目的 比较2012版和2007版美国睡眠医学会判读标准(AASM₂₀₁₂和AASM₂₀₀₇)对慢性阻塞性肺疾病(COPD)合并阻塞性睡眠呼吸暂停(OSA)的诊断及其睡眠和临床特点的影响。方法 分别采用AASM₂₀₀₇与AASM₂₀₁₂分析41名稳定期COPD患者的睡眠呼吸事件,比较两种判读标准对COPD患者的呼吸暂停低通气指数(AHI),合并OSA的比例的影响;再对符合AASM₂₀₁₂但不符合AASM₂₀₀₇诊断的重叠综合征患者(OS_2012-2007)与仅符合AASM₂₀₀₇诊断的COPD患者(COPD_AASM2007)的睡眠参数和临床指标进行比较。结果 对比AASM₂₀₀₇,AASM₂₀₁₂显著增加COPD的睡眠呼吸暂停低通气指数(AHI)[1.0 (1.0, 7.5) h^-1 vs 11.5 (4.1, 25.1) h^-1, P<0.001],及合并OSA的比例(36.6% vs 70.7%, P<0.05)。OS_2012-2007与COPD_AASM20072组之间的微觉醒指数与3期睡眠比例有统计学差异,但其他睡眠参数、血压及高血压患病人数均无明显差异。结论 AASM₂₀₁₂显著增加COPD患者AHI,及合并OSA的比例,但初步的结果提示 AASM₂₀₁₂下新增的OS_2012-2007患者的病理损害相对少且轻。

Objective To compare the effects of the 2012 and 2007 American Academy of Sleep Medicine (AASM₂₀₁₂ and AASM₂₀₀₇) scoring criteria on the diagnosis, sleep and clinical characteristics of chronic obstructive pulmonary disease (COPD) with obstructive sleep apnea (OSA). Methods AASM₂₀₀₇ and AASM₂₀₁₂ were used to analyze the sleep respiratory events of 41 patients with stable COPD. Differences in apnea-hypopnea index (AHI) and diagnosis of OSA in COPD patients between AASM₂₀₀₇ and AASM₂₀₁₂ criteria were compared. Differences in sleep parameters and clinical indexes were compared between patients with overlap syndrome who met the AASM₂₀₁₂ not AASM₂₀₀₇ criteria (OS_2012-2007) and COPD patients who only met the AASM₂₀₀₇ criteria (COPD_AASM2007). Results Using the AASM₂₀₁₂ criteria, the number of AHI [1.0 (1.0, 7.5) h^-1 vs 11.5 (4.1, 25.1) h^-1, P<0.001] and the proportion complicated with OSA (36.6% vs 70.7%, P<0.05) significantly increased compared to the AASM₂₀₀₇ criteria. There was a significant difference between OS_2012-2007 and COPD_AASM2007 in arousal index and third stage of sleep, but no significant difference in other sleep parameters, blood pressure and the number of patients with hypertension. Conclusions Using AASM₂₀₁₂ significantly increased AHI and the proportion complicated with OSA in COPD patients, but the preliminary results demonstrated that pathological damages of OS_2012-2007 were relatively mild.

目的 研究集体呼吸操对慢阻肺稳定期患者的执行率影响效果。方法 选取连州市人民医院呼吸内科、ICU 2019年6月—2020年6月收治的120例慢阻肺稳定期患者为研究对象,以随机数字表法分为试验组与对照组,每组各60例,对照组采取一对一训练,试验组采取集体呼吸操,对两组执行率、肺功能、六分钟步行距、圣乔治呼吸问卷(St. George's Respiratory Questionnaire Application,SGRQ)评分进行对比。结果 试验组执行率90.00%,与对照组75.00%相比较,差异有统计学意义(P＜0.05);护理前两组肺功能、六分钟步行距离、SGRQ评分相比较,差异无统计学意义(P＞0.05),护理后4周、护理后8周与护理前相比较,差异有统计学意义(P＜0.05); 试验组护理后4周、护理后8周肺功能、六分钟步行距、SGRQ评分与对照组相比较,差异有统计学意义(P＜0.05)。结论 集体呼吸操有助于提高慢阻肺稳定期患者执行率,进一步改善其肺功能以及运动耐力水平,值得在今后护理工作中推广使用。

