Asthma-chronic obstructive pulmonary disease overlap syndrome: A diagnostic puzzle for the clinicians

Although asthma and chronic obstructive pulmonary disease(COPD) are distinct airway diseases characterized by chronic inflammation, in some cases distinguishing between them is puzzling. For example, chronic smoking leads asthmatic inflammation to a differentiated pattern resembling the COPD inflammation, and in some cases to fixed obstruction as in COPD, and on the other hand, few COPD patients may present with airway reversibility. ACOS is the condition sharing features encountered both in asthma and COPD. Asthma-COPD overlap syndrome(ACOS) represents a diagnostic challenge in the clinical practice, since there is lack of specific indicators to distinguish it from asthma or COPD, and moreover, genetic risk factors, underlying pathology and molecular pathways, clinical characteristics, therapeutic interventions, response to treatment and prognosis are poorly described. The management of ACOS is recommended to be individualized and should target on the maximum effectiveness with the least side effects. Combination therapy with ICS/LABA or LAMA, or newly developed specific anti-eosinophil therapies and treatments specifically targeting neutrophils might be of relevance in the management of ACOS, but studies are needed in order to assess the response and prognosis. Based on the current knowledge about ACOS thus far, it would be recommended that we approached chronic obstructive airway disease rather by describing than by classifying the disease; this would allow us to have a picture that better describes the disease and to implement an individualized therapeutic approach, according to the custom phenotype. Nevertheless, more studies are needed in order to clarify several important issues with regard to ACOS, such as the genetic risk factors for developing ACOS, the links between genotype and phenotype, the molecular pathways and underlying mechanisms of ACOS, the identification of possible specific biomarkers for diagnosis and targeted treatment, the optimal therapeutic interventions, and finally, the prognosis of ACOS.

Exploring the biological mechanism of qi deficiency syndrome with chronic obstructive pulmonary disease(COPD)based on integrated pharmacology

Objective:To explore the potential biological mechanism of chronic obstructive pulmonary disease(COPD)qi deficiency syndrome,we used the integrated pharmacology network computing platform and carried out experimental verification.Methods:Using an integrated pharmacology strategy to analyze the potential biological targets of COPD qi deficiency syndrome.Based on the established qi deficiency syndrome rat model of COPD,the biological targets of lung and skeletal muscle were detected by electron microscopy,adenosine triphosphate(ATP)content assays,and western blotting.Results:According to the integrated pharmacological results,it was found that the locations of cell components related to COPD qi deficiency syndrome were mainly mitochondria.Electron microscopy results using lung tissue showed that mitochondria in the lipopolysaccharide(LPS group)and pulmonary instillation of LPS combined with cigarette smoke(LPStCS group)were swollen,deformed,and fragmented,with disappearing or broken crista.Results also showed that the total content of ATP in the lung and skeletal muscle of both groups was significantly lower than that in the control group at the 12th week(P<.05).At the 12th week,the expression of dynamin-related protein 1(DRP1)and mitofusin 1(MFN1)protein was significantly difference than that of the control group(P<.05).At the 10th and 14th weeks,changes in fission and fusion proteins in mitochondria of the lung and skeletal muscle were further detected.There was also a significant difference in the expression between the two groups compared to that in the control group at the 10th week and 14th week(P<.05).Conclusion:These findings suggest that the changes in mitochondrial morphology and ATP content and the unbalanced expression of DRP1 and MFN1 might be the key mechanisms underlying qi deficiency syndrome in rats with COPD.

Traditional Chinese medicine nursing protocols for chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease(COPD)is a complex respiratory disorder,characterized by chronic airflow limitation and an elevated inflammatory response of the airways.The people with COPD are more likely to develop comorbidities,with significant impacts on patients'quality of life,exacerbation frequency,and survival.Traditional Chinese medicine(TCM)exhibits good therapeutic effects on improving the clinical symptoms,lung function and quality of life in patients with COPD.Herein,this article primarily summarized the key points of common syndromes,TCM nursing methods and healthy guidance of COPD,aiming at maintaining and developing the strengths of TCM,improving its efficacy and standardizing its behavior.

