ObjectiveTo investigate the association between serum thyroid hormone levels and prognosis for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) without thyroid disease, and explore the prognostic value of serum thyroid hormone levels for patients with AECOPD.MethodsThe clinical data of 239 hospitalized cases of AECOPD [149 males, 90 females, aged 42-92 (77.7±8.9) years] from January 2013 to November 2017 were retrospectively analyzed. Serum thyroid hormone levels including total tetraiodothyronin (TT4), total triiodothyronin (TT3), thyroid stimulating hormone (TSH), free tetraiodothyronin (FT4) and free triiodothyronin (FT3) were measured by chemiluminescence immunoassay. All patients were divided into a survival group and a death group according to the prognosis. Serum thyroid hormone levels were compared between two groups. Correlations of serum thyroid hormone levels with the occurrence of death in AECOPD patients were analyzed. The prognostic value of serum thyroid hormone levels for AECOPD patients was explored by receiveroperating characteristic (ROC) curve analysis. And the best cut-off value of serum thyroid hormone level in predicting the risk of death was calculated.ResultsSerum TT4, TT3, FT4 and FT3 levels in the survival group were significantly higher than those in the death group [TT4: (89.35±21.45) nmol/L vs. (76.84±21.33) nmol/L; TT3: (1.05±0.34) nmol/L vs. (0.72±0.19) nmol/L; FT4: (16.17±2.91) pmol/L vs. (14.45±2.85) pmol/L; FT3: (3.06±0.81) pmol/L vs. (2.24±0.72) pmol/L; all P<0.05]. The differences of serum TSH level between two groups were not statistically significant [0.98 (0.54-1.83)vs. 0.57 (0.31-1.84), P>0.05]. Spearman correlation analysis showed that serum TT4, TT3, FT4 and FT3 levels were significant correlated with the occurrence of death (r values were 0.226, 0.417, 0.220, 0.387, respectively, P<0.05). And there was no significant correlation between serum TSH level and the occurrence of death (P>0.05). ROC curve analysis was done between serum thyroid hormone levels (TT4, TT3, TSH, FT4 and FT3) and the occurrence of death in the AECOPD patients. The areas under ROC curve were 0.659, 0.793, 0.588, 0.655 and 0.772, respectively. Serum TT3 was the best indicator for predicting the occurrence of death. When serum TT3 level was 0.85nmol/L, the Youden index was the highest (0.486), with a sensitivity of 70.2%, and a specificity of 78.3%. It was the best cut-offl value of serum TT3 to predict the risk of death in AECOPD patients.ConculsionsSerum thyroid hormone levels are significant associated with the prognostic for AECOPD patients. There is certain value of serum thyroid hormone levels in prognostic evaluation of AECOPD 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 summarize the association between CYP1A1 rs4646903 polymorphisms and COPD risk. Methods Systematic literature search was conducted (up to January 2016) in five online databases, ie. PubMed, Embase, China National Knowledge Infrastructure (CNKI), VIP database, and WanFang databases. The strength of association was calculated by odds ratio (OR) and corresponding 95% confidence interval (CI). Results Six case-control studies with 1 050 cases and 1 202 controls were included. This study suggested a significant association between the CYP1A1 rs4646903 polymorphism and COPD risk (CC vs. TT: OR=1.63, 95%CI 1.17-2.27, P=0.004; CC vs. TC+TT: OR=1.62, 95%CI 1.19-2.20, P=0.002). However, there was no significant difference between allele model (C vs. T, OR=1.20, 95%CI 0.95-1.51, P=0.118) and dominant model (CC+TC vs. TT, OR=1.19, 95%CI 0.82-1.72, P=0.366). Conclusions The CYP1A1 rs4646903 polymorphisms might alter the susceptibility of COPD. More well-designed studies with larger sample size are warranted.
