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.
Objective To investigate the expression and significance of Fork head /winged helix protein 3 (Foxp3) , retinoic acid-related orphan receptorγt (RORγt) , and interleukin-17 (IL-17) in Guinea pigs with emphysema. Methods Smoking and active immunization with elastin were separately used in guinea pigs to establish emphysema model. Then the destruction of lung tissue was assayed by measurement of the average radius of alveolar. The expressions of Foxp3 , RORγt, and IL-17 in lung tissue of the guinea pigs were detected by immunohistochemical technique. The results were compared with the normal control group by the analysis of variance or kruskal-Wallis test. Spearman rank correlation was used to analyze the correlation between the ratio of Foxp3/RORγt and IL-17, also the correlation between Foxp3/RORγt and the average radius of alveolar. Results In the smoking group and the active immunization group, the average radius of alveolar were significantly longer than the control group (Plt;0.05) . And the expression of Foxp3/RORγt was significantly unbalanced, with the number of Foxp3-positive cells decreased and RORγt-positive cells increased (Plt;0.05) . Meanwhile the level of IL-17 was significantly increased compared with the control group ( Plt;0.05) . The difference between the smoking group and the active immunization group was not significant (Pgt;0.05) . The ratio of Foxp3/RORγt was negatively correlated with the level of IL-17 and the average radius of alveolar. Conclusions Active immunization with elastin can induce emphysema in guinea pigs. The Foxp3/RORγt expression was unbalanced in lung tissue of guinea pigs with emphysema.This imbalance may be an important mechanism attributed to the disordered expression of CD4+ Treg cells and Th17 cells, which may be involved in autoimmune regulation and development of chronic obstructive pulmonary disease.
Objective To investigate the therapeutic effects of tiotropium in the treatment of stable COPD ( chronic obstructive pulmonary disease) patients of group D. Methods Sixty-two subjects with stable COPD in group D classified by combined COPD assessment in GOLD 2011, were randomly divided into a treatment group ( n = 32) and a control group ( n = 30) . The treatment group was treated with tiotropium ( 18 μg, inhalation, once daily) plus salmeterol /fluticasone ( 50/500 μg, inhalation, twice a day)and the control group was treated only with salmeterol / fluticasone ( 50/500 μg, inhalation, twice a day) . The exercise tolerance, dyspnea score and lung function were measured before and 1, 8,24, and 48 weeks after the treatment respectively. Results 8, 24, 48 weeks after the treatment respectively, there were improvements of 6 minute walk test and the dyspnea score of medical research council scale( MRC) in both groups than before treatment, and which was better in the treatment group. Compared with baseline and the control group, significantly greater improvements in the FVC, FEV1 and FEV1% pred were seen in the treatment group at all time points. In the control group, FVC, FEV1 and FEV1% pred 1 and 8 weeks after treatment were higher than those before treatment, but there was no significant difference after treatment of 24 and 48 weeks.Conclusion Combination treatment with tiotropium and salmeterol / fluticasone inhalation results in greater therapeutic benefits than salmeterol / fluticasone inhalation alone in stable COPD patients of group D.
Objective To investigate the prethrombotic state and effect of anticoagulation therapy in patients with chronic obstructive pulmonary disease(COPD) and ventilator-associated pneumonia (VAP)．Methods Forty-six COPD patients were divided into VAP group(25 cases)and non-VAP group (21 cases)．The VAP group were randomly subdivided into two groups：group A(conventional therapy group，n=13)，group B(conventional therapy+anticoagulation therapy group，n=12)．The D-dimer (DD)，fibfinogen(FIB)，pulmonary artery pressure(PAP)and the time of weaning were compared between these groups．Results In the COPD patients，the levels of DD，FIB and PAP were significantly increased in VAP group compared with non-VAP group[(0．50±0．26)mg／L，(3．67 ±0．88) L，(31．71 ± 5．66)mm Hg vs(0．23±0．12)mg／L，(1．56±0．45) L，(15．28 ±2．84)mm Hg，respectively，all Plt; 0．05]．In the COPD patients with VAP，the levels of DD，the content of FIB，PAP and mortality were significantly lower in group B with shorter time of weaning compared with group A[(0．22±0．16)mg／L， (1．56±1．17)g／L，(16．00±2．48)him Hg，8．33％ and(4．00±1．41)d vs(O／41±0．09)mg／L，(3．66± 1．03) L，(28．00±0．85)mm Hg，15．4％ and(10．76±3．35)d，respectively，all Plt;0．05]． Conclusions Prethrombotic state exists in COPD patients with VAP．Aggressive anticoagulation on base of routine therapy，by ameliorating microcireulation，call shorten the time of weaning and reduce the mortalit in these patient
Objective To investigate the role of inflammatory factors like serumleptin, adiponectin,interleukin-6( IL-6) , and C-reactive protein ( CRP) in the systemic inflammatory response of smokinginduced COPD. Methods Thirty male Wistar rats were randomly divided into three groups, ie. a high-dose smoking group, a low-dose smoking group, and a control group. Serum leptin, adiponectin, IL-6, and CRP levels were measured by ABC-ELISA. Results The serum leptin and adiponectin levels in both smoking groups decreased significantly compared with the control group( P lt; 0. 05) , while the difference was not significant between the two smoking groups ( P gt; 0. 05) . The serum IL-6 and CRP levels in both smoking groups increased significantly compared with the control group( P lt; 0. 05) , which were higher in the highdosesmoking group than those in the low-dose smoking group( P lt;0. 05) . Conclusions Smoking increases the serum levels of IL-6 and CRP, but reduces the serum levels of leptin and adiponectin in rats. These results suggest that leptin, adiponectin, IL-6, and CRP may be involved in the systemic inflammatory response of smoking-induced 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.
