伊伐布雷定对慢性阻塞性肺疾病合并心血管疾病心肺功能影响的系统评价

目的:系统评价伊伐布雷定对慢性阻塞性肺疾病(COPD)合并心血管疾病患者心肺功能的影响及安全性。方法:计算机检索PubMed、MEDLINE、Elsevier ScienceDirect、Cochrane Library、中国知网、万方数据库,收集2005年1月-2020年1月发表的有关伊伐布雷定在COPD合并心血管疾病中应用的随机对照研究文献,应用RevMan5.3软件、Stata12.0软件进行数据统计分析。结果:最终纳入12篇文献,包括756例患者。系统评价结果显示,与对照组比较,伊伐布雷定组在控制心率(WMD=-15,95%CI:-19.47～-11.11,P<0.05)、提高6 min步行距离(6MWD)(WMD=61.25,95%CI:45.8～76.69,P<0.05)、改善Borg呼吸困难评分(WMD=-0.68,95%CI:-0.93～-0.43,P<0.05)、降低COPD合并心力衰竭的N末端脑钠肽前体(NT-proBNP)水平(SMD=-2.18,95%CI:-3.57～-0.79,P<0.05)、减少COPD合并冠心病的心绞痛发作次数(W...     

伊伐布雷定治疗慢性阻塞性肺疾病合并心绞痛患者的临床观察

目的观察伊伐布雷定对慢性阻塞性肺疾病合并心绞痛患者的临床安全性及治疗效果。方法临床诊断慢性阻塞性肺疾病合并心绞痛患者32例,随机分成常规药物治疗组(对照组)和常规药物加伊伐布雷定治疗(5mg 2次/d)组(观察组)各16例。入组前测量患者心率、行Borg呼吸困难评分、6min步行试验并记录一周内发作心绞痛的次数。分别在第1、4、12周时复测上述指标。结果在对照组,第12周时患者心绞痛发作次数减少;在观察组,第1、4、12周时患者心室率下降,第4、12周时心绞痛发作次数较前减少、6min步行试验距离较前增加;与对照组相比,观察组在第1、4、12周时患者心室率下降、第4、12周时6min步行试验距离增加及心绞痛发作次数减少;两组患者用药前后及两组之间Borg呼吸困难评分无明显变化。结论伊伐布雷定用于治疗慢性阻塞性肺疾病合并心绞痛患者安全有效,常规药物治疗基础上可进一步改善临床症状。     

伊伐布雷定治疗慢性心力衰竭的有效性

<正>近几年来,心率在心血管疾病(尤其心力衰竭)中的管理已成为心血管医生关注的重点,也是研究的热点,尤其对处在心力衰竭易损期的患者心率管理更为关键,它是关系心力衰竭患者全因死亡、再入院及远期预后十分重要的客观指标;心率是评价心力衰竭死亡率和再住院率的危险指标之一,心率管理达标将有益于改善心力衰竭患者远期生存及生活质量[1]。近30年来β受体阻滞剂作为慢性心力衰竭治疗药物的基石,奠定了心力衰竭治疗的里程碑。但β受体阻滞剂因其负性肌力、降低血压等     

阿托伐他汀对吸烟伴慢性肺源性心脏病患者近期心肺事件的影响

目的 评价阿托伐他汀对吸烟伴慢性肺源性心脏病患者近期心肺事件的影响.方法 55例吸烟伴慢性阻塞性肺疾病(COPD)合并慢性肺心病、肺高压患者随机分为阿托伐他汀治疗组(n＝27)和常规治疗组(n＝28).两组患者均接受常规治疗,阿托伐他汀治疗组口服阿托伐他汀(20 mg/d).分别观察阿托伐他汀治疗组及常规治疗组治疗前、治疗后6个月肺功能、超声心动图和6 min步行距离的变化,并随访患者的近期心肺事件.结果 阿托伐他汀治疗组治疗6个月后肺动脉压较治疗前和同期常规治疗组同期明显下降(P<0.05)、6 min步行距离明显增加(P<0.05),第1秒用力呼气容积(FEV1)、FEV1/用力肺活量(FVC)等肺功能指标比常规组治疗6月后有明显改善(P<0.05);常规治疗组治疗前、治疗后6个月上述指标比较差异无统计学意义(P>0.05);阿托伐他汀治疗组近期心肺事件发生率明显低于常规治疗组(P<0.05).结论 阿托伐他汀可以改善吸烟伴慢性肺源性心脏病患者生活质量及肺功能、降低肺动脉压,改善患者的近期预后.     

