Study on the impact of comprehensive geriatric assessment on anxiety and depression in chronic obstructive pulmonary disease patients

BACKGROUND Psychological factors such as anxiety and depression will not only aggravate the symptoms of chronic obstructive pulmonary disease(COPD)patients and reduce the quality of life of patients,but also affect the treatment effect and long-term prognosis.Therefore,it is of great significance to explore the clinical application of senile comprehensive assessment in the treatment of COPD and its influence on psychological factors such as anxiety and depression.AIM To explore the clinical application of comprehensive geriatric assessment in COPD care and its impact on anxiety and depression in elderly patents.METHODS In this retrospective study,60 patients with COPD who were hospitalized in our hospital from 2019 to 2020 were randomly divided into two groups with 30 patients in each group.The control group was given routine nursing,and the observation group was given comprehensive assessment.Clinical symptoms,quality of life[COPD assessment test(CAT)score],anxiety and depression Hamilton Anxiety Rating Scale(HAMA)and Hamilton Depression Rating Scale(HAMD)were compared between the two groups.RESULTS CAT scores in the observation group decreased from an average of 24.5 points at admission to an average of 18.3 points at discharge,and in the control group from an average of 24.7 points at admission to an average of 18.3 points at discharge.The average score was 22.1(P<0.05).In the observation group,HAMA scores decreased from 14.2 points at admission to 8.6 points at discharge,and HAMD scores decreased from 13.8 points at admission to 7.4 points at discharge.The mean HAMD scores in the control group decreased from an average of 14.5 at admission to an average of 12.3 at discharge,and from an average of 14.1 at admission to an average of 11.8 at discharge.CONCLUSION The application of comprehensive geriatric assessment in COPD care has a significant effect on improving patients'clinical symptoms and quality of life,and can effectively reduce patients'anxiety and depression.

Association of extraintestinal manifestations of inflammatory bowel disease in a province of western Hungary with disease phenotype:Results of a 25-year follow-up study

AIM:IBD is a systemic disease associated with a large number of extraintestinal manifestations (EIMs).Our aim was to determine the prevalence of EIMs in a large IBD cohort in Veszprem Province in a 25-year follow-up study. METHODS:Eight hundred and seventy-three IBD patients were enrolled (ulcerative colitis/UC/:619,m/f:317/302, mean age at presentation:38.3 years,average disease duration:11.2 years;Crohn's disease/CD/:254,m/f:125/129, mean age at presentation:32.5 years,average disease duration:9.2 years).Intestinal,extraintestinal signs and laboratory tests were monitored regularly.Any alteration suggesting an EIMs was investigated by a specialist. RESULTS:A total of 21.3% of patients with IBD had EIM (UC:15.0%,CD:36.6%).Age at presentation did not affect the likelihood of EIM.Prevalence of EIMs was higher in women and in CD,ocular complications and primary sclerosing cholangitis (PSC) were more frequent in UC.In UC there was an increased tendency of EIM in patients with a more extensive disease.Joint complications were more frequent in CD (22.4% vsUC 10.2%,P<0.01).In UC positive family history increased the risk of joint complications (OR:3.63).In CD the frequency of type-1 peripheral arthritis was increased in patients with penetrating disease (P=0.028).PSC was present in 1.6% in UC and 0.8% in CD.Dermatological complications were present in 3.8% in UC and 10.2% in CD,the rate of ocular complications was around 3% in both diseases.Rare complications were glomerulonephritis,autoimmune hemolytic anaemia and celiac disease. CONCLUSION:Prevalence of EIM in Hungarian IBD patients is in concordance with data from Western countries.The high number of EIM supports a role for complex follow-up in these patients.

Heart-shaped anastomosis for Hirschsprung's disease: Operative technique and long-term follow-up

AIM: To study the long-term therapeutic effect of 'heartshaped' anastomosis for Hirschsprung's disease.METHODS: From January 1986 to October 1997, we performed one-stage 'heart-shaped' anastomosis for 193 patients with Hirschsprung's disease (HD). One hundred and fiftytwo patients were followed up patients (follow-up rate 79%).The operative outcome and postoperative complications were retrospectively analyzed.RESULTS: Early complications included urine retention in 2patients, enteritis in 10, anastomotic stricture in 1, and intestinal obstruction in 2. No infection of abdominal cavity or wound and anastomotic leakage or death occurred in any patients. Late complications were present in 22 cases,including adhesive intestinal obstruction in 2, longer anal in 5, incision hernia in 2, enteritis in 6, occasional stool stains in 7 and 6 related with improper diet. No constipation or incontinence occurred in any patient.CONCLUSION: The early and late postoperative complication rates were 7.8% and 11.4% respectively in our 'heartshaped anastomosis' procedure. 'Heart-shaped'anastomosis procedure for Hirschsprung's disease provides a better therapeutic effect compared to classic procedures.

