双水平气道正压通气对88例重叠综合征患者的临床疗效

目的:探讨双水平气道正压通气(Bi PAP)治疗重叠综合征(OS)患者的临床疗效。方法:选取2012年7月-2014年2月本院收治的88例诊断为重叠综合征的患者,随机分成实验组与对照组,对照组43例,给予常规药物治疗;实验组45例,在常规药物治疗的基础上辅以双水平气道正压通气治疗,对两组治疗前后的监测结果进行比较分析。结果:治疗后,实验组患者在不同时间点上p H和Pa O2高于对照组,Pa CO2、呼吸暂停指数(AHI)、睡眠紊乱指数、最长呼吸暂停时间以及病死率和不良反应发生率均低于对照组,差异均有统计学意义(均P0.05)。结论:采用Bi PAP治疗OS患者,能够有效降低患者病死率、减少不良反应发生率,并改善患者呼吸情况,提高睡眠质量。     

血浆N端脑钠肽前体与COPD合并慢性肺源性心脏病患者肺动脉压的相关性分析

目的探讨血浆N端脑钠肽前体与COPD合并慢性肺源性心脏病患者肺动脉压的相关性。方法将我院收治的94例COPD稳定期患者,根据心脏彩超检查明确合并慢性肺心病患者分为观察组46例,单纯COPD患者分为对照组48例,采用化学发光法测定两组患者血浆NT-proBNP水平,心脏彩超检查两组患者右心室前壁厚度、右心室舒张末期内径、左室射血分数、主肺动脉宽度、肺动脉压,并进行比较。结果与对照组比较,观察组血浆NT-proBNP水平明显升高(P0.05),右心室前壁厚度、右心室舒张末期内径、主肺动脉宽度、肺动脉压明显升高(P0.05)。血浆NT-proBNP水平与肺动脉压成明显正相关(r=-0.284,P0.01)。结论 COPD合并慢性肺心病患者血浆NT-proBNP水平升高,有助于评估肺动脉高压的严重程度。     

双水平气道正压通气(BIPAP)呼吸机治疗COPD并Ⅱ型呼吸衰竭患者的疗效评估

目的:探讨双水平气道正压通气治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的临床疗效。方法:选取我院收治的COPD合并Ⅱ型呼吸衰竭患者84例,随机分为对照组和研究组,每组42例。对照组患者给予常规治疗,研究组患者在常规治疗基础上给予双水平气道正压通气治疗。观察并记录两组患者治疗前后动脉血气分析、肺功能变化以及临床疗效。结果:研究组治疗有效率高于对照组,差异具有统计学意义(P0.05);与治疗前比较,两组患者治疗后PaO_2、SaO_2、pH均升高,而PaCO_2均降低,差异具有统计学意义(P0.05);与对照组比较,研究组治疗后PaO_2、SaO_2、pH水平较高,PaCO_2水平较低,差异具有统计学意义(P0.05);与治疗前比较,两组患者治疗后FEV1、FVC、FEV1%pre和FEV1/FVC均升高,差异具有统计学意义(P0.05);与对照组比较,研究组治疗后FEV1、FVC、FEV1%pre和FEV1/FVC较高,差异具有统计学意义(P0.05);研究组住院时间、气管插管率均低于对照组,差异具有统计学意义(P0.05)。结论:双水平气道正压通气(BIPAP)呼吸机治疗COPD并Ⅱ型呼吸衰竭患者疗效确切,能显著改善肺功能及动脉血气指标,值得推广。     

Airway wall thickness is increased in COPD patients with bronchodilator responsiveness

Rationale

Bronchodilator responsiveness (BDR) is a common but variable phenomenon in COPD. The CT characteristics of airway dimensions that differentiate COPD subjects with BDR from those without BDR have not been well described. We aimed to assess airway dimensions in COPD subjects with and without BDR.

Methods

We analyzed subjects with GOLD 1–4 disease in the COPDGene® study who had CT airway analysis. We divided patients into two groups: BDR + (post bronchodilator ΔFEV₁ ≥ 10%) and BDR-(post bronchodilator ΔFEV₁ < 10%). The mean wall area percent (WA%) of six segmental bronchi in each subject was quantified using VIDA. Using 3D SLICER, airway wall thickness was also expressed as the square root wall area of an airway of 10 mm (Pi10) and 15 mm (Pi15) diameter. %Emphysema and %gas trapping were also calculated.