Effects of TCM Nursing Based on Syndrome Differentiation on Pulmonary Function and Quality of Life in Patients with Acute Exacerbation of COPD

[Objectives] To investigate the effects of TCM nursing based on syndrome differentiation on pulmonary function and quality of life in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). [Methods] A total of 92 patients with AECOPD who came to Nanchong Chinese Medicine Hospital from March 2022 to February 2023 were selected for the study, and the intervention group (TCM nursing based on syndrome differentiation, 46 cases) and the conventional group (basic nursing, 46 cases) were selected for the study, and the pulmonary function and quality of life of the two groups were compared. [Results] Before nursing, there was no significant difference in levels of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and percentage of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) between the intervention group and conventional group ( P >0.05). After 3 months of nursing, the levels of FVC, FEV1 and FEV1/FVC in the intervention group were higher than those in the conventional group ( P <0.05). Before nursing, there was no significant difference in the scores of health, emotion and social functions between the two groups ( P >0.05). At three months of nursing, the scores of health, emotion, and social functions in the intervention group were higher than those in the conventional group ( P <0.05). [Conclusions] The implementation of TCM nursing based on syndrome differentiation in patients with AECOPD can effectively improve the pulmonary function and quality of life of patients, and has significant clinical implementation value.

Endothelial function and T-lymphocyte subsets in patients with overlap syndrome of chronic obstructive pulmonary disease and obstructive sleep apnea

Background:The coexistence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is termed overlap syndrome (OS).COPD and OSA both have increased risks of developing cardiovascular diseases.This study aimed to explore if patients with OS exhibited a higher prevalence of cardiovascular complications,and if patients with OS exhibited vascular endothelial dysfunction and abnormalities in the cellular immune function of T lymphocytes.Methods:Totally 25 patients with stable COPD (COPD group),25 patients with OSA (OSA group),25 patients with OS (OS group),and 20 healthy adults (control group) were enrolled between January 2017 and December 2017 from the Respiratory Department of Tianjin Medical University General Hospital.The clinical characteristics of the four groups were collected and the expression levels of soluble vascular cell adhesion molecule-1 (sVCAM-1),tumor necrosis factor-α(TNF-α),and T-lymphocyte subsets were detected.One-way analysis of variance,x^2 test and Pearson correlation were used to manage the data.Results:The prevalence of hypertension and coronary heart disease was significantly higher in the OS group than in the control,OSA,and COPD groups (x^2 =20.69,P < 0.05 and x^2 =11.03,P < 0.05,respectively).The levels of sVCAM-1 and TNF-α were significantly higher in the OS group than in other groups (F =127.40,P < 0.05 and F =846.77,P < 0.05,respectively).The percentage of CD4+ lymphocytes and CD4+/CD8+ were both significantly lower in the OS group than in any other group (F =25.40,P < 0.05 and F =75.08,P < 0.05,respectively).There were significantly negative correlations in the levels of sVCAM-1 and TNF-α with CD4^+/CD8^+ lymphocytes (r =-0.77,P < 0.05 and r =-0.83,P < 0.05,respectively).Conclusions:The prevalence of hypertension and coronary heart disease was higher in patients with OS than in patients with either OSA or COPD alone.Patients with OS exhibited more severe vascular endothelial injury,stronger inflammatory response,and lower cellular immune function.

ClinicalObservationofQiDeficiencySyndromein72PatientswithChronicObstructivePulmonaryDiseaseTreatedwithYiqiMianyiGranule（益气免疫冲

Seventy-two patients of chronic obstructive pulmonary disease (COPD) of Qi deficiency syn-drome with abnormal immune indices were treated with Yiqi Mianyi Granule (YQMYG) and the efficacy wascompared with that of 30 cases treated with Zhenqi fuzheng Granule (ZQFZG) for control. Results showedthat the markedly effective rate of symptomatic improvement ot Qi deficiency in YQMYG group was 65. 3%,the total effective rate 93. 1 % . 88. 6% of the immune indices lower than normal were corrected and 43. 7%ot them were normalized, while for indices that were higher than normal the rate were 78. 2 % and 52 . 9% re-spectively. These results suggested that YQMYG could improve symptom of Qi Deficiency markedly,strengthen cellutar immunity and regulate immune dysfunction. its therapeutic efficacy was obvfously superiorto ZQFZG ( P < 0 . 05 ).

