COPD 被定义为一种慢性肺部“炎症”性疾病。COPD 的炎症反应由吸烟、大气污染等有害颗粒或气体所诱发, 主要累及小气道和肺实质, 导致慢性支气管炎和气道阻塞; 同时还导致肺实质的破坏, 引起肺气肿, 形成不完全可逆的气流受限。COPD 的炎症以中性粒细胞为主, 肺泡巨噬细胞、CD8 + T细胞以及肥大细胞、嗜酸粒细胞、CD4 + T细胞和B 细胞等都可能参与了COPD 炎症过程。 糖皮质激素( 简称激素) 具有广泛的抗炎作用, 是临床最常用的抗炎药物。激素用于哮喘治疗取得了良好的临床疗效。但是在COPD 治疗上却存在许多争议．．．．．．
【摘要】 目的 观察沙美特罗替卡松粉吸入剂（沙美特罗50 μg/氟替卡松500 μg）治疗稳定期Ⅲ~Ⅳ级慢性阻塞性肺疾病（COPD）的疗效及安全性。 方法 将2008年1-12月就诊的62例稳定期Ⅲ~Ⅳ级COPD患者随机分成对照组和治疗组。对照组采用常规传统治疗方法，口服茶碱缓释片、祛痰剂；治疗组在常规传统治疗的基础上，加用沙美特罗替卡松粉吸入剂。6个月后评估两组患者肺功能、血气分析、呼吸困难程度及不良反应。治疗过程中，两组各有2例患者因失访退出研究。 结果 治疗前，对照组、治疗组1 s用力呼气量（FEV1）和FEV1%预计值比较，无统计学意义（Pgt;0.05）；治疗后，治疗组FEV1和FEV1%预计值明显增加，有统计学意义（Plt;0.05）。对照组治疗前后比较无改变（Pgt;0.05），治疗组较对照组呼吸困难程度明显好转，临床症状评分明显下降，两组间差异有统计学意义（Plt;0.05）。治疗结束时两组上述各指标比较，差异有统计学意义 （Plt;0.05）。两组均有少数出现咽喉不适，患者耐受好。 结论 沙美特罗替卡松粉吸入剂治疗稳定期Ⅲ~Ⅳ级COPD患者有效。【Abstract】 Objective To observe the efficacy and safety of inhaled formulations of Seretide (salmeterol 50 μg / fluticasone 500 μg) on grade Ⅲ ~ Ⅳ stable chronic obstructive pulmonary disease (COPD). Methods Sixty-two patients of grade Ⅲ-Ⅳ stable COPD were randomly divided into control group and treatment group. The control group was treated by conventional methods, oral theophylline and expectorant agents,while the treatment group was treated by inhalation of large dosage Seretide be added in the conventional treatment based on traditional. After six months, the lung function, blood gas analysis, respiratory difficulty and adverse effects were assessed. Results Before the treatment, the differences of forced expiratory volume in one second (FEV1) and FEV1% predicted value in the two groups were not statistically significant (Pgt;0.05). After treatment, FEV1 and FEV1% predicted value of treatment group were increased significantly(Plt;0.05). The control group showed no significant change before and after treatment(Pgt;0.05). The respiratory difficulty imprvoved significantly,while clinical symptom score decreased significantly in the treatment group,which compared with the control group (Plt;0.05). A few appeared thoat discomfort in the two groups. Well tolerated in patients. Conclusion Inhaled formulations of Seretide was effective and safty on stable period COPD patients with grade Ⅲ-Ⅳ.
Objective To evaluate the value of 18 F-fluorodeoxyglucose ( 18 F-FDG) metabolism imaging in evaluating the response of patients with non-small cell lung cancer ( NSCLC) in stable diseaseafter chemotherapy. Methods 28 patients with NSCLC in stable disease after chemotherapy admitted between September 2010 to September 2012 were retrospectively investigated. The reduction ratio of targetto-nontarget ratio ( T/N) before and after chemotherapy was calculated. The patients were followed up 3 to 12 months to measure progression-free survival ( PFS) . The correlation between the reduction ratio of T/N and PFS was analyzed. The patients were divided into a reduction group and a non-reduction group according to the difference of the reduction ratio of T/N and was compared the difference of the PFS.Results The reduction ratio of T/N had positive correlation with PFS( Pearson r = 0. 668, P lt; 0. 01) . The PFS of the reduction group was longer than that in the non-reduction group ( 8. 0 ±2. 5 months vs. 5. 3 ±1. 2 months,P lt;0. 05) . Conclusions The reduction ratio of T/N is positively correlated with PFS in NSCLC patients in stable disease after chemotherapy. It is possible to evaluate the efficacy of the treatment according to the reduction ratio of T/N.