Objective To study the effect of collective breathing exercises on the execution rate of patients with stable COPD. Methods A total of 120 patients with stable chronic obstructive pulmonary disease admitted to the department of respiratory medicine and ICU of Lianzhou People's Hospital from June 2019 to June 2020 were selected as the research objects. They were divided into the experimental group and the control group by a random number table. For 60 cases, the control group took one-to-one training, and the test group took collective breathing exercises. The performance rate, lung function, six-minute walk distance, and St. George's Respiratory Questionnaire Application (SGRQ) scores were compared between the two groups. Results The execution rate of the experimental group was 90.00%, compared with 75.00% of the control group, the difference was statistically significant (P<0.05); there was no statistically differences in lung function, six-minute walking distance, and SGRQ score between the two groups before nursing ( P>0.05), 4 weeks after nursing, 8 weeks after nursing, and before nursing, the difference was statistically significant (P<0.05); in the experimental group, 4 weeks after nursing, 8 weeks after nursing, lung function, six-minute walking distance, SGRQ score was compared with the control group, the difference was statistically significant (P<0.05). Conclusion Group breathing exercises may help improve the performance rate of patients with chronic obstructive pulmonary disease in stable phase, and further improve their lung function and exercise endurance. It is worth popularizing in future nursing work.

目的 应用iTRAQ联合质谱技术筛选COPD大鼠肺组织差异表达蛋白。方法 20只雄性SD大鼠(200~220 g),随机分为对照组和模型组,每组10只,采用熏烟法建立COPD大鼠模型。观察大鼠肺组织病理学改变,测定肺功能,BALF白细胞数,肺组织总蛋白iTRAQ标记后质谱鉴定,用生物信息学方法分析蛋白表达变化。结果 与对照组相比,模型组大鼠支气管黏膜下肌层增厚,肺内可见大量炎性细胞浸润,肺功能降低,BALF白细胞数升高(均P<0.05)。质谱鉴定出4 916种蛋白,筛选出468个差异表达蛋白,其中285个表达上调,183个表达下调。筛选了上皮细胞粘着连接蛋白、fMLP、整合素等与COPD相关蛋白。结论 基于iTRAQ技术的蛋白质组学方法筛选出COPD大鼠差异表达蛋白,为进一步研究COPD的发生机制奠定了基础。

Objective iTRAQ and mass spectrometry were used to screen the differentially expressed proteins in the lung of COPD rats. Methods 20 male SD rats (200-220g)were randomly divided into control group and treatment group, with 10 rats in each group. COPD rat model was established by smoking. The lung function, the number of BALF leukocytes, the total protein iTRAQ in lung tissue were measured and identified by mass spectrometry. The differentially expressed proteins were identified by bioinformatic analysis. Results Compared with the control group, the submucous layer of bronchus in the model group was thickened, a large number of inflammatory cells were seen in the lung, the lung function was reduced, and the number of BALF leukocytes was increased. 4 916 proteins were identified by mass spectrometry, 468 differentially expressed proteins were screened, 285 of which were up-regulated and 183 down regulated. Among them, the important COPD related proteins were epithelial adhesion connexin, fMLP and integrins. Conclusion iTRAQ technology screened out the differentially expressed proteins of COPD rats, which laid the foundation for the further study of COPD mechanism

目的 了解我区慢性阻塞性肺疾病(COPD)稳定期患者药物使用现状,为临床规范治疗COPD指明方向。方法 对在我院治疗的COPD患者采取问卷调查的方式对其稳定期自我用药情况进行调查分析,调查内容包括吸烟史、病程、稳定期用药的种类、用药方式等。结果 我区COPD患者稳定期治疗药物种类繁多,应用LABA/ICS、吸入LAMA比例较低,存在滥用口服抗生素及无指征使用口服激素等不规范用药情况。结论 我区COPD患者稳定期药物部分符合COPD指南推荐,但存在不规范用药。

目的 探讨集束化护理模式在AECOPD并呼吸衰竭患者初次无创通气中的作用。方法 选我院2016年10月—2018年12月收治AECOPD并呼吸衰竭需初次无创通气的患者为研究对象,随机分为对照组和观察组,对照组予传统护理,观察组予集束化护理,各30例;分别记录两组患者每日无创通气时间、总住院时间、循环呼吸指标(HR、RR)、指尖血氧饱和度、血气分析、并发症、患者满意度和护理质量。结果 观察组患者的每日无创通气时间,指尖血氧饱和度、pH值、氧分压和二氧化碳分压改善均优于对照组,并发症发生率和住院时间低于对照组,满意度和护理质量较高(P<0.01)。结论 集束化护理可以提高AECOPD并呼吸衰竭患者无创通气的疗效,减少并发症、缩短住院天数,改善预后。

