糖皮质激素对支气管哮喘急性发作期患者血清嗜酸细胞阳离子蛋白及肺功能的影响

目的探讨糖皮质激素对支气管哮喘急性发作期患者血清嗜酸细胞阳离子蛋白(ECP)及肺功能的影响。方法选择我院哮喘急性发作期患者(支气管哮喘组)和慢性单纯型支气管炎急性发作患者(单纯型慢支组)各21例,另选同期健康体检者10例。两组患者在常规治疗基础上给予糖皮质激素:泼尼松30mg/d或相当剂量的氢化可的松。3组研究对象均采用荧光酶标法pharmaciaCAP检测系统测定治疗前、后血清ECP及1s用力呼气容积(FEV1)。结果3组研究对象治疗前ECP间差异有非常显著性意义(P<0.01),两两比较支气管哮喘组与单纯型慢支组,支气管哮喘组与正常对照组间差异亦均有非常显著性意义(P<0.01)。单纯型慢支组与正常对照组间差异无显著性意义(P>0.05)。支气管哮喘组患者治疗前、后ECP间差异亦有非常显著性意义(P<0.01)。支气管哮喘患者FEV1治疗前(62±12)与治疗周后(79±14)差异有非常显著性意义(P<0.01)。结论血清ECP是支气管哮喘急性发作期的一项特异指标,糖皮质激素治疗可降低其水平,改善肺功能。     

COPD急性发作期患者血清IL-2、IL-8、CRP水平变化及与肺功能的相关性分析

目的:探讨慢性阻塞性肺疾病(COPD)急性发作期患者血清中的白细胞介素2(IL-2)和白细胞介素8(IL-8)、C反应蛋白(CRP)水平变化及与肺功能的相关性。方法:检测COPD组治疗前、后(n=34)和对照组(n=32)血清IL-2和IL-8、CRP水平,以及与第1秒用力呼吸量占预计值的百分比的相关分析。结果:①COPD组治疗前血清IL-2和IL-8、CRP水平均高于对照组,有明显统计学差异(P<0.05)。COPD组IL-2和IL-8、CRP水平与FEV1/pre%呈负相关(r=-0.814,P<0.05);②COPD组IL-2和IL-8、CRP水平治疗前、后有显著统计学差异(P<0.05);③COPD组治疗后血清IL-2和IL-8、CRP水平均高于对照组,有明显统计学差异(P<0.05)。结论:COPD气道炎症与IL-2和IL-8、CRP水平释放增多有关,检测血清IL-2、IL-8、CRP水平可作为判断COPD预后的指标。     

容积二氧化碳图死腔参数在慢性阻塞性肺疾病和支气管哮喘中的异同特点分析

目的探讨死腔参数在慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）与支气管哮喘（简称哮喘）中变化趋势的异同。方法对49例COPD患者、35例哮喘患者和35名健康志愿者的肺通气指标及Threshhold死腔（VDT）、Langley死腔（VDL）、Fowler死腔（VDF）、Wolff死腔（VDW）和Bohr死腔（VDB）进行测定分析。结果与健康对照组比较,COPD组VDT显著减小,而VDW、VDB则显著增大,差异均有统计学意义（P〈0.05）,COPD组中VDL、VDF与健康对照组比较差异无统计学意义;在哮喘组中,VDT、VDL、VDF、VDW均较健康对照组显著减小,而VDB与健康对照组比较差异无统计学意义。阻塞程度相同的COPD与哮喘患者比较,VDF、VDW和VDB在COPD组显著高于哮喘组,而VDT、VDL在两组间差异则无统计学意义。相关分析显示,在COPD组中,VDT、VDF、VDW及VDB均与FEV1/FVC呈负相关（P〈0.05）。VDF、VDW及VDB还与FEV1呈负相关（P〈0.05）。而在哮喘组中,除VDB与FEV1呈负相关外（P〈0.05）,其余死腔参数与FEV1/FVC、FEV1均无明显相关性（P〉0.05）。结论由于COPD和哮喘患者在呼吸生理方面变化的异同,其各容积二氧化碳图死腔参数的变化也有所区别。通过分析两者死腔参数的变化趋势,可为临床工作者在COPD和哮喘的诊断及鉴别诊断中提供参考。     

