Objective To observe the changes in pulmonary function in chronic obstructive pulmonary disease (COPD) patients with different GOLD grades, diffusing capacity for carbon monoxide in percent predicted value (DLCO%pred), and the relationship between DLCO%pred and hyperinflation parameter, the ratio of residual volume to total lung capacity (RV/TLC). Methods Their age, sex, body mass index (BMI), and lung function parameters were recorded. Group according to GOLD grade, and compare the lung function among different groups; With DLCO%pred 60% as the cut-off value, the lung function of each group was compared. Pearson and Spearman correlation determined the relationship between DLCO%pred and age, RV/TLC, and other factors. Results Four hundred and thirty-one patients were enrolled. With the increase of GOLD grade, the pulmonary function became worse (P<0.05). Compared with DLCO%pred ≥ 60%, the group with DLCO%pred<60% had lower BMI (t=–5.642, P<0.001) and worse pulmonary function (P<0.001). The correlation analysis showed that BMI (r=0.352, P<0.001), forced vital capacity in percent predicted value (FVC%pred) (r=0.349, P<0.001), forced expiratory volume in one second in percent predicted value (FEV1%pred) (r=0.414, P<0.001), the ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) (r=0.434, P<0.001), peak expiratory flow in percent predicted value (PEF%pred) (r=0.335, P<0.001), maximal mid expiratory flow in percent predicted value (MMEF%pred) (r=0.405, P<0.001), inspiratory capacity in percent predicted value (IC%pred) (r=0.301, P<0.001) were positively correlated with DLCO%pred; while RV/TLC (r=–0.328, P<0.001), GOLD grade (r=–0.430, P<0.001) were negatively correlated with DLCO%pred; However, there was no significant correlation between age (r=–0.012, P=0.810), sex (r=0.076, P=0.117) and DLCO%pred. Conclusions With the increase of GOLD grade, DLCO%pred decreases, and RV/TLC increases. RV/TLC is negatively correlated with DLCO%pred. Attaching importance to the evaluation of hyperinflation and diffusing capacity of COPD patients is helpful in evaluating COPD in all aspects, and has particular clinical significance.
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.
ObjectiveTo investigate the pathogenesis, clinical manifestations, diagnosis and treatment of common variable immune deficiency (CVID).MethodsOne case of CVID with cellular immunodeficiency leading to bronchiectasis and liver cirrhosis was analyzed retrospectively. Relevant literatures were also searched through WanFang Database, China National Knowledge Infrastructure and PubMed, Ovid, Embase, Cochrane using the key words " common variable immunodeficiency”, " common variable hypogammaglobulinemia” in Chinese and English.ResultsA 52-year-old female patient, complained of cough, expectoration for 20 years, edema for 7 years and aggravated for 3 months with a history of recurrent respiratory infections was hospitalized in the West China Hospital of Sichuan University. The chest computed tomography revealed bronchiectasis, liver cirrhosis and portal hypertension. Laboratory tests showed remarkable hypogammaglobulinemia. The CD4+ T-cell count was below the normal range. Probable diagnosis of CVID was made based on clinical characteristics and laboratory tests. Immunoglobulin infusion with a dose of 20 g was given and the symptoms were relieved. About 288 case reports including 8 000 patients were searched. Most of them were reported individually. Conclusions CVID has a low morbidity and is rare in China. It is mostly caused by genetic factors. When there are recurrent infections in common areas of body, infections in rare areas or infections of conditioned pathogen, clinicians should be vigilant and give intervention as soon as possible. Family and genetic researches could be done when permitted.
ObjectiveTo investigate the value of neutrophil/lymphocyte ratio (NLR) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) by detecting the relationship between NLR and other well-known inflammatory biomarkers.MethodsRetrospective study of 610 AECOPD cases was performed. In order to analyze the influence of NLR level on disease condition, treatment plan and prognosis, the clinical data with acute exacerbation were collected and the value of NLR in AECOPD were analyzed.ResultsThe level of NLR was higher in the group with pneumonia than that in the non-pneumonia group (P<0.05), and the more severe the pulmonary inflammation, the higher the NLR level (P<0.05). The level of NLR was higher in the group with heart failure and the group treated with ventilator and glucocorticoid (P<0.05). The NLR level was higher in the group of hospital stay over 14 days than the group of hospital stay less than 14 days (P<0.05). The NLR value of the death group was higher than that of the survival group (P<0.05). With the increase of NLR value, the mortality rate in hospital increased gradually. Compared with C-reactive protein and interleukin-6, NLR had the highest odds ratio by binary regression analysis. Cutoff value of NLR was 5.92 by analysis of receiver-operating characteristic curve with a sensitivity of 88% and a specificity of 51%, and the area under the curve in predicting in-hospital death was 0.727 (OR=4.112, 95% confidence interval 0.609 - 0.849, P=0.02).ConclusionsNLR can be used as an inflammatory marker to evaluate the severity of AECOPD and to predict the prognosis.
ObjectiveTo analyze risk factors, clinical features and outcome factors of invasive pulmonary aspergillosis (IPA) in severe H1N1 patients so as to achieve early diagnosis and improve prognosis.MethodsFifty severe H1N1 influenza patients with IPA admitted to West China Hospital and 64 severe H1N1 influenza patients in the same period matched by age and gender were collected. Patient characteristics, laboratory examinations, radiological imaging, microbiology data and prognostic indicators were involved into analysis.ResultsThe mortality of severe H1N1 influenza patients with IPA was significantly higher than those without IPA (51.6% vs. 32.0%, P=0.036). However, the incidence of IPA in severe H1N1 influenza patients was not related with the patient's age, gender, underlying disease, glucocorticoid use and CD4+ T cell count. Serum C-reactive protein level [(125.0±88.8) vs. (86.1±80.1) mg/L, P=0.038] and interleukin-6 level [(148.7±154.2) vs. (81.7±110.2) μg/L, P=0.039] of severe H1N1 influenza patients with IPA were significantly higher than those without IPA. Besides, more patients presented with fever (81.3% vs. 64.0%, P=0.038) and dyspnea (51.6% vs. 24.0%, P=0.003) in severe H1N1 patients with IPA. The radiological imaging of severe H1N1 patients with IPA were mostly characterized by combining with nodular changes on the basis of ground-glass opacity.ConclusionThe occurrence of IPA in severe H1N1 influenza patients may be related with pulmonary excessive inflammatory response secondary to viral invasion rather than basic condition of the patient.