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。
ObjectiveTo explore the clinical manifestations, pathogenesis, prognosis and the therapeutic modalities of the patients with solid tumors combined with remarkable hematologic abnormalities. MethodsGastric cancer in a paitnet was diagnosed by endoscopy as well as pathological biopsy and myeloproliferative neoplasms (MPNs) were excluded through bone marrow examinations. Therefore, the primary and metastatic malignancies were excised. ResultsAlthough surgical operation improved the hematologic changes, the high tumor load caused the poor prognosis. ConclusionThe solid tumors may present with hematologic manifestations which is similar to the symptoms of MPNs; it belongs to the para-neoplastic phenomenon and may be an independent poor prognostic factors.
ObjectiveTo explore the postoperative effect of preoperative anemia on patients undergoing unilateral total hip arthroplasty (THA).MethodsA total of 200 patients undergoing unilateral primary THA from July to September 2018 were selected. According to the preoperative hemoglobin level and the World Health Organization definition of anemia (hemoglobin below 120 g/L for women and below 130 g/L for men), the patients were divided into the non-anemia group and the anemia group. All anemia patients were given dietary guidance and balanced diet before the operation, and no drug treatment was given. Both groups adopted accelerated rehabilitation strategy during the perioperative period, and postoperative anemia was treated according to a unified standard. The intraoperative blood loss and length of operation of the two groups were recorded. The presence of anemia on the first postoperative day, postoperative blood transfusion rate, incidence of postoperative complications (hypotension, nausea and vomiting on the first postoperative day, and infection-related unplanned readmission within 90 days after discharge), range of motion of the hip joint (hip flexion and hip abduction), and length of hospital stay were compared between the two groups.ResultsIn the 200 patients, 51 (25.50%) presented anemia before surgery and 149 did not. There were 114 cases developing mild anemia and 7 cases developing moderate anemia after surgery in the non-anemia group, with an anemia incidence of 81.21%; in the anemia group, there were 30 cases of mild anemia and 20 cases of moderate anemia, and 1 case did not have anemia after surgery. The postoperative transfusion rates of the non-anemia group and the anemia group were 2.01% and 11.76%, respectively, and the incidences of postoperative complications were 7.38% and 35.29%, respectively; the differences were statistically significant (P<0.05). However, there was no statistically significant difference in hip mobility or length of hospital stay between the two groups (P>0.05).ConclusionsQuite a few patients undergoing THA have anemia before surgery. The incidence of postoperative anemia is high due to the trauma and massive bleeding of the operation, and preoperative anemia will aggravate anemia after surgery. Preoperative anemia can increase the perioperative transfusion rate of THA patients, increase the incidence of postoperative complications, and affect the hospitalization experience of patients.