Inter-disease Comparison of Research Quantity and Quality: Bronchial Asthma and Chronic Obstructive Pulmonary Disease

Background. The two obstructive airway diseases bronchial asthma and chronic obstructive pulmonary disease (COPD) represent major global causes of disability and death. Whereas COPD research was largely underfunded in the 1980s and 1990s, increased funding activities have been initiated since the year 2000. However, detailed scientometric data on the development of research for asthma and COPD have not been generated so far. Methods. The present scientometric study was conducted to establish a database of research quantity and quality in the 20-year period between 1987 and 2006 using the Web of Science information system and the United Kingdom and Germany for comparison of research activities. Results. The information database Web of Science was screened and during the period from 1987 to 2006 a number of 8,874 items related to asthma was published by UK affiliations. Of these, 1,824 were published in cooperation with a total of 86 other countries. This is a ratio of 20.55%. In the same period, 3,341 items were published by German institutions (923 in cooperation with 56 other countries, ratio of 27.63%). Citation analysis demonstrated an average citation of 24.48 per UK article and 17.62 per German article. For COPD, 2,179 items were published by UK affiliations and 689 items by German institutions. Of the UK COPD publications, 570 were published in cooperations with 47 countries (ratio of 22.95 %). By contrast, 218 of the 689 German COPD articles were published with 29 other countries (ratio of 25.49%). When citation analysis was performed, average citation ratios of 18.93 for the UK and 10.61 for German were found. Conclusion. Summarizing this first country-specific comparative benchmarking analysis for obstructive pulmonary diseases it can be concluded that () asthma research dominated in the past 20 years; () COPD research gained importance in the field since the end of the 1990s; () there are large differences present in the research output between the two high-income countries examined.     

血清同型半胱氨酸和半胱氨酸天冬酶-3水平与慢性阻塞性肺疾病患者认知障碍的关系研究

背景血清同型半胱氨酸(Hcy)和半胱氨酸天冬酶-3(caspase-3)水平与神经退行性病变有关,但二者与慢性阻塞性肺疾病(COPD)患者认知障碍的关系尚未明确。目的分析血清Hcy和caspase-3水平与COPD患者认知障碍的关系。方法选取2016年1月—2019年6月邯郸市中心医院呼吸内科收治的COPD患者156例作为病例组,根据蒙特利尔认知评估量表(MoCA)评分将其分为A组58例(认知功能正常)、B组65例(轻度认知障碍)及C组33例(中重度认知障碍);另选取同期体检健康者150例作为对照组。比较病例组和对照组受试者动脉血气分析指标〔包括动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)及pH值〕、肺功能指标〔包括第1秒用力呼气容积(FEV1)、呼气峰值流速(PEF)、最大呼气中段流量(MMEF)及用力肺活量(FVC)〕、MoCA评分,对照组、A组、B组、C组受试者血清Hcy、caspase-3水平;血清Hcy和caspase-3水平与COPD患者MoCA评分的相关性分析采用Pearson相关分析;绘制受试者工作特征曲线(ROC曲线)以评价血清Hcy和caspase-3水平对COPD患者认知障碍的预测价值。结果(1)病例组患者PaO2、pH值低于对照组,PaCO2高于对照组,FEV1和FVC小于对照组,PEF和MMEF慢于对照组(P<0.05)。(2)病例组患者视空间与执行功能、命名、记忆、注意、语言、抽象思维、延时回忆、定向评分及MoCA总分均低于对照组(P<0.05)。(3)A组、B组、C组患者血清Hcy和caspase-3水平高于对照组,B组和C组患者血清Hcy和caspase-3水平高于A组,C组患者血清Hcy和caspase-3水平高于B组(P<0.05)。(4)Pearson相关分析结果显示,血清Hcy、caspase-3水平与COPD患者MoCA评分呈负相关(r值分别为-0.553、-0.567,P<0.01)。(5)ROC曲线显示,血清Hcy水平预测COPD患者认知障碍的曲线下面积(AUC)为0.781〔95%CI(0.695,0.886)〕,最佳截断值为13.56 ng/L,灵敏度、特异度分别为70.75%、92.62%;血清caspase-3水平预测COPD患者认知障碍的AUC为0.776〔95%CI(0.691,0.873)〕,最佳截断值为7.83 ng/L,灵敏度、特异度分别为71.34%、91.08%。结论血清Hcy和caspase-3水平与COPD患者认知功能呈负相关,且二者均对COPD患者认知障碍具有一定预测价值。     

