【Abstract】 Objective To observe the plasma levels of adiponectin and interleukin-17 ( IL-17) in patients with chronic obstructive pulmonary disease ( COPD) at acute exacerbation or stable stage, and analyze their relationship. Methods Sixty male COPD patients with normal weight ( with BMI range of 18. 5-24. 9 kg/m2 ) were enrolled, including 30 patients with acute exacerbations of COPD ( AECOPD) and 30 patients with stable COPD. Twenty healthy nonsmoking male volunteers were included as controls. The plasma levels of adiponectin and IL-17 as well as lung function ( FEV1% pred and RV% pred) were measured in all subjects. Results The concentrations of adiponectin and IL-17 were significantly higher in the AECOPD patients than those of the patients with stable COPD and the contro1s ( P lt; 0. 001) . Theconcentrations of adiponectin and IL-17 were significantly higher in the patients with stable COPD than those of the controls ( P lt;0. 01) . Adiponectin was positively correlated with IL-17 in the AECOPD patients ( r =0. 822, P lt;0. 001) and in the patients with stable COPD ( r =0. 732, P lt;0. 001) . Adiponectin was positivelycorrelated with RV% pred in the AECOPD patients ( rs = 0. 764, P lt;0. 001) and in the patients with stable COPD ( rs =0. 967, P lt;0. 001) . There was no significant relationship between adiponectin and FEV1% pred ( P gt;0. 05) . Conclusions The plasma level of adiponectin in COPD patients is elevated which is relatedwith excessive inflation of lung. Adiponectin may be involved in the process of inflammation in COPD as a new pro-inflammatory cytokine.
ObjectiveTo explore the diagnostic efficacy of Geriatric Nutritional Risk Index (GNRI) in malnutrition of elderly patients with chronic obstructive pulmonary disease (COPD) in outpatient department. MethodsOne hundred and five elderly outpatients with COPD were enrolled in the study, and their nutritional screening was carried out. The clinical and laboratory parameters of patients in the normal nutrition group (high GNRI group) and malnutrition group (low GNRI group) were compared, and the correlation analysis was conducted. The diagnostic efficacy of GNRI was evaluated based on the malnutrition universal screening tool (MUST). ResultsThe prevalence of malnutrition was high in COPD elderly outpatients. The prevalence of malnutrition in group D was 61.8%. There were significant differences between the two groups in body mass index, serum albumin, FEV1 percentage in the predicted value, 6-minute walk distance, and the number of acute exacerbations in the past year. GNRI was significantly related to the above parameters. The sensitivity, specificity and accuracy of GNRI were 81.8%, 83.6% and 82.9%, using MUST as the standard. ConclusionGNRI can be used for nutritional screening of COPD patients in elderly outpatients, which is simple, convenient and relatively accurate, and can be popularized in other medical institutions.
【摘要】 目的 觀察沙美特羅替卡松粉吸入劑（沙美特羅50 μg/氟替卡松500 μg）治療穩定期Ⅲ~Ⅳ級慢性阻塞性肺疾病（COPD）的療效及安全性。 方法 將2008年1-12月就診的62例穩定期Ⅲ~Ⅳ級COPD患者隨機分成對照組和治療組。對照組采用常規傳統治療方法，口服茶堿緩釋片、祛痰劑；治療組在常規傳統治療的基礎上，加用沙美特羅替卡松粉吸入劑。6個月后評估兩組患者肺功能、血氣分析、呼吸困難程度及不良反應。治療過程中，兩組各有2例患者因失訪退出研究。 結果 治療前，對照組、治療組1 s用力呼氣量（FEV1）和FEV1%預計值比較，無統計學意義（Pgt;0.05）；治療后，治療組FEV1和FEV1%預計值明顯增加，有統計學意義（Plt;0.05）。對照組治療前后比較無改變（Pgt;0.05），治療組較對照組呼吸困難程度明顯好轉，臨床癥狀評分明顯下降，兩組間差異有統計學意義（Plt;0.05）。治療結束時兩組上述各指標比較，差異有統計學意義 （Plt;0.05）。兩組均有少數出現咽喉不適，患者耐受好。 結論 沙美特羅替卡松粉吸入劑治療穩定期Ⅲ~Ⅳ級COPD患者有效。【Abstract】 Objective To observe the efficacy and safety of inhaled formulations of Seretide (salmeterol 50 μg / fluticasone 500 μg) on grade Ⅲ ~ Ⅳ stable chronic obstructive pulmonary disease (COPD). Methods Sixty-two patients of grade Ⅲ-Ⅳ stable COPD were randomly divided into control group and treatment group. The control group was treated by conventional methods, oral theophylline and expectorant agents,while the treatment group was treated by inhalation of large dosage Seretide be added in the conventional treatment based on traditional. After six months, the lung function, blood gas analysis, respiratory difficulty and adverse effects were assessed. Results Before the treatment, the differences of forced expiratory volume in one second (FEV1) and FEV1% predicted value in the two groups were not statistically significant (Pgt;0.05). After treatment, FEV1 and FEV1% predicted value of treatment group were increased significantly(Plt;0.05). The control group showed no significant change before and after treatment(Pgt;0.05). The respiratory difficulty imprvoved significantly,while clinical symptom score decreased significantly in the treatment group,which compared with the control group (Plt;0.05). A few appeared thoat discomfort in the two groups. Well tolerated in patients. Conclusion Inhaled formulations of Seretide was effective and safty on stable period COPD patients with grade Ⅲ-Ⅳ.
