Objective To investigate the therapeutic effects of thyroid hormone replacement on critically ill COPD patients with low serum thyroid hormone. Methods Sixty-seven critically ill patients with acute exacerbation of COPD ( AECOPD) , and complicated with respiratory and/ or heart failure and low serum thyroid hormone, admitted from July 2008 to June 2011, were recruited for the study. They were randomly divided into an intervention group ( n = 34) and a control group ( n = 33) . The control group received conventional treatment and the intervention group received conventional treatment plus additional thyroid hormone replacement therapy. Results Compared with the control group, the overall efficacy of the intervention group was not significantly different ( 88. 2% vs. 81. 8% , P gt; 0. 05) , while average effective time was significantly shorter [ ( 9. 6 ±2. 5) d vs. ( 12. 3 ±2. 8) d, P lt; 0. 05] . The post-treatment serum FT3 , FT4 , TT4 , and h-TSH levels were significantly higher in the intervention group than those in the control group, and significantly higher than baseline ( P lt;0. 05) . Conclusions For AECOPD patients complicated with respiratory and/or heart failure and low serum thyroid hormone, thyroid hormone supplement at low dosage will help to improve serumthyroid hormone level, and promote early recovery.
Objective To investigate the intervention effect of 3-phosphoinositede dependent protein kinase-1 (PDK1) inhibitor on prostaglandin E2 (PGE2) in smoking-induced chronic obstructive pulmonary disease (COPD) mice. Methods Fifty C57BL/6 male mice were randomly divided into normal control group, smoking group, smoking +low dose PDK1 inhibitor group, smoking + medium dose PDK1 inhibitor group and high dose PDK1 inhibitor group with 10 mice in each group. The mice in the normal control group inhaled phosphate-buffered saline twice a day for 12 weeks, and the mice in the smoking group were fumigated twice a day, 5 days per week for 12 weeks, and the other three groups were given intraperitoneal injection of low-dose PDK1 inhibitor OSU-03012 (0.25 mg/kg), medium-dose PDK1 inhibitor (0.5 mg/kg) and high-dose PDK1 inhibitor (1.0 mg/kg) respectively before smoking. After smoking, lung function was tested, the bronchoalveolar lavage fluid (BALF) of each mouse was taken for cell count, the PGE2 in serum and BALF of mice was determined by enzyme linked immunosorbent assay, and the lung tissue of mice was sectioned with paraffin and stained by hematoxylin-eosin (HE), and pathological changes were observed under microscope. Results Compared with the control group, FEV100/FVC and FEV200/FVC of the mice in each smoking group were significantly decreased (P<0.05); The number of cells in BALF of smoking group was significantly higher than that of normal control group (P<0.05). There was no significant difference in the total number of BALF cells, the proportion of neutrophils and macrophages between the smoking + low-dose PDK1 inhibitor group and the smoking group. However, the total number of BALF cells and the proportion of neutrophils in the smoking + medium dose PDK1 inhibitor group and the high dose PDK1 inhibitor group gradually decreased, while the proportion of macrophages gradually increased, compared with the normal control group, the PGE2 concentrations of serum and BALF in the smoking group and the smoking + PDK1 inhibitor group were significantly higher than those in the control group. Compared with the smoking group, the PGE2 concentrations of serum and BALF in the middle and high dose PDK1 inhibitor groups were significantly lower than those in the smoking group. HE staining of lung tissue showed that there were a large number of inflammatory cell infiltration, alveolar cavity dilatation, alveolar wall rupture and fusion, alveolar formation, significant decrease in the number of alveoli and other pathological changes in the smoking group, which were consistent with the pathological changes of COPD. The inflammatory cell infiltration, mucus obstruction and alveolar dilatation were slightly alleviated in the smoking + low-dose PDK1 inhibitor group, while the inflammatory cell infiltration, alveolar wall thinning and alveolar dilatation were improved in both the medium-dose inhibitor group and the high-dose inhibitor group, and the improvement was more obvious in the high-dose inhibitor group. Conclusion The lung function of the smoked COPD mouse decreases, the airway inflammation is obvious, and the secretion of PGE2 is also increased, while the use of PDK1 inhibitor could reduce the secretion of PGE2, reduce airway inflammation and pathological changes, and improve lung function in a dose-dependent manner.
