目的 评价噻托溴铵对不同表型慢性阻塞性肺疾病（COPD）患者的疗效。 方法 选取2008年10月－2010年5月COPD患者81例，根据胸部高分辨率CT上的形态表现分型，以气道病变为主型纳入A组，以肺气肿为主型纳入B组，按方案吸入噻托溴铵，在给药前后分别测定肺功能、圣?乔治呼吸问卷评分（SGRQ）及6 min步行距离。 结果 用药3个月后A组的第1秒用力肺活量（FEV1）、用力肺活量（FVC）、FEV1/FVC及FEV1占预计值（%）比B组明显提高，两组比较差异有统计学意义（P＜0.05），SGRQ评分比较B组明显下降，运动耐力（6 min步行距离）增加（P＜0.05）。 结论 噻托溴铵在COPD的治疗中，针对不同的表型，其疗效不同。
Objective To investigate the relationship of pulmonary surfactant protein D( SP-D) with chronic obstructive pulmonary disease ( COPD) by measuring SP-D level in serum and lung tissue of rats with COPD.Methods The rat COPD model was established by passive smoking as well as intratracheal instillation of lipopolysaccharide ( LPS) . Thirty male SD rats were randomly divided into a control group, a LPS group, and a COPD group( n =10 in each group) . The pathologic changes of lung tissue and airway were observed under light microscope by HE staining. Emphysema changes were evaluated by mean linear intercept ( MLI) of lung and mean alveolar number ( MAN) . The level of SP-D in serum was measured by enzymelinked immunosorbent assay ( ELISA) . The expression of SP-D in lung tissue was detected by Western-blot and immunohistochemistry.Results The MLI obviously increased, and MAN obviously decreased in the COPD group compared with the control group ( Plt;0.05) . There was no significant difference in the MLI and MAN between the LPS group and the control group ( Pgt;0.05) . The serum SP-D level was ( 49.59 ±2.81) ng/mL and ( 53.21±4.17) ng/mL in the LPS group and the COPD group, which was significantly higher than that in the control group [ ( 42.14±2.52) ng/mL] ( Plt;0.05) . The expression of SP-D in lung tissue was 0.56±0.01 and 0.63±0.01 in the LPS group and the COPD group, which was also obviously ber than that in the control group ( 0.39 ±0.01) ( Plt;0.05) .Meanwhile the SP-D levels in serumand lung tissue were higher in the COPD group than those in the LPS group ( Plt;0.05) . The levels of SP-D between serum and lung tissue were positively correlated in all three groups ( r=0.93, 0.94 and 0.93, respectively, Plt;0.01) .Conclusion Both the SP-D level in serum and in lung tissue increase significantly in COPD rats and correlate well each other, which suggests that SP-D may serve as a biomarker of COPD.
Objective To investigate the therapeutic effects of thyroid hormone replacement on critically ill COPD patients with low serum thyroid hormone. Methods Sixty-seven critically ill patients with acute exacerbation of COPD ( AECOPD) , and complicated with respiratory and/ or heart failure and low serum thyroid hormone, admitted from July 2008 to June 2011, were recruited for the study. They were randomly divided into an intervention group ( n = 34) and a control group ( n = 33) . The control group received conventional treatment and the intervention group received conventional treatment plus additional thyroid hormone replacement therapy. Results Compared with the control group, the overall efficacy of the intervention group was not significantly different ( 88. 2% vs. 81. 8% , P gt; 0. 05) , while average effective time was significantly shorter [ ( 9. 6 ±2. 5) d vs. ( 12. 3 ±2. 8) d, P lt; 0. 05] . The post-treatment serum FT3 , FT4 , TT4 , and h-TSH levels were significantly higher in the intervention group than those in the control group, and significantly higher than baseline ( P lt;0. 05) . Conclusions For AECOPD patients complicated with respiratory and/or heart failure and low serum thyroid hormone, thyroid hormone supplement at low dosage will help to improve serumthyroid hormone level, and promote early recovery.
