Objective To explore the clinical effect and safety of sildenafil combined with bosentan in the treatment of connective tissue disease associated moderate-severe pulmonary arterial hypertension (CTD-MS-PAH ). Methods Seventy-six patients with CTD-MS-PAH during January 2013 to January 2017 were collected and divided into group A (41 cases) and group B (35 cases) using a stratified random sampling approach. The patients in group A received 25 mg sildenafil tablet therapy, three times a day. The patients group B received 25 mg sildenafil and 62.5 mg bosentan tablet therapy, twice a day. Both groups were treated for 12 weeks. Before and after the trial, all patients undertook six-minute walk test. Meanwhile the Borg dyspnea index score, the pulmonary artery systolic pressure (PASP), right ventricular diameter (RVD), B-type natriuretic peptide (BNP), the partial pressure of oxygen in artery (PaO2), blood pressure, heart rate, liver and kidney function were all measured. Results After the therapy, six-minute walking distance increased, Borg dyspnea index score decreased, PASP, RVD and plasma BNP decreased, and PaO2 increased in both groups (all P<0.05), but group B was superior to group A (allP<0.05). There were no significant differences in blood pressure, heart rate, liver or kidney function compared with those before the treatment in both groups (allP>0.05). Conclusion Sildenafil combined with bosentan can significantly decrease the level of pulmonary arterial pressure and effectively improve the cardiopulmonary function in CTD-MS-PAH patients with good safety.
ObjectiveTo explore the relationship between morning symptoms and other clinical characteristics in patients with chronic obstructive pulmonary disease (COPD), and to look for related risk factors affecting morning symptoms.MethodsThis cross-sectional observational study included 153 patients with stable COPD. Morning symptoms were evaluated with the Chinese-version of Chronic Obstructive Pulmonary Disease Morning Symptom Diary (Ch-COPD-MSD). And modified version of the British medical association respiratory questionnaire (mMRC), COPD assessment test (CAT), questionnaire clinical COPD questionnaire (CCQ) score were scored, and the BODEx index was calculated.ResultsA total of 153 stable COPD patients were included. The patients aged 59.6±7.6 years with a mean forced expiratory volume in one second of (52.0±20.7)% predicted (FEV1%pred). The median score of morning symptoms was 31.00. Morning symptoms severity was different between GOLD groups A to D: median (interquartile range) score in GOLD A was 23.50 (20.00 - 27.25), in GOLD B was 31.00 (26.00 - 38.00), in GOLD C was 30.00 (23.75 - 35.75), and in GOLD D was 36.50 (27.00 - 47.50) (P<0.001). Meanwhile, under different mMRC, CAT, CCQ scores, the difference in the median score of morning symptoms was statistically significant (all P=0.000). Score of morning symptoms was negatively correlated with the FEV1%pred (r=–0.24, P<0.001), and positively correlated with the score of mMRC, CAT, CCQ, and the BODEx index (r value was 0.50, 0.60, 0.53, 0.40, respectively, P<0.001). Multiple linear regression analysis showed that CAT score was the important factor associated with morning symptoms severity in COPD (B=0.829, P<0.001).ConclusionsMorning symptoms are associated with multiple clinical indicators for assessing the severity of COPD, and health status is the most strongly associated with morning symptoms. Clinical evaluation of morning symptoms in patients with COPD can be helpful in comprehensive assessment of the patient’s condition.
Objective To compare the clinical characteristics and treatment of patients with chronic obstructive pulmonary disease (COPD) in the year of 2018, 2019, 2020, and 2021. Methods A cross-sectional multicenter study was conducted on patients with stable COPD from 13 hospitals of China south area in year of 2018, 2019, 2020 and 2021. The demographic data, pulmonary function, COPD assessment test (CAT), exacerbation in the past year and treatment regimens were collected. Results The CAT scores of the COPD patients in the year of 2018, 2019, 2020 and 2021 were (16.5±6.7), (14.5±6.7), (14.1±6.2) and (13.4±6.6), respectively. The CAT scores decreased year by year (P<0.05). The forced expiratory volume in one second percentage predicted value (FEV1%pred) of the COPD patients in the year of 2018, 2019, 2020 and 2021 were (52.8±21.4)%, (51.3±19.2)%, (53.4±21.5)% and (56.6±21.7)%, respectively. Compared with year of 2018, the patients in 2019, 2020 and 2021 had higher FEV1%pred. Compared with year of 2019 and 2020, the patients 2021 had higher FEV1%pred (P<0.05). The median of exacerbation in the past year of the COPD patients in the year of 2018, 2019, 2020 and 2021 were 1, 1, 0 and 0, respectively. Compared with year of 2018 and 2019, the median of exacerbation in the past year in 2020 and 2021 were lower (P<0.05). The proportion of double [long-acting β2-agonist (LABA)+long-acting muscarinic antagonist (LAMA)] and triple inhaled [LAMA+LABA+ inhaled corticosteroid (ICS)] drugs were 0%, 0.7%, 3.5% and 17.0%, as well as 47.9%, 41.2%, 27.8% and 26.0%. Compared with year of 2018 and 2019, the proportion of double inhaled drugs in 2020 and 2021 was higher, while triple inhaled drugs was lower (P<0.05). In addition, the proportion of influenza vaccine/pneumonia vaccine was 0%, 0.1%, 3.5% and 4.3%, respectively. Compared with year of 2018 and 2019, the proportion of influenza vaccine/pneumonia vaccine in year of 2020 and 2021 was higher (P<0.05). Conclusions Symptoms and exacerbation burden of patients with COPD tend to be less in China in recent years and the time of patients visited hospital tends to move forward. Furthermore, the proportion of patients with double inhaled drugs (LABA+LAMA) increased, while triple inhaled (LAMA+LABA+ICS) decreased. In addition, the proportion of patients vaccinated with influenza/pneumonia is increased but the overall proportion is still low.
目的 利用磁共振弥散张量成像技术（DTI）对右侧难治性颞叶癫痫（TLE）患者术前及术后脑白质各向异性分数（FA）进行纵向随访研究，并对其与病程等临床症状之间的相关性进行分析，探讨右侧TLE患者的脑白质FA变化模式。 方法 2008年7月－2009年8月纳入10例右侧难治性TLE患者。对每个受试者采用GE 3.0 T磁共振及8通道头线圈扫描，所有DTI图像通过单次回波平面成像序列采集。采用基于体素分析的SPM8软件对受试患者术前术后FA图进行配对t检验，观察难治性TLE患者脑白质变化模式。采用Pearson相关计算FA变化幅度与病程等临床症状之间的相关性，经比较校正后P值＜0.05的区域为有统计学意义的区域。 结果 右侧TLE患者FA值降低的区域包括左侧颞下回、双侧额中回及左侧壳核、右侧楔叶。FA升高的区域包括左侧海马旁回、左侧颞叶、右侧额下回和左侧中央旁小叶。相关分析发现，右侧TLE患者右侧额下回FA变化值与发病年龄呈负相关，左侧颞下回FA变化值与术后随访间隔时间呈负相关。 结论 右侧难治性TLE患者手术治疗后大脑白质变化不仅局限于颞叶，还涉及颞叶外结构。