Objective To investigate the prevalence and predisposing factors of gastroesophageal reflux（GER）in patients with chronic obstructive pulmonary disease（COPD）and its impacts on the frequency of COPD exacerbations.Methods 50 patients with acute exacerbation of COPD were enrolled in the study.All patients filled a modified version of clinically validated standardized Mayo Clinic GER questionnaire.Pulmonary function tests（PFT），body mass index（BMI），serum albumin，and medications were recorded.The patients were divided in to GER group（13 patients with GER symptoms longer than one year and diagnosed GER by gastroscope） and non-GER group（37 patients without GER symptoms）.Results There were no significant differences in the BMI，serum albumin，use of inhaled steroids and theophylline between the two groups.Forced expiratory volume in one second as a percentage of the predicted value（FEV1%pred）（37% vs 38.3%，P=0.608.），residual volume % predicted（123.4 % vs 137.8%，P=0.222），and residual volume to total lung capacity（139.4% vs 141.5%，P=0.798） were not significantly different between the two groups.The number of COPD exacerbations per year was significantly higher in patients with GER compared to patients without GER（4.5 vs 1.3，P=0.006）.Conclusions The severity of airflow obstruction and the hyperinflation is unlikely to contribute to the development of GER.Patients with GER experience significantly more exacerbations per year when compared to patients without GER，suggesting more highlight warrant in treatment of GER in COPD patients.
ObjectiveTo explore the diagnostic efficacy of Geriatric Nutritional Risk Index (GNRI) in malnutrition of elderly patients with chronic obstructive pulmonary disease (COPD) in outpatient department. MethodsOne hundred and five elderly outpatients with COPD were enrolled in the study, and their nutritional screening was carried out. The clinical and laboratory parameters of patients in the normal nutrition group (high GNRI group) and malnutrition group (low GNRI group) were compared, and the correlation analysis was conducted. The diagnostic efficacy of GNRI was evaluated based on the malnutrition universal screening tool (MUST). ResultsThe prevalence of malnutrition was high in COPD elderly outpatients. The prevalence of malnutrition in group D was 61.8%. There were significant differences between the two groups in body mass index, serum albumin, FEV1 percentage in the predicted value, 6-minute walk distance, and the number of acute exacerbations in the past year. GNRI was significantly related to the above parameters. The sensitivity, specificity and accuracy of GNRI were 81.8%, 83.6% and 82.9%, using MUST as the standard. ConclusionGNRI can be used for nutritional screening of COPD patients in elderly outpatients, which is simple, convenient and relatively accurate, and can be popularized in other medical institutions.
Objective To systematically evaluate the risk factors for secondary respiratory failure (RF) on chronic obstructive pulmonary disease (COPD), so as to provide evidence for formulating prevention and control strategies. Methods PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, Chongqing VIP databases and SinoMed were searched for articles published from the dates of establishment of databases to August 2021. To collect the relevant case-control studies or cohort studies on the risk factors of secondary RF in patients with COPD. The patients were divided into two groups, RF group and non RF group. Meta-analysis was carried out with RevMan 5.3 software after selecting literature, extracting data and evaluating quality according to inclusion and exclusion criteria. Results A total of 16 case-control studies involving 2 417 patients were included. There were 856 cases in RF group and 1 561 cases in non RF group. The results of meta-analysis showed that age [mean difference (MD)=0.58 years, 95% confidence interval (CI) (0.18, 0.97) years, P=0.004], number of acute attacks per year [MD=2.68 times, 95%CI (2.58, 2.78) times, P<0.001], number of acute attacks per year over 3 [odds ratio (OR)=3.37, 95%CI (2.40, 4.73), P<0.001], serum albumin level [MD=−2.93 g/L, 95%CI (−3.92, −1.94), P<0.001], serum uric acid [MD= −59.91 mmol/L, 95%CI (−66.57, −53.25) mmol/L, P<0.001], nosocomial infection [OR=4.53, 95%CI (3.44, 5.98), P<0.001], no-inhaled glucocorticoid [OR=3.63, 95%CI (2.95, 4.48), P<0.001], acid-base imbalance [OR=13.22, 95%CI (10.14, 17.23), P<0.001], COPD very serious [OR=1.82, 95%CI (1.50, 2.21), P<0.001], cardiovascular disease [OR=2.73, 95%CI (1.99, 3.74), P<0.001], kidney disease [OR=3.62, 95%CI (2.67, 4.90), P<0.001] were risk factors for RF in COPD. Sensitivity analysis showed that the results of meta-analysis were stable. Conclusion According to the results of meta-analysis, the risk factors of secondary RF in COPD can be identified in time and preventive measures can be taken to effectively reduce the incidence of aspiration failure and improve the prognosis and outcome of patients.
