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find Author "刘辉国" 8 results
  • Chronic obstructive pulmonary disease:From airway inflammation to systemic inflammation

    慢性阻塞性肺疾病(COPD)是一种具有气流受限特征的疾病,气流受限不完全可逆,呈进行性发展,其发病与肺部对有害气体或有害颗粒尤其是吸炯引起的异常炎症反应有关。一般来说,40岁以上的患者,如果过去或现在还在吸炯 有咳嗽、咳痰或气紧,就应考虑COPD可能。COPD的诊断与病情程度分级一般取决于肺功能检测所反映的气流受限程度,但是有越来越多的证据显示COPD的临床表现与气流受限程度不完全相关[1] 。因此,为了对COPD有一个全面系统的认识,还需要同时评估影像学表现、运动耐力和体重指数(BMI)。正是基于此项认识,有作者[2]认为COPD不能仅仅理解为一种肺部的慢性疾病,COPD患者常伴有全身多个系统的慢性病变,它可能是一种慢性全身性炎症综合征(chronic systemic inflammatory syndrome)o如有多个研究发现COPD可能伴有某种程度的全身炎症反应[3,4],Gan等[5]通过荟萃分析认为,即使在稳定期COPD也有外周血中性粒细胞(尤其是活化的表型)增多、急性相反应蛋白(C反应蛋白和纤维蛋白原)、白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)水平增加。有趣的是,其他慢性疾病如慢性心力衰竭、肥胖、糖尿病甚至正常的老龄化也有同样程度的全身炎症反应 。

    Release date:2016-08-30 11:37 Export PDF Favorites Scan
  • 睡眠呼吸暂停致缺血性脑卒中病理机制的研究进展

    睡眠呼吸暂停综合症被定义为7 h 睡眠中呼吸暂停及低通气反复发作在30 次以上, 或呼吸紊乱指数( AHI) ≥5 次/h。由其引起的睡眠时反复发生的低氧血症和高碳酸血症, 不仅可导致呼吸系统的病理生理变化, 同时可引起循环系统、血液系统、内分泌系统及神经系统等一系列连锁反应, 亦可引起包括缺血性脑卒中在内的一些危及生命的危重症[ 1 ] 。缺血性脑卒中是指突然发生的脑组织局部供血动脉血流灌注减少或血流完全中断, 停止供血、供氧、供糖等, 使该局部脑组织崩解破坏。Basetti 等[ 2] 研究发现, 在脑卒中患者中, 阻塞性睡眠呼吸暂停综合征 ( OSAS) 的患病率为44% ~72% , 而在正常人群中仅为4% 。而Fischer 等[ 3 ] 发现OSAS 患者发生脑梗死的概率是无OSAS 的31 倍。一项大型的前瞻性流行病学研究显示, 在校正其他危险因素( 包括高血压) 后, OSAS患者发生脑卒中或出现死亡的危险度为1. 97( 95% CI 1. 12 ~3. 48, P = 0. 02) [ 4 ] 。Arzt 等[ 5] 对1475 例研究对象的研究结果显示, 在校正年龄、性别、体重指数( BMI) 、吸烟及饮酒史等因素的影响后, 有重度OSAS者( AHI gt; 20 次/h) 较无OSAS 者( AHI lt; 5 次/h) 脑卒中发生有明显差异( OR 4. 33; 95% CI 1. 32 ~14. 24, P = 0. 02) , 从而证实了睡眠呼吸暂停综合征为脑卒中发生的独立危险因素。但其发生发展的具体机制尚不完全清楚。从目前国内外的多项研究推测, 可能与下列因素有关。

    Release date:2016-09-13 03:51 Export PDF Favorites Scan
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  • Clinical characteristics, predictive factors and short-term prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease complicated with active pulmonary tuberculosisin