Effects of hospital–community integrated transitional care on quality of life in patients with chronic obstructive pulmonary disease

Objective: To explore the effects of “hospital–community integrated transitional care” model on quality of life in patients with chronic obstructive pulmonary disease (COPD). Methods: A total of 117 inpatients with COPD from the Department of Respiratory Medicine in a tertiary general hospital in Nanjing were enrolled by convenience sampling from January to December in 2016 and then were divided into intervention group (n = 60) and control group (n = 57) by random number table. Patients in the intervention group accepted both routine care and hospital– community integrated transitional care for 3 months after discharge. Assessment of quality of life by telephone follow-up or interview within a week before discharge and 1, 3, and 6 months after discharge was evaluated using the Short Form-36 (SF-36) health survey questionnaire. Results: For a total score of quality of life, there was a significant difference between the two groups (P < 0.05): 1, 3, and 6 months after discharge. In addition, for each dimension score of quality of life, there were no significant differences (P > 0.05) except vitality dimension, 1 month after discharge, and there were significant differences in all dimensions, 3 and 6 months after discharge (P < 0.05) Conclusions: Hospital–community integrated transitional care model can improve the quality of life of patients with COPD.

Functional and psychosocial effects of pulmonary Daoyin on patients with COPD in China:study protocol of a multicenter randomized controlled trial

BACKGROUND： Chronic obstructive pulmonary disease （COPD） is a major public health problem worldwide. Pulmonary rehabilitation （PR） is an established intervention for the management of patients with COPD. Exercise training is an important part of PR, and its effectiveness in patients with COPD is well established. However, alternative methods of PR training such as Daoyin have not been appropriately studied. Hence, alternative forms of exercise training that require less exercise equipment and no specific training place should be evaluated. This paper describes the study protocol of a clinical trial that aims to determine if pulmonary Daoyin training will improve the exercise capacity and psychosocial function of patients with COPD in China. METHODS AND DESIGN： A multicenter, randomized, controlled trial will be conducted. A total of 464 patients meeting the inclusion criteria will be enrolled into this study with 232 patients in each of the trial group and the control group. Based on patient education, patients in the trial group will receive pulmonary Daoyin and continue with their usual therapy for three months. In the control group, patients will continue with their usual therapy. The primary outcome measures are exercise capacity assessed by the six-minute walking distance test and lung function. Secondary outcomes include dyspnea and quality of life. Measurements will be taken at baseline （month 0） and after the study period （month 3）. DISCUSSION： It is hypothesized that pulmonary Daoyin will have beneficial effects in improving exercise capacity and psychosocial function of patients with stable COPD, and will provide an alternative form of exercise training that is accessible for the large number of people with COPD. TRIAL REGISTRATION： This trial has been registered in ClinicalTrials.gov. The identifier is NCT01482000.

Helicobacter pylori infection and respiratory diseases:a review

In the past few years,a variety of extradigestive disorders, including cardiovascular,skin,rheumatic and liver diseases, have been associated with Helicobacter pylori(H.pylori) infection.The activation of inflammatory mediators by H.pylori seems to be the pathogenetic mechanism underlying the observed associations.The present review summarizes the current literature,including our own studies,concerning the association between H.pyloriinfection and respiratory diseases. A small number of epidemiological and serologic,case- control studies suggest that H.pylori infection may be associated with the development of chronic bronchitis.A frequent coexistence of pulmonary tuberculosis and H.pylori infection has also been found.Moreover,recent studies have shown an increased H.pyloriseroprevalence in patients with bronchiectasis and in those with lung cancer.On the other hand,bronchial asthma seems not to be related with H.pylori infection. All associations between H.pylori infection and respiratory diseases are primarily based on case-control studies, concerning relatively small numbers of patients.Moreover, there is a lack of studies focused on the pathogenetic link between respiratory diseases and H.pylori infection. Therefore,we believe that larger studies should be undertaken to confirm the observed results and to clarify the underlying pathogenetic mechanisms.