Results

2355 subjects in the BDR-group and 1306 in the BDR + group formed our analysis. The BDR + group had a greater Pi10, Pi15, and mean segmental WA% compared to the BDR-group. In multivariate logistic regression using gender, race, current smoking, history of asthma, %emphysema, %gas trapping, %predicted FEV₁, and %predicted FVC, airway wall measures remained independent predictors of BDR. Using a threshold change in FEV₁ ≥ 15% and FEV₁ ≥ 12% and 200 mL to divide patients into groups, the results were similar.

Conclusion

BDR in COPD is independently associated with CT evidence of airway pathology. This study provides us with greater evidence of changes in lung structure that correlate with physiologic manifestations of airflow obstruction in COPD.     

慢性阻塞性肺疾病合并糖尿病患者肺部真菌感染病原学及易感因素分析

目的探讨慢性阻塞性肺疾病(COPD)合并糖尿病患者肺部真菌感染的病原学及易感因素。方法对58例COPD合并糖尿病肺部真菌感染患者进行病原学及预后分析,并与无糖尿病的COPD真菌感染患者76例进行比较。结果 2组患者病原菌均以白色念珠菌占首位,研究组真菌发病率高于对照组,预后较对照组更差。抗生素、年龄、糖皮质激素和营养状态等因素对2组患者真菌感染的影响差异无统计学意义。结论白色念珠菌仍是COPD患者肺部真菌感染的主要致病菌。糖尿病增加COPD患者感染真菌的风险,并且加重病情,影响预后。     

慢性阻塞性肺疾病并念珠菌性口炎患者病原学及危险因素分析

目的 探讨入院慢性阻塞性肺疾病(COPD)并念珠菌性口炎患者的病原学特征以及相关危险因素.方法 采用病例研究,对2007年4月1日至2011年1月31日入院的82例COPD并念珠菌性口炎患者和82例无念珠菌性口炎COPD患者进行匹配,应用SPSS 17.0统计软件行条件logistic回归模型分析COPD患者念珠菌性口炎发生的危险因素.结果 (1)从念珠菌性口炎患者假膜培养共分离出念珠菌83株,以白念珠菌(90.4％)为最多,其次为光滑念珠菌(3.6％)、克柔念珠菌(2.4％)、热带念珠菌(2.4％)、近平滑念珠菌(1.2％);(2)统计学分析结果显示全身应用、吸入糖皮质激素是入院患者口腔念珠菌感染的独立危险因素.结论 白色念珠菌是COPD患者口腔部念珠菌感染的主要病原菌,规范使用全身糖皮质激素、正确吸入糖皮质激素是预防COPD患者口腔念珠菌感染的关键.     

Use of a mandibular advancement device in patients with congestive heart failure and sleep apnoea

Objective: To evaluate the practical use of the mandibular advancement device (MAD) for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) over 1 year. Subjects: Twenty‐five patients aged 66 ± 8 years (mean ± SD) met the inclusion criteria and were included in the study. Design: In a prospective, clinical trial, the apnoea‐hypopnoea index (AHI), a measure of SA, was determined with a portable device. Failure to enter treatment and compliance, adverse events and signs and symptoms of temporomandibular disorders (TMD) were examined before intervention and 4–6 weeks, 6 months, and 1 year after intervention. Results: Six patients had removable dentures of whom four had complete dentures. Before treatment, eight patients reported minor symptoms of TMD. The AHI fell from 19.3 ± 12.1 to 11.8 ± 9.5 (p = 0.004) with use of the device. In most patients, use of the MAD had no severe effects on the signs and symptoms of TMD. Adverse events such as pain in the temporomandibular joints, soreness in the teeth, and tiredness in the jaws were reported by 10 patients. Dental complications were observed in two patients. Sixty‐four per cent of the patients were still using the MAD at the 1‐year follow‐up. Conclusions: Both the general and oral health of CHF patients were important in treatment with a MAD. The MAD therapy had no severe effect on the masticatory system and edentulous patients could be treated.     