ObjectiveTo assess the mortality, acute exacerbations, exercise capacity, symptoms and significant physiological parameters (lung function, respiratory muscle function and gas exchange) of patients with severe stable chronic obstructive pulmonary disease (COPD) with respiratory failure treated by noninvasive positive pressure ventilation (NPPV).MethodsA meta-analysis of randomized controlled trials was carried out by searching PubMed, Cochrane library, Embase, OVID, Chinese Biomedical Literature Database and the bibliographies of the retrieved articles up to February 2017. Studies of patients with severe stable COPD with respiratory failure receiving long-term noninvasive positive pressure ventilation and comparison with oxygen therapy were conducted, and at least one of the following parameters were reviewed: frequency of acute exacerbations, mortality, lung function, respiratory muscle function, gas exchange, 6-minute walk test.ResultsSix studies with 695 subjects met the inclusion criteria and were analyzed. The PaCO2 was significantly decreased in patients who received long-term NPPV. No significant difference was found between long-term NPPV and oxygen therapy in mortality, frequency of acute exacerbations, gas exchange, lung function, respiratory muscle function and exercise capacity. The subgroup analysis showed that NPPV improves survival of patients when it is targeted at greatly reducing hypercapnia.ConclusionCurrent evidence suggests that there is no significant improvement by application of NPPV on severe stable COPD with respiratory failure patients, but NPPV may reduce patients’ mortality with the aim of reducing hypercapnia.
Objective To determine if supervised hospital-based exercise can maintain the benefits of functional exercise ability and quality of life gained from a pulmonary rehabilitation program in COPD.Methods A prospective and randomized study was carried out. Following completion of an eight-week pulmonary rehabilitation program in hospital, 43 COPD patients were recruited and randomized into either a supervised group ( supervised, every 10 days, hospital-based exercise, 22 cases ) or a control group ( unsupervised home exercise,21 cases) and followed for 12 months. Measurements were taken at baseline and 12 months later. Exercise measurements include six-minute walk test( 6MWT) and pulmonary function test. Quality of life was measured using the Chronic Respiratory Questionnaire ( CRQ) . Results After 12 months of different exercise program,6MWT in the supervised group was significantly longer than that in the unsupervised group[ ( 532. 0 ±168. 4) m vs ( 485. 0 ±151. 6) m, P lt; 0. 05] . There was no significant difference in pulmonary function between the two groups. The quality of life of the supervised group was higher than that of the unsupervised group( 114. 6 ±20. 8 vs 105. 6 ±21. 7, P lt;0. 05) . Conclusions After the completion of pulmonary rehabilitation program, a supervised, every 10 days, hospital-based following exercise program can maintain better functional exercise capacity and quality of life compared to home exercise in COPD patients.
Objective To investigate the serum level of surfactant protein D ( SP-D) in patients with chronic obstructive pulmonary disease ( COPD) and its clinical significance. Methods Serumlevels of SP-D in patients with acute exacerbations of COPD ( n = 29) , stable COPD ( n = 26) , and control subjects ( n = 19 ) were measured by ELISA. Multiple regression modeling was performed to determine the independent relationship between SP-D and lung function variables. Results The serum SP-D levels were significantly increased in the patients who experienced an acute exacerbation [ ( 70. 6 ±20. 7) ng/mL] compared with the patients with stable COPD and the control subjects [ ( 47. 9 ±13. 3) ng/mL and ( 31. 2 ±11. 4) ng/mL] ( both P lt; 0. 01) . The serum SP-D levels in the patients with stable COPD increased significantly than the control subjects ( P lt; 0. 01) . Smoking index and staging of COPD were positively related to SP-D level. Serum SP-D levels were also found to be inversely related to FEV1% pred in stable COPD. Conclusion Serum SP-D may be a potential diagnostic and staging biomarker for COPD.
Objective Allergic bronchopulmonary aspergillosis (ABPA) is characterized by anexaggerated reaction to airway colonization aspergillus which affects patients with underlying diseases such asbronchial asthma, cystic fibrosis or other respiratory diseases. ABPA exhibit significant heterogeneity due to theunderlying diseases. The clinical features of patients with ABPA were analyzed retrospectively, so as to explore theimpact of underlying diseases on clinical characteristics. Methods The clinical data of hospitalized patients diagnosed with ABPA from January 2010 to September 2019 in Peking University People's Hospital were reviewed for retrospective analysis. Results A total of 40 ABPA patients were enrolled. Of which 8 cases (20.0%) were previously diagnosed as chronic obstructive pulmonary disease and/or bronchiectasis, named non-asthma group; while the other 32 cases met the diagnosis criteria of asthma, named asthma group. The non-asthma ABPA patients had a shorter course [78 (6 - 300) months vs. 192 (39 - 480) months, P=0.02], a higher percentage of peripheral blood neutrophils (79.9%±12.5% vs. 68.1%±18.1%, P=0.01) and higher score of emphysema [2 (0 - 2) vs. 0 (0 - 1), P=0.02] than the asthma group. Conclusions There is no significant difference in clinical and radiological characteristics between ABPA patients without asthma and those with asthma. The diagnosis of ABPA should also be considered when patients with chronic pulmonary diseases such as chronic obstructive pulmonary disease and bronchiectasis have aggravation of dyspnea, increase of eosinophils in peripheral blood and typical imaging features such as mucus attenuation.