Objective To observe the value of serum soluble receptor of advanced glycation endproducts (sRAGE) combined with lung function and high resolution lung CT (HRCT) in predicting the risk of chronic obstructive pulmonary disease (COPD) developing non-small cell lung cancer (NSCLC). Methods From January 2019 to June 2021, 140 patients with COPD combined with NSCLC, 137 patients with COPD, and 133 patients with NSCLC were enrolled in the study from the People's Hospital of Ningxia Hui Autonomous Region. General data, clinical symptoms, pulmonary function indexes and HRCT emphysema indexes (EI) were collected. Serum sRAGE levels of these patients were measured by enzyme linked immunosorbent assay. Clinical characteristics of patients with COPD complicated with NSCLC were analyzed. Serum sRAGE, lung function and lung HRCT were combined to evaluate the correlation between the degree of emphysema and the occurrence of NSCLC in COPD, and receiver operator characteristic (ROC) curve analysis was performed for diagnostic efficiency. Results Compared with NSCLC group, COPD combined with NSCLC group had higher proportion of male patients, higher proportion of elderly patients, higher smoking index, and higher proportion of squamous cell carcinoma (P<0.05). FEV1 and FEV1%pred in COPD combined with NSCLC group were significantly lower than those in COPD group and NSCLC group. The Goddard score and EI values of emphysema were significantly increased (P<0.05). Serum sRAGE was significantly lower than that of COPD group and NSCLC group (P<0.05). Serum sRAGE level was positively correlated with FEV1%pred (r=0.366, P<0.001) and FEV1/FVC (r=0.419, P<0.001), and negatively correlated with Goddard score (r=–0.710, P=0.001) and EI value (r=–0.515, P<0.001). Binary multi-factor logistic regression analysis showed that age, smoking index, EI, Goddard score, RV/TLC were positively correlated with the risk of COPD developing NSCLC, while FEV1%pred, FVC, FEV1/FVC and serum sRAGE were negatively correlated with the risk of COPD developing NSCLC. ROC curve results showed that the area under the curve (AUC) of single diagnosis of sRAGE was 0.990, and the optimal cut-off value of 391.98 pg/mL with sensitivity of 93.3% and specificity of 89.7%. The AUC of sRAGE combined with age, smoking index, EI, Goddard score, FEV1%pred, FVC, FEV1/FVC, RV/TLC was 1.000 with sensitivity of 96.7%, specificity of 96.6%, and Yoden index of 0.933. Conclusion The combination of serum sRAGE, lung function and HRCT emphysema score can improve prediction of NSCLC occurrence in COPD.
The Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease is produced based on important studies published in last five years and published online. So far it is the most influential evidence-based strategy for the diagnosis, treatment and prevention of chronic obstructive pulmonary disease to guide clinical professionals.
Objective?To investigate the relationship between syndromes of traditional Chinese medicine (TCM) and lung function in patients with chronic obstructive pulmonary disease (COPD) at stable phase. MethodsBased on diagnostic criterion of TCM, five groups of symptoms of TCM about stable COPD were established including lung Qi deficiency, lung and spleen Qi deficiency, lung and kidney Qi deficiency, lung Spleen Kidney Qi deficiency, and deficiency of both Qi and Yin. A total of 300 cases which were up to the standard were differentiated into 5 groups by the symptoms. Some basic details and lung function of the patients were recorded, and then statistical analysis was performed to analyze the differences of lung function among groups. ResultsForced expiratory volume in the first second in descending order was lung Qi deficiency group, lung and spleen Qi deficiency group, lung and kidney Qi deficiency group, and lung spleen kidney Qi deficiency group (P<0.05). ConclusionThese findings suggest that with the progressing of COPD, the symptom type of TCM for COPD patients at stable phase may vary from lung Qi deficiency to lung and spleen Qi deficiency, or to lung and kidney Qi deficiency, and even lung, spleen and kidney Qi deficiency. Lung function tests help reveal substance and pathogenesis of TCM syndromes of patients with stable COPD, and provide evidence for the clinical syndrome.
ObjectiveTo evaluate the effects of home mechanical ventilation (HMV) for stable chronic obstructive pulmonary disease (COPD) patients with respiratory failure in Tongzhou district of Beijing city. MethodsTwenty stable COPD patients with respiratory failure were included in the study.During the one-year follow-up period,4 patients died and 1 withdrew and 15 patients finished the follow-up.The patients was followed up by telephone each month and guided in drug administration,HMV,and rehabilitation therapy.At the beginning of the study and one year later,the patients were interviewed and accessed on the general data,nutritional status,COPD assessment test (CAT),Borg dyspnea and respiratory fatigue score,Hamilton depression scale,Hamilton anxiety scale,and arterial blood gas analysis. ResultsAt the end of one-year follow-up,nutrition index,CAT,Borg dyspnea and respiratory fatigue score,Hamilton depression scale,Hamilton anxiety scale,pH,and PaO2 did not change significantly (P>0.05),while PaCO2 decreased significantly compared with those at the beginning of the study (P<0.05).Compared with the past year,the times of hospitalization due to acute exacerbation of COPD was significantly reduced during the follow-up year (P<0.05). ConclusionHMV can ameliorate carbon dioxide retention and reduce times of hospitalization due to acute exacerbation of COPD for COPD patients with respiratory failure.