随着近年来对慢性阻塞性肺疾病( COPD) 的深入研究，人们逐渐揭示了其发病机制中的众多关键环节，据此开发了新型的药物和治疗手段。大量国际多中心临床研究已证明COPD 是一个可防可治的疾病，正确的治疗能够改善患者的症状，提高生活质量，乃至延缓疾病的进程。为更好地防治COPD，全球学者共同推出了《慢性阻塞性肺疾病全球倡议 ( GOLD) 》以指导广大医师规范、合理地诊断、治疗和预防COPD。然而， 在我国由于多方面的原因，COPD 的防治工作面临如下的难题。
Objective To analyze the risk factors of treatment failure by noninvasive positive pressure ventilation (NPPV) in patients with acute respiratory failure (ARF) due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and explore the best time that NPPV be replaced by invasive ventilation when NPPV failure occurs. Methods The data of patients with ARF due to AECOPD who were treated with NPPV from January 2013 to December 2015 were retrospectively collected. The patients were divided into two groups: the NPPV success group and the NPPV failure group (individuals who required endotracheal intubation or tracheotomy at any time). The Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score was analyzed; the Glasgow Coma Scale score, respiratory rate (RR), pH value, partial pressure of oxygen (PaO2), PaO2/fraction of inspired oxygen (FiO2) ratio, and partial pressure of carbon dioxide were also analyzed at admission, after 2 hours of NPPV, and after 24 hours of NPPV. Results A total of 185 patients with ARF due to AECOPD were included. NPPV failed in 35.1% of the patients (65/185). Multivariate analysis identified the following factors to be independently associated with NPPV failure: APACHEⅡscore≥30 [odds ratio (OR)=20.603, 95% confidence interval (CI) (5.309, 80.525), P<0.001], RR at admission≥35 per minute [OR=3.723, 95%CI (1.197, 11.037), P=0.020], pH value after 2 hours of NPPV<7.25 [OR=2.517, 95%CI (0.905, 7.028), P=0.070], PaO2 after 2 hours of NPPV<60 mm Hg (1 mm Hg=0.133 kPa) [OR=3.915, 95%CI (1.374, 11.508), P=0.010], and PaO2/FiO2 after 2 hours of NPPV<200 mm Hg [OR=4.024, 95%CI (1.542, 11.004), P=0.010]. Conclusion When patients with ARF due to AECOPD have a higher severity score, have a rapid RR at admission, or fail to improve in terms of pH and oxygenation after 2 hours of NPPV, the risk of NPPV failure is higher.
ObjectiveTo observe the effects of perindopril on expression level of phosphatidylinositol 3-kinase (PI3K) and lung function in rats with obstructive pulmonary disease (COPD),and investigate the therapeutic effects of perindopril on COPD. MethodsSixty male SD rats were randomly divided into a control group,a COPD group,and a perindopril group,with 20 rats in each group. The rat model of COPD was established by intratracheal instillation of lipopolysachride and exprosure to cigarette smoke in the COPD group and the perindopril group. The rats in the perindopril group were intragastricly infused with perindopril additionally. All rats were sacrificed after 28 days. The lung function was observed and PI3K protein expression was detected using Western blot method. The pathologic changes of the lung tissue and airway were observed by HE staining. ResultsHE staining revealed that the rat COPD model was successfully established. The COPD group appeared obvious emphysema which was allievated significantly in the perindopril group. Pulmonary function indices in the COPD group and the perindopril group were significantly decreased compared with the control group with VE value decreased by 40% and 22%,PEP value decreased by 33% and 15%,and FEV0.3 value decreased by 18% and 7%,respectively. The expression of PI3K was significantly increased in the COPD group and the perindopril group than the control group,but more significantly in the COPD group (P<0.05). ConclusionPerindopril can significantly improve lung function in rats with COPD possibly through down-regulation of PI3K expression in the lung.
The pulmonary rehabilitation treatment of patients with chronic obstructive pulmonary disease (COPD) has become a current research hotspot. Pulmonary rehabilitation can effectively improve the lung function, quality of life, and physical and mental health, reduce the risk of death, but there are still certain limitations in the implementation of pulmonary rehabilitation for COPD. Based on existing research, this article introduces the benefits of pulmonary rehabilitation for COPD, and elaborates on the timing, location selection, and course of pulmonary rehabilitation, aiming to provide a basis for developing personalized pulmonary rehabilitation plans for COPD.