目的 分析稳定期慢性阻塞性肺疾病患者血浆可溶性尿激酶型纤溶酶原激活因子受体(suPAR)、IL-8和MMP-9的水平,探讨其在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者中的临床意义。方法 入选60例稳定期COPD患者设为观察组,再根据肺功能分为Ⅱ级、Ⅲ级及Ⅳ级亚组;同时选取同期健康体检者70例作为对照组,检测两组的血清suPAR、IL-8和MMP-9水平及肺功能,比较观察组跟对照之间的差异,同时比较Ⅱ级、Ⅲ级、Ⅳ级亚组及对照组之间的差异。结果 观察组血清suPAR、IL-8和MMP-9水平高于对照组;Ⅱ级、Ⅲ级及Ⅳ级各亚组的血清suPAR、IL-8和MMP-9均高于对照组;Ⅲ级及Ⅳ级组高于Ⅱ级组;以上差异均有统计学意义(P<0.05)。但Ⅲ级与Ⅳ级比较无差异(P>0.05)。结论 血清suPAR、IL-8和MMP-9在稳定期COPD患者中水平增高,且反映了其严重程度,有望成为COPD病情评估新指标及未来分子水平治疗的新靶点。

Objective To analyze the serum soluble urokinase-type plasminogen activator receptor, IL-8 and MMP-9 levels in stable chronic obstructive pulmonary disease and explore its clinical significance.Methods 60 patitents with stable COPD were selected as the observation group, and subdivided to subgroups stage Ⅱ, Ⅲ and Ⅳ. Meanwhile, 70 healthy individuals were enrolled as the control group. And then suPAR、IL-8 and MMP-9 levels and pulmonary function were measured in both groups. The differences between both groups as well as all the subgroups were compared.Results The suPAR level of the observation group was higher than that of the control group. Also, compared with the control group, stage Ⅱ, Ⅲ and Ⅳ subgroups showed much higher level of suPAR,IL-8,MMP-9. And it was higher in stageⅢand Ⅳthan in stageⅡ. However, there was no difference between Stage Ⅲ and Ⅳ.Conclusion The suPAR,IL-8 and MMP-9 level are higher in COPD patients and are related to the severity of stages. Therefore, it could be an appropriate biomarker as well as a novel target for future therapy and further evaluation.

目的 分析慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并肺动脉高压(pulmonary hypertention,PH)的危险因素。方法 回顾2014年1月—2015年1月广州医科大学附属第一医院住院患者55例,经心脏彩色多普勒超声测量肺动脉收缩压(PASP),分为:轻度组(36≤PASP＜50 mmHg),中度组(51≤PASP＜70 mmHg)和重度组(PASP≥70 mmHg),分析比较三组临床特征,危险因素采用单因素及多因素Logistic回归分析。结果 年龄(75.3±11.6)岁,PASP为(52.6±15.1)mmHg。单因素分析中-重度PH与年龄、HCT、PaCO₂、PaO₂、D-二聚体有关;多因素Logistic回归分析确定3项危险因素:HCT[比值比(OR)=51.82,95% CI: 2.34～1149.02],RV(OR=4.53,95% CI: 2.83～7.27),及PaCO₂(OR=1.02,95% CI: 1.00～1.03)。结论 呼吸病相关PH多为轻-中度,高水平的HCT、RV直径及PaCO₂提示PH病情较重。

Objective To analyze the clinical risk factors of pulmonary hypertension (PH) associated with chronic obstructive pulmonary disease(COPD). Methods A total of 55 hospitalized patients from 2014 to 2015 were enrolled in the study and were classified into three groups according to pulmonary artery systolic pressure (PASP) with echocardiography as follows: the mild group (36≤PASP＜50 mmHg), the moderate group (51≤PASP＜70 mmHg) and the severe group (PASP≥70 mmHg). Clinical data were recorded and retrospectively analyzed. Results The average age of all patients was (75.3±11.6)years. Echocardiography showed a mean PASP was 52.6±15.1 mmHg. Age, hematocrit (HCT), partial pressure of carbon dioxide (PaCO₂), the oxygen partial pressure (PaO₂), D-dimer and right ventricular (RV) diameter (>20 mm) were associated with moderate-to-severe PH on an univariate regression analysis, while RV (diameter >20 mm)[odds ratio (OR)=4.53, 95% CI: 2.83～7.27], HCT(OR=51.82, 95% CI: 2.34~1149.02) and PaCO₂ (OR=1.02, 95% CI: 1.00-1.03), to these patients, were independent risk factors using the multiple logistic regression analysis. Conclusion PH related to respiratory diseases is mostly mild-to-moderate. Haemoptysis,high levels of RV diameter, HCT and PaCO₂ suggest a serious condition of patients with PH related to chronic respiratory disease.