The role of uPAR in epithelial-mesenchymal transition in small airway epithelium of patients with chronic obstructive pulmonary disease

Background

Epithelial-mesenchymal transition (EMT) plays a crucial role in small airway fibrosis of patients with chronic obstructive pulmonary disease (COPD). Increasing evidence suggests that the urokinase plasminogen activator receptor (uPAR) is involved in the pathogenesis of COPD. Increased uPAR expression has been implicated in the promotion of EMT in numerous cancers; however the role of uPAR in EMT in small airway epithelial cells of patients with COPD remains unclear. In this study, we investigated the degree of EMT and uPAR expression in lung epithelium of COPD patients, and verified the effect of uPAR on cigarette smoke extract (CSE)-induced EMT in vitro.

Methods

The expression of EMT biomarkers and uPAR was assessed in lung epithelium specimens from non-smokers (n = 25), smokers (n = 25) and non-smokers with COPD (n = 10) and smokers with COPD (n = 18). The role of uPAR on CSE-induced EMT in human small airway epithelial cells (HSAEpiCs) was assessed by silencing uPAR expression in vitro.

Results

Markers of active EMT and uPAR expression were significantly increased in the small airway epithelium of patients with COPD compared with controls. We also observed a significant correlation between uPAR and vimentin expression in the small airway epithelium. In vitro, CSE-induced EMT in HSAEpiCs was associated with high expression of uPAR, and targeted silencing of uPAR using shRNA inhibited CSE-induced EMT. Finally, we demonstrate that the PI3K/Akt signaling pathway is required for uPAR-mediated EMT in HSAEpiCs.

Conclusions

A uPAR-dependent signaling pathway is required for CSE-induced EMT, which contributes to small airway fibrosis in COPD. We propose that increased uPAR expression in the small airway epithelium of patients with COPD participates in an active EMT process.     

慢性阻塞性肺疾病患者继发肺部真菌感染的临床分析

目的探讨慢性阻塞性肺疾病(COPD)患者继发肺部真菌感染的临床特点。方法回顾性分析2008年1月到2010年12月安徽医科大学第一附属医院收治的COPD继发肺部真菌感染患者病例,并对其耐药情况进行比较。结果本组199例COPD患者检出白色念珠菌137例(68.84%),光滑念珠菌32例(16.08%),热带念珠菌17例(8.54%),克柔念珠菌9例(4.52%),毛霉菌3例(1.51%),清酒假丝酵母菌1例(0.50%);白色念珠菌检出率有下降趋势,热带念珠菌有上升趋势;196例真菌对伏立康唑、氟康唑、两性霉素B、伊曲康唑、氟胞嘧啶的耐药率分别为3.6%、5.1%、1.0%、8.7%和0;2008年至2010年白色念珠菌和光滑念珠菌耐药率变化差异无统计学意义。结论 COPD患者继发肺部真菌感染病原菌仍以白色念珠菌为主,其次为光滑念珠菌和热带念珠菌;白色念珠菌和光滑念珠菌耐药率无明显改变。     

Elevated levels of serum chemerin in patients with obstructive sleep apnea syndrome

Context: Chemerin is implicated to be correlated with obesity and inflammation.

Objective: This study aims to investigate whether serum chemerin is associated with the presence of obstructive sleep apnea syndrome (OSAS).

Methods: A total of 132 patients with OSAS and 108 healthy subjects were enrolled in this study.

Results: Serum chemerin levels were significantly elevated in OSAS patients (120.93 ± 25.84 µg/L vs. 107.51 ± 20.41 µg/L). Multivariable logistic regression analysis revealed that serum chemerin levels were an independent determinant of the presence of OSAS (OR 1.030, 95% CI 1.016–1.045; p < 0.001). Serum chemerin levels in severe OSAS patients were significantly higher compared with those in mild and moderate OSAS patients (p = 0.015 and p = 0.020, respectively). Spearman correlation analysis indicated that serum chemerin levels were correlated with the severity of OSAS (r = 0.210, p = 0.016). Serum chemerin were positively correlated with waist circumference (r = 0.164, p = 0.008), body mass index (r = 0.158, p = 0.014), systolic blood pressure (r = 0.135, p = 0.037), homeostasis model assessment of insulin resistance (r = 0.140, p = 0.031), C-reactive protein (r = 0.202, p = 0.002), and apnea–hypopnea index (r = 0.152, p = 0.022).

Conclusion: Elevated serum chemerin levels could be an independent predicting marker of the presence and severity of OSAS.     