36-Month Follow-Up Study of Post-Intervention Chronic Heart Failure Patients

Aim: Although numerous studies of disease management and case management of chronic heart failure (CHF) have been carried out, length of effectiveness after program commencement has not been examined, so we examined a follow-up study at 36 months after program commencement. Methods: Participants went for follow-up visits to one Japanese clinic which specializes in internal cardiovascular medicine and they were given diagnoses of CHF. 104 outpatients participated in this study and randomized control trial was implemented. An educational program was implemented for 6 months. The data were collected at baseline, 3, 6, 9, 12 months from both intervention and control groups and at 24 and 36 months from the intervention group. Results: There was significant improvement in New York Heart Association (NYHA) in the intervention group between baseline and 36 months. Improvement in weight monitoring and activities or exercise in the intervention group continued up to 36 months. Meanwhile, sodium restricted diets and quitting smoking and/or drinking depended on individual preference and it was difficult to make improvements in these areas. Conclusions: The educational program showed promise in preventing CHF outpatients from deteriorating significantly on a long-term basis as self-monitoring of activity and weight continued significantly and there were no participants with CHF who deteriorated in the intervention group at 36 months after program commencement, although the program aimed only to provide illness and self-management knowledge. On the other hand, future work will need to compare participants in this program to a control group over an extended period of time with consideration for relieving the burden of the control group.

Survivors of COVID-19 exhibit altered amplitudes of low frequency fluctuation in the brain: a resting-state functional magnetic resonance imaging study at 1-year follow-up

Although some short-term follow-up studies have found that individuals recovering from coronavirus disease 2019(COVID-19)exhibit anxiety,depression,and altered brain microstructure,their long-term physical problems,neuropsychiatric sequelae,and changes in brain function remain unknown.This observational cohort study collected 1-year follow-up data from 22 patients who had been hospitalized with COVID-19(8 males and 11 females,aged 54.2±8.7 years).Fatigue and myalgia were persistent symptoms at the 1-year follow-up.The resting state functional magnetic resonance imaging revealed that compared with 29 healthy controls(7 males and 18 females,aged 50.5±11.6 years),COVID-19 survivors had greatly increased amplitude of low-frequency fluctuation(ALFF)values in the left precentral gyrus,middle frontal gyrus,inferior frontal gyrus of operculum,inferior frontal gyrus of triangle,insula,hippocampus,parahippocampal gyrus,fusiform gyrus,postcentral gyrus,inferior parietal angular gyrus,supramarginal gyrus,angular gyrus,thalamus,middle temporal gyrus,inferior temporal gyrus,caudate,and putamen.ALFF values in the left caudate of the COVID-19 survivors were positively correlated with their Athens Insomnia Scale scores,and those in the left precentral gyrus were positively correlated with neutrophil count during hospitalization.The long-term follow-up results suggest that the ALFF in brain regions related to mood and sleep regulation were altered in COVID-19 survivors.This can help us understand the neurobiological mechanisms of COVID-19-related neuropsychiatric sequelae.This study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University(approval No.2020 S004)on March 19,2020.

Chronic thromboembolic pulmonary hypertension is associated with a loss of total lung volume on computed tomography

BACKGROUND Although lung volumes are usually normal in individuals with chronic thromboembolic pulmonary hypertension(CTEPH),approximately 20%-29%of patients exhibit a restrictive pattern on pulmonary function testing.AIM To quantify longitudinal changes in lung volume and cardiac cross-sectional area(CSA)in patients with CTEPH.METHODS In a retrospective cohort study of patients seen in our hospital between January 2012 and December 2019,we evaluated 15 patients with CTEPH who had chest computed tomography(CT)performed at baseline and after at least 6 mo of therapy.We matched the CTEPH cohort with 45 control patients by age,sex,and observation period.CT-based lung volumes and maximum cardiac CSAs were measured and compared using the Wilcoxon signed-rank test and the Mann-Whitney u test.RESULTS Total,right lung,and right lower lobe volumes were significantly reduced in the CTEPH cohort at follow-up vs baseline(total,P=0.004;right lung,P=0.003;right lower lobe;P=0.01).In the CTEPH group,the reduction in lung volume and cardiac CSA was significantly greater than the corresponding changes in the control group(total,P=0.01;right lung,P=0.007;right lower lobe,P=0.01;CSA,P=0.0002).There was a negative correlation between lung volume change and cardiac CSA change in the control group but not in the CTEPH cohort.CONCLUSION After at least 6 mo of treatment,CT showed an unexpected loss of total lung volume in patients with CTEPH that may reflect continued parenchymal remodeling.