目的 探讨吸烟对稳定期COPD患者炎症反应和肺功能的影响。方法 选取2013年8月—2016年9月我院门诊收治的稳定期COPD患者70例为研究对象,其中吸烟35例(X1组)、不吸烟35例(X2组),另选取同期入院的不吸烟健康志愿者35例纳入健康组,采用酶联免疫吸附试验(ELISA)测定血清白介素-6(IL-6)、白细胞介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)水平,以肺功能检测仪测定三组一秒用力呼气容积(FEV1)、一秒用力呼气容积/用力肺活量比值(FEV1/FVC)、FEV1占预计值百分比(FEV1％),并采用自拟症状评分表及简明健康调查简表(SF-36)评价呼吸困难程度及生活质量。结果 X1组IL-6、IL-8及TNF-α依次为(135.27±1.24)pg/mL、(189.45±1.14)pg/mL、(39.39±1.14)pg/mL,明显高于X2组、健康组(P均<0.05);X1组FEV1(0.75±0.14)L、FEV1/FVC(3.65±1.87)％、FEV1％(3.45±0.12)％低于X2组、健康组(P均<0.05);X1组症状积分(10.17±1.02)分较X2组、健康对照组高(P<0.05),而其SF-36评分(54.27±1.46)分明显低于X2及健康组(P<0.05);X2组上述指标与健康组比较亦有统计学意义(P均<0.05)。结论 吸烟可明显增加稳定期COPD患者IL-6、IL-8、TNF-α等炎症因子水平,同时降低肺功能,临床应采取措施进行有效干预,防止患者病情恶化。

目的 探讨慢性阻塞性肺疾病急性期加重期(AECOPD)患者血清降钙素原(PCT)、白介素6(IL-6)、超敏C反应蛋白(hs-CRP)水平变化及与肺功能的相关性。方法 选择121例COPD急性加重期患者为实验组研究对象,选取同期体检的80例稳定期COPD患者为对照组,比较两组患者血清PCT、IL-6、hs-CRP的差别,并对三者与COPD患者肺功能的相关性进行探讨。结果 实验组患者IL-6、hs-CRP水平显著高于对照组(P＜0.05)。实验组FEV1值、FEV1%显著低于对照组(P＜0.05)。Pearson分析显示,实验组hs-CRP与肺功能指标FEV1%呈负相关关系(r=-1.51,P=0.048)。结论 AECOPD患者的血清炎症因子水平明显高于COPD稳定期患者,血清炎症因子与慢阻肺患者肺功能损伤密切相关。

目的 探讨加味六君子汤联合经口营养补充对COPD稳定期伴营养不良患者营养状况和肺功能的影响。方法 收集呼吸内科COPD稳定期并伴营养不良的患者40例,分为试验组和对照组各20例。试验组在对照组基础上再给予加味六君子汤和经口营养补充,观察治疗前、治疗后3月的营养相关指标和肺功能指标,然后进行统计分析。结果 ①治疗后3月,试验组的体质量、白蛋白、前白蛋白和肺功能指标较治疗前均明显改善(P<0.05)。②与对照组比较,试验组的白蛋白、前白蛋白、血红蛋白均明显升高(P<0.05),肺功能亦有显著改善(P<0.05)。③上臂肌围(MAMC)、三头肌皮褶厚度(TSF)在治疗后的组内及组间比较差异均无统计学意义(P>0.05)。结论 加味六君子汤联合经口营养补充有助于COPD稳定期伴营养不良患者体质量增加、蛋白升高,营养状况好转,从而增加呼吸肌储备,改善患者肺功能。

Objective To observe the influence of modified-liujunzi-decoction combined with Oral nutritional supplements(ONS) on the nutrition status and lung function in patients with chronic obstructive pulmonary disease(COPD). Methods 40 patients of COPD stable phase with malnutrition were divided into two groups and each group with 20 cases. On the basis of the control group, the experimental group was given again modified-liujunzi-decoction and ONS. All cases were tested before and 3 months after treatment, for detecting the nutrition related index and lung function index; T-test was used for data statistical analysis. Results ①3 months after treatment, the body weight, serum albumin, prealbumin and lung function index of the experimental group were significantly improved compared with those before treatment (P<0.05). ②Compared with the control group, the serum albumin, prealbumin and hemoglobin were significantly increased in the experimental group (P<0.05), and lung function was also significantly improved (P<0.05). ③After treatment, the mid-arm muscle circumference (MAMC), triceps skinfold thickness (TSF) comparison of intra group and intra group differences were not statistically significant(P>0.05). Conclusion Modified-liujunzi -decoction combined with oral nutritional supplements help to increase body weight, protein, and improve nutritional status in patients of COPD stable phase with malnutrition, thereby increasing their respiratory muscle reserve and improving lung function.