ObjectiveTo investigate the effect of pulmonary rehabilitation on pulmonary function,perception of dyspnea and quality of life in stable COPD patients of different severity. Methods300 patients with COPD in stable stage were divided into a moderate COPD group (n=120),a severe COPD group (n=100) and a very severe COPD group (n=80). Each group was randomly subdivided into a control group and a treatment group. The treatment groups received pulmonary rehabilitation for 6 months in addition to usual care,and the control groups received usual care without pulmonary rehabilitation. Pulmonary function(FEV1),6 minute walking distance (6MWD),modified medical research council (mMRC) scale,and acute exacerbation frequency of COPD were compared before and after intervention and among groups. ResultsAfter pulmonary rehabilitation for 6 months,the quality of life score and 6MWD were significantly improved in the treatment groups with moderate,severe,very severe COPD,and the increscent of 6MWD was greatest in the severe COPD patients. The mMRC of the patients with very severe COPD improved significantly after pulmonary rehabilitation(P<0.05). Lung function before and after the intervention in three groups all showed no significant difference (P>0.05). The acute exacerbation frequency of the severe COPD patients was significantly reduced by pulmonary rehabilitation (P<0.05), while there was no significant change in the moderate and very severe groups (P>0.05). ConclusionPulmonary rehabilitation can improve exercise tolerance and quality of life of COPD patients with different severity,reduce acute exacerbation frequency in severe COPD,reduce the dyspnea degree in very severe COPD. Pulmonary rehabilitation is a cost-effective treatment for stable COPD.
目的:研究呼吸操改善慢性阻塞性肺疾病(COPD)患者肺功能的机制。方法:对本院46例COPD 患者随机分成对照组和治疗组,按常规内科治疗并对其有计划地进行健康知识教育。治疗组在常规内科治疗加康复指导基础上,增加呼吸操训练。测定治疗前后6分钟步行距离、血清白三烯、呼出气中一氧化氮浓度(fractional exhaled nitric oxide, FENO)。结果:治疗组较对照组6分钟步行能力改善,血清白三烯水平下降(Plt;0.05)、呼气NO含量下降(Plt;0.05)。结论:加强COPD患者的健康指导及呼吸操训练可改善患者肺功能状况,明显提高生活质量
ObjectiveTo investigate the effects of pulmonary rehabilitation on the exercise capacity and quality of life in patients with stable chronic obstructive pulmonary disease (COPD) for a optimal strategy for pulmonary rehabilitation. MethodsOne hundred and six patients with COPD in stable stage were divided into group B (n=37), group C (n=36), and group D(n=33) based on GOLD 2011.Each group of patients were randomly subdivided into a control group(usual care), a pulmonary rehabilitation strategy group 1 (breathing training), and a pulmonary rehabilitation strategy group 2 (breathing training and exercise training), and they were intervened for 24 weeks.Pulmonary function(FEV1%pred), COPD Assessment Test (CAT), modified British Medical Research Council dyspnea scale(mMRC), BODE index and 6-minute walking distance(6MWD) were compared before and after intervention. ResultsAfter pulmonary rehabilitation intervening for 24 weeks, in group B and group C, pulmonary rehabilitation strategy group 2 showed the best effect, CAT, mMRC, BODE index, and 6MWD were proved significantly different before and after pulmonary rehabilitation (P < 0.05).In group D, all indexes had no significant difference between pulmonary rehabilitation strategy group 1 and group 2 before and after pulmonary rehabilitation (P > 0.05), but they were better than those of the control group.Correlation analysis showed that CAT score had significant correlation with FEV1 % pred, mMRC, BODE index and 6MWD (P < 0.01). ConclusionPatients with different subgroup of COPD based on GOLD 2011 may take different pulmonary rehabilitation strategies to achieve the optimal effect.
