients had a higher EAT volume [143.7 (P_25–75, 108.3–196.6) vs 129.1 (P_25–75, 91.3–170.8) cm³, p = 0.02)] and the EAT volume was significantly associated with CAC (r = 0.38, p<0.001) and CRP (r = 0.32, p<0.001) but not with microalbuminuria (r = 0.12, p = 0.13). In COPD patients, EAT volume was associated with: age, pack-years, BMI, gender, FEV₁%, 6 MWD, MMRC and HTN. Multivariate analysis showed that only pack-years (B = 0.6, 95% CI: 0.5–1.3), BMI (B = 7.8, 95% CI: 5.7–9.9) and 6 MWD (B = −0.2, 95% CI: −0.3–−0.1), predicted EAT volume.

Conclusions

EAT volume is increased in COPD patients and is independently associated with smoking history, BMI and exercise capacity, all modifiable risk factors of future cardiovascular events. EAT volume could be a non-invasive marker of COPD patients at high risk for future cardiovascular events.     

Predicting Daily Physical Activity in Patients with Chronic Obstructive Pulmonary Disease

Background

Objectively measuring daily physical activity (PA) using an accelerometer is a relatively expensive and time-consuming undertaking. In routine clinical practice it would be useful to estimate PA in patients with chronic obstructive pulmonary disease (COPD) with more simple methods.

Objectives

To evaluate whether PA can be estimated by simple tests commonly used in clinical practice in patients with COPD.

Methods

The average number of steps per day was measured for 7 days with a SenseWear Pro™ accelerometer and used as gold standard for PA. A physical activity level (PAL) of <1.4 was considered very inactive. Univariate and multivariate analyses were used to examine the relationship between the 6-minute walking distance (6MWD), the number of stands in the Sit-to-Stand Test (STST), hand-grip strength and the total energy expenditure as assessed by the Zutphen Physical Activity Questionnaire (TEE_ZPAQ). ROC curve analysis was used to identify patients with an extremely inactive lifestyle (PAL<1.4).

Results

In 70 patients with COPD (21 females) with a mean [SD] FEV₁ of 43.0 [22.0] %predicted, PA was found to be significantly and independently associated with the 6MWD (r = 0.69, 95% CI 0.54 to 0.80, p<0.001), STST (r = 0.51, 95% CI 0.31 to 0.66, p = 0.001) and TEEZPAQ (r = 0.50, 95% CI 0.30 to 0.66, p<0.001) but not with hand-grip strength. However, ROC curve analysis demonstrated that these tests cannot be used to reliably identify patients with an extremely inactive lifestyle.

Conclusions

In patients with COPD simple tests such as the 6-Minute Walk Test, the Sit-to-Stand Test and the Zutphen Physical Activity Questionnaire cannot be used to reliably predict physical inactivity.     

Cluster Analysis in Patients with GOLD 1 Chronic Obstructive Pulmonary Disease

Background

We hypothesized that heterogeneity exists within the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 spirometric category and that different subgroups could be identified within this GOLD category.

Methods

Pre-randomization study participants from two clinical trials were symptomatic/asymptomatic GOLD 1 chronic obstructive pulmonary disease (COPD) patients and healthy controls. A hierarchical cluster analysis used pre-randomization demographics, symptom scores, lung function, peak exercise response and daily physical activity levels to derive population subgroups.

Results

Considerable heterogeneity existed for clinical variables among patients with GOLD 1 COPD. All parameters, except forced expiratory volume in 1 second (FEV₁)/forced vital capacity (FVC), had considerable overlap between GOLD 1 COPD and controls. Three-clusters were identified: cluster I (18 [15%] COPD patients; 105 [85%] controls); cluster II (45 [80%] COPD patients; 11 [20%] controls); and cluster III (22 [92%] COPD patients; 2 [8%] controls). Apart from reduced diffusion capacity and lower baseline dyspnea index versus controls, cluster I COPD patients had otherwise preserved lung volumes, exercise capacity and physical activity levels. Cluster II COPD patients had a higher smoking history and greater hyperinflation versus cluster I COPD patients. Cluster III COPD patients had reduced physical activity versus controls and clusters I and II COPD patients, and lower FEV₁/FVC versus clusters I and II COPD patients.

Conclusions

The results emphasize heterogeneity within GOLD 1 COPD, supporting an individualized therapeutic approach to patients.

