COPD 是一種可預防、可治療, 以氣流不完全可逆受限并呈進行性發展為特征的疾病, 與肺部對有害氣體或有毒顆粒的異常炎癥反應有關。在全球范圍內COPD 是引起死亡和功能致殘的主要疾病之一。COPD 在全球患病率和死亡率位居第四, 并呈不斷上升的趨勢[1] 。本病具有明顯的肺外效應, 包括引起全身系統性炎癥、代謝改變、神經激素激活,以及對肌肉骨骼、心血管系統等其他系統的影響等[2] 。既往認為COPD 僅引起紅細胞增多, 但近期研究發現COPD 引起的系統性炎癥可影響紅細胞的生成, 貧血亦同樣存在于部分COPD 患者。目前認為, COPD導致的貧血與其他許多慢性疾病如慢性心衰一樣, 同屬于一種慢性病性貧血( anemia of chronic disease, ACD) , 稱為COPD 相關性貧血, 其患病率高于繼發性紅細胞增多癥在COPD 的患病率[3-5] 。本文就COPD 相關性貧血的流行病學概況、病理生理機制、臨床重要性及干預的最新研究進展如下綜述。
ObjectiveTo analyze the disease burden and temporal trends of chronic obstructive pulmonary disease (COPD) attributable to air pollution in China from 1990 to 2021. MethodsUtilizing data from the Global Burden of Disease Study 2021 (GBD 2021), we assessed the burden of COPD attributable to air pollution in China through metrics including death counts, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), age-standardized DALY rate (ASDR), annual percentage change (APC), and average annual percentage change (AAPC). A Bayesian Age-Period-Cohort (BAPC) model was employed to project future trends in COPD burden attributable to air pollution. ResultsIn 2021, China’s ASMR and ASDR for COPD attributable to air pollution were 32.57 and 533.84 per 100,000 population, respectively, exceeding global averages. From 1990 to 2021, both ASMR and ASDR exhibited significant declining trends, with AAPCs of ?5.24% (95% CI ?5.78% to ?4.70%) and ?5.28% (95% CI ?5.75% to ?4.81%), respectively. The burden intensified with advancing age and was disproportionately higher among males compared to females. BAPC projections indicate a continued decline in COPD burden from 2022 to 2035, with ASMR expected to decrease from 56.40 to 23.02 per 100,000 and ASDR from 900.14 to 408.64 per 100,000. Conclusion Despite sustained reductions in the burden of COPD attributable to air pollution in China from 1990 to 2021, with further declines anticipated through 2035, national rates remain elevated relative to global benchmarks. Male and elderly populations bear the highest burden, underscoring the urgency for targeted interventions to mitigate air pollution exposure and address health disparities in vulnerable demographics.
Objective To evaluate the impacts of pulmonary rehabilitation at different levels of exercise intensity on health status of patients with moderate to severe COPD. Methods Thirty-two COPD patients treated with pulmonary rehabilitation by ergometry exercise were randomly assigned to exercise intensity level either by anaerobic threshold （AT group; n=15） or by maximum tolerate [high intensity group（HI group）; n=17]. Nine COPD patients without exercise training served as control. Bicycle exercise training was conducted in two separate days each week for 12 weeks. Spirometry，cardiopulmonary exercise testing，the St George’s Respiratory Questionnaire （SGRQ） were accessed before and after the rehabilitation program. Results Exercise intensity （%Wmax） was significantly higher in HI group than AT group （69%±14% vs 52%±7%，Plt;0.01）. Significant improvement of SGRQ scores after rehabilitation were found both in AT group （－11.91±15.48 U） and HI group （－8.39±9.49 U）. However，no significant difference was found between the two groups in the degree of improvement （Z=－0.540，P=0.589）. Symptoms and impacts subscale scores of SGRQ were decreased significantly in HI group，but only symptoms scores decreased significantly in AT group. The control group did not show any significant improvement in SGRQ scores. No statistically significant correlation was found between improvement of peak oxygen consumption per predicted (VO2peak%pre) and SGRQ scores. Conclusion Both pulmonary rehabilitation strategies by anaerobic threshold and by maximum tolerate can improve health status of COPD patients significantly with no significant difference between each other.
Objective To study the sedative effects and safety of dexmedetomidine and midazolamfor acute exacerbate of chronic obstructive pulmonary disease ( AECOPD) underwentmechanical ventilation.Methods 68 AECOPD patients underwentmechanical ventilation were enrolled and randomly divided into adexmedetomidine group ( n =34) and a midazolam group ( n = 34) by acute physiology and chronic healthevaluation Ⅱ ( APACHEⅡ) score. The patients in the dexmedetomidine group were given a loading dose( 1 μg/kg) and then maintained with 0. 2-0. 8 mg·kg- 1 ·h- 1 . The patients in the midazolam group weregiven a loading dose ( 0. 05 mg/kg) and then maintained with 0. 06-0. 2 mg· kg- 1 · h- 1 . Sedation levelwas assessed by Ramsay score and maintained a Ramsay score of 3-4. The sedation onset time, disablesedatives wake time, duration of mechanical ventilation, extubation success rate, ICU length of stay, and 28days mortality after admission to the ICU were compared between two groups. And calmer respiratorydepression, circulatory and delirium adverse reactions incidence were also compared. Results Thedifferences in patients’age, gender, and APACHEⅡ score between two groups were not significant ( P gt;0. 05) . Compared with the midazolam group, the dexmedetomidine group had more rapid onset of sedation[ ( 49. 80 ±8. 20) s vs. ( 107. 55 ±19. 65) s, P lt;0. 01] , shorter wake-up time [ ( 18. 90 ±2. 30) min vs. ( 40. 82 ±19. 85) min, P lt;0. 01] , shorter duration of mechanical ventilation [ ( 4. 9 ±1. 6) d vs. ( 7. 8 ±2. 5) d,P lt;0. 01] , higher successful extubation rate ( 79. 41% vs. 58. 82% , P lt;0. 01) , and shorter ICUlength of stay[ ( 6. 5 ±2. 5) d vs. ( 9. 6 ±3. 4) d, P lt;0. 05] . Dexmedetomidine had lower respiratory depression rate, littleeffects on hemodynamics, lower occurrence and short duration of delirium. Conclusion It is highlyrecommended that dexmedetomidine be used for sedation in AECOPD patients with mechanical ventilation.