多学科分级协作管理在慢性阻塞性肺疾病患者吞咽筛查及干预中的效果评价

目的:探讨多学科分级协作管理对慢性阻塞性肺疾病患者吞咽筛查及干预的效果。方法:成立慢性阻塞性肺疾病患者吞咽项目多学科管理小组,制订慢性阻塞性肺疾病患者吞咽功能筛查、干预流程,以及制定多学科分级协作管理流程、进食管理常规、培训方案和质量控制方案,开展培训并完成考核。于2022年5—10月在中山大学附属第三医院呼吸与危重症医学科实施吞咽筛查及干预并持续质量控制。结果:共筛查慢性阻塞性肺疾病患者186例,其中,并发吞咽障碍43例,发生率为23.12%(43/186)。实施多学科分级协作管理后,患者吞咽筛查率为100.00%(186/186),吞咽障碍患者根据容积-黏度吞咽测试结果进行干预率为100.00%(43/43),营养吞咽专科护士会诊率为24.19%(45/186),营养医生会诊率为19.89%(37/186),吞咽康复治疗师会诊率为5.91%(11/186)。43例吞咽障碍患者干预后体质量[(61.21±10.99)kg]、血红蛋白[(132.44±11.27)g/L]、血清白蛋白[(37.63±3.51)g/L]、血清前白蛋白水平[(199.77±40.15)mg/L]均高于干预前[分别为(59.99±10.96)kg、(124.67±10.86)g/L、(35.01±2.82)g/L、(177.12±40.09)mg/L](t=-9.871、-8.634、-7.708、-11.703,P值均<0.001);干预后营养风险NRS 2002评分[(2.47±0.74)分]、显性误吸发生率[16.28%(7/43)]、吸入性肺炎发生率[2.33%(1/43)]均低于干预前[分别为(3.53±0.91)分、89.74%(35/39)、35.90%(14/39)](t=10.488,χ^(2)=44.177、0.245,P值均<0.001);干预后专科护理团队临床营养及吞咽理论得分[(86.43±3.80)分]、技能得分[(87.29±2.51)分]均高于干预前[分别为(76.00±6.04)分、(76.76±4.95)分](t=-10.890、-8.584,P值均<0.001)。结论:对慢性阻塞性肺疾病患者常规进行吞咽功能筛查,及早识别并发吞咽障碍患者,进行多学科分级协作管理,可降低患者的营养风险,提升患者进食的安全性,促进专科护理的精细化发展。

住院慢性阻塞性肺疾病急性加重期患者合并低钠血症的相关危险因素分析

目的探讨住院慢性阻塞性肺疾病急性加重期(AECOPD)患者中合并低钠血症的独立危险因素。方法本回顾性横断面研究收集遂宁市人民医院老年医学科和绵阳市第三人民医院老年病科2019年1月—2021年12月的住院慢性阻塞性肺疾病急性加重期(AECOPD)患者327例。根据排除和入选标准,最后纳入患者215例,其中正常血钠AECOPD患者(NN-AECOPD)165例,AECOPD合并低钠血症患者(LN-AECOPD)50例。收集和记录患者一般资料、基础疾病、肺功能、血常规、PCT、CRP、血气分析和电解质数据。首先对数据进行单因素分析。然后对单因素分析有统计学差异的变量建立二元logistics回归模型。结果单因素分析显示两组患者的胸腔积液(PE)、社区获得性肺炎(CAP)和2型糖尿病的发生率,血淋巴细胞%、血清PCT和血清镁水平有显著统计学差异(均P<0.05)。然后,将有显著统计学差异的6个因子代入二元logistics回归方程后发现AECOPD患者中社区获得性肺炎(CAP)(R=5.109,P<0.001)与低钠血症独立相关。结论研究表明社区获得性肺炎是导致AECOPD患者低钠血症的重要原因。AECOPD合并社区获得性肺炎患者出现血电解质异常更加常见。同时若AECOPD患者合并低钠血症,我们应该考虑该患者合并社区获得性肺炎的可能。