Trial registration

www.clinicaltrials.gov. NCT01360788 and NCT01072396.     

TLR-4 在慢性阻塞性肺病患者肺组织表达的研究

目的:观察COPD患者肺组织中TLR-4,IL-8,MUC5AC的表达,并探讨其在气道炎症、气道高分泌中的作用。方法:非COPD、COPD组男性肺癌病人各20例,取其肺叶切除后的外周肺组织,对肺组织标本行HE及AB-PAS染色,用免疫组织化学方法检测肺组织中TLR-4,IL-8,MUC5AC的表达并分析其相关性。结果:①COPD患者肺组织中TLR-4,IL-8,MUC5AC表达较对照组增高(P<0.05)。TLR-4主要在气道上皮细胞、肺巨噬细胞及血管内皮细胞表达,IL-8在气道壁、肺泡间隔、血管壁及肺组织内浸润的单核细胞、巨噬细胞、多形核白细胞均有表达,MUC5AC主要在气道上皮杯状细胞中表达。②TLR-4、IL-8表达与气道炎细胞评分成正相关(P<0.05)。TLR-4与IL-8、MUC5AC表达成正相关(P<0.05)。结论:COPD患者肺组织中TLR-4高表达可能参与了COPD的气道炎症及气道高分泌,这可能是通过增加IL-8与MUC5AC的表达来实现的。     

运动疗法对慢性阻塞性肺疾病患者抑郁状态的效果观察

目的:探讨运动疗法对慢性阻塞性肺疾病(COPD)患者抑郁状态的临床效果。方法:选取52例COPD患者,随机分为试验组和对照组,各26例。对照组给予支气管扩张、健康教育、氧疗,试验组在对照组的基础上实施运动疗法,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、ADL生活质量量表对两组患者治疗前后进行评估。结果:对照组患者SAS、SDS评分治疗前后无明显变化,试验患者SAS、SDS评分均明显低于治疗前(P0.05),两组治疗后组间比较,差异亦有统计学意义(P0.05);试验组生活质量的改善优于对照组(P0.05)。结论:运动疗法能有效的改善COPD患者焦虑、抑郁负性情绪,提高患者的生存质量。     

纳洛酮治疗慢性阻塞性肺病合并II型呼吸衰竭患者临床疗效研究

目的：探讨纳洛酮治疗慢性阻塞性肺病合并II型呼吸衰竭患者血清降钙素原、炎症因子的改变及临床疗效。方法：收集2013 年5 月至2014 年9 月来我院治疗的COPD合并II 型呼吸衰竭患者60 例,根据治疗方法不同随机分为对照组和观察组,对照组 给与常规治疗,观察组在常规治疗的基础上给与纳洛酮治疗。记录两组患者在治疗前后静脉血PaCO2、PaO2的变化以及临床疗 效。采用Elisa 法检测两组患者在治疗前后血清PCT、TNF-琢、IL-6 含量的变化,并用RT-PCR 法检测两组患者在治疗前后血清 PCT、TNF-琢、IL-6 DNA 的改变。结果：观察组患者在治疗前静脉血PaCO2的值为81.3± 9.4 mmHg,治疗后下降为45.4± 5.3 mmHg,PaO2由49.6± 3.9 mmHg 上升至81.3± 5.9 mmHg,均优于对照组,与对照组比较差异有统计学意义（P＜0.05）;临床总有 效率为85.7%,高于对照组的68%,且差异有统计学意义（P＜ 0.05）。ELISA 检测结果显示,两组患者在治疗后,血清PCT,CRP、 IL-6 含量均显著下降,且观察组下降程度高于对照组,RT-PCR 检测结果与ELISA检测结果相一致。结论：纳洛酮治疗COPD 合 并II型呼吸衰竭的临床疗效显著,能有效的提高PaO2,降低PaCO2,且能有效的减缓炎症反应的加重。     

Assessment of Health Status in Patients with Newly Diagnosed Chronic Obstructive Pulmonary Disease

Subject

Chronic obstructive pulmonary disease (COPD) is a common disease worldwide. This study aimed to investigate the health status of patients with newly diagnosed COPD.

Methods

A total of 45 healthy controls and 218 patients with newly diagnosed COPD were recruited. Pulmonary function test (PFT) values, COPD assessment test (CAT) scores, exacerbation history, and demographics were recorded.

