Objective To compare BODE index with GOLD staging for the severity evaluation in patients with chronic obstructive pulmonary disease ( COPD) . To investigate the relationship between BODE index and quality of life. Methods A total of 100 patients with stable COPD were enrolled. All participants were examined with lung function test and St George’s Respiratory Questionnaire ( SGRQ) for evaluation of quality of life. BODE index and it’s four components including body mass index( BMI) , airflow obstruction ( FEV1%pred) , dyspnea( MMRC) , and exercise capacity( 6MWD) were calculated. The participants were divided into four groups of severity using GOLD guidelines and BODE index quartiles. Results The associations between SGRQ total score and SGRQ subscales, and BODE index were significant( P lt;0. 01) .BODE index was a significant predictor of the quality of life, explaining 41. 3% of the total score of the SGRQ ( P lt;0. 01) . However, GOLD classification showed a correlation only with SGRQ activity score ( P lt;0. 05) but not with other SGRQ scores. There were significant differences in SGRQ total score and SGRQsubscales between different severity groups of BODE index( P lt;0. 01) . But there was no difference in SGRQ score between different severity groups of GOLD classification, except SGRQ activity score. Conclusion BODE scoring system is better correlated with the quality of life as assessed by the disease severity inpatients with COPD than the GOLD staging criteria.
Objective To evaluate the effects of indoor temperature and relative humidity on acute exacerbations of chronic obstructive pulmonary disease（AECOPD）.Methods A total of 70 moderate to very severe COPD patients were recruited.The data including indoor temperature and relative humidity twice daily，increase over their stable symptoms in "major" symptoms（dyspnea，sputum purulence，sputum amount） and "minor" symptoms（nasal discharge/congestion，sore throat，cough），and adjustment of medication were recorded on diary cards.All data were collected from Jan 2005 to Dec 2005 by telephone inquiring or home visiting.Furthermore，the corresponding median outdoor temperature，relative humidity and air pressure from atmosphere bureau were compared with indoors parameters to examine the different effects on AECOPD.Results Fifty-five cases completed the whole investigation.Indoor temperature and relative humidity were both risk factors when logistic regression was used to evaluate the effect.Our research showed that AECOPD was significantly related to indoor and ourdoor environment factors.The correlation coefficient of all factors were r=－0.686（indoor temperature），r=－0.671（outer temperature），r=0.105（indoor humidity），r=－0.115（outer humidity），r=0.545（atmospheric pressure） respectively.Conclusions The indoor temperature and relative humidity，especially low temperature and high relative humidity，had important effects on AECOPD of moderate to very severe patients.It may be helpful to prevent AECOPD by adjusting the indoor temperature and relative humidity.
Objective To explore the profile and diagnosis value of airway resistances before and after bronchial dilation test ( BDT) in patients with COPD and asthma. Methods Airway resistances before and after BDT were measured in COPD patients and asthma patients with different severity by impulse oscillometry ( IOS) , and the characteristic changes of the two different diseases were analyzed compared with healthy subjects. Results Airway resistance indexes except X5 were higher in the COPD and the asthma patients than those in the healthy subjects before BDT ( P lt; 0. 05) . There were significant differences in airway resistance indexes except X5 and Rc between the mild asthma patients and the moderate to severe asthma patients. Significant difference in Z5, Fres, and Rp were observed in the mild COPD patientscompared with the moderate to severe COPD patients. There were statistical differences in airway resistance indexes except X5 between the two groups before and after BDT both in the COPD and the asthma patients ( P lt;0. 05) . The rates of change in Z5, Fres, R5, and Rp were higher than those of FEV1% pred, especially higher in the asthma patients than in the COPD patients ( P lt; 0. 05) . Significant negative correlations between FEV1% pred and Z5, Fres, R5, Rp were revealed in the COPD and the asthma patients ( P lt;0. 01) .The correlation between Fres and FEV1% pred was most significant in the COPD and the asthma patients ( r = - 0. 561, - 0. 761) . Conclusion Airway resistances measured by IOS is sensitive indicators in detecting the airflow obstruction in COPD and asthma, and is useful in early and differential diagnosis of COPD and asthma.