青海高原慢性阻塞性肺疾病所致慢性肺源性心脏病流行病学调查

目的 了解青海高原慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)所致慢性肺源性心脏病的患病情况.方法 采用分层、不等比、整群随机抽样方法对青海省≥15岁共计23 725人,按照"慢性阻塞性肺疾病,肺心病高危人群基线调查表"进行COPD流行病学调查.对肺功能检查筛...     

伊伐布雷定联合比索洛尔在老年慢性射血分数降低心力衰竭合并慢性阻塞性肺疾病中的应用价值

目的 探讨伊伐布雷定(Iva)联合比索洛尔在慢性射血分数降低心力衰竭(HFrEF)合并慢性阻塞性肺疾病(COPD)中的应用价值。方法 采用随机数字表法把90例HFrEF合并COPD患者分为对照组和观察组各45例。对照组给予富马酸比索洛尔片治疗,观察组给予Iva联合比索洛尔治疗。对比两组的疗效、心脏不良事件、比索洛尔平均日剂量、心功能指标、炎性因子和圣乔治呼吸问卷(SGRQ)评分。结果 观察组疗效明显优于对照组,再住院率明显低于对照组(P<0.05)。治疗后与对照组相比,观察组左室射血分数(LVEF)和静息心率达标率明显高,6 min步行距离(6MWD)明显长,比索洛尔平均日剂量、N末端B型利钠肽前体(NT-proBNP)、白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α、超敏C-反应蛋白(hs-CRP)、呼吸症状评分、活动受限评分、疾病影响评分和SGRQ总分均明显低(P<0.05)。结论 Iva联合比索洛尔治疗慢性HFrEF合并COPD可提高疗效、心功能和生活质量,同时可降低再住院率和炎症反应程度。     

伊伐布雷定治疗慢性收缩性心力衰竭的效果

目的 探讨伊伐布雷定治疗慢性收缩性心力衰竭的临床疗效。方法 入选左室收缩功能不全并发慢性心力衰竭且为窦性心率≥70次/min患者76例,随机分为伊伐布雷定组（试药组,39例）和常规治疗组（对照组,37例）,在2周、4周、6周及3个月时随访,记录其心率、血压、心血管不良事件、药物剂量。入院后及3个月行6分钟步行试验及心脏彩超。结果 3个月时,与对照组相比,试药组心率显著降低［(72±5)次/min vs.(62±4)次/min,P<0.05］,血压显著升高［(116±8) mmHg vs.(123±7) mmHg,P<0.05］,左室射血分数显著提高（P<0.05）,左室收缩末内径及左房直径较对照组显著减小［分别(4.6±0.3) cm vs.(4.1±0.2) cm;(4.0±0.4) cm vs.(3.7±0.2) cm,均P<0.05］。6分钟步行距离显著增加［(522±81) m vs.(578±91) m,P<0.05］;两组心功能分级至少增加1级,试药组左室射血分数改善更显著（62% vs. 35%,P<0.05）。结论 伊伐布雷定治疗慢性收缩性心力衰竭的疗效优于常规治疗。     

伊伐布雷定研究进展

If通道阻滞剂伊伐布雷定已经欧盟批准上市,用于治疗正常窦性心律、对β受体阻滞剂禁忌或不能耐受的慢性稳定型心绞痛患者,对心衰、急性冠脉综合征等的研究目前也取得了一定成果。     

