【摘要】 目的 探讨莫西沙星对急性肺脓肿治疗的临床疗效及安全性分析。方法 选择2008年6月—2009年6月收治的36例急性肺脓肿患者,随机分为莫西沙星组和对照组,分别给予静脉滴注莫西沙星和头孢哌酮舒巴坦联合替硝唑治疗。比较两组疗效及安全性。结果 莫西沙星组和对照组总有效率分别为90.63%、93.75%;细菌敏感性分别为73.3%、86.7%;细菌清除率分别为83.7%、92.4%;不良反应总发率分别为16.7%、11.1%。两组比较无统计学差异(Pgt;005)。结论 经验性莫西沙星治疗急性肺脓肿的疗效及安全性与头孢哌酮舒巴坦联合替硝唑相似。但莫西沙星治疗费用低且利于口服序贯治疗而更具有优势,可推荐作为经验性或首选用药。
ObjectiveTo investigate the clinical characteristics and predicting factors for death in critically ill patients with severe community-acquired pneumonia (CAP). MethodA total of 143 hospitalized patients with severe CAP between January 2009 and December 2012 were included and their clinical data were retrospectively analyzed. According to the clinical outcome, patients were divided into survival group and death group, and their clinical features and laboratory test results were compared, and multivariate regression analysis was conducted to search for predicting factors for death. ResultsIn this study, a total of 118 patients survived and 25 patients died, and the mortality rate was 17.5%. The number of underlying diseases in the two groups were different, and death group had more patients with 3 kinds of diseases than the survival group[76.0% (19/25) vs. 22.8% (13/57), P<0.05]. The intubation rate in the death group was significantly higher than that in the survival group[84.0% (21/25) vs. 33.1% (39/118), P<0.05], and the arterial blood pH value (7.15±0.52 vs. 7.42±0.17, P<0.05), HCO3- concentration[(18.07±6.25) vs. (25.07±5.44) mmol/L, P<0.05], PaO2[(58.92±35.18) vs. (85.92±32.19) mm Hg (1 mm Hg=0.133 kPa), P<0.05] and PaO2/FiO2[(118.23±98.02) vs. (260.17±151.22) mm Hg, P<0.05)] in the death group were significantly lower than those in the survival group. And multivariate regression analysis indicated that the number of underlying diseases[OR=0.202, 95%CI (0.198, 0.421), P=0.003], PaO2[OR=1.203, 95%CI (1.193, 1.294), P=0.011] and PaO2/FiO2[OR=0.956, 95%CI (0.927, 0.971), P=0.008] were independent predictors of death in the patients with severe pneumonia. ConclusionsPatients who died of severe pneumonia often had severe illnesses before admission, and the number of underlying diseases and PaO2 have highly predictive value for death.
Objective To evaluate the relationship between COPD and atherosclerosis, and analyze the risk factors of atherosclerosis among COPD patients. Methods A total of 40 COPD patients and 43 normal subjects were enrolled in the study. Carotid intima-media thickness (IMT) and plaques were detected in both groups. Blood samples were collected to measure the concentration of high sensitive C-reactive protein (hs-CRP) , fibrinogen (Fbg) , total cholesterol (TC) , triglyceride (TG) , high density lipoprotein cholesterol (HDL-C) , low density lipoprotein cholesterol (LDL-C) , while smoking index was recorded. Multiple regression analysis was performed to evaluate the correlative factors of IMT among COPD patients. According to whether luminal stenosis appeared, the COPD patients were allocated into group A ( without luminal stenosis) and group B ( with luminal stenosis) . Age, gender, hs-CRP, Fbg, TC, TG, HDL-C, LDL-C, and smoking index of the two groups were compared respectively. Results Hs-CRP, Fbg, thickness of IMT, plaques detection rate, and smoking index in the COPD group were significantly higher than those in the control group ( Plt;0.05) . TC, HDL-C, LDL-C in the COPD group were significantly lower than those in the control group ( Plt;0. 05) .Multiple regression analysis of IMT correlative factors among COPD patients showed that age, hs-CRP, Fbg, TC, TG, LDL-C, HDL-C, and smoking index were in linear relationship with IMT thickening. Age, hs-CRP, TC, and smoking index were positively correlated with IMT ( Plt;0.05) . Hs-CRP and smoking index in the group A were lower than those in the group B ( Plt;0. 05) .While TC, TG, LDL-C, and HDL-C in the group A were higher than those in the group B ( Plt;0.05) . Conclusions Age, smoking index, hs-CRP, and TC are risk factors for thickening of carotid artery IMT in COPD patients. Furthermore, smoking index, hs-CRP, TC, TG, LDL-C, and HDL-C are related to the severity of IMT thickening. The ultrasound detection of carotid artery IMT can be a valuble tool to screen atherosclerosis in patients with COPD.
