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Evaluation of lung capacity and diffusing capacity in patients with chronic obstructive pulmonary disease

Objective To observe the changes in pulmonary function in chronic obstructive pulmonary disease (COPD) patients with different GOLD grades, diffusing capacity for carbon monoxide in percent predicted value (DLCO%pred), and the relationship between DLCO%pred and hyperinflation parameter, the ratio of residual volume to total lung capacity (RV/TLC). Methods Their age, sex, body mass index (BMI), and lung function parameters were recorded. Group according to GOLD grade, and compare the lung function among different groups; With DLCO%pred 60% as the cut-off value, the lung function of each group was compared. Pearson and Spearman correlation determined the relationship between DLCO%pred and age, RV/TLC, and other factors. Results Four hundred and thirty-one patients were enrolled. With the increase of GOLD grade, the pulmonary function became worse (P<0.05). Compared with DLCO%pred ≥ 60%, the group with DLCO%pred<60% had lower BMI (t=–5.642, P<0.001) and worse pulmonary function (P<0.001). The correlation analysis showed that BMI (r=0.352, P<0.001), forced vital capacity in percent predicted value (FVC%pred) (r=0.349, P<0.001), forced expiratory volume in one second in percent predicted value (FEV1%pred) (r=0.414, P<0.001), the ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) (r=0.434, P<0.001), peak expiratory flow in percent predicted value (PEF%pred) (r=0.335, P<0.001), maximal mid expiratory flow in percent predicted value (MMEF%pred) (r=0.405, P<0.001), inspiratory capacity in percent predicted value (IC%pred) (r=0.301, P<0.001) were positively correlated with DLCO%pred; while RV/TLC (r=–0.328, P<0.001), GOLD grade (r=–0.430, P<0.001) were negatively correlated with DLCO%pred; However, there was no significant correlation between age (r=–0.012, P=0.810), sex (r=0.076, P=0.117) and DLCO%pred. Conclusions With the increase of GOLD grade, DLCO%pred decreases, and RV/TLC increases. RV/TLC is negatively correlated with DLCO%pred. Attaching importance to the evaluation of hyperinflation and diffusing capacity of COPD patients is helpful in evaluating COPD in all aspects, and has particular clinical significance.

強迫振蕩技術應用于慢性阻塞性肺疾病無創通氣患者的臨床研究進展

中性粒細胞與淋巴細胞比值、血漿D-二聚體及B型鈉尿肽聯合檢測對慢性阻塞性肺疾病急性加重患者預后的預測意義

目的 探究聯合檢測中性粒細胞與淋巴細胞比值（neutrophil to lymphocyte ratio，NLR）、血漿 D-二聚體及 B 型鈉尿肽（B-type natriuretic peptide，BNP）水平預測慢性阻塞性肺疾病（簡稱慢阻肺）急性加重期患者預后的價值。方法 回顧性分析 2015 年 12 月—2018 年 2 月于四川大學華西醫院呼吸與危重癥醫學科住院治療的慢阻肺急性加重期患者 565 例，按照住院結局分為好轉組（n=469）和未愈或死亡組（n=96），收集患者的基本臨床資料和入院 24 h 內 NLR、血漿 D-二聚體及 BNP 檢查結果，進行組間比較，分析上述指標單獨及聯合檢測對慢阻肺急性加重患者住院結局的預測效能。結果 未愈或死亡組患者 NLR、血漿 D-二聚體、血漿 BNP 水平均顯著高于好轉組，差異有統計學意義（P<0.05）。在單獨預測慢阻肺急性加重患者預后方面，血漿 BNP 水平的曲線下面積最大，為 0.665（P<0.001），血漿D-二聚體的敏感性最高，為73.7%。與單獨預測相比，各指標聯合預測的曲線下面積提高為 0.681（P<0.001），敏感性提高為 81.1%。結論 聯合檢測NLR、血漿D-二聚體及BNP水平對預測慢阻肺急性加重患者預后有一定的價值，值得在臨床上推廣。