补肾纳气中药对COPD大鼠膈肌细胞形态及相关肌细胞特异性microRNA下游指标的影响

目的探讨全真一气汤的作用机制及横膈在肾不纳气证形成中的意义。方法将80只SD大鼠按照随机数字表法分为六组,正常组(A组)10只、慢性阻塞性肺疾病(COPD)肾不纳气证组(B组)60只[模型组(B_(1)组)15只、中药实验组(B_(2)组)15只、中药对照组(B_(3)组)15只、西药对照组(B_(4)组)15只]及COPD非肾不纳气证组(C组)10只,A组、B_(1)组大鼠给予氯化钠,B_(2)组给予全真一气汤,B_(3)组给予六君子汤,B_(4)组给予氨茶碱片,共60 d。HE染色观察A组、B_(1)组及C组的肺、膈肌病理形态,实时荧光定量聚合酶链式反应(qPCR)检测各组microRNA-1(以下简写为“miR-1”)、组蛋白去乙酰化酶4(HDAC4)及过氧化物酶体增殖物激活受体γ辅助因子1α(PGC-1α)表达,Western blot(WB)法检测以上指标的蛋白含量。结果B_(1)组膈肌纤维细胞排列紊乱、变形、间隙增宽,且重于C组。qPCR结果显示,其他各组miR-1表达皆低于A组(P<0.05),且B_(2)组、B_(4)组低于B_(1)组(P<0.05),B_(2)组低于B_(3)组(P<0.05);B_(2)组、B_(3)组和B_(4)组HDAC4表达高于B_(1)组,且B_(2)组HDAC4、PGC-1α表达皆高于B_(3)组(P<0.01),B_(1)组与C组HDAC4、PGC-1α表达差异均有统计学意义。WB结果显示,B_(2)组HDAC4蛋白表达高于B_(1)组和B_(3)组,PGC-1α蛋白表达高于B_(1)组、C组及B_(3)组、B_(4)组,C组PGC-1α蛋白表达高于B_(1)组。结论膈肌参与肾不纳气证的形成,全真一气汤可通过下调miR-1,影响HDAC4、PGC-1α的蛋白表达,改善COPD膈肌损伤。

天津地区部分居民慢性阻塞性肺疾病影响因素分析

目的 分析天津部分地区常住居民肺通气功能情况及拟诊慢性阻塞性肺疾病(COPD)的影响因素,为天津地区COPD的精准防控提供参考。方法 于2022年6月—12月随机抽取天津市和平区、津南区和宝坻区的35岁及以上的常住居民5 693例。收集基本信息、吸烟史、治疗用药,填写中国慢阻肺筛查问卷(COPD-SQ)。根据COPDSQ结果,将研究对象分为COPD低危组(COPD-SQ评分<16分,4 648例)及COPD高危组(COPD-SQ评分≥16分,1 045例)。进行体格检查并完成肺功能筛查。采用多因素Logistic回归分析COPD患病的独立危险因素。结果 纳入对象年龄56(48,64)岁,男性2 393例(42.0%),吸烟1 381例(24.3%),体质量指数(BMI)25.1(23.0,27.6)kg/m^(2),腰臀比0.917(0.874,0.957),拟诊COPD 650例(11.4%);正在接受规范的COPD患者18例,占拟诊COPD人群的2.8%。与COPD低危组相比,COPD高危组男性占比、年龄、吸烟率、腰臀比、血压及拟诊COPD占比较高,BMI、外周经皮血氧饱和度、FVC占预计值的百分比、FEV1占预计值的百分比、1秒用力呼气量占用力肺活量百分比、呼气峰流量占预计值的百分比、最大呼气中期流量占预计值的百分比、PEF50占预计值的百分比较低(均P<0.05)。和平区、津南区及宝坻区吸烟及拟诊COPD占比差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,男性、吸烟以及高龄是拟诊COPD的独立影响因素。结论 天津地区35岁及以上常住居民吸烟率较高,年龄、吸烟状况及性别均与COPD的发病相关。