ObjectiveTo observe the frequency and severity of carotid atherosclerotic stenosis in senior chronic obstructive pulmonary disease (COPD) patients and explore the related risk factors in order to provide a theoretical basis for the effective prevention of cardiovascular comorbidity in COPD. MethodsStable COPD out-patients followed up in Sichuan Provincial People's Hospital were prospectively enrolled between August 2012 and August 2015, who had carotid atherosclerosis confirmed by cervical vascular color ultrasonic inspection within 3 months. All the patients were divided into a carotid stenosis group and a non-carotid stenosis group. Demographic and laboratory data were extracted and compared between two groups. Pearson correlation and Logistic regression analysis were performed to analyze the risk factors related to carotid stenosis. ResultsOf 380 consecutive senior patients with COPD and carotid atherosclerosis, 199 (52.37%) had carotid stenosis. Compared with those without carotid stenosis, the patients in the carotid stenosis group had significantly higher levels of hypersensitive C reactive protein (hs-CRP), uric acid (UA), brain natriuretic peptide (BNP) and smoking index (P < 0.05). Lower levels of forced expiratory volume in one second (FEV1%) and body mass index (BMI) were also observed in the carotid stenosis group (P < 0.05). Pearson correlation and logistic regression analysis showed that hs-CRP (OR 1.040, 95%CI 1.011-3.070), UA (OR 1.003, 95%CI 1.000-2.006), FEV1 (OR 0.899, 95%CI 0.200-5.722), smoking index (OR 1.002, 95%CI 1.001-2.904) and BMI (OR 0.955, 95%CI 0.312-4.866) were associated with carotid stenosis. ConclusionsCarotid atherosclerotic stenosis is common in senior COPD patients. Higher levels of hs-CRP, UA and smoking index and lower levels of FEV1 and BMI may be independent risk factors for carotid stenosis in COPD.
ObjectiveTo analyze the clinical characteristics and related prognostic factors of post-renal transplantation pneumonia.MethodsThe clinical data of 89 patients with post-renal transplantation pneumonia in Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital from 1st January 2014 to 31st December 2015 were collected in the study. Kaplan-Meier method was used to calculate overall survival. Cox analysis was used to analyze the related prognostic factors.ResultsPost-renal transplantation pneumonia occurred mainly within 6 months after renal transplantation. The prominent clinical manifestations were cough (95.5%), fever (56.1%), and dyspnea (12.3%). The mortality of post-renal transplantation pneumonia was 11.2% and all death occurred within 5 months after transplantation. The overall survival rate significantly decreased in the patients with C-reactive protein (CRP) ≥40 mg/L (P<0.001), procalcitonin ≥1 ng/ml (P=0.002), brain natriuretic peptide >100 pg/ml (P<0.001), platelet ≤100×109/L (P<0.001), or those with occurrence time of pneumonia <180 days (P=0.013). Platelet ≤100×109/L could increase the risk of death by 66.6 times (RR=0.015, P=0.006), and CRP ≥ 40 mg/L could increase the risk of death by 20 times (RR=0.05, P=0.029).ConclusionsPost-renal transplantation pneumonia has prominent clinical characteristics. Platelet ≤100×109/L or CRP ≥40 mg/L can increase the risk of death and can be used as an independent prognoctic factor of post-renal transplatation pneumonia.
