Objective To analyze the differences in microbial communities in bronchoalveolar lavage fluid (BALF) from patients with simple pneumonia versus those with chronic obstructive pulmonary disease (COPD) combined with lower respiratory tract infection using metagenomic next-generation sequencing (mNGS). Methods Patients hospitalized for pulmonary infections at the First Affiliated Hospital of Xinjiang Medical University between December 2021 and March 2023 were included. Based on the presence of COPD, the patients were divided into two groups: those with simple pneumonia and those with COPD combined with lower respiratory tract infection. mNGS was employed to detect microbes in BALF, and the microbial community distribution characteristics of the two groups were analyzed. Results A total of 97 patients were included, of whom 80 (81.82%) had positive microbial detection results. The smoking index in COPD group with lower respiratory tract infection was significantly higher than that in the group with simple pneumonia (t= ?3.62, P=0.001). Differences in microbial community distributions were observed between the groups. At the genus level, 19 species of microorganisms were detected in the simple pneumoniapulmonary infection group, including 8 bacteria (42.11%), 2 fungi (10.53%), 3 viruses (15.79%), and 6 other types of microorganisms (31.58%). In contrast, 22 types of microbes were detected in COPD group with lower respiratory tract infection, including 10 bacteria (47.62%), 3 fungi (14.29%), 4 viruses (19.05%), and 4 other types of microorganisms (19.05%). Differences were also noted in reads per million (RPM) values; bacterial RPM values at the genus level were significantly higher in the COPD group during non-severe pneumonia compared to the simple pneumonia group (Z=–2.706, P=0.007). In the patients with severe pneumonia, RPM values at the genus and species levels were significantly higher than those in non-severe pneumonia (Z=?2.202, P=0.028; Z=?2.141, P=0.032). In COPD combined with severe pneumonia, bacterial RPM values were significantly higher at the species level compared to non-severe pneumonia (Z=?2.367, P=0.017). ConclusionsThere are differences in the distribution of microbial communities at the genus and species levels in BALF from patients with COPD combined with lower respiratory tract infection compared to those with simple pulmonary pneumonia. Bacteria are the predominant microbial type in both groups, but the dominant bacterial species differ between them. Simple pneumonia are primarily associated with bacterial, viral, and other types of microbial infections, while COPD combined with lower respiratory tract infection is predominantly associated with fungal and bacterial infections. RPM values may serve as an indicator of the severity of pneumonia.
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 The purpose of the current research was to analyze the relevant risk factors for short-term death in patients with chronic obstructive pulmonary disease (COPD) and heart failure (HF), and to build a predictive nomogram. Methods We conducted a retrospective analysis of clinical data from 1 323 COPD and HF comorbidity patients who were admitted to the Affiliated Hospital of Southwest Medical University from January 2018 to January 2022. Samples were divided into survival and death groups based on whether they died during the follow-up. General data and tested index of both groups were analyzed, and the discrepant index was analyzed by single factor and multiple factor Logistic regression analysis. R software was applied to create the nomogram by visualizing the results of the regression analysis. The accuracy of the results was verified by C index, calibration curve, and ROC curve. Results The results from the multiple factor Logistic regression analysis indicated that age (OR=1.085, 95%CI 1.048 to 1.125), duration of smoking (OR=1.247, 95%CI 1.114 to 1.400), duration of COPD (OR=1.078, 95%CI 1.042 to 1.116), comorbidity with respiratory failure (OR=5.564, 95%CI 3.372 to 9.329), level of NT-proBNP (OR=1.000, 95%CI 1.000 to 1.000), level of PCT (OR=1.153, 95%CI 1.083 to 1.237), and level of D-dimer (OR=1.205, 95%CI 1.099 to 1.336) were risk factors for short-term death of COPD and HF comorbidity patients. The level of ALB (OR=0.892, 95%CI 0.843 to 0.942) was a protective factor that was used to build the predictive nomogram with the C index of 0.874, the square under the working characteristics curve of the samples of 0.874, the specify of 82.5%, and the sensitivity of 75.0%. The calibration curve indicated good predictive ability of the model. Conclusion The nomogram diagram built by the current research indicated good predictability of short-term death in COPD and HF comorbidity patients.