Results

Forced expiratory volume in 1 s percent (FEV1%) predicted was significantly decreased and the CAT score was significantly increased in patients with COPD compared with healthy controls (P <0.001). Among the COPD patients, the most commonly reported respiratory symptoms were cough (86.7%), sputum (80.3%), and dyspnea (45%). A total of 86.2% patients were in the moderate or severe stage (spirometric classification) of COPD, and 71.5% were in Group C or Group D (combined assessment). A total of 33.9% of the patients had 2 or more exacerbations in the previous year. Nearly half of the patients (45.4%) had a high CAT score of ≥10. Patients with a history of more exacerbations had a higher CAT score.

Conclusions

Most COPD patients were symptomatic and appeared to have moderate to severe airflow limitation or a high risk of exacerbation before definitely being diagnosed with COPD using the PFT.     

Cognitive Impairment in Chronic Obstructive Pulmonary Disease

Background/Purpose

Chronic obstructive pulmonary disease (COPD), especially in severe forms, is commonly associated with multiple cognitive problems. Montreal Cognitive Assessment test (MoCA) is used to detect cognitive impairment evaluating several areas: visuospatial, memory, attention and fluency. Our study aim was to evaluate the impact of stable COPD and exacerbation (AECOPD) phases on cognitive status using MoCA questionnaire.

Methods

We enrolled 39 patients (pts), smokers with COPD group D (30 stable and 9 in AECOPD) and 13 healthy subjects (control group), having similar level of education and no significant differences regarding the anthropometric measurements. We analyzed the differences in MoCA score between these three groups and also the correlation between this score and inflammatory markers.

Results

Patients with AECOPD had a significant (p<0.001) decreased MoCA score (14.6±3.4) compared to stable COPD (20.2±2.4) and controls (24.2±5.8). The differences between groups were more accentuated for the language abstraction and attention (p<0.001) and delayed recall and orientation (p<0.001) sub-topics. No significant variance of score was observed between groups regarding visuospatial and naming score (p = 0.095). The MoCA score was significantly correlated with forced expiratory volume (r = 0.28) and reverse correlated with C-reactive protein (CRP) (r = −0.57), fibrinogen (r = −0.58), erythrocyte sedimentation rate (ESR) (r = −0.55) and with the partial pressure of CO₂ (r = −0.47).

Conclusions

According to this study, COPD significantly decreases the cognitive status in advanced and acute stages of the disease.     

急诊慢性阻塞性肺疾病急性加重期患者预后相关因素分析

目的:探讨急诊收治的慢性阻塞性肺疾病急性加重期患者的预后相关因素。方法:选取我院2008年12月-2013年12月急诊收治的慢性阻塞性肺疾病急性加重期患者94例,根据预后结果分为死亡组17例及存活组77例,回顾分析两组患者的相关资料。结果:存活组较死亡组BMI、血肌酐值、清蛋白、pH值、PaCO2、FT3差异具有统计学意义。死亡组较存活组在APACHEⅡ,CCS,有创通气率及合并肺心病率上差异均具有统计学意义。结果显示合并肺心病率、APACHEⅡ评分、肌酐、清蛋白为影响慢性阻塞性肺疾病急性加重期患者预后的独立因素。结论:急诊收治的慢性阻塞性肺疾病急性加重期患者如合并肺心病率,APACHEⅡ评分较高,血肌酐较高,清蛋白较低,这些因素提示我们患者预后较差,需及早进行相关治疗。     

Alterations in Adenosine Metabolism and Signaling in Patients with Chronic Obstructive Pulmonary Disease and Idiopathic Pulmonary Fibrosis

Background

Adenosine is generated in response to cellular stress and damage and is elevated in the lungs of patients with chronic lung disease. Adenosine signaling through its cell surface receptors serves as an amplifier of chronic lung disorders, suggesting adenosine-based therapeutics may be beneficial in the treatment of lung diseases such as chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF). Previous studies in mouse models of chronic lung disease demonstrate that the key components of adenosine metabolism and signaling are altered. Changes include an up-regulation of CD73, the major enzyme of adenosine production and down-regulation of adenosine deaminase (ADA), the major enzyme for adenosine metabolism. In addition, adenosine receptors are elevated.