Objective To evaluate the clinical relationship between serum carcinoembryonic antigen (CEA) and mortality of anti-melanoma differentiation associated gene 5 (MDA5) antibody positive dermatomyositis with interstitial lung disease (ILD). MethodsThe consecutive clinical data of 214 patients with anti MDA5 antibody positive dermatomyositis from West China Hospital of Sichuan University from February 2017 to September 2019 were collected retrospectively, including demographic, laboratory examination and imaging examination data. Patients were divided into CEA elevated group (CEA≥4.63 ng/mL) and CEA normal group (CEA<4.63 ng/mL) according to CEA level. R4.1.2 software was used for statistical analysis of all data, and Kaplan Meier method was used to draw the survival curve. Cox proportional hazard model was used to analyze the survival of patients with ILD, and to explore the risk factors associated with the survival of patients with anti-MDA5 antibody positive dermatomyositis with ILD. Results There were 180 patients with ILD who met the inclusion and exclusion criteria, 57 patients with rapidly progressive pulmonary interstitial fibrosis (RPILD), and 123 patients without RPILD; 121 women and 59 men, with an average age of 50.2±10.7 years; The average follow-up was 23.5 months, and 52 patients died. Univariable analysis suggested that CEA≥4.63 ng/mL, smoking, RPILD, lactate dehydrogenase (LDH) ≥321 IU/L, albumin<30 g/L and dyspnea were risk factors associated with death in patients with anti MDA5 dermatomyositis combined with ILD. Multivariable Cox regression analysis showed that CEA≥4.63 ng/mL [hazard ratio (HR) =3.01, 95% confidence interval (CI) 1.23 - 7.32, P=0.015], RPILD (HR=3.87, 95%CI 2.09 - 7.19, P<0.001), smoking (HR=2.37, 95%CI 1.25 - 4.47, P=0.008), LDH≥321 IU/L (HR=2.47, 95%CI 1.23 - 4.96, P=0.011), albumin<30 g/L (HR=2.57, 95%CI 1.38 - 4.78, P=0.003) were independent predictors for mortality. ConclusionsSerum CEA level can be used as a clinical prognostic predictor in patients with anti-MDA5 positive dermatomyositis and ILD. RPILD, smoking, LDH≥321 IU/L, and albumin<30 g/L are independent predictors for mortality.
Objective To systematically evaluate risk prediction models for acute exacerbation of chronic obstructive pulmonary disease (COPD), and provide a reference for early clinical identification. Methods The literature on the risk prediction models of acute exacerbation of COPD published by CNKI, VIP, Cochrane, Embase and Web of Science database was searched in Chinese and English from inception to April 2022, and relevant studies were collected on the development of risk prediction models for acute exacerbations of COPD. After independent screening of the literature and extraction of information by two independent researchers, the quality of the included literature was evaluated using the PROBASTA tool. Results Five prospective studies, one retrospective case-control study and seven retrospective cohort studies were included, totally 13 papers containing 24 models. Twelve studies (92.3%) reported the area under the receiver operator characteristic curve ranging 0.66 to 0.969. Only five studies reported calibrated statistics, and three studies were internally and externally validated. The overall applicability of 13 studies was good, but there was a high risk of bias, mainly in the area of analysis. Conclusions The existing predictive risk models for acute exacerbations of COPD are unsatisfactory, with wide variation in model performance, inappropriate and incomplete inclusion of predictors, and a need for better ways to develop and validate high-quality predictive models. Future research should refine the study design and study report, and continue to update and validate existing models. Secondly medical staff should develop and implement risk stratification strategies for acute exacerbations of COPD based on predicted risk classification results in order to reduce the frequency of acute exacerbations and to facilitate the rational allocation of medical resources.
