2021年西藏拉萨市≥40岁社区民慢阻肺患病率及知晓率调查

目的 了解西藏自治区拉萨市≥40岁社区居民慢性阻塞性肺疾病(简称慢阻肺或COPD)的患病率及知晓率情况。方法 此次研究通过参考WHO慢性阻塞性肺疾病负担研究项目,并结合西藏本地域特点而制定的调查表,采用整群随机抽样方法,抽取西藏自治区拉萨市≥40岁常住社区居民。调查通过入户及集中采集的形式,经由统一培训合格的相关医护人员采取面对面的方式帮助调查对象进行问卷调查,并进行体检及肺功能检查。结果 纳入资料完整、有肺功能检查结果且质量控制合格的713例,其中男性223人、女性490人,平均年龄(55.94±9.238)岁。慢阻肺患病率为6.45%,其中男患病率9.87%,女患病率4.90%;生物燃料接触史患病率5.76%,非生物燃料接触史患病率11.36%,吸烟者患病率6.88%,非吸烟者患病率6.18%。调查人群对慢阻肺疾病名称知晓率为0.84%(6/713),慢阻肺患者疾病名称知晓率为6.52%(3/46)。肺功能检查率为3.65%(26/713),慢阻肺患者肺功能检查率为2.17%(1/46)。结论 2021年拉萨市40岁及以上社区居民慢阻肺患病率较高,但对其知晓率及肺功能检查率低。应加大对人群慢性阻塞性肺疾病防治知识的宣传、教育力度,提高慢阻肺高危人群肺功能的检查率,加强早期预防控制,提高诊断率、降低漏诊率。

麻杏石甘汤联合西药治疗AECOPD的效果及对患者血清炎性因子水平的影响

目的:探讨用麻杏石甘汤联合西药治疗慢性阻塞性肺疾病急性加重期(AECOPD)的效果及对患者血清炎性因子水平的影响。方法:以江门市五邑中医院江海分院收治的AECOPD患者68例为研究对象,其入组时间为2020年7月至2021年12月。按照随机分组的原则将其分为对照组和观察组,每组各有患者34例。对照组患者予以西药进行治疗,观察组患者在此基础上加用麻杏石甘汤进行治疗。比较两组患者的临床疗效、临床症状及体征评分、血清炎性因子的水平及肺功能指标。结果:治疗后,观察组患者血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)和白细胞介素-6(IL-6)的水平均低于对照组患者,差异有统计学意义(P<0.05)。治疗后,观察组患者的用力肺活量(FVC)、一秒钟用力呼气容积(FEV1)和FEV_(1)/FVC均高于对照组患者,差异有统计学意义(P<0.05)。治疗后,观察组患者的喘息评分、咳嗽评分、胸闷气短评分、咳痰评分和肺部啰音评分均低于对照组患者,差异有统计学意义(P<0.05)。观察组患者治疗的总有效率高于对照组患者,差异有统计学意义(P<0.05)。结论:用麻杏石甘汤联合西药治疗AECOPD的效果显著,能有效减轻患者的临床症状,改善其肺功能和血清炎性因子的水平。

Cardiac response to exercise in mild-to-moderate chronic obstructive pulmonary disease

Objective Chronic obstructive pulmonary disease （COPD） increases the risk of cardiovascular problem.The symptom of dyspnea on exertion may be associated with pulmonary dysfunction or heart failure, or both. The study objective was to determine whether cardiac dysfunction adds to the mechanism of dyspnea caused mainly by impaired lung function in patients with mild-tomoderate COPD. Methods Patients with COPD and healthy controls performed incremental and constant work rate exercise testing. Venous blood samples were collected in 19 COPD patients and 10 controls before and during constant work exercise for analysis of Nterminal-pro-BNP （NT-pro-BNP）. Results Peak oxygen uptake and constant work exercise time （CWET） were significantly lower in COPD group than in control group （15.81±3.65 vs 19.19±6.16 ml/min kg, P=0.035 and 7.78±6.53 min vs 14.77±7.33 rain, P=0.015, respectively）. Anaerobic threshold, oxygen pulse and heart rate reserve were not statistically significant between COPD group and control group. The NT-pro-BNP levels both at rest and during constant work exercise were higher in COPD group compared to control group, but without statistical significance. The correlations between CWET and NT-proBNP at rest or during exercise in patients with COPD were not statistically significant. Conclusions Heart failure does not contribute to exercise intolerance in mild-to-moderate COPD.（J Geriatr Cardioi 2009; 6：147-150）.