Objective To investigate the therapeutic effects of thyroid hormone replacement on critically ill COPD patients with low serum thyroid hormone. Methods Sixty-seven critically ill patients with acute exacerbation of COPD ( AECOPD) , and complicated with respiratory and/ or heart failure and low serum thyroid hormone, admitted from July 2008 to June 2011, were recruited for the study. They were randomly divided into an intervention group ( n = 34) and a control group ( n = 33) . The control group received conventional treatment and the intervention group received conventional treatment plus additional thyroid hormone replacement therapy. Results Compared with the control group, the overall efficacy of the intervention group was not significantly different ( 88. 2% vs. 81. 8% , P gt; 0. 05) , while average effective time was significantly shorter [ ( 9. 6 ±2. 5) d vs. ( 12. 3 ±2. 8) d, P lt; 0. 05] . The post-treatment serum FT3 , FT4 , TT4 , and h-TSH levels were significantly higher in the intervention group than those in the control group, and significantly higher than baseline ( P lt;0. 05) . Conclusions For AECOPD patients complicated with respiratory and/or heart failure and low serum thyroid hormone, thyroid hormone supplement at low dosage will help to improve serumthyroid hormone level, and promote early recovery.
【摘要】 目的 探討老年慢性阻塞性肺疾病(COPD)患者院內肺部真菌感染的可能易患因素、感染時間、臨床特征、感染常見真菌與預后。 方法 回顧性分析36例65歲以上COPD 院內肺部真菌感染患者與同期40例65歲以上COPD院內肺部非真菌感染患者的臨床資料。 結果 老年COPD患者院內肺部真菌感染的可能易患因素與長期使用廣譜抗生素、糖皮質激素,低蛋白血癥、粒細胞減少相關;吸煙時間較長及每年住院次數增多也是老年COPD患者發生院內肺部真菌感染的可能易感因素;約1/3患者肺部真菌發生在入院1~2周,臨床特征無特異性;病原菌主要為白色念珠菌(8055%),胸部X線表現以支氣管肺炎及團塊影改變為主,預后較差。 結論 老年COPD患者若長期使用廣譜抗生素和(或)糖皮質激素,有低蛋白血癥或粒細胞減少,可能會并發院內肺部真菌感染,預后較差,長期吸煙及多次住院患者也應提高警惕,重視可能易患因素并盡早采取預防與治療措施,減少死亡的發生。【Abstract】 Objective To investigate the possible risk factors of nosocomial pulmonary fungal infection, infection time, the clinical features, common infection fungal and prognosis of elderly patients with chronic obstructive pulmonary disease (COPD). Methods The clinical data of 36 patient of COPD complicated with nosocomial pulmonary fungal infection over 65 years old and 40 patients without nosocomial pulmonary fungal infection were retrospectively analyzed. Results Longterm use of broadspectrum antibiotics and (or) glucocorticoid, hypoalbuminemia, neutropenia, smoking for a long time, and hospitalizations were risk factors for nosocomial pulmonary fungal infection in elderly COPD patients. In about 1/3 of patients, nosocomial pulmonary fungal infection occurred within one to two weeks of hospitalization. The clinical features were nonspecific. Pathogens were mainly Candida albicans (8055%). Bronchial pneumonia and group block were the main findings in Chest Xray. The prognosis was poor. Conclusion Elderly patients with COPD are prone to nosocomial pulmonary fungal infection if they have hypoproteinemia, neutropenia or use longterm broadspectrum antibiotics and (or) glucocorticoids.