《Lancetgt;杂志2007年9月9589号的封面以“目前在中国人口中估计有超过190万死于从不吸烟的被动吸烟者”为警示，并组织了一期慢性阻塞性肺疾病(COPD)专辑，涉及内容广泛且颇具新意。
Objective To explore the differences in lung function, neutrophil polarization, and serum total immunoglobulin E (IgE) levels among bronchial asthma patients, chronic obstructive pulmonary disease (COPD) patients, and asthma-COPD overlap syndrome (ACO) patients. Methods The retrospective analysis enrolled 127 patients with respiratory system diseases diagnosed and treated in Wuwei People’s Hospital between March 2016 and March 2019. Among them, 45 patients with moderate and severe bronchial asthma were in included the asthma group, 42 patients with acute exacerbations of COPD were included in the COPD group, and 40 patients with moderately persistent and severely persistent ACO were included in the ACO group. Forty-eight healthy examinees in the same period were selected as the control group. The pulmonary function [forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1 to FVC (FEV1/FVC) ratio, and percentage of FEV1 to predicted value (FEV1%pred)], neutrophil polarization, and serum total IgE levels of the four groups were compared. Results In the control group, the ACO group, the asthma group, and the COPD group, the FEV1 values were (3.65±0.79), (2.04±0.58), (1.81±0.46), and (1.59±0.43) L, respectively, the FVC values were (4.13±0.92), (3.18±0.76), (2.69±0.63), and (2.43±0.58) L, respectively, the serum total IgE levels were (92.36±12.20), (334.81±55.96), (455.61±65.59), and (142.65±28.36) U/mL, respectively, and the between-group differences were all statistically significant (P<0.05). In addition, the FEV1/FVC ratios in the asthma group, the COPD group, and the ACO group were (67.93±11.51)%, (63.81±9.22)%, and (61.28±9.23)%, respectively, the FEV1%pred levels were (74.55±11.70)%, (63.29±8.60)%, and (61.34±7.91)%, respectively, which were lower than those in the control group [(83.60±7.18)% and (94.23±8.21)%] (P<0.05). The spontaneous polarization rates in the ACO group, the asthma group, the COPD group, and the control group were (29.43±5.58)%, (25.11±4.09)%, (16.28±4.51)%, and (7.18±2.12)%, respectively, the arbitrary polarization rates in the ACO group, the asthma group, the control group, and the COPD group were (30.01±5.29)%, (25.76±5.53)%, (21.42±4.36)%, and (19.85±5.00)%, respectively, the directional polarization rates in the asthma group, the ACO group, the control group, and the COPD group were (14.67±2.30)%, (8.21±1.81)%, (5.12±1.10)%, and (2.52±0.63)%, respectively, and the between-group differences were all statistically significant (P<0.05). Conclusion There are certain differences in lung function, neutrophil polarization, and serum immunoglobulin E level among patients with bronchial asthma, COPD, and asthma-COPD overlap syndrome.
Objective To investigate the changes of pulmonary diffusing capacity and pulmonary capillary blood volume in stable COPD patients with mixed ventilation dysfunction, and explore the possible pathophysiological factors. Methods 159 stable COPD patients with mixed ventilation dysfunction were recruited in the study and 36 normal subjects were recruited as control. The Belgium medisoft box5500 was used to determine the pulmonary ventilation function, lung capacity, and pulmonary diffusing capacity. The measured parameters included forced vital capacity ( FVC) , forced expiratory volume in one second ( FEV1 ) ,maximal voluntary ventilation ( MVV) , vital capacity ( VC) , total lung capacity( TLC) , residual volume ( RV) , minute volume of alveolar ventilation ( VA ) , lung diffusing capacity for carbon monoxide ( DLCO) , pulmonary membrane diffusing capacity for carbon monoxide ( DMCO) , and pulmonary capillary blood volume ( Vc) . The above parameters were compared between the COPD patients and the normal subjects. The relationship was analyzed between DLCO% pred, DMCO% pred, Vc% pred and all the ventilation parameters. Results In stable COPD patients with mixed ventilation dysfunction, all parameters of pulmonary ventilation function, lung capacity, and pulmonary diffusing capacity were significantly different from the normal subjects ( Plt;0. 05 or Plt;0.01) . FVC, VC, VA, and DMCO of the COPD patients were about 66% of the calculated value or more. The average TLC%pred was a little higher than the normal. FEV1 , MVV, DLCO and Vc were abnormally lower which were between 36% ～44% . The average RV%pred was 188% of the predicted value. Obvious correlation could be detected between DLCO% pred, DMCO% pred, Vc%pred and FEV1%pred, FEV1/FVC, TLC% pred, RV%pred, RV/TLC and VA% pred etc.Conclusions In COPD patients with mixed ventilation dysfunction, the pulmonary blood capillary is damaged seriously which lead to a significant decrease of the capacity of pulmonary blood capillary, as well as seriously air distribution disturbance and ventilation/bloodstream mismatch. The Vc decline may develope before the impairment of pulmonary diffusing capacity which may contribute to the damaged of DLCO and DMCO.