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。     

Circadian-rhythm differences among emergency department patients with chronic obstructive pulmonary disease exacerbation

The purpose of the study was determine whether patients with chronic obstructive pulmonary disease (COPD) exacerbation who present to the emergency department (ED) during the night (00:00 to 07:59 h) vs. other times of the day have more severe COPD exacerbation, require more intensive treatment, and have worse clinical outcomes. A multicenter cohort study was completed involving 29 EDs in the United States and Canada. Using a standard protocol, consecutive ED patients with COPD exacerbation were interviewed, and their charts were reviewed. Of 582 patients enrolled, 52% were women, and the median age was 71 yrs (interquartile range, 64-77 yrs). Nighttime patients (15% of cohort) did not differ from patients presenting at other times except that they were less likely to have private insurance, more likely to have a history of corticosteroid use, and have a shorter duration of symptoms exacerbation. Except for a few features indicative of more severe COPD exacerbation (such as higher respiratory rate at ED presentation, greater likelihood of receiving noninvasive positive pressure ventilation, and increased risk of endotracheal intubation), nighttime patients did not differ from other patients with respect to ED management. Nighttime patients were approximately three-fold more likely to be intubated in the ED (odds ratio, 3.46; 95% confidence interval, 1.10-10.9). There were no day-night differences regarding ED disposition and post-ED relapse. Except for some features indicating more severe exacerbation, nighttime ED patients had similar chronic COPD characteristics, received similar treatments in the ED, and had similar clinical outcomes compared with patients presenting to the ED at other times of the day.     

白介素-18在被动吸烟诱导的慢性阻塞性肺疾病大鼠中的表达

目的 研究白介紊-18(Interleukin-18,IL-18)在被动吸烟诱导的慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)大鼠中的表达变化.方法 将20只大鼠随机分为2组,即正常对照组和COPD模型组.应用单纯被动吸烟法建立大鼠COPD模型,香烟烟雾暴露时间为6个月.利用酶联免疫吸附法测定2组大鼠血清和支气管肺泡灌洗液(bronchoal veolar lavage fluid,BALF)中的IL-18浓度,用实时定量RT-PCR法测定BALF中IL-18 mRNA的表达水平,用HE染色法观察肺组织形态学改变,用免疫组织化学染色法检测IL-18在肺组织中的表达.结果 1.COPD模型组血清和BALF中的IL-18浓度较正常对照组显著增加(P＜0.01);2.COPD模型组BALF中IL-18 mRNA的表达水平较正常对照组显著增高(P＜0.01);3.COPD模型组肺组织中IL-18的表达较正常对照组显著增加(P＜0.01).结论 被动吸烟诱导的COPD大鼠外周血和肺部均高表达IL-18,提示IL-18在吸烟所致的COPD发病机制中可能起重要作用.     

Vitamin D supplementation during rehabilitation in COPD: a secondary analysis of a randomized trial

Rationale

Pulmonary rehabilitation is an important treatment for patients with Chronic Obstructive Pulmonary Disease, who are often vitamin D deficient. As vitamin D status is linked to skeletal muscle function, we aimed to explore if high dose vitamin D supplementation can improve the outcomes of rehabilitation in Chronic Obstructive Pulmonary Disease.

Material and methods

This study is a post-hoc subgroup analysis of a larger randomized trial comparing a monthly dose of 100.000 IU of vitamin D with placebo to reduce exacerbations. 50 Subjects who followed a rehabilitation program during the trial are included in this analysis. We report changes from baseline in muscle strength and exercise performance between both study arms after 3 months of rehabilitation.

Results

Vitamin D intervention resulted in significantly higher median vitamin D levels compared to placebo (51 [44-62] ng/ml vs 15 [13-30] ng/ml; p < 0.001). Patients receiving vitamin D had significantly larger improvements in inspiratory muscle strength (-11±12 cmH2O vs 0±14 cmH2O; p = 0.004) and maximal oxygen uptake (110±211 ml/min vs -20±187 ml/min; p = 0.029). Improvements in quadriceps strength (15±16 Nm) or six minutes walking distance (40±55 meter) were not significantly different from the effects in the placebo group (7±19 Nm and 11±74 meter; p>0.050).

Conclusion

High dose vitamin D supplementation during rehabilitation may have mild additional benefits to training.     