Objective To explore the relationship between thrombocytosis and all-cause in-hospital mortality in patients with chronic obstructive pulmonary disease (COPD) and low-risk pulmonary embolism (PE). Methods In a multicenter retrospective study on clinical characteristics, COPD patients with proven acute PE between October 2005 and February 2017 were enrolled. The patients in risk classes III-V on the basis of the PESI score were excluded. The patients with COPD and low-risk PE were divided into two groups of those with thrombocytosis and without thrombocytosis after extracting platelet count on admission. The clinical characteristics and prognosis of the two groups were compared. Multivariate logistic regression was performed to reveal an association between thrombocytosis and all-cause in-hospital mortality after confounding variables were adjusted. Results A total of 874 consecutive patients with COPD and PE at low risk were enrolled in which 191 (21.9%) with thrombocytosis. Compared with those without thrombocytosis, the thrombocytopenic group had significantly lower body mass index [(20.9±3.3) kg/m2 vs. (25.1±3.8) kg/m2, P=0.01], lower levels of forced expiratory volume in one second (FEV1) [(0.9±0.4) L vs. (1.3±0.3) L, P=0.001] and lower partial pressure of oxygen in the arterial blood (PaO2) [(7.8±1.2) kPa vs. (9.7±2.3) kPa, P=0.003]. The COPD patients with thrombocytosis had a higher proportion of cardiovascular complications as well as higher level of systolic pulmonary arterial pressure (sPAP) [(46.5±20.6) mm Hg vs. (34.1±12.6) mm Hg, P=0.001]. Multivariate logistic regression analysis after adjustment for confounders revealed that thrombocytosis was associated with all-cause mortality in hospitalized patients with COPD and low-risk PE (adjusted OR=1.53, 95%CI 1.03–2.29), and oral antiplatelet treatment was a protective factor (adjusted OR=0.71, 95%CI 0.31–0.84). Conclusions Thrombocytosis is an independent risk factor for all-cause in-hospital mortality in COPD patients with PE at low risk. Antiplatelet therapy may play a protective role in the high-risk cohort.
ObjectiveTo understand the genetic polymorphisms of MUC5B and TOLLIP in Chinese patients with idiopathic pulmonary fibrosis (IPF), and to explore whether gene polymorphism variation in Chinese IPF patients can be used as a genetic biomarker for accurate treatment and prognosis judgment.MethodsA total of one hundred and twenty-six patients with IPF were enrolled in this study. The baseline characteristics, total lung capacity (TLC), forced vital capacity (FVC), carbon monoxide diffusion function (DLCO), imaging changes of the patients were followed up. The levels of serum sputum glycosylated antigen-6 (Krebs Von den Lungen-6, KL-6) and B lymphocyte chemotactic factor C-X-C motif chemokine 13 (CXCL13) were detected by chemiluminescent enzyme immunoassay and enzyme-linked immunosorbent assay. The gene MUC5B rs35705950 and TOLLIP rs5743890, rs5743894 single nucleotide polymorphism (SNP) were determined by polymerase chain reaction.ResultsOne hundred and twenty-six patients with IPF were found with AA type by TOLLIP rs5743890 and rs5743894 SNP, accounting for 100.0%; MUC5B rs35705950 SNP was expressed as 116 patients (92.1%) with GG type, and 10 patients (7.9%) with GT type, no TT patients were detected. There was no significant difference in clinical characteristics between the two groups in age and non-smokers (P>0.05). Compared with group G, annual decrease of lung function (FVC, DLCO, and TLC), serum biomarkers (KL-6 and CXCL13), annual increase of reticular and honeycombing lesions, and mortality were significantly lower in group T (P<0.05). The median survival time of IPF patients carrying the MUC5B SNP rs35705950 minor allele (gene phenotype GT) heterozygous was significantly higher than that of homozygous IPF patients with a genetic phenotype of GG.ConclusionsThere are genetic polymorphisms in Chinese patients with IPF. MUC5B rs35705950 and TOLLIP rs5743890, rs5743894 gene subtypes have low mutation rates in the cohort. Compared with homozygous patients of MUC5B SNP rs35705950, heterozygous patients have smaller changes in lung function and radiological image, lower levels of serum KL-6 and CXCL13, and better prognosis.