    ObjectiveTo study the clinical features, predictive factors and short-term prognosis of active pulmonary tuberculosis in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsThis study enrolled patients hospitalized for AECOPD in ten tertiary hospitals of China from September 2017 to July 2021. AECOPD patients with active pulmonary tuberculosis were included as case group, AECOPD patients without pulmonary tuberculosis were randomly selected as control group from the same hospitals and same hospitalization period as the patients in case group, at a ratio of 4:1. The basic information, comorbidities, clinical manifestations and auxiliary examinations, and adverse in-hospital outcomes between the two groups were compared.ResultsA total of 14007 inpatients with AECOPD were included in this study, and 245 patients were confirmed to have active pulmonary tuberculosis, with an incidence rate of 1.75%. In terms of basic information, the proportions of male and patients with history of acute exacerbation in the past year in the case group were higher than those in the control group (P<0.05), and the age and body mass index (BMI) were lower than those of the control group (P<0.05); in terms of comorbidities, the proportions of patients with hypertension and diabetes in the case group were lower than those in the control group (P<0.05). In terms of clinical manifestations, the prevalence of fever and hemoptysis in case group was higher than that of control group (P<0.05); as for laboratory examinations, the levels of hemoglobin, platelet count, serum albumin, inflammatory markers [erythrocyte sedimentation rate (ESR), C reactive protein] and the proportion of positive TB-IGRA were higher than that of control group (P<0.05). The prevalence of pulmonary bullae, atelectasis and bronchiectasis in the case group was higher than that in the control group. After multivariate logistic regression analysis, hemoptysis (OR= 3.68, 95%CI 1.15-11.79, P=0.028), increased ESR (OR=3.88, 95%CI 2.33-6.45, P<0.001), atelectasis (OR = 3.23, 95%CI 1.32-7.91, P=0.01) were independent predictors of active pulmonary tuberculosis in patients with AECOPD. In terms of in-hospital outcomes, there was a trend of higher hospital mortality than the control group (2.3% vs. 1%), but the difference was not statistically significant. However, the case group had longer hospital stay [9 d (6~14) vs. 7 d (5~11), P<0.001] and higher hospital costs [15568 ¥ (10618~21933) vs. (13672 ¥ (9650~21473), P=0.037]. ConclusionIt is not uncommon for AECOPD inpatients to be complicated with active pulmonary tuberculosis, which increases the length of hospital stay and hospitalization costs. When AECOPD patients present with hemoptysis, elevated ESR, and atelectasis, clinicians should be highly alert to the possibility of active pulmonary tuberculosis.

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  • Clinical features, short-term prognosis and risk factors of Pseudomonas aeruginosa infection in patients with acute exacerbation of chronic obstructive pulmonary disease

    ObjectiveTo study the clinical features, short-term prognosis and risk factors of Pseudomonas Aeruginosa (P.aeruginosa) infection in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsThis study enrolled patients hospitalized for AECOPD in ten tertiary hospitals of China from September 2017 to July 2021. AECOPD patients with P.aeruginosa infection were included as case group, AECOPD patients without P.aeruginosa infection were randomly selected as control group from the same hospitals and same hospitalization period as the patients in case group, at a ratio of 2∶1. The differences in basic conditions, complications, clinical manifestations on admission and in-hospital prognosis between the two groups were compared, and the risk factors of P.aeruginosa infection were analyzed. ResultsA total of 14007 inpatients with AECOPD were included in this study, and 338 patients were confirmed to have P.aeruginosa infection during hospitalization, with an incidence rate of 2.41%. The in-hospital prognosis of AECOPD patients with P.aeruginosa infection was worse than that of the control group, which was manifested in higher hospital mortality (4.4% vs. 1.9%, P=0.02) and longer hospital stay [13.0 (9.0, 19.25)d vs. 11.0 (8.0, 15.0)d, P=0.002]. In terms of clinical features, the proportions of patients with cough, expectoration, purulent sputum, dyspnea in the case group were higher than those in the control group, and the inflammatory indicators (neutrophil ratio, erythrocyte sedimentation rate) and partial pressure of carbon dioxide in arterial blood gas were higher than those in the control group, while the serum albumin was significantly lower than that in the control group (all P<0.05). Multivariate logistic regression analysis showed that Parkinson's disease [odds ratio (OR)=5.14, 95% confidence interval (CI): 1.43 to 18.49, P=0.012], bronchiectasis (OR=4.97, 95%CI: 3.70 to 6.67, P<0.001), invasive mechanical ventilation (OR=2.03, 95%CI: 1.23 to 3.36, P=0.006), serum albumin<35 g/L (OR=1.40, 95%CI: 1.04 to 1.88, P=0.026), partial pressure of carbon dioxide ≥45 mm Hg (OR=1.38, 95%CI: 1.01 to 1.90, P=0.046) were independent risk factors for P.aeruginosa infection in AECOPD patients. ConclusionsP.aeruginosa infection has a relative high morbidity and poor outcome among AECOPD inpatients. Parkinson’s disease, bronchiectasis, invasive mechanical ventilation, serum albumin below 35 g/L, partial pressure of carbon dioxide ≥45 mm Hg are independent risk factors of P.aeruginosa infection in AECOPD inpatients.

