根据慢性阻塞性肺疾病全球创议(GOLD)的定义，慢性阻塞性肺疾病急性加重(AECOPD)是“在COPD的自然病程中发生的事件，气紧、咳嗽或／和咳痰等基础症状加重超出正常的日间变异的范围，急性发病，可能需要改变常规的治疗”[1]。AECOPD意味着对医疗卫生资源耗用的增加，如非预约的就医、使用药物增加，使用抗生素或口服皮质激素甚至住院，等等。仅仅依据是否占用卫生资源来定义AECOPD并不适当，这一点还要取决于医疗卫生资源的可获得性，同时有研究提示部分AECOPD可以是自限性的，特别是轻度急性加重。另一方面，占用医疗卫生资源的形式可以大致评估AECOPD的严重程度，如需要增加常规的吸人性药物常常意味着轻度AECOPD，需要短程口服抗生素或糖皮质激素意味着中度AECOPD，而需要住院者多为重度AECOPD。AECOPD是导致COPD患者健康状态降低乃至死亡的主要原因，也是耗用医疗卫生资源从而构成COPD疾病负担的主要部分，需要采用有力的干预措施以降低其发生率[2]。
COPD 是一种可预防、可治疗, 以气流不完全可逆受限并呈进行性发展为特征的疾病, 与肺部对有害气体或有毒颗粒的异常炎症反应有关。在全球范围内COPD 是引起死亡和功能致残的主要疾病之一。COPD 在全球患病率和死亡率位居第四, 并呈不断上升的趋势[1] 。本病具有明显的肺外效应, 包括引起全身系统性炎症、代谢改变、神经激素激活,以及对肌肉骨骼、心血管系统等其他系统的影响等[2] 。既往认为COPD 仅引起红细胞增多, 但近期研究发现COPD 引起的系统性炎症可影响红细胞的生成, 贫血亦同样存在于部分COPD 患者。目前认为, COPD导致的贫血与其他许多慢性疾病如慢性心衰一样, 同属于一种慢性病性贫血( anemia of chronic disease, ACD) , 称为COPD 相关性贫血, 其患病率高于继发性红细胞增多症在COPD 的患病率[3-5] 。本文就COPD 相关性贫血的流行病学概况、病理生理机制、临床重要性及干预的最新研究进展如下综述。
Objective To estimate the effects of N-acetylcystein (NAC) combined with conventional treatment on the patients with stable COPD. Methods Literatures published between January 1995 and September 2010 were searched in the databases including PubMed, CHEST, CNKI, CBM, VIP and WANGFANG for collecting the randomized control trials (RCTs) of NAC combined with the conventional treatment versus the conventional treatment on patients with stable COPD. The studies were screened according to the inclusive and exclusive criteria, the data were extracted, the quality was assessed and the meta-analysis was conducted with RevMan 5.0 software. Results A total of seven RCTs including 404 patients with stable COPD were enrolled. The meta-analysis demonstrated that, a) the short-term usage of NAC could improve PaO2 (SMD=0.05 mmHg, 95%CI –0.23 to 0.32) and PaCO2 (SMD= –0.29 mmHg, 95%CI –0.76 to 0.17) without significant differences compared with the control group; and b) the NAC could significantly improve FEV1 (SMD=1.11L, 95%CI 0.69 to 1.50) and clinical symptoms (RR=17.32, 95%CI 7.11 to 42.18), and reduce the frequency of acute exacerbation (RR=0.20, 95%CI 0.07 to 0.54) with significant differences. Conclusion The NAC used in a short-term can significantly improve arterial blood gas (ABG) and pulmonary function, and it can improve clinical symptoms and reduce the frequency of acute exacerbation. But for the possibility of moderate bias due to lower quality of the included studies and unclear implementation of RCTs, this conclusion should be cautiously applied in clinic with patients’ conditions in considered and it has to be verified with more large-scale and high-quality RCTs.
Objective To review literatures regarding the diagnosis of asthma with the measurement of exhaled nitric oxide( eNO) and assess the effectiveness and accuracy of eNO in the diagnosis of asthma.Methods MEDLINE, OVID, CBMdisc, CNKI( 1991 to 2008) for studies involving the diagnostic value of eNO were searched, and references of included studies were also hand searched. QUADAS ( Quality Assessment of Diagnostic Accuracy Studies) items were used for quality assessment in the systematic review. Meta-disc software was used to analyze heterogeneity. Sensitivity, specificity and summary diagnostic odds ratio( SDOR) were used for the pooled analysis. The summary receiver operating characteristic ( SROC)curves were drew and the summary areas under the SROC ( SAUC) were calculated. Finally, sensitivity analysis was performed. Results Eleven literatures with15 studies were included. These 15 studies had well controlled the bias of partial verification, differential verification, incorporation and withdrawals. The possibility of the disease progression bias was less and the reference standard review could have a greater bias. The spectrumcomposition of a study, the inclusion and exclusion criteria and the reporting quality were poorly reported. In statistical analysis, the totally pooled sensitivity, pooled specificity, SDOR, SAUC of the measurement of eNO in the diagnosis of asthma was 0. 68, 0. 79, 12. 73, 0. 8446, respectively. Sensitivity analysis demonstrated no disproportionate influences of individual study. Conclusions eNO has a certain value in the diagnosis of asthma. To make further analysis, more studies with high quality are needed.