慢性阻塞性肺疾病患者睡眠质量和焦虑抑郁情况及其影响因素:一项多中心横断面研究

背景慢性阻塞性肺疾病(以下简称慢阻肺)易使患者睡眠质量下降,并产生焦虑抑郁症状,但常被医护人员和患者自身忽视。了解慢阻肺患者睡眠质量和焦虑抑郁情况及其影响因素,有助于提高患者的生活质量,但相关多中心研究尚少。目的调查慢阻肺患者的睡眠质量和焦虑、抑郁情况,并探究其影响因素。方法采用方便抽样,对2022年8—11月在安徽省7家医院呼吸与危重症医学科就诊的慢阻肺患者进行招募,收集患者的人口学特征、呼吸困难等级、气流受限严重程度、营养不良风险、身体活动水平、疫苗接种和近1年急性加重情况。分别采用匹兹堡睡眠质量指数(PSQI)和医院焦虑抑郁量表(HADS)评估慢阻肺患者的睡眠质量和焦虑抑郁症状,并采用多因素Logistic回归分析其影响因素。结果共调查慢阻肺患者248例,其中睡眠质量差的发生率为60.9%(151/248),仅8.9%(22/248)的患者认为自己有很好的睡眠质量,一半以上的患者实际睡眠时间不足(54.4%)或睡眠效率低(60.1%);29.4%(73/248)的慢阻肺患者至少存在焦虑或抑郁其中一种症状,其中35例存在焦虑症状,61例存在抑郁症状,23例同时存在焦虑和抑郁两种症状。多因素Logistic回归分析结果显示,年龄大(OR=1.052,95%CI=1.018~1.086)、有营养不良风险(OR=3.393,95%CI=1.855~6.206)是慢阻肺患者睡眠质量差的危险因素,有规律的身体活动是慢阻肺患者睡眠质量差的保护因素(OR=0.450,95%CI=0.242~0.834)(P<0.05)。近1年急性加重次数≥2次(OR=2.220,95%CI=1.093~4.510)、有营养不良风险(OR=1.961,95%CI=1.044~3.683)是慢阻肺患者发生焦虑抑郁症状的危险因素(P<0.04)。慢阻肺患者PSQI评分与焦虑症状得分(HADS-A)(r_(s)=0.413)、抑郁症状得分(HADS-D)(r_(s)=0.430)存在正相关关系,HADS-A评分和HADS-D评分存在正相关关系(r_(s)=0.719,P<0.05)。结论慢阻肺患者中睡眠质量差和焦虑抑郁症状的发生率较高,年龄、营养不良风险、规律的身体活动和近1年急性加重次数是重要的影响因素。医护人员、家属和患者自身应提高对睡眠质量和焦虑抑郁的认识,对重点患者积极开展筛查和干预工作,以改善患者的睡眠质量和心理健康。

高尿酸血症与慢性肺源性心脏病的相关性研究:基于LASSO回归与倾向性评分匹配法

背景近年来众多研究表明高尿酸血症(HUA)是某些疾病的影响因素,然而HUA是否为慢性肺源性心脏病(CPHD)的影响因素仍需进一步研究。目的探讨HUA与CPHD的相关性,旨在为CPHD患者血尿酸(SUA)水平的管理提供理论依据。方法纳入2019—2023年新疆医科大学第一附属医院收治的1171例慢性阻塞性肺疾病(COPD)患者为研究对象,根据其是否患有CPHD分为CPHD组(470例)和COPD组(701例)。收集患者一般资料和实验室检查及超声心动图检查结果。采用LASSO回归法对变量进行筛选,采用倾向性评分匹配法(PSM)排除混杂因素影响。采用多因素Logistic回归分析探究COPD患者合并CPHD的影响因素。结果CPHD组女性、汉族、吸烟、饮酒、特发性肺纤维化、慢性支气管炎、支气管哮喘比例、淋巴细胞百分比、左心室舒张末期内径、左心室收缩末期内径、心输出量、左心室射血分数低于COPD组,心功能3~4级、HUA、肺栓塞、先天性心脏病比例、红细胞计数、中性粒细胞百分比、SUA、血尿素氮、D-二聚体、N末端-B型利钠肽前体、右心房内径、右心室内径、左心房内径、右心室流出道内径、肺动脉内径高于COPD组,差异有统计学意义(P<0.05)。LASSO回归筛选出变量后进行PSM,最终得到COPD组469例、CPHD组469例。匹配后CPHD组心功能3~4级、HUA占比、右心房内径、右心室内径、右心室流出道内径、肺动脉内径大于COPD组,支气管哮喘、淋巴细胞百分比低于COPD组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,HUA升高、心功能3~4级、右心房内径、右心室内径、肺动脉内径增加是COPD患者合并CPHD的危险因素(P<0.05),患有支气管哮喘、左心室舒张末期内径增加为COPD患者合并CPHD的保护因素(P<0.05)。将SUA水平按四分位数分层,多因素Logistic回归分析结果显示,与Q1(SUA<237.31μmol/L)比较,Q4(SUA>381.29μmol/L)患者患有CPHD的风险增加1.421倍。结论HUA是CPHD疾病发生、发展的影响因素,积极控制SUA水平有助于预防CPHD的发生、发展。