ObjevtiveThe morbidity of intensive care unit-acquired swallowing disorder (ICU-ASD) was clarified through meta-analysis by synthesizing previous evidence, in order to provide an evidence-based basis for early identification and intervention of ICU-ASD. Methods A computerized search of PubMed, Embase, Web of Science, The Cochrane Library, CHINAL, China Knowledge Network, Wanfang Data Knowledge Service Platform, and Chinese Science and Technology Journal Database was conducted to retrieve the relevant literature on the morbidity of ICU-ASD published in China and abroad from the database establiment to December 2022. Considering the quality of the included literature, the Chinese database excluded master's theses and non-core journals. Meta-analysis of morbidity was performed using Stata 12.0. Results A total of 19 papers, including 4291 patients, were included. Meta-analysis showed that the overall morbidity of ICU-ASD was 36% [95% confidential interval (CI) 26% - 46%; I2=97.62%, P<0.01]. Subgroup analyses showed that the morbidity of ICU-ASD in Asian, European, South American, and North American was 39% (95%CI 28% - 50%), 23% (95%CI 8% - 44%), 52% (95%CI 46% - 57%), and 39% (95%CI 20% - 61%), respectively; and that the morbidity of male and female ICU-ASD was 36% (95%CI 24% - 48%) and 33% (95%CI 22% - 45%), respectively; the morbidity of ICU-ASD was 41% (95%CI 30% - 52%) and 31% (95%CI 18% - 44%) in the patients with and without hypertension, respectively; the morbidity of ICU-ASD was 58% (95%CI 42% - 73%) and 51% (95%CI 36% - 66%) in the patients with and without respiratory disease respectively; the morbidity of ICU-ASD in the patients with and without diabetes mellitus was 37% (95%CI 24% - 51%) and 39% (95%CI 28% - 51%), respectively; the morbidity of ICU-ASD in the patients with and without renal disease was 40% (95%CI 23% - 59%) and 35% (95%CI 24% - 46%), respectively; the morbidity of ICU-ASD in the patients with intubation caliber ≤7.5 mm and >7.5 mm was 31% (95%CI 19% - 45%) and 37% (95%CI 22% - 54%), respectively; the morbidity of ICU-ASD in the patients with and without heart failure was 58% (95%CI 30% - 84%) and 36% (95%CI 23% - 51%), respectively; and the morbidity of ICU-ASD in patients with and without arrhythmia was 36% (95%CI 11% - 65%) and 31% (95%CI 21% - 42%), respectively; the morbidity of ICU-ASD in the patients with and without neurologic disease was 48% (95%CI 24% - 72%) and 34% (95%CI 15% - 57%), respectively. Begg's test P<0.05, Egger's test P<0.05, suggesting publication bias in the study, and the cut-and-patch method corrected for an overall incidence result of 27% (95%CI 18% - 36%). Conclusions Meta-analysis reveals an overall morbidity of 36% for ICU-ASD and 27% for the cut-and-patch correction. Subgroup analysis reveals that the morbidity of ICU-ASD is significantly higher in patients with hypertension, heart failure, and neurological disorders than in patients without these disorders. Current evidence suggests that the prevalence of ICU-ASD is high and needs to be taken seriously. Timely screening and assessment of swallowing disorders is recommended for intensive care unit patients, especially those with hypertension, heart failure, and neurological disorders.