Objective To evaluate systematically the effectiveness and safety of procalcitonin ( PCT) -guided therapy in comparison with standard therapy in patients with suspected or confirmed severe bacterial infections in intensive care unit ( ICU) . Methods Five randomized controlled trials ( 927 patients) were included for statistical analysis by the cochrane collaboration′s RevMan5. 0 software. Results PCT-guided therapy was associated with a significant reduction in duration of antibiotic therapy [ MD =- 2. 01, 95% CI ( - 2. 37, - 1. 64) , P lt;0. 00001] , but the mortality [ OR =1. 11, 95% CI ( 0. 83, 1. 49) ,P =0. 47] and length of ICU stay[ MD = 0. 49, 95% CI( - 1. 44, 2. 42) , P = 0. 62] were not significantly different. Conclusions An algorithmbased on serial PCT measurements would allow a more judicious use of antibiotics than currently traditional treatment of patients with severe infections in ICU. It can reduce the use of antibiotics and appears to be safe.
Objective To describe and compare the distributions of aminoglycosides modifying enzymes ( AMEs) in imipenem-resistant Pseudomonas aeruginosa ( IRPA) collected from5 cities in China. Methods A total of 146 strains of IRPA were collected from 5 cities of China ( Chengdu, Hangzhou, Beijing, Shanghai, and Guangzhou) . The polymerase chain reaction ( PCR) were used to amplify the genes of AMEs in IRPA. Results Six positive genotypes were amplified out of 16 genotypes of AMEs by PCR. The total positive rate of AMEs is 65. 06% . The positive rates of genes of aac( 3) -Ⅱ, aac( 6′) -Ⅰ, aac( 6′) -Ⅱ, ant( 2″) -Ⅰ, ant ( 3″) -Ⅰ and aph( 3′) -Ⅵ were 33. 6% , 15. 8% , 19. 9% , 28. 8% , 14. 4%, and 4. 8% , respectively. The genotypes of AMEs were discrepant in different areas as 6 genotypes in Huangzhou and Shanghai, 4 genotypes in Chengdu and Beijing, and 3 genotypes in Guangzhou. Conclusion The results show that the positive rate of AMEs genes is high in IRPA, and the distribution is discrepant among different areas.
Objective To explore the effects of SU5416，a vascular endothelial growth factor receptor (VEGFR) inhibitor，on inflammation in mice with bleomycin-induced pulmonary fibrosis.Methods C57BL/6 mice were randomly divided into four groups，ie.a control group，a bleomycin-induced pulmonary fibrosis (BPF) group,early intervention with SU5416 group (days 1-14，SE)，and delayed intervention with SU5416group (days 15-28，SD).Bleomycin (10 mg/kg) was instilled into the trachea of the mice to induce pulmonary fibrosis.After the instillation，SU5416 (50 mg/kg) was injected into the peritoneal cavities of the mice twice a week.The mice treated with bleomycin alone or with bleomycin followed by SU5416 were sacrificed on the day 14 and day 28 after the instillation of bleomycin.Lung tissues were taken and processed for determination of hydroxyl proline content.Bronchoalveolar lavage fluid (BALF) was collected for total and differential cell counts and measurements of lactic dehydrogenase (LDH) levels.Results It was found that the hydroxyl proline contents，the number of macrophages，and the LDH contents from the mice treated with bleomycin alone on day 14 were greatly increased.However，only the hydroxyl proline showed a significant increase in the mice treated with bleomycin alone on day 28.The number of macrophages，LDH contents，and hydroxyl proline contents were greatly reduced in the mice treated with bleomycin and early administration of SU5416 on day 14 when compared with those treated with bleomycin alone.But there were no significant differences in the above parameters of the mice treated with bleomycin and delayed administration of SU5416 on day 14.Conclusion This study indicates that early intervention by SU5416 might attenuate the fibrosis through inhibiting early inflammation in animal model of pulmonary fibrosis induced by bleomycin.
Objectives To evaluate the effect and safety of mycobacterium vaccae in the treatment of recurrent treated pulmonary tuberculosis. Methods We searched PubMed (1997 to 2006), VIP (1997 to 2006), Wanfang database (1997 to 2006), The Cochrane Central Register of Controlled Trials (Issue 4, 2006) and the National Research Register (1996 to 2006). Randomized controlled trials comparing the mycobacterium vaccae immunotherapy group and the control group were included. Two reviewers independently performed data extraction and quality assessment. Data were analyzed using RevMan 4.2.2 software by The Cochrane Collaboration. Results Eleven high quality trials were included. Meta-analyses showed that mycobacterium vaccae immunotherapy plus chemotherapy resulted in higher sputum negative conversion rate (RR=1.36, 95%CI 1.21 to 1.54), higher lesion absorption rate (RR=1.39, 95%CI 1.13 to 1.72), and lower lesion non-absorption rate (RR=0.46, 95%CI 0.36 to 0.60), compared with the control group. These differences were all statistically significant. No serious adverse events were reported. Conclusion As an adjunct to chemotherapy, mycobacterium vaccae is helpful for patients with recurrent treated pulmonary tuberculosis in terms of improving cell-medicated immunity, sputum negative conversion and X-ray manifestation. More high quality studies are needed for further analysis.