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  • Validation of predictive models for short-term mortality and adverse outcomes in acute exacerbation of chronic obstructive pulmonary disease with community-acquired pneumonia

    ObjectiveTo compare the predictive value of the BAP-65 score, the DECAF score, the CURB-65 score, and the Pneumonia Severity Index (PSI) on short-term mortality and adverse outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with community-acquired pneumonia (CAP). MethodsThis study enrolled patients hospitalized for AECOPD and CAP from ten hospitals in China from September 2017 to July 2021. All-cause mortality within 30 days was investigated. Patients were divided into the death and the survival groups according to their survival status. The differences in basic conditions, complications, symptoms, signs and auxiliary examination results between the two groups were compared, and the independent risk factors of all-cause mortality were analyzed. The included patients were scored and graded according to the 4 scales, respectively, and the validity of the four scales in predicting short-term mortality and adverse outcomes was compared based on the receiver operating charateristic (ROC) curve analysis. ResultsA total of 3375 patients including 2545 males and 830 females with a mean age of (73.66 ±10.73) years were enrolled in this study. Within 30 days, 129 (3.82%) patients died and 614 (18.19%) patients had an adverse outcome (including all-cause death, invasive mechanical ventilation and admission into intensive care unit). Altered state of consciousness, diabetes mellitus, atrial fibrillation, chronic pulmonary heart disease, age, pulse rate, serum albumin, diastolic blood pressure, and pH value were independent risk factors for 30-day mortality in AECOPD patients with CAP. The area under the ROC curve (AUC) of the CURB-65 score, BAP-65 score, DECAF score, and PSI score for predicting all-cause mortality were 0.780, 0.782, 0.614, and 0.816, and these AUCs for predicting adverse outcomes were 0.694, 0.687, 0.564 and 0.705, respectively. PSI score had the best predictive efficacy for all-cause mortality and adverse outcomes, and the DECAF score had the worst predictive efficacy. ConclusionsAECOPD patients with CAP have a relatively high incidence of all-cause mortality and adverse outcomes within 30 days. Altered state of consciousness, diabetes mellitus, atrial fibrillation, chronic pulmonary heart disease, age, pulse rate, serum albumin, diastolic blood pressure, and pH value are independent risk factors for 30-day mortality. PSI score has the best performance in predicting all-cause mortality and adverse outcomes, while the DECAF score has the worst performance.

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  • Disease severity and comorbidities of outpatients with asthma from urban area in China

    ObjectiveTo investigate the disease severity and comorbidities in outpatient with asthma from urban area in China.MethodsA face-to-face, questionnaire-based survey was carried out in outpatient department in 30 general hospitals from 30 provinces in China mainland except for Tibet during October 2015 to May 2016, and asthma patients who meet the including criteria were enrolled. Data of demographic characteristics, smoking status, disease severity, and comorbidities were collected.ResultsA total of 3 875 cases were included. According to GINA criteria, the proportion of diseases severity was as following: intermittent status 52.5% (2 033/3 875), mild persistent 24.5% (951/3 875), moderate persistent 16.9% (656/3 875), and severe persistent 6.1% (235/3 875). The overweight rate was 32.9% (1 274/3 875), the rate of obesity was 10.3% (401/3 875), and the smoking rate was 20.1% (777/3 875). Obesity and smoking were related to poor asthma control. 75.9% (2 941/3 875) of the patients had comorbidities: allergic rhinitis 43.4% (1682/3 875), hypertension 16.4% (634/3 875), nasosinusitis 8.7% (338/3 875), chronic obstructive pulmonary disease 7.3% (283/3 875), bronchiectasis 3.0% (118/3 875), and rhinopolypus 2.9% (114/3 875).ConclusionsThe majority of asthma patients from outpatient department are mild asthma patients. The proportion of allergic rhinitis and bronchiectasis in asthma patients is higher than mean level. Asthma patients with comorbidities of obesity and smoking is related to poor asthma control.

    Release date:2019-01-23 10:50 Export PDF Favorites Scan
  • Correlation of treatment compliance analysis with lung function and control level in asthma

    ObjectiveTo analyze the relationship between medication compliance of patients with uncontrolled asthma and lung function,airway inflammation level, asthma control level and quality of life so as to obtain important references for improving patient compliance and asthma control level in the future. MethodsQuestionnaires were performed in asthma patients who did not achieve asthma control and had poor compliance in 32 third-class hospitals in 28 provinces of China mainland. All patients were tested for lung function and airway inflammation levels. So the relevant data of asthma compliance was investigated and analyzed. ResultsA total of 923 patients were investigated and the questionnaire recovery rate was 100%. Two hundred and forty-three (26.33%) answered cognitive related questions about asthma completely correctly. Treatment compliance in asthma patients was positively correlated with lung function and significantly negatively correlated with exhaled nitric oxide. Better treatment compliance in asthma has higher level of asthma control and quality of life. Poor compliance in asthma patients will lead to decreased lung function and elevated levels of airway inflammation, resulting in decreased asthma control and quality of life. ConclusionAsthma treatment compliance is related to lung function, airway inflammation, asthma control level and quality of life.

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