Carbon Dioxide Emissions by the Transportation Sector and Its Impact on Health in the Kathmandu Valley, Nepal

Air pollution is one of the leading cause of death for underdeveloped as well as developed countries. In 2011, the air pollution was the second leading cause of death in one of the main hospitals of the Kathmandu Valley, Nepal, and it was the third leading cause in the United States. Burning fossil fuels for transportation was one of the major causes. Among various impacts of the air pollution, COPD （chronic obstructive pulmonary disease） was one of the main consequences. In the 570 km2 Kathmandu Valley, vehicle registration was increased from 45,871 in 1990/1991 to 570,145 in 2010/2011, an increase of over 12-fold over 20 years. The vehicle registration and number of COPD patients＇ data were collected from various government divisions. In addition, the average daily travel distance and fuel mileage data were collected with a survey with residents of the Kathmandu Valley. This paper calculates the amount of carbon dioxide （CO2） emissions by transportation sector and determines correlation between CO2 emissions and COPD patients. Results show that there was a very high level of CO2 emissions, and it was positively correlated with the number of COPD patients in the valley.

Effect of Yiqibushenhuoxue decoction on chronic obstructive pulmonary disease measured by St. George's respiratory disease questionnaire scores and forced expiratory volume

OBJECTIVE: To investigate the effects of Yiqibushenhuoxue decoction on stable chronic obstructive pulmonary disease(COPD) by observing its influences on patients' quality of life and airway inflammation.METHODS: Seventy patients with stable COPD were randomly divided into a treatment group(n=35) treated with Yiqibushenhuoxue decoction plus Seretide and a control group(n=35) treated with Seretide only.The dosage of Yiqibushenhuoxue decoction was 100 mL each time, twice a day, and the dosage of Seretide was salmeterol 50 μg/fluticasone 250 μg twice a day. Both groups were treated for 12 weeks. Before and after the treatment, St George's respiratory disease questionnaire(SGRQ)scores,forced expiratory volume,and forced expiratory volume in 1 second/forced vital capacity(FEV1/FVC)were measured.RESULTS:The SGRQ scores in both groups were significantly lower than those before treatment(P<0.05). After treatment, the total SGRQ scores and each subscore in the treatment group were significantly lower than those in the control group(P<0.05). The percentage of the predicted FEV1% and FEV1/FVC were higher in both groups, but no statistical differences were detected from before to after the treatment or between the two groups(P>0.05).CONCLUSION: Yiqibushenhuoxue decoction could significantly decrease the SGRQ scores in patients with stable COPD, which suggests that it is able to improve patient symptoms.

Correlation between lower gastrointestinal tract symptoms and quality of life in patients with stable chronic obstructive pulmonary disease

OBJECTIVE:To explore correlations between the symptoms of constipation and abdominal distention and severity of chronic obstructive pulmonary disease(COPD)in patients with stable disease.METHODS:We studied 191 patients with stable COPD(according to defined criteria)in this cross-sectional study from four three-level class A Chinese medicine hospitals in China.We built an Epidata 3.0 database and performed statistical analysis with SPSS,version 17.0.We analyzed correlations between the frequency of lower gastrointestinal tract symptoms(constipation and abdominal distention)and scores for major pulmonary symptoms(cough,sputum and wheezing)based on the St.George's Respiratory Questionnaire(SGRQ),6-minute walking distance(6MWD)and frequency of acute exacerbations of COPD(AECOPD).RESULTS:In addition to their pulmonary symptoms,39.79%and 40.31%of study patients withstable COPD reported constipation and abdominal distention,respectively.Scores for major pulmonary symptoms(cough,sputum and wheezing),AECOPD and SGRQ values in patients with constipation and abdominal distention were significantly greater,and the 6MWD markedly shorter,than in those without them.According to Pearson's correlation analysis,there were strong correlations between these lower gastrointestinal tract symptoms and scores for pulmonary symptoms,SGRQ,6MWD and AECOPD.CONCLUSION:Lower gastrointestinal tract symptoms such as constipation and abdominal distention can adversely affect pulmonary symptoms,frequency of acute exacerbations and quality of life in patients with stable COPD.