Objective To evaluate the clinic outcomes of coronary artery bypass grafting （CABG） on patients of coronary artery disease complicated with chronic obstructive pulmonary disease（COPD）. Methods The data of 27 patients of coronary artery diseases complicated with COPD who had received CABG from Jan. 1998 to Dec. 2004, were retrospectively summarized. 18 patients received off-pump CABG （off-pump group）,and 9 cases received on- pump CABG （on-pump group）. All patients accepted the evaluation about clinical respiratory complications, oxygenation index （PaO2/FiO2）, related respiratory function index, plasma intercellular adhesion molecule 1 （ICAM-1） and the amount of neutrophil in pulmono-alveolar perfusion fluid at the different time point including the start of CPB （for off-pump group, the measurement accepted at the start of operation）, end of CPB （end of operation for off-pump group）, and at 2, 6, 12, and 24h after operation. Results There was no operation-related death in two groups. One died of respiratory failure 14 days after operation in the hospital in off-pump group, there were more respiratory complications in on-pump group than that in off-pump group, and PaO2/FiO2 in on-pump group was higher than that in off-pump group at CPB 30min （at the start of operation）, but lower than that in off-pump group postoperative at 6 h, 12 h（P〈0. 05）, the concentration of plasma ICAM-1 had obvious difference between two groups from CPB 30 min （at the start of operation） to post-operative 24 h （P 〈 0. 05）. The neutrophils in bronchoalveolar lavage in on-pump group was higher than that in off-pump group from CPB 30 min （at the start of operation） to 24 h after operation （P〈0. 05）. Conclusion Off-pump CABG seems more suitable than on-pump CABG for coronary artery disease patients with COPD due to less damage on oxygen-exchange capability and less respiratory complication.
【Abstract】 Objective To observe the plasma levels of adiponectin and interleukin-17 ( IL-17) in patients with chronic obstructive pulmonary disease ( COPD) at acute exacerbation or stable stage, and analyze their relationship. Methods Sixty male COPD patients with normal weight ( with BMI range of 18. 5-24. 9 kg/m2 ) were enrolled, including 30 patients with acute exacerbations of COPD ( AECOPD) and 30 patients with stable COPD. Twenty healthy nonsmoking male volunteers were included as controls. The plasma levels of adiponectin and IL-17 as well as lung function ( FEV1% pred and RV% pred) were measured in all subjects. Results The concentrations of adiponectin and IL-17 were significantly higher in the AECOPD patients than those of the patients with stable COPD and the contro1s ( P lt; 0. 001) . Theconcentrations of adiponectin and IL-17 were significantly higher in the patients with stable COPD than those of the controls ( P lt;0. 01) . Adiponectin was positively correlated with IL-17 in the AECOPD patients ( r =0. 822, P lt;0. 001) and in the patients with stable COPD ( r =0. 732, P lt;0. 001) . Adiponectin was positivelycorrelated with RV% pred in the AECOPD patients ( rs = 0. 764, P lt;0. 001) and in the patients with stable COPD ( rs =0. 967, P lt;0. 001) . There was no significant relationship between adiponectin and FEV1% pred ( P gt;0. 05) . Conclusions The plasma level of adiponectin in COPD patients is elevated which is relatedwith excessive inflation of lung. Adiponectin may be involved in the process of inflammation in COPD as a new pro-inflammatory cytokine.
Objective To study the effect of noninvasive positive pressure ventilation (NPPV) in chronic obstructive pulmonary disease (COPD) patients with hypercapnic coma secondary to respiratory failure.Methods COPD patients with or without coma secondary to respiratory failure were both treated by bi-level positive airway pressure (BiPAP) ventilation on base of routine therapy.There were 32 cases in coma group and 42 cases in non-coma group.Such parameters as arterial blood gas (ABG)，Glasgow coma scale (GCS)，time of NPPV therapy，achievement ratio，and adverse effects were investigated.Results 30 patients in the coma group were improved after NPPV treatment (26 cases recovered consciousness treated by BiPAP in 2 hours，3 cases recovered between 3~8 hours，1 case recovered after 24 hours).The parameters of ABG，the tidal volume and the minute ventilation volume were improved after BiPAP.The time of effective therapy was (9±4) days in the coma group and (7±3) days in the non-coma group with no significant difference (Pgt;0.05).The achievement ratio was similar in two groups (93.75% vs 97.62%，Pgt;0.05).But the incidence of gastrointestinal tympanites reached to a higher level in the coma group (80.5%) than the non-coma group (10.6%).Conclusion COPD patients with hypercapnic coma secondary to respiratory failure isn’t the absolute contraindication of NPPV treatment.