Objective Investigate zinc finger protein 36 (ZFP36) and zinc finger protein 36L1 (ZFP36L1) expression in peripheral blood of patients with chronic obstructive pulmonary disease (COPD). Methods Peripheral blood samples were collected from 42 individuals with acute exacerbation of COPD (AECOPD), 21 with stable COPD, and 18 healthy participants. The levels of ZFP36 and ZFP36L1 proteins and mRNA expressions were evaluated using ELISA and qPCR techniques. Difference in expression levels among the three groups was examined. Spearman analysis and receiver operating characteristic (ROC) curve were carried out for assessment of diagnostic and predictive value of FP36 and ZFP36L1 for COPD and AECOPD. Results Compared with the healthy group, ZFP36L1 protein expression was downregulated in the COPD stable group. ZFP36 protein expression was downregulated in the AECOPD group compared with the COPD stable group. Similar differences were observed in mRNA expression levels. ZFP36 and ZFP36L1 levels were negatively correlated with inflammatory markers. ZFP36 levels were positively correlated with ZFP36L1 and lung function, and negatively correlated with smoking index, modified Medical Research Council score, occurrence of respiratory failure during hospitalization, exacerbation frequency within 3 months, and total hospitalizations. The area under the curve (AUC) for diagnosing AECOPD using ZFP36 was 0.980, with sensitivity of 95.2% and specificity of 90.5%. When combined with FEV1%pred, the AUC improved to 0.985, with sensitivity of 92.9% and specificity of 100%. For predicting post-discharge exacerbations in AECOPD when combined with neutrophil-to-lymphocyte ratio (NLR), sensitivity of ZFP36 alone was 66.7% and specificity was 88.9%. The AUCs for diagnosing COPD using ZFP36, ZFP36L1, and interleukin-8 (IL-8) were 0.889, 0.989, and 0.981, respectively. The sensitivities were 61.9%, 90.5%, and 95.2%, and specificities were 100%, 100%, and 94.4%, respectively. Conclusions Peripheral blood ZFP36 has good diagnostic value for AECOPD. Combined with FEV1%pred, it can further increase diagnostic value. As a predictive indicator for frequent exacerbations within 3 months of discharge in COPD patients, its predictive sensitivity and specificity are superior to inflammatory markers such as NLR. ZFP36 exhibits anti-inflammatory effects in AECOPD. Peripheral blood ZFP36L1 has good diagnostic value for COPD.
Objective To investigate the clinical manifestations of two common obstructive airway inflammatory diseases [ chronic obstructive pulmonary disease ( COPD) and asthma] in elderly patients for proper diagnosis and treatment of COPD complicated with asthma.Methods 102 elderly patients diagnosed with either COPD or asthma, who visited the Guangzhou Institute of Respiratory Disease fromOctober 2010 to March 2011, were recruited for the study. Comparisons of clinical manifestation, pulmonary function tests ( PFTs) , chest CT and sputum cytological tests were carried out between the patients with asthma-only,COPD-only, and COPD complicated with asthma. Results Of all 102 patients,18 were diagnosed as asthmaonly ( 17. 6% ) , 36 as COPD complicated with asthma ( 35. 3%) , and 48 as COPD-only ( 47. 1% ) . The patients with COPD-only had longer history of present illness in which most had a history of exposure to cigarette smoking. 91. 7% complained of cough as the first symptom, 80% showed severe impairment in PFTs. Among these patients, sputum neutrophilic granulocytes were ( 78. 3 ±5. 1) % , which was significantly higher than the other two groups ( P lt; 0. 05) . Glucocorticosteroid treatment was less effective in thesepatients. In the patients with COPD complicated with asthma, half were smokers, and cough was the first symptom in 63. 9% subjects and wheezing was the first symptom in rest. About 60% had severely impaired PFTs, and these patients responded to glucocorticosteroid better than the COPD-only patients. In the asthmaonlygroup, most complained of wheezing as the first symptom and had better PFTs. However, sputum eosinophilic granulocyte was as high as ( 13. 5 ±3. 1) % . They responded to glucocorticosteroid effectively.Conclusions COPD and asthma were both obstructive airway inflammatory diseases, but pulmonary function and responses to glucocorticosteroid therapy were different. It is necessary to understand the severity and mechanism of airway function impairment in order to improve the proper diagnosis and treatment of asthmaand COPD in elderly.