伊伐布雷定治疗慢性稳定性心绞痛的临床疗效观察

【】目的：观察盐酸伊伐布雷定对慢性稳定性心绞痛(SAP)的疗效及安全性。方法：前瞻性入选门诊就诊(2013年4月-2014年1月)的24例SAP患者,随机、双盲分为盐酸伊伐布雷定组和阿替洛尔组。每组各12例。观察治疗前后两组静息及最大运动量时心率水平、心绞痛发作次数、运动耐量的变化。结果：1.盐酸伊伐布雷定组的静息心率治疗前后分别为75.4±2.5次/分和63.7±3.3次/分(P＜0.05),最大运动量心率由治疗前122.8±4.6次/分降低至105.4±5.1次/分(P＜0.05)；阿替洛尔组治疗前后的静息心率由74.8±3.6次/分降低至64.5±4.1次/分(P＜0.05),最大运动量心率由127.5±5.3次/分降低至114.8±6.4次/分(P＜0.05)。静息心率两组间比较差异无统计学意义(P＞0.05),而盐酸伊伐布雷定降低最大运动量时心率优于阿替洛尔组(P＜0.05)。2.盐酸伊伐布雷定组治疗前后心绞痛发作次数由3.45±1.24次/周减少至1.87±1.31次/周(P＜0.05),心绞痛持续时间由7.55±3.88min缩短为2.13±4.11min(P＜0.05)；阿替洛尔组治疗前后心绞痛发作次数由 3.61±1.41次/周减少至2.11±1.53次/周(P＜0.05),心绞痛持续时间由8.01±3.24min缩短为2.75±3.37min(P＜0.05)。两组间比较差异无统计学意义(P＞0.05)。3.运动耐量方面,盐酸伊伐布雷定组从服药前的368.65±122.32s增加至服药12周后的501.39±131.63s(P＜0.05)；阿替洛尔组从服药前的371.35±113.45s增加至服药12周后的467.49±142.54s(P＜0.05),两组间差异有统计学意义(P＜0.05)。结论：伊伐布雷定同阿替洛尔一样可显著降低SAP患者心率、减少心绞痛发作,增加运动耐量,且具有良好的安全性及耐受性。     

阿托伐他汀对慢性阻塞性肺疾病合并肺动脉高压患者的影响

目的:评价阿托伐他汀对慢性阻塞性肺疾病(COPD)合并慢性肺源性心脏病(简称肺心病)患者肺动脉高压(PH)的影响。方法:55例COPD合并慢性肺心病、PH患者随机分为2组:阿托伐他汀组(AL组,27例)和常规治疗组(28例)。2组患者均接受常规治疗,阿托伐他汀组口服阿托伐他汀,20mg/d。分别观察阿托伐他汀组及常规治疗组治疗前、治疗后6个月血浆中一氧化氮(nitric oxide,NO)、内皮素I(endothelin-1,ET-1)、超声心动图变化。结果:阿托伐他汀组治疗6个月后ET-1、PH较治疗前和常规治疗组治疗6个月时明显下降(P<0.05)、内源性一氧化氮(NO)明显升高(P<0.05)。常规治疗组治疗前、治疗后6个月上述指标比较差异无统计学意义(P>0.05)。结论:阿托伐他汀可调节NO及ET-1的分泌,有效降低PH。     

慢性阻塞性肺疾病合并肺源性心脏病危险相关因素分析

目的：：探讨慢性阻塞性肺疾病( COPD)合并肺源性心脏病危险相关因素。方法：选取50例慢性阻塞性肺疾病合并肺源性心脏病住院患者作为研究组,同时选取同期COPD未合并肺源性心脏病住院患者作为对照组,分析COPD患者发生肺心病的危险因素。结果：研究组患者在PaO2、 PaCO2、 CD4+/CD8+、 FEV1及FEV1/FVC方面均差于对照组,差异有统计学意义(P<0．05)。疾病加重次数、吸烟指数及SGRQ评分是慢性阻塞性肺疾病合并肺源性心脏病的危险因素。结论：稳定患者病情,减少COPD急性发作次数,戒烟,及时疏导患者负性心理有利于降低慢性阻塞性肺疾病合并肺源性心脏病的危险性,提高患者生活质量,改善预后。     

