Objective To determine the efficacy of forced expiratory volume in six seconds( FEV6 ) as an alternative for forced vital capacity( FVC) in the diagnosis for mild-moderate chronic obstructive pulmonary disease( COPD) .Methods A total of 402 mild-moderate COPD and 217 non-COPD patients’ spirometric examinations were retrospectively analyzed. The correlation between FEV6 and FVC, FEV1 /FVC and FEV1 /FEV6 was evaluated by the Spearman test. Considering FEV1 /FVC lt;70% as being the ‘golden standard’ for airway obstruction, a ROC curve was used to determine the best cut-off point for the FEV1 /FEV6 ratio in the diagnosis for COPD. Results The Spearman correlation test revealed the FEV1 and FEV6 , FEV1 /FEV6 and FEV1 /FVC ratios were highly correlated ( r = 0. 992, 0. 980, respectively, P = 0. 000) . Using FEV1 /FEV6 lt; 70% as the diagnosis standard, 12. 69% of the 402 patients could not be diagnosed as COPD. The FEV1 /FVC ratio of these patients was very close to 70% . The best cut-off point for the FEV1 /FEV6 ratio in the diagnosis of mild-moderate COPD was 72% while the sensitivity and specificity were 94. 7% and 92. 2% , respectively. Conclusions There is a b correlation between FEV1 /FVC and FEV1 /FEV6 . The FEV6 can be a valid alternative for FVC in the diagnosis for mild-moderate COPD, although it may result in false negative. The best cut-off point for the FEV1 /FEV6 ratio is 72% .
Objective To explore the predictive value of serum procalcitonin (PCT), D-dimer (D-D) and decoy receptor 3 (DcR3) for prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and respiratory failure undergoing non-invasive ventilation (NIV). Methods A total of 95 patients with AECOPD and respiratory failure undergoing basic treatment and NIV in the hospital were retrospectively enrolled between September (n=65) 2017 and February 2021. According to prognosis after treatment, they were divided into a good prognosis group and a poor prognosis group (n=30). The general data of all patients were collected. The influencing factors of prognosis were analyzed by multivariate logistic regression model. The levels of DcR3, PCT and D-D were detected by enzyme-linked immunosorbent assay, colloidal gold colorimetry and immunoturbidimetry. The patients condition was assessed by scores of acute physiology chronic health evaluation scoring system Ⅱ (APACHEⅡ). The partial pressure of arterial oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) were recorded. And the above indexes between the two groups were compared. The relationship between DcR3, PCT, D-D and APACHEⅡ score, PaO2, PaCO2 was analyzed by Pearson correlation analysis. The prognostic value of DcR3, PCT and D-D was analyzed by receiver operating characteristic (ROC) curve. Results There was no significant difference in gender, GOLD grading or underlying diseases between the poor prognosis group and the good prognosis group (P>0.05), but there were significant differences in age, DcR3, PCT, D-D, APACHEⅡ score, PaO2 and PaCO2 after treatment (P<0.05). DcR3, PCT, D-D, APACHEⅡ score and PaCO2 in the poor prognosis group were higher than those in the good prognosis group, while PaO2 was lower than that in the good prognosis group (P<0.05). Logistic regression analysis showed that DcR3 ≥5.50 ng/mL (OR=21.889), PCT ≥ 5.00 μg/L (OR=3.782), D-D ≥3.00 μg/L (OR=4.162) and APACHEⅡ score ≥20 points (OR=2.540) were all influencing factors of prognosis (P<0.05). The results of Pearson correlation analysis showed that DcR3, PCT and D-D were positively correlated with APACHEⅡ score and PaCO2, while negatively correlated with PaO2 (P<0.05). The results of ROC curve analysis showed that area under ROC curve of DcR3, PCT and D-D for predicting the prognosis were 0.745 (95%CI 0.631 - 0.859), 0.691 (95%CI 0.579 - 0.803) and 0.796 (95%CI 0.696 - 0.895), respectively (P<0.05). Conclusion The serum DcR3, PCT and D-D levels are related to disease progression in patients with AECOPD and respiratory failure after NIV, which have good predictive efficiency for prognosis and can be applied as important biological indexes to evaluate prognosis and guide treatment.
【摘要】 目的 探討慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）治療方案及藥學監護的內容。 方法 以2007年12月收治的1例COPD患者為例，結合COPD治療指南，為COPD急性加重期患者制定個體化的藥學監護計劃并實施全程的藥學監護。 結果 患者COPD急性加重期的藥物治療方案有效合理。通過全程的藥學監護，及時發現和解決了患者藥物治療的問題，為臨床合理用藥提供了意見。 結論 對COPD患者實施藥學監護具有可行性和實用性。【Abstract】 Objective To investigate the treatment and pharmaceutical care for chronic obstructive pulmonary disease (COPD) patients. Methods In December 2007, a patient with COPD was diagnosed, and based on the clinical data, COPD treatment guidelines were adopted to analyze treatment plans. For patients with acute exacerbation of COPD, individualized pharmaceutical care plan was proposed, and pharmaceutical care was performed during the whole course of disease. Results The drug treatment for the one patient with acute exacerbation of COPD was effective and reasonable. Treatment problems were observed and solved through pharmaceutical care which had given reasonable suggestions for medication. Conclusion The implementation of pharmaceutical care for COPD patients is feasible and practical.
目的 探討慢性阻塞性肺疾病急性加重（AECOPD）合并肺栓塞（PE）的臨床特點。 方法 回顧性分析2009年1月－2012年6月38例AECOPD合并PE患者（栓塞組）的臨床資料，并與42例單純AECOPD（對照組）臨床資料進行對比。 結果 栓塞PE組不對稱性下肢水腫發生率明顯高于對照組（P＜0.05），另外肺動脈高壓、D-二聚體及修改的Geneva評分與對照組比較存在一定差異，且差異有統計學意義（P＜0.05）。 結論 AECOPD合并PE的臨床表現并不特異，當AECOPD出現不對稱性水腫、D-二聚體升高、肺動脈高壓及修改的Geneva評分升高等表現不能解釋原因時，要考慮PE的可能，并盡快選擇CT肺動脈成像或肺動脈造影以明確診斷。