诱导痰炎性标志物对支气管哮喘和慢性阻塞性肺疾病稳定期的鉴别诊断价值

目的 探讨诱导痰中嗜酸细胞（Eos）和嗜酸细胞阳离子蛋白（ECP）水平对支气管哮喘与慢性阻塞性肺疾病（COPD）稳定期的鉴别诊断价值.方法 选择支气管哮喘患者62例,检测肺功能并分别采用瑞氏染色及荧光免疫法检测高渗盐水诱导痰中Eos数量和ECP水平.选择51例慢性阻塞性肺疾病稳定期患者和30名健康人作为对照.结果 支气管哮喘患者诱导痰中Eos数量[（14.4±6.3）%]和ECP水平[（413±199）μg/L]显著高于COPD稳定期组[（3.2±1.5）%、（54±35）μg/L,P〈0.01]和对照组[（1.1±0.6）%、（46±23）μg/L,P〈0.01].以诱导痰中Eos≥7%和ECP≥100μg/L作为与稳定期COPD鉴别的标准,诊断哮喘的敏感性分别为79.3%和81.2%,特异性分别为81.0%和83.0%.联合检测两者的敏感性和特异性分别为85.2%和86.0%.结论 检测诱导痰Eos和ECP水平有助于支气管哮喘与COPD稳定期的鉴别.     

无创通气在慢性阻塞性肺疾病患者撤机中的应用

目的：探讨无创通气应用于慢性阻塞性肺疾病（COPD）患者有创机械通气撤机中的作用。方法：62例cOPD合并呼吸衰竭应用有创通气后撤机拔管的患者，分为治疗组32例，对照组30例，治疗组在常规药物治疗基础上应用无创通气，对照组应用常规治疗（药物治疗＋吸氧）。观察两组的血气分析指标、再插管率、住院天数及住院病死率等。结果：治疗组给予无创通气后与对照组比较动脉血气PaO2明显上升（P〈0．05），PaCO2下降明显（P〈0．05），两组再插管率为9%和30％（P〈0．05），住院天数为（32±10）d和（38±15）d（P〈0．05），住院病死率为6．2％和23．3％（P〈0．05）。结论：撤机拔管后立即开始应用无创通气的患者再插管率下降，住院天数减少及病死率下降。     

胸腔镜手术对慢性阻塞性肺病伴肺大疱患者的治疗研究

目的探讨胸腔镜手术对慢性阻塞性肺病（COPD）伴肺大疱的治疗效果。方法 2007年10月—2010年6月我科收治的52例COPD伴肺大疱患者行胸腔镜下肺大疱切除术,其中伴气胸者10例;若胸腔内粘连尚可分离、肺大疱呈局限性非均质性分布,予完全胸腔镜下肺大疱切除;若胸腔镜探查发现胸腔内广泛粘连、肺大疱太多或弥漫分布以及麻醉难以实现单肺通气,则采用胸腔镜加小切口肺大疱切除术;并对手术前后患者的肺功能进行对比分析。结果术后随访44例3～36个月,患者胸闷伴轻度呼吸困难等症状明显改善,术前气胸者无气胸复发;术后3、6个月肺功能均较术前明显改善（P〈0.05）。结论胸腔镜手术治疗COPD伴肺大疱疗效明显。手术指征、手术方法、围术期的策略以及管理对治疗效果起决定作用。     

基因重组生长激素在COPD急性加重期的治疗

目的　研究基因重组生长激素 (r- h GH)在慢性阻塞性肺疾病 (COPD)急性加重期治疗中的临床应用价值。方法　 30例 COPD急性加重期患者随机分成生长激素组和对照组。两组均给予抗感染、氧疗及营养支持等。生长激素组在上述治疗基础上加用 r- h GH,每晚 1次皮下注射 ,连续应用 7～ 10日。观察各组的治疗疗程 ,治疗前后的血糖峰值及胰岛素的用量。结果　生长激素组平均疗程 9.9± 3.8日 ,少于对照组 (13.8± 4 .3日 ) (p<0 .0 5 ) ,两组治疗前后的血糖峰值及胰岛素用量无显著差异。结论　 r- h GH能够缩短 COPD急性加重期患者的治疗疗程     