红霉素对慢性阻塞性肺疾病大鼠ICAM-1、MMP-9的表达影响

目的：观察慢性阻塞性肺疾病（COPD）大鼠肺组织中ICAM-1及MMP-9的表达及红霉素的干预作用。方法：复制COPD大鼠模型,并用红霉素干预,收集支气管肺泡灌洗液行细胞学计数和分类检查;采用HE染色观察病理形态变化;免疫组化法检测大鼠支气管肺组织ICAM-1、MMP-9的表达。结果：与模型组比较,干预组支气管肺组织中ICAM-1、MMP-9表达显著降低;模型组中ICAM-1、MMP-9的表达与BALF中白细胞总数及中性粒细胞数成正相关;ICAM-1与MMP-9的表达成正相关。结论：COPD大鼠肺组织中的ICAM-1、MMP-9表达明显升高,可能与COPD的发病机制有关;红霉素可降低ICAM-1、MMP-9的表达,可能是红霉素在COPD中抗炎症反应的作用机制之一。     

大剂量乙酰半胱氨酸对高龄患者慢性阻塞性肺病合并肺间质纤维化急性加重期的干预作用及机制初探

目的：观察大剂量乙酰半胱氨酸（NAC）对高龄患者慢性阻塞性肺病（COPD）合并肺问质纤维化（PIF）急性加重期的干预作用,并对干预机制进行初步探讨。方法：年龄大于80岁COPD合并PIF患者18例,分为对照组（8例）和观察组（10例）,对照组给予常规治疗,观察组在对照组治疗基础上给予口服乙酰半胱氨酸颗粒600mg／次,3次／d,连用30天,观察两组治疗前后临床症状、肺功能指标（FVC、FEV1、FEV1／FVC）、动脉血氧分压（PaO2）、血液中细胞因子（IL-2和TNF—α）和影像学的变化。结果：观察组治疗总有效率和细菌培养转阴率显著升高（P〈0．05）;两组治疗后FVC、FEV1、FEV1／FVC、PaO2均较治疗前显著上升（P〈0．05）,血液中IL-2和TNF—α较治疗前显著下降（P〈0．05）;组间比较存在显著性差异（P〈0．05）;观察组治疗后胸部CT见感染明显控制。结论：在常规治疗基础上合用大剂量NAC可以有效治疗急性加重期COPD合并PIF的老年患者,机制可能与抑制炎性因子表达、减少细菌在呼吸道内的附着有关。     

多潘立酮对慢性阻塞性肺疾病机械通气患者胃肠功能障碍的临床效果观察

目的:探讨多潘立酮对慢性阻塞性肺疾病(COPD)机械通气患者胃肠功能障碍的临床效果.方法:采用前瞻性随机对照研究方法,选择2010年11月～2012年11月我院重症医学科收治的需要机械通气且存在胃肠功能障碍的COPD患者48例,按抽签法随机分为两组,对照组(n=24)为常规治疗组,治疗组(n_24)在常规治疗基础上给予鼻饲多潘立酮片10 mg,3次/天.观察周期为1周,通过观察患者胃肠功能障碍症状的恢复情况、胃排空情况及实验室检查指标评价多潘立酮的疗效.结果:治疗组和对照组胃肠功能障碍临床症状改善的有效率分别为87.5％和62.5％,治疗组显著高于对照组(P＜0.05);治疗组和对照组胃排空功能的有效率分别为83.33％和58.33％,治疗组显著高于对照组(P＜0.05);对照组治疗前后血红蛋白、离子、白蛋白、肌酐、尿素氮水平比较无显著差异(P＞0.05),治疗组治疗前后各指标亦无统计学差异(P＞0.05).治疗后两组血红蛋白,白蛋白有所升高,但各指标比较无统计学差异(P＞0.05).结论:多潘立酮辅助治疗可以有效改善COPD机械通气患者的胃肠功能障碍,促进胃排空,提高肠内营养的耐受性.     

PBL健康教育模式在COPD稳定期患者中的应用

目的探讨PBL健康教育模式对慢性阻塞性肺疾病(COPD)稳定期患者疾病相关知识知晓率及治疗依从性的影响。方法将252例COPD稳定期患者随机分为观察组136例和对照组116例。对照组采用传统的健康教方法进行宣教,观察组按照PBL健康教育模式进行宣教,比较两组患者对疾病相关知识的知晓率及治疗依从性。结果与对照组比较,观察组对COPD相关知识知晓率及治疗依从性均较高,差异有统计学意义(P0.01)。结论 PBL在COPD稳定期患者的健康教育中更具有针对性,有效改善了患者对COPD相关知识的知晓率及治疗依从性,从而有利于疾病的康复。