Echocardiographic Detection of Occult Cor Pulmonale During Exercise in Patients with Chronic Obstructive Pulmonary Disease

We tested the ability of cycle ergometer exercise echocardiography to detect cases of occult cor pulmonale among 25 patients with chronic obstructive pulmonary disease (COPD). The M-mode echocardiographic ventricular septal motion, left ventricular shape determined by short-axis two-dimensional (2-D) echocardiography, and right and left ventricular pressure curves were recorded at rest and during exercise and were compared between patients. The ventricular septal motion was normal at rest in all of the patients. In nine patients (dip group), there was marked downward ventricular septal motion in early diastole during exercise, indicating distortion of the left ventricular shape. There were no distinct changes in the remaining 16 patients (non-dip group). At rest, the cardiac index was significantly lower, and right ventricular systolic and mean pulmonary artery pressures were significantly higher in the dip group than in the non-dip group. However, no significant difference was noted in the right ventricular end-diastolic pressure between the two groups at rest. The right ventricular systolic and end-diastolic pressures were greater during exercise in the dip group than in the non-dip group. In all of the patients in the dip group, the right ventricular pressure exceeded the left ventricular pressure only in early diastole, coinciding with the early diastolic dip of the ventricular septum, during exercise. In conclusion, occult cor pulmonale can be diagnosed accurately by the appearance of an early diastolic dip of the ventricular septum and distorted left ventricular shape during exercise in patients with COPD.     

老年男性肺心病患者睾丸内分泌功能状态

20例老年男性肺心病患者血浆睾酮(T)低下,经HCG兴奋后,重症组血浆T基础值、峰值、峰值上升速率均显著低于正常对照组(P <0.01或<0.05)。轻症组T基础值也明显低于正常对照组,但峰值、峰值净增值、峰值上升速率与正常无明显差异。缓解期基础T值仍低于正常(P <0.05)。实验结果表明,患者睾丸内分泌功能减退以原发性损害为主,同时也存在继发因素以及下丘脑-垂体-性腺轴之间的反馈机制失调。     

慢性肺心病QRS向量系统性研究

为探索心电向量图对慢性肺心病右室肥大的诊断标准,对50例肺心病、32例肺气肿和143例,正常成人的QRS向量进行了系统性研究。结果表明,取Rx<0.5mV、Sx/Rx>0.58、横面S/R>1.1、最大空间向量仰角≥65°为右室肥大诊断标准,对肺心病诊断敏感性为90％,对肺气肿及正常组诊断特异性分别为87.5％和96.5％。     

COPD患者肺部感染控制窗的影响因素分析

目的探讨COPD患者肺部感染控制窗（PIC窗）的影响因素及临床意义。方法对68例早出现PIC窗的患者和62例晚出现PIC窗的患者进行调查，判定PIC窗的影响因素。结果COPD患者的较早出现PIC窗组为（3．6±0．8）d，较晚出现PIC窗组为（7．8±0．6）d，两组差异有统计学意义（P〈0．001）；Logistic多因素回归分析结果为雾化吸入支气管舒张剂（P=0．006）和床旁支气管镜吸痰（P=0．001）是主要影响因素；结论雾化吸人支气管舒张剂和床旁支气管镜吸痰治疗有利于COPD患者PIC窗提早出现，把握好PIC窗，有助于危重症COPD急性加重期的治疗。     

慢性支气管炎、COPD及肺心病患者BNP、肺功能和血气变化的研究

目的探讨慢性支气管炎(慢支)、COPD、慢性肺源性心脏病(肺心病)患者不同时期BNP(B型钠尿肽)、肺功能、动脉血气的变化。方法慢支、COPD、肺心病患者均空腹抽静脉血检测BNP;另抽动脉血检测血气;并行肺功能检测。三组间对比,并与正常组对照。结果由慢支发展到COPD、肺心病时BNP逐渐升高(P<0.05);慢支、COPD及肺心病各组FEV1/FVC、MMEF逐渐降低(P均<0.05),动脉血氧分压(PaO2)、PH值逐渐降低,二氧化碳分压(PaCO2)逐渐增高(P均<0.05)。BNP与PaO2、PH呈显著负相关(r=-0.69,-0.58,P均<0.01),而与PaCO2呈正相关(r=0.55,P<0.01)。BNP与FEV1/FVC、MMEF均呈显著负相关,P均<0.01)。结论血浆BNP水平与血气分析及肺功能变化关系密切,血浆BNP水平可以作为判断COPD病情严重程度的一个指标。     