Methodology/Principal Findings

The focus of this study was to utilize tissues from patients with COPD or IPF to examine whether changes in purinergic metabolism and signaling occur in human disease. Results demonstrate that the levels of CD73 and A_2BR are elevated in surgical lung biopsies from severe COPD and IPF patients. Immunolocalization assays revealed abundant expression of CD73 and the A_2BR in alternatively activated macrophages in both COPD and IPF samples. In addition, mediators that are regulated by the A_2BR, such as IL-6, IL-8 and osteopontin were elevated in these samples and activation of the A_2BR on cells isolated from the airways of COPD and IPF patients was shown to directly induce the production of these mediators.

Conclusions/Significance

These findings suggest that components of adenosine metabolism and signaling are altered in a manner that promotes adenosine production and signaling in the lungs of patients with COPD and IPF, and provide proof of concept information that these disorders may benefit from adenosine-based therapeutics. Furthermore, this study provides the first evidence that A_2BR signaling can promote the production of inflammatory and fibrotic mediators in patients with these disorders.     

Effects of Tai Chi in Patients with Chronic Obstructive Pulmonary Disease: Preliminary Evidence

Background

Currently, several studies assessed the role of Tai Chi (TC) in management of chronic obstructive pulmonary disease, but these studies have wide variation of sample and convey inconclusive results. We therefore undertook a meta-analysis to assess the effects of TC.

Methods

A computerized search through electronic databases was performed to obtain sample studies. The primary outcomes were 6-min walking distance (6MWD) and dyspnea. Secondary outcomes included health-related quality of life and pre-bronchodilator spirometry. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated and heterogeneity was assessed with the I² test. A random-effects meta-analysis model was applied.

Results

Eight randomized controlled trials involving 544 patients met the inclusion criteria. The pooled WMDs were 34.22 m (95% CI 21.25–47.20, P<0.00001) for 6 MWD, –0.86 units (95% CI –1.44––0.28, P = 0.004) for dyspnea, 70 ml (95% CI 0.02–0.13, P = 0.01) for FEV₁, 120 ml (95% CI 0.00–0.23, P = 0.04) for FVC. TC significantly improved the Chronic Respiratory Disease Questionnaire total score, and the St George’s Respiratory Questionnaire score except impact score.

Conclusions

Findings suggest that TC may provide an effective alternative means to achieve results similar to those reported following participation in pulmonary rehabilitation programs. Further studies are needed to substantiate the preliminary findings and investigate the long-term effects of TC.     

慢性阻塞性肺疾病合并心力衰竭患者的预后影响因素分析

目的:探讨慢性阻塞性肺疾病合并心力衰竭患者的预后影响因素。方法:选取我院自2007年12月-2012年12月收住入院的慢性阻塞性肺疾病患者352例,其中合并心力衰竭患者124例,随访1年两组的结局事件发生率及相关预后。结果:年龄、糖尿病、脑卒中病史、肿瘤、合并CHF均为COPD患者死亡的危险因素(P0.05)。与未合并CHF组比较,合并CHF组患者的死亡、因COPD再次入院、脑梗死或心肌梗死的危险性增高(P0.05)。结论:CHF是COPD的常见合并症,是COPD患者死亡或相关心血管疾病的危险因素,临床需密切关注。     

慢性阻塞性肺疾病合并肺曲菌病一例及文献复习

目的:提高对慢性阻塞性肺疾病合并侵袭性肺曲菌病(COPD合并IPA)临床特点、诊断及治疗的认识.方法:回顾性分析2011年4月收治的一例COPD合并IPA患者的临床资料及诊治经过,并复习相关文献.结果:男患,“咳嗽、咳痰30余年,气短3年,加重1月余”入院,肺部CT示双肺多发结节影、空洞影,经抗炎、抗念珠菌治疗无效,CT下肺结节病灶活检病理示肺曲菌.抗曲菌治疗后症状好转、肺部影像明显吸收.结论:COPD合并IPA正逐渐引起重视,临床特征无明显特异性,肺部影像以结节影、空洞影多见,早期常规治疗无效时应积极抗曲菌治疗,可明显改善症状,降低死亡率,病理活检是确诊的依据.     