The value of neutrophil to lymphocyte ratio in acute exacerbations of chronic obstructive pulmonary disease

ObjectiveTo investigate the value of neutrophil/lymphocyte ratio (NLR) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) by detecting the relationship between NLR and other well-known inflammatory biomarkers.MethodsRetrospective study of 610 AECOPD cases was performed. In order to analyze the influence of NLR level on disease condition, treatment plan and prognosis, the clinical data with acute exacerbation were collected and the value of NLR in AECOPD were analyzed.ResultsThe level of NLR was higher in the group with pneumonia than that in the non-pneumonia group (P<0.05), and the more severe the pulmonary inflammation, the higher the NLR level (P<0.05). The level of NLR was higher in the group with heart failure and the group treated with ventilator and glucocorticoid (P<0.05). The NLR level was higher in the group of hospital stay over 14 days than the group of hospital stay less than 14 days (P<0.05). The NLR value of the death group was higher than that of the survival group (P<0.05). With the increase of NLR value, the mortality rate in hospital increased gradually. Compared with C-reactive protein and interleukin-6, NLR had the highest odds ratio by binary regression analysis. Cutoff value of NLR was 5.92 by analysis of receiver-operating characteristic curve with a sensitivity of 88% and a specificity of 51%, and the area under the curve in predicting in-hospital death was 0.727 (OR=4.112, 95% confidence interval 0.609 - 0.849, P=0.02).ConclusionsNLR can be used as an inflammatory marker to evaluate the severity of AECOPD and to predict the prognosis.

慢性阻塞性肺疾病急性加重期肺康復研究進展

慢性阻塞性肺疾病過度充氣的研究進展

高空、高原、地下空間環境對呼吸功能的影響

成人超重和肥胖患者體重指數與肺功能的關系

目的 探討成人超重和肥胖患者人體重指數（BMI）與肺功能的關系，并試圖分析極度肥胖（BMI>40 kg/m2）患者彌散功能的改變。 方法 回顧性收集2021年1月—2023年12月到四川大學華西醫院就診的超重和肥胖患者390例的一般資料和肺功能數據，根據患者身高和體重計算BMI。根據世界衛生組織肥胖分級，分為超重組（25 kg/m2≤BMI<30 kg/m2，n=37）、Ⅰ級肥胖組（30 kg/m2≤BMI<35 kg/m2，n=106）、Ⅱ級肥胖組（35 kg/m2≤BMI<40 kg/m2，n=110）和Ⅲ級肥胖組（BMI≥40 kg/m2，n=137）。采用方差分析或Wilcoxon配對符號秩檢驗比較根據BMI不同分組間患者的肺功能指標。Spearman或Pearson相關性分析判定BMI與肺功能各指標之間的相關性，并使用簡單線性回歸或分段線性回歸進行相關性分析。結果 不同BMI分組在超重和肥胖患者中年齡、性別和吸煙史的差異有統計學意義（P<0.05）。肺功能數據比較：Ⅲ級肥胖組用力肺活量占預計值百分比（FVC%pred）、肺總量占預計值百分比（TLC%pred）、肺活量占預計值百分比（VC%pred）、第1秒用力呼氣容積占預計值百分比（FEV1%pred）、最大呼氣流量占預計值百分比（PEF%pred）低于超重組和Ⅰ級肥胖組（P<0.05），超重組深吸氣量占預計值百分比（IC%pred）高于Ⅰ級肥胖組、Ⅱ級肥胖組和Ⅲ級肥胖組（P<0.05），超重組和Ⅰ級肥胖組肺一氧化碳彌散量占預計值百分比（DLCO%pred）低于Ⅱ級肥胖組（P<0.05），FEV1/FVC、峰值呼氣中段流量占預計值百分比（MMEF%pred）在四組之間沒有明顯差異。相關性分析顯示，VC%pred（r=–0.254，P<0.05）、TLC%pred（r=–0.151，P<0.05）與BMI呈負相關。BMI<40 kg/m2時，DLCO%pred與BMI正相關（r1=0.224，P<0.05）；BMI≥40 kg/m2時，DLCO%pred與BMI呈負相關（r2=–0.176，P<0.05）。結論 隨著BMI升高，超重和肥胖患者肺通氣功能下降，主要表現為限制性通氣功能障礙。當BMI<40 kg/m2時，超重和肥胖患者彌散功能隨BMI增加而升高，可能原因是其肺血容量增加使DLCO%pred升高；但BMI≥40 kg/m2時，患者彌散功能隨BMI增加而下降，可能原因是極度肥胖時肺泡組織受脂肪浸潤或結締組織沉積導致的擴散障礙。