Paraoxonase 1 Activity in Patients with Chronic Obstructive Pulmonary Disease

Introduction: Paraoxonase 1 (PON1) is an antioxidative enzyme manly associated with high density lipoproteins (HDL) in the peripheral blood. The aim of this study was to determine the PON1 paraoxonase and arylesterase activities in patients with chronic obstructive pulmonary disease (COPD). We also aimed to determine the concentration of reduced thiol groups as a marker of protein oxidation. Materials and methods: The study included 105 patients with stable COPD and 44 healthy controls. PON1 activities and thiols concentration were assayed in sera by spectrophotometry. Results: PON1 basal (POX) and salt-stimulated paraoxonase activity (POX1) as well as arylesterase activity (ARE) were significantly reduced in COPD patients. In addition, concentration of reduced thiol groups was significantly decreased in COPD group. PON1 activities were similar in patients with different disease severity (GOLD stages). However, a significant reduction in POX, POX1 and ARE was observed already in GOLD II stage when compared to controls. POX and POX1 showed modest while ARE yielded very good power for discrimination between healthy subjects and COPD patients. Univariate and multivariate logistic regression analysis indicated that ARE is a good COPD predictor. Conclusion: Reduction of PON1 activity observed in COPD patients could be partly caused by oxidative environment. Lower concentrations of reduced thiol groups in COPD patients suggest that a decrease in PON1 activity could reflect oxidative changes of enzyme free cysteine residues. Furthermore, decreased PON1 arylesterase activity might indicate a down-regulation of PON1 concentration. Our results suggest that ARE could be considered as potential biomarker for COPD diagnosis.     

Illness Perceptions and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

This study aimed at identifying cognitive and emotional representations relevant for improving health care communication and quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD). One-hundred-seventy-one COPD outpatients completed questionnaires on illness perceptions and QoL. After controlling for the effects of age, pulmonary function, and dyspnea, patients with decreased attention to symptoms, with more positive beliefs about the effects and outcomes of their illness, and with less strong emotional reactions to the illness, had higher QoL scores. The results of this study are discussed in relation to the associations found in other illnesses.     

Pulmonary Embolism in Chronic Obstructive Pulmonary Disease: A Population-Based Cohort Study

Background: To evaluate the incidence of pulmonary embolism (PE) in patients with chronic obstructive pulmonary disease (COPD) in Taiwan. Methods: This was a retrospective population-based cohort study using data retrieved from Taiwan's National Health Insurance Research Database (2000 to 2008), which contains 99% of Taiwanese healthcare data. The evaluations included 355,878 COPD patients and 355,878 non-COPD patients for comparison. Results: The incidence of PE in the COPD cohort was 12.31 per 10,000 person-years (1.37/10,000 persons/y), which was approximately 4-times higher than in the comparison cohort (0.35/10,000 persons/y). In the COPD cohort, risk of PE was higher in the young age group (20-59 y, HR 4.64, 95% CI 3.06-7.03) than in other age groups. Risk of PE was higher in patients with COPD combined with hypertension, coronary artery disease, and cancer, or those with previous operation (HR 4.16, 4.75, 4.56, and 4.50 respectively) than in those with COPD and no comorbidity. Conclusions: The overall incidence of PE is lower in Taiwan than in western countries. However, the prevalence of PE in COPD patients is higher than in non-COPD patients and increases with age. It is crucial to incorporate PE into the differential diagnosis of COPD exacerbation for clinical physicians.