Objective To investigate the impact of nutritional risk on unplanned readmissions in elderly patients with chronic obstructive pulmonary disease (COPD), to provide evidence for clinical nutrition support intervention. Methods Elderly patients with COPD meeting the inclusive criteria and admitted between June 2014 and May 2015 were recruited and investigated with nutritional risk screening 2002 (NRS 2002) and unplanned readmission scale. Meanwhile, the patients’ body height and body weight were measured for calculating body mass index (BMI). Results The average score of nutritional risk screening of the elderly COPD patients was 4.65±1.33. There were 456 (40.07%) patients who had no nutritional risk and 682 (59.93%) patients who had nutritional risk. There were 47 (4.13%) patients with unplanned readmissions within 15 days, 155 (13.62%) patients within 30 days, 265 (23.28%) patients within 60 days, 336 (29.53%) patients within 180 days, and 705 (61.95%) patients within one year. The patients with nutritional risk had significantly higher possibilities of unplanned readmissions within 60 days, 180 days and one year than the patients with no nutritional risk (all P<0.05). The nutritional risk, age and severity of disease influenced unplanned readmissions of the elderly patients with COPD (all P<0.05). Conclusions There is a close correlation between nutritional risk and unplanned readmissions in elderly patients with COPD. Doctors and nurses should take some measures to reduce the nutritional risk so as to decrease the unplanned readmissions to some degree.
Objective To evaluate the effects of different ways of exercise training on elderly patients with chronic obstructive pulmonary disease ( COPD) , which focuse on the changes of cardiopulmonary exercise function and COPD symptoms. Methods 54 cases of elderly patients with stable COPD were randomly allocated to a control ( 15 cases) , a lower-limb ( 20 cases) , or a upper-Limb and lower-Limb combined exercise group ( 19 cases) . All patients received conventional medical therapy.Meanwhile, the exercise groups received training for 16 weeks. The improvements of resting spirometry,cardiopulmonary exercise test ( CPET) , and dyspnea ( Borg scale rating) were evaluated before and after the training scheme. Results There was no significant difference in resting spirometry after exercise training( P gt;0. 05) . Exercise tolerance and Borg scale were improved in both exercise groups significantly than baseline ( P gt;0. 05) and the control group ( P gt;0. 05) . VE@ 50% Vo2max was improved significantly in the combined group( 4. 81 ±0. 70 vs. 2. 49 ±1. 15, P lt; 0. 001) . Breathing reserve ( BR) was elevated in bothexercise groups than the control ( P lt; 0. 01) , and the improvement in the combined group was more significant ( 9. 79 ±1. 57 vs. - 1. 36 ±2. 82, P lt; 0. 001) . Gas exchange response ( VD /VT ) was slightly improved after rehabilitation in the combined group( P lt;0. 05) . Borg scale after rehabilitation was correlatedwith FEV1% pred, BR, and Vo2 /kg after rehabilitation[ Borg = 9. 516 - 0. 174 ×FEV1% pred - 0. 156 × (Vo2 /kg) - 0. 023 ×BR] . Conclusions Upper-limb combined with lower-limb exercise training can markedly improve the level of aerobic capacity and ventilation in elderly patients with stable COPD, and then improve the exercise tolerance.
Objective To investigate the rate of pulmonary function test, medication treatment, and relevant factors among patients with chronic obstructive pulmonary disease (COPD) aged 40 years or older in community of Guangdong Province, and to provide evidences for targeted intervention of COPD. Methods A multistage stratified cluster sampling was conducted in the community residents, who participated in the COPD surveillance project of in Guangdong Province during 2019 to 2020. A total of 3384 adults completed questionnaire and pulmonary function test. The Rao-Scott χ2 test based on complex sampling design, and non-conditional Logistic regression were used to explore possible influencing factors of pulmonary function test and medication treatment in COPD patients. Results Out of the 3384 adults, 288 patients with COPD were confirmed, including 253 males (87.8%) and 35 females (12.2%), and 184 patients (60.4%) were over 60 years old or more. The pulmonary function test rate was 10.7% [95% confidence interval (CI) 6.8% - 14.6%], and medication treatment rate was 10.6% (95%CI 7.0% - 14.1%). The results showed that wheezing, awareness of COPD related knowledge and pulmonary function test were related to whether COPD patients had pulmonary function test (P<0.05). Wheezing and personal history of respiratory diseases were related to medication treatment rate (P<0.05). Conclusions The rates of pulmonary function test and medication treatment among COPD patients aged 40 years or older are low. Health education about COPD should be actively carried out, and the screening of individuals with a history of respiratory diseases and respiratory symptoms should be strengthened so as to reduce the burden of COPD diseases.