Objective To investigate the prevalence of depression in patients with chronic obstructive pulmonary disease ( COPD) and risk factors. Methods 215 patients with stable COPD were recruited in the study. The Patient Health Questionnaire-9 ( PHQ-9) standardized scale were performed for the depression survey. Meanwhile CAT, pulmonary function test and the history taking ( sex, age, height, weigh, smoking status, education level) were applied to evaluate all the COPD patients. The COPD patients were classified into A, B, C, and D groups according to 2011 GOLD new COPD classification system. Pearson chi-square test and multivariate logistic modeling were used to estimate the prevalence of depression and the risk factors. Results The prevalence of depression in COPD patients whose PHQ-9 scores ≥7 was 37.7% with 18.5% , 35.8% , 46.5% , and 62.5% respectively in A, B, C, and D groups. There was significant difference in prevalence between each groups ( Plt;0.05) . Compared with the COPD patients without depression, the COPD patients with depression had younger age, more female, higher education level, higher CAT scores and smaller means of body mass index ( BMI) . Logistic analysis revealed that depression in COPD was associated with age, sex, education level, BMI, FEV1% pred and CAT scores. The patients who with younger age, female sex, higher education level, lower FEV1% pred, lower BMI and higher CAT scores were had higher rsik to be complicated with depression. However no significant difference was observed between different FEV1 /FVC or smoking status. Conclusions This study confirms the high prevalence of depression in patients with stable COPD, and the prevalence in A, B, C, and D groups of COPD are different. Sex, age, education level, FEV1% pred, BMI, and CAT scores are the risk factors of depression in COPD.
ObjectiveTo investigate the risk factors associated with failure of weaning from invasive mechanical ventilation in gerontal patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsA retrospective study was conducted on 76 patients aged 65 years and older with AECOPD who received invasive mechanical ventilation and met the weaning criteria from July 2012 to June 2014. The subjects who passed the spontaneously breathing trial (SBT) and did not need mechanical ventilation within 48 h were enrolled into a weaning success group. The subjects who did not pass the SBT or needed mechanical ventilation again within 48 h were enrolled into a weaning failure group. The risk factors associated with failure of weaning were studied by univariate and multivariate Logistic regression analysis. ResultsThere were 53 subjects in the weaning success group and 23 in the weaning failure group. The incidences of sepsis, multiple organ dysfunction syndrome (MODS), fungal infection, hypoproteinemia, duration for mechanical ventilation > 14 d, the prevalences of aeropleura, cardiac failure, diabetes, coronary heart disease and hepatic insufficiency were higher in the weaning failure group than those in the weaning success group (P < 0.05). Logistic analysis revealed that MODS (OR=8.070), duration for mechanical ventilation > 14 d (OR=17.760), cardiac failure (OR=4.597) and diabetes (OR=13.937) were risk factors of weaning failure (P < 0.05). ConclusionMODS, duration for mechanical ventilation > 14 d, cardiac failure and diabetes were associated with the failure of weaning from invasive mechanical ventilation in gerontal patients with AECOPD.