噻托溴胺对慢性阻塞性肺疾病稳定期患者生存质量的评价

目的观察中度慢性阻塞性肺疾病(COPD)稳定期吸入噻托溴胺的临床疗效。方法将40例中度COPD(Ⅱ～Ⅲ级)稳定期患者随机分为2组,治疗组(噻托溴铵组)(n=20,思力华,Boehinger Ingelheim,18ug,1次/d,早晨给药)和对照组(n=20,按需使用短效抗胆碱能支气管扩张剂),整个观察期为1年,观察2组用药3个月、6个月和1年后肺功能的变化以及StGeorge′s呼吸问卷(SGRQ)等情况,通过6min步行试验(6MWT)观察运动耐力的变化以及随访3～12个月急性加重的例次及住院例次。结果用药3个月后治疗组FEV1、FVC、FEV1/FVC及FEV1占预计值(%)比对照组明显改善,2组比较差异有显著性(P0.05),治疗组运动耐力(6MWT)增加,SGRQ评分比较治疗组明显下降,随访3～12个月治疗组急性加重例次明显减少,与对照组比较差异有显著性(P0.05);治疗组用药后3个月、6个月和1年后肺功能比较无显著差异(P0.05)。结论吸入噻托溴胺可以改善稳定期(Ⅱ～Ⅲ级)COPD患者肺功能与运动耐力,减少急性加重的发作,改善生活质量,不良反应少,使用方便,值得临床广泛推广。     

Antibiotic Resistance in Sputum Isolates of Streptococcus pneumoniae in Chronic Obstructive Pulmonary Disease is Related to Antibiotic Exposure

ABSTRACT

Streptococcus pneumoniae (S. pneumoniae) is recovered from sputum of patients with chronic obstructive pulmonary disease (COPD) during stable disease and exacerbations. In patients with community acquired pneumonia, antibiotic exposure in the prior 3–6 months is associated with recovery of antibiotic resistant isolates of S. pneumoniae. Whether the same relationship is seen in COPD is not known. From April 1994 to June 2004, 127 adults with COPD were enrolled in a prospective longitudinal study. Sputum isolates of S. pneumoniae were characterized with susceptibility testing and pulsed-field gel electrophoresis (PFGE). The relationship between antibiotic use in the previous 3 and 6 months with either new acquisition of a resistant pneumococcal isolate or development of resistance (4-fold increase in MIC) in a pre-existing colonizing pneumococcal strain was determined. A total of 194 pneumococcal isolates were recovered from 38 patients. Among 71 newly acquired and 4 resistance-emergent strains analyzed further, rates of resistance to penicillin (MIC ≥2), erythromycin (MIC ≥1), tetracycline (MIC ≥8) and trimethoprim/sulfamethoxazole (MIC ≥4) were 8%, 24%, 17% and 16% respectively. Flouroquinolone resistance was not seen. Among strains isolated from patients exposed to a macrolide within 6 months, 53.6% displayed erythromycin resistance vs. 14% of strains without such exposure (p = 0.00085). Similar associations were not seen for other antibiotics. Macrolide use in the previous 6 months is associated with macrolide resistance in sputum isolates of S. pneumoniae. Recent antibiotic exposure may help in determining appropriate antibiotic treatment in these patients.     

Changes in Serum Eosinophil Cationic Protein Levels after Exercise Challenge in Asthmatic Children

The aim of the present study was to assess the relationship between serum eosinophil cationic protein levels and the severity of exercise-induced bronchoconstriction in asthmatic children. The 48 asthmatic children were divided into exercise-induced bronchoconstriction group and non-exercise-induced bronchoconstriction group. In the exercise-induced bronchoconstriction group, the post-exercise serum eosinophil cationic protein levels were significantly increased as compared with the pre-exercise serum eosinophil cationic protein levels. These results suggested that eosinophil cationic protein may serve as a possible contributor to the pathophysiology of exercise-induced bronchoconstriction in asthmatic children.