慢性阻塞性肺疾病CT定量参数改变及其与肺功能指标的关系

目的观察未经治疗COPD患者CT定量参数变化及其与肺功能指标的关系。方法回顾性分析99例未经治疗COPD患者资料;根据气流受限程度分为A组(GOLD 1级,轻度受限,36例)、B组(GOLD 2级,中度受限,37例)及C组(GOLD 3、4级,明显受限,26例);分析首检及随访胸部CT定量参数、肺功能指标的差异及其相关性。CT定量参数包括全肺容积、低衰减区百分比(LAA%)、肺血管总计数与肺表面积比值(N_(total)/LSA)、截面积_(<5 mm^(2))的肺血管计数与肺表面积比值(N_(<5 mm^(2))/LSA)、理论气道内周长为10 mm的管壁面积平方根(Pi10)、全肺气道壁体积、壁厚及壁面积百分比(WA%)等,而肺功能指标包括吸入支气管舒张剂后第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)及二者比值(FEV_(1)/FVC)和FEV_(1)率(FEV_(1)%)。结果相比首检各项指标,随访时各组FVC、FEV_(1)、FEV_(1)/FVC,以及N_(total)/LSA、N_(<5 mm^(2))/LSA均降低(P均<0.05),而LAA%、Pi10及全肺气道壁体积均升高(P均<0.05)。相比A组,B、C组LAA%降低而Pi10升高,且幅度随气流受限程度加重而增加(P均<0.05)。LAA%、Pi10及全肺气道壁体积与肺功能指标呈负相关(P均<0.05);N_(total)/LSA、N_(<5 mm^(2))/LSA与肺功能指标呈正相关(P均<0.05)。结论定量CT参数LAA%、N_(total)/LSA、N_(<5 mm^(2))/LSA、Pi10及全肺气道壁体积均与肺功能相关,能较好反映COPD气道及血管纵向变化。

中医医院传染病流行病学特征分析

目的分析中医医院传染病报告率变化趋势和流行病学特征。方法对某三甲中医医院2019—2022年报告传染病进行描述性分析,比较不同年份间报告情况的差异。结果2019—2022年医院共报告传染病5742例,报告率从125.83/10万降至87.14/10万。报告数最多的病种是梅毒。报告率居前10位的传染病除肺结核外均呈下降趋势。2019—2022年传染病报告在传播方式(χ^(2)=32.385,P<0.001)、诊断类型(χ^(2)=10.816,P=0.013)、病例来源(χ^(2)=15.593,P=0.001)、年龄(χ^(2)=53.631,P<0.001)、职业(χ^(2)=156.581,P<0.001)方面比较,差异有统计学意义。结论中医医院应该依据传染病分布特点对住院、门诊病例分别制定防控措施,重点关注梅毒、肺结核。

2018—2021年新疆维吾尔自治区喀什地区肺结核患者家庭内密切接触者发病情况及影响因素分析

目的:分析结核病高负担环境中肺结核患者家庭内密切接触者发病风险及影响因素。方法:从“中国疾病预防控制信息系统”子系统“结核病管理信息系统”中收集2018年1月1日至2021年12月31日新疆维吾尔自治区喀什地区12个县(市)确诊的肺结核患者作为指示病例,通过接触者筛查建立家庭内密切接触者队列,跟踪随访观察其发病情况。采用泊松回归模型分析指示病例的病原学特征、治疗状态、暴露情况,以及家庭内密切接触者既往肺结核病史等对其肺结核发病的影响因素。结果:截至2021年12月31日,共计调查了40182例肺结核指示病例、57142名家庭内密切接触者。在4年的随访期间,随访时间中位数(四分位数)为3.2(2.7,3.3)年,共计发现了3585例家庭内密切接触者肺结核续发患者,续发率为6.27%,共计观察180543人年,平均发病密度为1985.68/10万人年。其中,指示病例确诊后的第1年,其家庭内密切接触者肺结核发病率最高,约为3317.62/10万人年。泊松回归分析显示,指示病例病原学检测为涂阴、初治,家庭内密切接触者为男性、≥55岁、既往有肺结核接触史和肺结核病史均是家庭内密切接触者肺结核发病的危险因素[RR(95%CI)值分别为2.491(2.347~2.562)、1.221(1.102~1.354)、1.449(1.306~1.607)、8.451(6.388~11.179)、2.680(2.314~3.104)、4.479(3.852~5.207)]。结论:家庭内密切接触者是肺结核指示病例传播的高危人群,应加强家庭内密切接触者的筛查和宣传教育工作,尤其是其中的老年、男性、既往有肺结核接触史和肺结核病史者;也有必要在结核病高负担地区系统地扩大和加强家庭内密切接触者的追踪和预防性治疗策略。同时,建议在当前策略基础上纳入全部肺结核患者的密切接触者进行筛查,尤其是涂阴和仅分子生物学检测阳性患者。