Effects of N-acetylcystein on Patients with Stable COPD: A Meta-analysis

Objective　To estimate the effects of N-acetylcystein (NAC) combined with conventional treatment on the patients with stable COPD. Methods　Literatures published between January 1995 and September 2010 were searched in the databases including PubMed, CHEST, CNKI, CBM, VIP and WANGFANG for collecting the randomized control trials (RCTs) of NAC combined with the conventional treatment versus the conventional treatment on patients with stable COPD. The studies were screened according to the inclusive and exclusive criteria, the data were extracted, the quality was assessed and the meta-analysis was conducted with RevMan 5.0 software. Results　A total of seven RCTs including 404 patients with stable COPD were enrolled. The meta-analysis demonstrated that, a) the short-term usage of NAC could improve PaO2 (SMD=0.05 mmHg, 95%CI –0.23 to 0.32) and PaCO2 (SMD= –0.29 mmHg, 95%CI –0.76 to 0.17) without significant differences compared with the control group; and b) the NAC could significantly improve FEV1 (SMD=1.11L, 95%CI 0.69 to 1.50) and clinical symptoms (RR=17.32, 95%CI 7.11 to 42.18), and reduce the frequency of acute exacerbation (RR=0.20, 95%CI 0.07 to 0.54) with significant differences. Conclusion　The NAC used in a short-term can significantly improve arterial blood gas (ABG) and pulmonary function, and it can improve clinical symptoms and reduce the frequency of acute exacerbation. But for the possibility of moderate bias due to lower quality of the included studies and unclear implementation of RCTs, this conclusion should be cautiously applied in clinic with patients’ conditions in considered and it has to be verified with more large-scale and high-quality RCTs.

Common variable immune deficiency with cellular immunodeficiency leading to bronchiectasis and liver cirrhosis: case report and literature review

ObjectiveTo investigate the pathogenesis, clinical manifestations, diagnosis and treatment of common variable immune deficiency (CVID).MethodsOne case of CVID with cellular immunodeficiency leading to bronchiectasis and liver cirrhosis was analyzed retrospectively. Relevant literatures were also searched through WanFang Database, China National Knowledge Infrastructure and PubMed, Ovid, Embase, Cochrane using the key words " common variable immunodeficiency”, " common variable hypogammaglobulinemia” in Chinese and English.ResultsA 52-year-old female patient, complained of cough, expectoration for 20 years, edema for 7 years and aggravated for 3 months with a history of recurrent respiratory infections was hospitalized in the West China Hospital of Sichuan University. The chest computed tomography revealed bronchiectasis, liver cirrhosis and portal hypertension. Laboratory tests showed remarkable hypogammaglobulinemia. The CD4+ T-cell count was below the normal range. Probable diagnosis of CVID was made based on clinical characteristics and laboratory tests. Immunoglobulin infusion with a dose of 20 g was given and the symptoms were relieved. About 288 case reports including 8 000 patients were searched. Most of them were reported individually. Conclusions CVID has a low morbidity and is rare in China. It is mostly caused by genetic factors. When there are recurrent infections in common areas of body, infections in rare areas or infections of conditioned pathogen, clinicians should be vigilant and give intervention as soon as possible. Family and genetic researches could be done when permitted.