ObjectiveTo investigate the effect of noninvasive positive-pressure ventilation for elderly patients with chronic obstructive pulmonary disease (COPD) combined with left heart failure. MethodsA total of 152 patients (70-85 years old) diagnosed with COPD combined with left heart failure and treated in our hospital between June 2011 and January 2015 were randomly divided into trial group (noninvasive positive-pressure ventilation with routine treatment, n=76) and control group (routine treatment, n=76). Respiratory rate, heart rate, blood pressure, pH, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of oxygen (PaO2) and left ventricular ejection fraction (LVEF) were analyzed and compared between the two groups after treatment. We did t-test to analyze the difference of these indexes between the two groups statistically. ResultsRespiratory rate, heart rate and PaCO2 in both of the two groups after the treatment were significantly lower than those before the treatment (P<0.001), while PaO2 and LVEF in both of the two groups after the treatment were significantly higher than those before the treatment (P<0.001). The systolic pressure and diastolic pressure in both of the two groups after the treatment didn't differ much from those before the treatment (P>0.05). The pH value after the treatment increased only in the trial group compared with that before the treatment (P<0.05). The respiratory rate, heart rate, pH value, PaO2, PaCO2 and LVEF after the treatment in trial group were meliorated compared with those in the control group (P<0.05). ConclusionTreatment with noninvasive positive-pressure ventilation for elderly patients with COPD combined with left heart failure is more efficient than the routine treatment.
Objective To study the intervention effect of ginkgo biloba extract（GBE） on airway and vascular remodeling in rat model of chronic obstructive pulmonary disease(COPD).Methods Forty wistar rats were randomly divided into group A，B，C and D.The rat model of COPD were established by intratracheally injection of lipopolysaccharide and exposure to cigarette smoke in groups B，C and D.Groups C and D were given intraperitoneally injection with 40 mg/kg GBE respectively from day1 to day14 and day29 to day42.Forty-three days later，the rats were sacrificed for lung pathological examination.Results Group B，C and D all showed pathological changes characteristic of COPD to different extent.The average area and standard number of alveoli showed significant difference between each groups（all Plt;0.01）.The structure of bronchiole walls in group C and D show mild changes.The ratio of bronchial smooth muscle thickness to bronchial wall thickness and bronchial wall area to bronchial area of group C and D showed significant difference when compared with group A and B（all Plt;0.01）.The vascular smooth muscle cell of group C and D had mild hyperplasia and the vascular wall had slightly thickened.The ratio of vascular smooth muscle thickness to vascular wall thickness and vascular wall area to vascular area in group C and D showed significant difference when compared with group A and B（all Plt;0.01）.Conclusion GBE has inhibitory effects on airway and vascular remodeling in rats model of COPD.
Objective To investigate the phenotyping of COPD by cluster analysis and evaluate the value of this method.Methods 168 COPD patients were enrolled from Beijing Tongren Hospital. Demographic and clinical data, such as, sex, age, body mass index ( BMI) , smoking index, course of disease,exacerbation rate, and comorbidities were collected. Pulmonary function test, emphysema scoring by HRCT,dyspnea by MMRC score, COPD assessment test ( CAT) score, six-minute walk test were performed for each patient during the stable stage. Cluster analysis was conducted using SPSS 13. 0. Results According to the GOLD criteria,5, 75, 75, and 13 patients were classified into GOLD stage 1, 2, 3, and 4, respectively. There was no difference among different stages in sex distribution, BMI, smoking index, hypertension, and cerebral infarction incidence( P gt; 0. 05) , but the differences in age, disease course, dyspnea score, six-minute walk distance, BODE score, CAT score, coronary heart disease, exacerbation rate, and HRCT emphysema visual score were significant( P lt;0. 05) . By cluster analysis,168 patients were finally classified into three groups:younger/mild, older/ severe, and older/moderate. The patients with the same GOLD stage appeared indifferent clusters and the patients belonging to different GOLD stages could be in the same cluster. There were significant differences among three groups in age, BMI, exacerbation rate, dyspnea score, CAT score, and comorbidities. The result showed that HRCT emphysema visual score was also an important index todifferentiate clusters, suggesting that emphysema was an important phenotype of COPD. Conclusions Cluster analysis can classify homogeneous subjects into the same cluster, and heterogeneous subjects into different clusters. The results suggest that COPD phenotyping by cluster analysis is clinically useful and significant.