两样本孟德尔随机化分析哮喘与慢性阻塞性肺疾病的因果关系

目的:采用两样本孟德尔随机化(mendelian randomization,MR)方法探究哮喘和慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)间是否存在因果关系。方法:从全基因组关联研究(genome-wide association studies,GWAS)汇总数据中筛选出与哮喘强相关的单核苷酸多态性(single nucleotide polymorphism,SNP)作为工具变量,采用逆方差加权法(inverse variance weighted,IVW)作为主要分析方法,MR-Egger法、加权中位数法、简单模型和加权模型作为辅助分析方法,以评价哮喘和COPD发病风险之间的因果关系,同时采用孟德尔随机多态性残差和离群值(mendelian randomization pleiotropy residual sum and outlier,MR-PRESSO)检验检测是否存在离群的SNP,MR-Egger截距测试、Cochran Q检验评估工具变量的水平多效性和异质性。结果:共纳入61个SNP,IVW结果显示,哮喘是COPD的危险因素(OR=1.146,95%CI=1.023-1.283,P=0.020;OR=1.153,95%CI=1.003~1.326,P=0.045),其余4种辅助分析方法的结果与IVW方法显示的结果一致,MR-PRESSO检验、Cochran Q检验、MR-Egger截距测试以及留一法的结果均显示了结果的稳定性。结论:哮喘是COPD的危险因素。

健康体检人群血尿酸与气流阻塞的相关性

目的:探讨中国台湾健康体检人群中血尿酸水平与肺功能指标和气流阻塞之间的相关性。方法:利用中国台湾美兆健康资源中心的体检资料,选取于1996—2016年间进行体检的40岁以上人群进行横断面分析,按照性别分别进行血尿酸水平与肺功能指标的相关性分析,以及血尿酸水平对气流阻塞影响的Logistic回归分析。结果:共纳入35465人,平均年龄(45.70±7.30)岁,男性16411人,女性19054人,其中,男性的血尿酸水平高于女性,存在气流阻塞的人群血尿酸水平高于无气流阻塞的人群。女性血尿酸水平与肺功能指标[第一秒用力呼气容积(forced expiratory volume in one second,FEV1)、用力肺活量(force vital capacity,FVC)]之间呈负相关(P<0.05),男性血尿酸水平与肺功能指标FEV1、FVC之间则无显著相关性(P>0.05)。在调整年龄、教育程度、吸烟、饮酒、工作强度、体重指数、是否咳嗽、高血压病史、糖尿病病史等指标,以及白细胞、白蛋白等生化指标后,随着血尿酸浓度的升高,女性更易存在气流阻塞(OR=1.12,95%CI:1.02~1.22,P<0.05)。按照是否患高尿酸血症进行分组,结果显示与血尿酸正常组相比,女性中高尿酸血症组更易存在气流阻塞(OR=1.36,95%CI:1.06~1.75,P<0.05),而男性中血尿酸浓度与气流阻塞患病之间无显著相关性(OR=1.04,95%CI:0.96~1.13,P>0.05),是否患高尿酸血症与气流阻塞的存在无显著相关性(OR=1.12,95%CI:0.89~1.39,P>0.05)。结论:女性健康体检人群中,血尿酸水平与肺功能指标FEV1、FVC之间存在负相关,高尿酸血症与气流阻塞的存在有相关性,在男性中则不明显。未来仍需要前瞻性研究来进一步验证高血尿酸水平是否与气流阻塞的发生相关联。