慢性阻塞性肺疾病急性加重的研究

Current progression in acute exacerbation of chronic obstructive pulmonary disease

慢性阻塞性肺疾病（COPD）具有很高的发病率和死亡率，而慢性阻塞性肺疾病急性加重（AECOPD）则是COPD患者就诊以及住院治疗的主要原因，也是庞大医疗费用的主要来源。本文就近年来对AECOPD的定义、病理生理、病因、治疗以及预防等的研究进展进行综述，其中一些方面已得到循证医学的证实，比如吸烟与AECOPD的关系、糖皮质激素及无创性正压通气在治疗AECOPD的作用等；但仍有一些问题尚存在争议，特别是细菌感染在AECOPD中的作用，以及抗菌治疗在AECOPD治疗中的地位，还需要更多的，设计严密的研究来证实。

Chronic obstructive pulmonary disease（COPD） is characterized by airflow obstruction that is progressive and not fully reversible with a high morbidity and mortality. Acute exacerbation is a leading cause of hospital admission for the patients with COPD, and is also the main source of their huge medical cost. In this article, we review the current progresses in the definition, pathophysiology,etiology, treatment and prophylaxis of acute exacerbation COPD. Among these progresses, some have been proved by evidencebased medicine,for example, smoking impact on acute exacerbation COPD, corticosteroids and noninvasive positive pressure ventilation in treatment benefit. But there are still other problems remaining disputable, especially the role of bacterial infection in etiology and the effect of antibacterial treatment in acute exacerbation COPD. They still need more well-designed studies to be confirmed.