Objective?To investigate the relationship between syndromes of traditional Chinese medicine (TCM) and lung function in patients with chronic obstructive pulmonary disease (COPD) at stable phase. MethodsBased on diagnostic criterion of TCM, five groups of symptoms of TCM about stable COPD were established including lung Qi deficiency, lung and spleen Qi deficiency, lung and kidney Qi deficiency, lung Spleen Kidney Qi deficiency, and deficiency of both Qi and Yin. A total of 300 cases which were up to the standard were differentiated into 5 groups by the symptoms. Some basic details and lung function of the patients were recorded, and then statistical analysis was performed to analyze the differences of lung function among groups. ResultsForced expiratory volume in the first second in descending order was lung Qi deficiency group, lung and spleen Qi deficiency group, lung and kidney Qi deficiency group, and lung spleen kidney Qi deficiency group (P<0.05). ConclusionThese findings suggest that with the progressing of COPD, the symptom type of TCM for COPD patients at stable phase may vary from lung Qi deficiency to lung and spleen Qi deficiency, or to lung and kidney Qi deficiency, and even lung, spleen and kidney Qi deficiency. Lung function tests help reveal substance and pathogenesis of TCM syndromes of patients with stable COPD, and provide evidence for the clinical syndrome.
ObjectiveTo explore the relationship of levels of serum interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α) and C-reactive protein (CRP) with lung function in elderly patients with stable COPD and whose pulmonary function classification was levelⅡor above. MethodsSixty elderly patients with stable COPD and with the pulmonary function classification of levelⅡor above and 35 age-matched healthy subjects in the Gansu Provincial Hospital from November 2012 to March in 2014 were recruited in the study.Serum IL-6, TNF-αand CRP levels were detected by electro-chemiluminescence immunoassay (ECLI), enzyme-linked immunosorbent assay and immunoturbidimetric assay, respectively.And their relationships with lung function were explored by Spearman correlation analysis. ResultsThe levels of serum IL-6[(33.0±15.1) mg/L vs.(15.9±8.7) mg/L], TNF-α[(53.8±20.1) pg/mL vs.(22.2±8.0) pg/mL] and CRP[(8.7±3.9) mg/L vs.(5.8±2.3) mg/L] were significantly higher in the stable COPD patients than those in the healthy controls (P < 0.01).With the increase of COPD severity grade, the levels of serum IL-6, TNF-αand CRP increased gradually, and the lung function of FEV1%pred and FEV1/FVC decreased gradually (P < 0.05).The levels of serum IL-6, TNF-αand CRP were negatively correlated with lung function (P < 0.05). ConclusionsThere is airway inflammation in elderly patients with stable COPD.Airway inflammation may be the reason of the decline of pulmonary function in patients with stable COPD.
Objective To study the efficacy and safety of Yi Huo Hua Tan granule in the treatment of stable chronic obstructive pulmonary disease (COPD) patients with a traditional Chinese medicine (TCM) syndrome of Qi deficiency with phlegm and blood stagnation. Methods The stable COPD patients with a TCM syndrome of Qi deficiency with phlegm and blood stagnation who visited the outpatient in the Department of Integrated Traditional and Western Medicine, West China Hospital of Sichuan University between August 2016 and March 2017 were selected. The patients were randomly divided into an experimental group and a control group using a random number table method. Patients in both groups received conventional western medicine, with Yi Huo Hua Tan granule being additionally prescribed in patients in the experimental group. The treatment during was 60 days. The TCM effective rate, TCM syndrome score, COPD Assessment Test (CAT) score, modified Medical Research Council Dyspnea Scale, six minutes walking distance, long-term prognostic indicators, lung function indicators, inflammatory cytokines in serum and induced sputum supernatant were compared between groups. The safety of Yi Huo Hua Tan granule was also observed. Results A total of 69 patients were included, including 34 patients in the experimental group and 35 patients in the control group. After treatment of Yi Huo Hua Tan granule for 2 months , the total effective rate of TCM syndrome was 44.1% and 8.6% in the experimental group and the control group, respectively (P=0.001). There were statistically significant differences at 2 months and 4 months of follow-up visits between groups (P<0.05). After 2 months treatment, TCM syndrome score, CAT score, modified Medical Research Council score, number of acute exacerbations per year, hospitalization per year, and total length of hospital stay per year in the experimental group were lower than those in the control group (P<0.05). The six minutes walking distance, forced vital capacity, forced expiratory volume in one second, forced expiratory volume in one second /predicted value, serum, and the concentrations of interleukin (IL)-6, IL-1β, and IL-10 in induced sputum supernatant between the two groups showed no statistically significant difference (P>0.05). There was no significant change in blood routine, liver and kidney function, electrocardiogram, or urine and urine routine of the patients in the two groups. Conclusion Yi Huo Hua Tan granule improves the clinical symptoms and quality of life in patients with stable COPD, with a good safety.