ObjectiveTo determine the diagnostic value of serum KL-6 level in patients with interstitial lung diseases (ILD). MethodsAll the ILD patients enrolled were hospitalized from April 2013 to April 2014. Patients with other pulmonary diseases and healthy subjects were chosen as control groups simultaneously. Serum KL-6 concentrations were measured by chemiluminescent enzyme immunoassay. The association with serum KL-6 level and pulmonary function was analyzed. ResultsThere were 149 ILD patients, 155 patients with other pulmonary diseases, and 64 healthy subjects. The average serum levels of KL-6 were (1 801.86±2 831.36) U/mL, (267.00±124.41) U/mL, (201.28±81.18) U/mL in the patients with ILD, the patients with other pulmonary diseases and the healthy controls, respectively. The sensitivity and the specificity of the serum KL-6 for the diagnosis of ILD was 83.89% and 92.24% respectively when the cut-off level was set at 500 U/mL. The Kappa value was 0.767 (P < 0.001). The best cut-off value of KL-6 was 469.5 U/mL. Serum KL-6 levels in the patients with ILD were significantly higher compared with the patients with chronic obstructive pulmonary disease, pneumonia, tuberculosis, bronchiectasis and the healthy controls, respectively (all P < 0.001). The KL-6 levels in the pulmonary alveolar proteinosis patients were significantly higher compared with the patients with cryptogenic organizing pneumonia (COP), the patients with idiopathic pulmonary fibrosis (IPF) and the patients with connective tissue disease (CTD-ILD) (all P < 0.001). While the KL-6 concentration in IPF and CTD-ILD were significantly higher than that in COP (P=0.003 and P=0.008, respectively). Significant negative correlations were found between the levels of serum KL-6 and vital capacity as a percentage of the predicted value, forced vital capacity as a percentage of the predicted value, forced expiratory volume in one second as a percentage of the predicted value and carbon monoxide diffusing capacity as a percentage of the predicted value (all P < 0.001). Follow-up study showed the levels of serum KL-6 were consistent with clinical efficacy. ConclusionSerum KL-6 level is a reliable serum marker for ILD, and is related with the severity of disease and clinical efficacy.
ObjectiveTo analyze the correlation between the sarcopenia index (the ratio of creatinine to cystatin C, CCR) and the severity of chronic obstructive pulmonary disease (COPD), and evaluate its potential value as an indicator for auxiliary diagnosis of COPD and assessment of disease severity. Methods A total of 315 patients who underwent pulmonary function tests at Tongren People's Hospital from January 2022 to December 2022 were selected. Among them, 180 patients were diagnosed with COPD, and 135 patients were non-COPD. The COPD group was further divided into GOLD1 group (mild, n=36), GOLD2 group (moderate, n=70), and GOLD3 group (severe, n=74) according to Chronic Obstructive Lung Disease (GOLD) classification. The clinical data, laboratory indicators, and pulmonary function test results of the patients were collected. Correlation analysis was used to explore the correlation between CCR and clinical data. Binary logistic regression analysis was used to explore the influencing factors of COPD. A receiver operating characteristic curve was drawn, and the area under the curve (AUC) was calculated to evaluate the predictive value of CCR for COPD. ResultsAmong the 315 enrolled patients, the prevalence of COPD was 57.14% (180/315). The CCR level of the COPD patients was significantly lower than that of the non-COPD patients. The more severe the condition of COPD patients, the lower the CCR value. The results of Spearman correlation analysis showed that CCR was significantly positively correlated with diffusion capacity of the lung for carbon monoxide, forced expiratory volume in the first second (FEV1) as a percentage of predicted value, FEV1/forced vital capacity, albumin, eosinophils, endogenous creatinine clearance rate, low-density lipoprotein cholesterol, and haemoglobin, and significantly negatively correlated with C-reactive protein, D-dimer, age, and neutrophil to lymphocyte ratio (all P<0.05). Binary logistic regression showed that after adjusting for other relevant factors, CCR was found to be an independent risk factor for the occurrence of COPD (OR=0.902, 95%CI 0.879 - 0.925, P<0.05). When the CCR value was 77.450, the AUC was 0.841 (95%CI 0.798 - 0.885), with a sensitivity of 60.7% and a specificity of 96.1%.ConclusionCCR is closely related to the disease condition and its severity in patients with stable-phase COPD, and it is an independent influencing factor for the occurrence of COPD.