Objectives To evaluate pulmonary physicians’knowledge level about prevention and treatment of chronic obstructive pulmonary disease( COPD) in some urban areas in China. Methods A total of 258 pulmonary physicians were interviewed face-to-face in 24 hospitals from July to October in 2006. The questionnaire included the knowledge of COPD, prescriptions at initial visit and follow-up, pulmonary function test monitoring, assessment and intervention in stable COPD, knowledge and evaluation of the commonly used medicines, the effects of smoking cessation and adopted measures, as well as the knowledge of treatment prospects and patients’ education. Results Eighty-eight percent of pulmonary physicians considered themselves knowledgeable on COPD, and 95% were familiar with the severity classification. Most of them knew about GOLD and Chinese Guideline of Prevention and Treatment to COPD, and paid attention to chest X-ray and pulmonary function test during diagnosis. The standards in evaluation of stable COPD patients were not well understood, and 92% of physicians claimed for pulmonary function test in stable stage. Seventy-nine percent of physicians actively suggested the patients quit smoking. The prescription for COPD patients at iniative and maintenance therapy met the guideline on the whole, but the mucolytic agents were appreciated too much and used too frequently. Thirty-three percent of physicians took it necessary to treat stable COPD,and 69% believed that pharmacotherapy for stable COPD could rersult in satisfactory quality of life.Conclusions In some big cities in China, the pulmonary physicians have good knowledge about COPD. But long-term prevention and intervention, especially in pharmacotherapy, are still unsatisfactory.
摘要:目的:应用区域阻抗法测定慢性阻塞性肺疾病（COPD）患者的肺血流灌注及肺通气分布的变化,与放射性核素肺显像方法比较,探讨肺区域阻抗方法的临床应用价值。 方法: 测定对象为18例中重度COPD患者,均为男性,平均年龄63.8岁,应用肺区域阻抗法及放射性核素法,分别测定肺血流灌注及肺通气的分布。〖HTH〗结果〖HTSS〗: 本研究发现肺区域阻抗法在测定肺血流灌注分布方面,仅在左下肺区域高于核素法测得的数值(Plt;0.05),余肺区测定结果相近,无显著差异。在肺通气的测定方面,阻抗法所得数值与核素法测得的数值有一定的不同,在左上、右上区域高于核素法测得的数值,在左中肺区测得的数值低于核素法测得的数值(Plt;0.05),余肺区测定结果相近,无显著差异。结论: 虽然目前区域阻抗方法暂不能取代放射性核素的测定,但作为一种辅助手段,可简便、快速了解肺内的通气、血流等生理病理改变。Abstract: Objective: To evaluate the clinical capability of regional electric impedance pneumograph and scintigraphy in measurement of pulmonary perfusion and ventilation in patients with COPD. Methods: Thirtytwo patients with different respiratory diseases underwent regional electric impedance pneumograph and scintigraphy, the pulmonary perfusion and ventilation were obtained and recorded. Results:The pulmonary perfusion results got by regional electric impedance pneumograph in the left lower region was lower than the results measured by scintigraphy, there were significant difference (Plt;0.05), and no difference in other pulmonary region. The pulmonary ventilation results got by regional electric impedance pneumograph in the both upper region were higher and in the left middle region were lower than the results measured by scintigraphy, there were significant difference(Plt;0.05), and no difference in other pulmonary region. Conclusion:The result got by regional electric impedance pneumograph could not replace the result got by scintigraphy at present, but this is a quick, simple,and convenient measurement to get parameter of the pulmonary perfusion and ventilation.
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.