Systemic and Pulmonary Vascular Remodelling in Chronic Obstructive Pulmonary Disease

BackgroundChronic Obstructive Pulmonary Disease (COPD) is associated with subclinical systemic atherosclerosis and pulmonary vascular remodelling characterized by intimal hyperplasia and luminal narrowing. We aimed to determine differences in the intimal thickening of systemic and pulmonary arteries in COPD subjects and smokers. Secondary aims include comparisons with a non-smokers group; determining the clinical variables associated with systemic and pulmonary intimal thickening, and the correlations between systemic and pulmonary remodelling changes.MethodsAll consecutive subjects undergoing lung resection were included and divided into 3 groups: 1) COPD, 2) smokers, and 3) non-smokers. Sections of the 5th intercostal artery and muscular pulmonary arteries were measured by histo-morphometry. Four parameters of intimal thickening were evaluated: 1) percentage of intimal area (%IA), 2) percentage of luminal narrowing, 3) intimal thickness index, and 4) intima-to-media ratio.ResultsIn the adjusted analysis, the systemic arteries of COPD subjects showed greater intimal thickening (%IA) than those of smokers (15.6±1.5% vs. 14.2±1.6%, p = 0.038). In the pulmonary arteries, significant differences were observed for %IA between the 2 groups (37.3±2.2% vs. 29.3±2.3%, p = 0.016). Among clinical factors, metabolic syndrome, gender and COPD status were associated with the systemic intimal thickening, while only COPD status was associated with pulmonary intimal thickening. A correlation between the %IA of the systemic and pulmonary arteries was observed (Spearman’s rho = 0.46, p = 0.008).ConclusionsGreater intimal thickening in systemic and pulmonary arteries is observed in COPD patients than in smokers. There is a correlation between systemic and pulmonary vascular remodelling in the overall population.     

COPD评估测试与BODE 指数的相关研究

目的：探讨COPD 评估测试（COPD Assessment Test, CAT）中文版在我国慢性阻塞性肺疾病患者生活质量评价中的价值,并 探讨其与BORD 指数相关性。方法：选择2010 年6 月至2012 年6 月在新疆维吾尔自治区人民医院呼吸与危重症医学科就诊的 89 例COPD 患者,在急性期和稳定期分别进行CAT 评分及BORD 指数评分。将结果进行配对t 检验,评价CAT 量表对COPD 患者病情变化的敏感性,再进行相关性检验,评价其有效性。结果：配对t 检验显示CAT 评分在稳定期较急性期有明显改善（P<0. 01）,与临床症状、肺功能、呼吸困难指数改善一致,CAT 评分分值与BORD指数相关性较好（r=0.541,P < 0.000）。结论：CAT 评分 是评价我国COPD患者生活质量有效、敏感、可行的方法。     

顺尔宁对稳定期慢性阻塞性肺疾病患者的疗效分析

目的：探讨顺尔宁治疗稳定期慢性阻塞性肺疾病（COPD）患者的临床效果。方法：将60例稳定期COPD患者随机分为研究组和对照组,每组各30例。经2周洗脱期后,对照组采用常规治疗,研究组在常规治疗基础上加用顺尔宁治疗,共治疗4周。比较两组患者肺功能参数、血气分析、生活质量以及血清LTB4、IL-8浓度的变化。结果：治疗后两组患者的肺功能参数、血气分析指标和生活质量均有改善,研究组肺功能参数改善程度较对照组显著（P〈0．05）;研究组的生活质量改善明显优于对照组（P〈0．05）：治疗后两组患者的血清LTB4、IL-8水平较治疗前均下降,且研究组明显低于对照组（P〈0．05）。结论：顺尔宁能降低稳定期慢性阻塞性肺疾病患者血清LTB4、IL-8含量,改善患者肺功能及血气分析指标,有效提高患者的生命质量,值得临床推广。     

COPD评估测试与BODE指数的相关研究

目的：探讨COPD评估测试（COPD Assessment Test,CAT）中文版在我国慢性阻塞性肺疾病患者生活质量评价中的价值,并探讨其与BORD指数相关性。方法：选择2010年6月至2012年6月在新疆维吾尔自治区人民医院呼吸与危重症医学科就诊的89例COPD患者,在急性期和稳定期分别进行CAT评分及BORD指数评分。将结果进行配对t检验,评价CAT量表对COPD患者病情变化的敏感性,再进行相关性检验,评价其有效性。结果：配对t检验显示CAT评分在稳定期较急性期有明显改善（P〈0.01）,与临床症状、肺功能、呼吸困难指数改善一致,CAT评分分值与BORD指数相关性较好（r=0.541,P〈0.000）。结论：CAT评分是评价我国COPD患者生活质量有效、敏感、可行的方法。