ObjectivesTo analyze the application value of 6-minute walking test (6MWT) in the clinical evaluation of chronic heart failure (CHF).MethodsPubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang Data and CNKI databases were searched online to collect randomized controlled trials (RCTs) of 6-minute walking distance (6MWD) as the CHF evaluation index. Two reviewers independently screened literature, extracted data, and then analyzed data by using SPSS 17.0 statistical software. The 6MWD with symptom, quality of life, exercise tolerance (ETT), left ventricular ejection fraction (LVEF), peak oxygen consumption (pVO2) were analyzed by Kappa consistency test, and the possible influencing factors of 6MWD were analyzed by logistic regression.ResultsA total of 158 RCTs involving 17 853 patients were included. The results of statistical analysis showed that: 6MWD was consistent with the improvement of symptoms, quality of life, ETT, LVEF and pVO2 (Kappa>0.4). Baseline 6MWD (OR=2.91, 95%CI 1.278 to 6.634,P=0.011) and NYHA Ⅲ-Ⅳ ratio (OR=2.59, 95%CI 1.091 to 6.138, P=0.031) were the independent influencing factors for 6MWD improvement separately.ConclusionsThe 6MWT is an objective and reliable indicator of CHF evaluation.
Objective To investigate the levels and clinical significance of cold-inducible RNA-binding protein (CIRBP) and mucin 5AC (MUC5AC) in serum and bronchoalveolar lavage fluid (BALF) of patients with interstitial lung disease (ILD). Methods A total of 63 ILD patients who were hospitalized in the Department of Pulmonary and Critical Care Medicine, The First Hospital of Lanzhou University from January 2022 to February 2024 were collected, including 22 patients with idiopathic pulmonary fibrosis (IPF), 20 patients with connective tissue disease-related interstitial lung disease (CTD-ILD), and 21 patients with other types of ILD. Thirty healthy individuals with matching demographic characteristics during the same time period were selected as the healthy group. Enzyme linked immunosorbent assay was used to detect the levels of CIRBP and MUC5AC in serum of healthy group, the levels of CIRBP and MUC5AC in serum and BLAF of ILD patients. The levels of CIRBP and MUC5AC in serum were compared between the healthy group and the ILD group, and the levels of CIRBP and MUC5AC in serum and BALF were compared among the patients with different types of ILD. The correlations were analyzed between the levels of CIRBP and MUC5AC and the lung function, blood gas analysis, and 6-minute walk distance (6MWD) in the patients with different types of ILD. The receiver operating characteristic curve was drawn according to the levels of CIRBP and MUC5AC in serum. The optimal cut-off value, sensitivity and specificity of serum CIRBP and MUC5AC for diagnosis of ILD were determined. Results The serum CIRBP level in the three groups of ILD patients was higher than that of the healthy group (P<0.01), but there was no significant difference in the serum CIRBP level among the three groups of ILD patients (P>0.05). There was no significant difference in serum MUC5AC levels between the three groups of ILD patients and the healthy group, as well as among the three groups of ILD patients (P>0.05). There was no significant difference in the levels of CIRBP and MUC5AC in BALF among the three groups of ILD patients (P>0.05). CIRBP in BALF of the IPF patients was negatively correlated with 6MWD, while CIRBP in serum of the CTD-ILD patients was negatively correlated with partial pressure of oxygen and arterial oxygen saturation. CIRBP in serum of other ILD patients was negatively correlated with total lung capacity as a percentage of predicted value (TLC%pred), forced vital capacity as a percentage of predicted value (FVC%pred), diffusion capacity of carbon monoxide of lung as a percentage of predicted value (DLCO%pred), and 6MWD, while CIRBP in BALF was negatively correlated with DLCO%pred. The MUC5AC in BALF of IPF patients was negatively correlated with DLCO%pred, while the MUC5AC in BALF of CTD-ILD patients was negatively correlated with TLC%pred, DLCO%pred, and 6MWD. The serum MUC5AC in other ILD patients was negatively correlated with FVC%pred, DLCO% pred, and 6MWD. The sensitivity was 77.6%, and the specificity was 96.7% for diagnosing ILD with serum CIRBP. Sensitivity was 55.1%, and specificity was 76.7% for diagnosing ILD with serum MUC5AC. The combination of the two indicators resulted in a sensitivity of 87.8% and a specificity of 86.7% for the diagnosis of ILD. Conclusion The high expression levels of CIRBP and MUC5AC have certain diagnostic efficacy and disease assessment effects on ILD, and may serve as potential biomarkers for ILD.