基于NHANES数据库低氧重叠综合征与心血管病的关联性研究

目的探讨阻塞性睡眠呼吸暂停综合征(Obstructive sleep apnea,OSA)、慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)及重叠综合征(overlap syndrome,OS)与心血管疾病的相关性。方法选取2005年~2008年美国国家健康和营养调查(National health and nutrition examination survey,NHANES)数据,共7716名参与者纳入本研究。按照是否存在OSA、COPD分为4组:无OSA及COPD组(n=3072)、单纯OSA组(n=4062)、单纯COPD组(n=180)、OS组(n=402)。本研究采用多因素logistic回归以探究OSA、COPD及OS与多种心血管疾病的关联。同时探究OSA、COPD和OS与年龄、性别、肥胖等心血管危险因素在心血管疾病中的关联性。结果相较于无OSA及COPD组,OS组心肌梗死(OR=2.85,95%CI=1.94~4.21)、充血性心力衰竭(OR=4.32,95%CI=2.73~6.84)、心绞痛(OR=3.07,95%CI=1.92~4.91)、卒中(OR=2.52,95%CI=1.61~3.97)、冠心病(OR=3.1,95%CI=2.22~4.31)及总体心血管疾病(OR=3.43,95%CI=2.54~4.63)的风险增加显著相关。单纯OSA症状人群中卒中发生率为无OSA及COPD组的1.46倍(OR=1.46,95%CI=1.07~1.99),充血性心力衰竭(OR=3.27,95%CI=1.77~6.07)、冠心病(OR=1.68,95%CI=1.03~2.73)和总体心血管疾病(OR=1.93,95%CI=1.25~3.00)的风险也显著升高。未观察到单纯OSA症状与心血管疾病的风险增加的相关性。OSA、COPD及重叠综合征与总体心血管疾病、冠心病和心肌梗死的关联在各亚组人群中稳定。结论OSA-COPD综合征与心肌梗死、充血性心力衰竭、心绞痛、卒中、冠心病及总体心血管疾病的发生风险增高存在显著相关性。监测及控制OSA-COPD重叠综合征对心血管疾病的预防有着重要意义。

糠酸氟替卡松/乌美溴铵/维兰特罗三联疗法与传统ICS/LAMA疗法对ACO患者的临床疗效差异分析

目的探讨糠酸氟替卡松/乌美溴铵/维兰特罗(FF/UMEC/VI)三联疗法对哮喘-慢性阻塞性肺疾病重叠综合征(ACO)患者的临床疗效及与吸入型糖皮质激素(ICS)/长效抗胆碱能拮抗剂(LAMA)联合疗法的差异性。方法纳入2019年6月至2022年6月呼吸与危重症医学科收治的90例ACO患者,随机分为研究组与对照组,各45例。对照组患者予以ICS/LAMA治疗,研究组患者予以FF/UMEC/VI三联疗法治疗,治疗12周后比较两组患者用药前后肺功能指标变化、症状改善情况及疗效评价。结果治疗前研究组与对照组患者基础临床资料及各项肺功能指标差异无统计学意义(P>0.05)。治疗12周后研究组患者各项肺功能指标及血气分析指标较治疗前均显著改善(P<0.05)。不同方案治疗12周后,研究组患者各项肺功能改善程度均高于对照组患者(P<0.05)。治疗12周后研究组患者症状改善指标及治疗有效率均高于对照组患者(P<0.05)。结论FF/UMEC/VI三联疗法对于ACO患者具有显著治疗效果,能够改善患者肺功能,缓解患者临床症状,具有较为广阔的应用前景。

黏蛋白1与呼吸系统疾病关系的研究进展

慢性黏液高分泌导致的气道炎症可能会逐渐进展并影响患者的肺功能。黏液蛋白是黏液层的关键成分,其中黏蛋白1是一种重要的膜结合型黏蛋白,目前的研究聚焦于评估黏蛋白1在肺纤维化、肺癌和间质性肺疾病等肺部疾病中的临床应用,尤其是作为诊断、预测进展和评估治疗效果的生物标志物。因此,深入了解黏蛋白1在肺部疾病中的生物学机制和作用方式,特别是与疾病发展和进展的关联,探索黏蛋白1在肺部疾病早期诊断和预后评估中的预测价值,将为肺部疾病的诊断和治疗提供新的理论依据。

慢性阻塞性肺疾病急性加重期中医证型结构方程分析

目的为慢性阻塞性肺疾病急性加重期(Acute Exacerbation of Chronic Obstructive Pulmonary Disease,AECOPD)临床辨证诊断和证型的量化标准提供参考依据。方法通过临床调研,应用先进的数理统计方法结构方程对AECOPD中医证候进行系统的研究。收集病例资料100例,数据分析软件选择R语言,首先经过探索性分析,利用最大方差旋转方法,提取出五个共因子,归纳为F1至F5,依据中医理论进行证型辨证命名。结果通过结构方程初步揭示了AECOPD的疾病的五个常见的证型:风寒证、肾虚证、脾虚证、阴虚证、痰湿证,同时分析出了五大常见证型的辨证要点。AECOPD结构方程中各因子与临床证型间存在着较好的对应关系。结论AECOPD的基础证型是风寒、肾虚、脾虚、阴虚、痰湿证等。

吴鞠通温病思辨体系治疗慢性阻塞性肺病临证探赜

清代著名温病学家吴鞠通在《温病条辨》中所建立的三焦辨证思辨理论,对于治疗慢性阻塞性肺病具有重要的临证指导作用。其创立的宣白承气汤,肺肠合病,脏腑同治,为后世医者治疗肺系病证提供了理论渊薮。笔者基于其思辨理论和宣白承气汤,应用在慢性阻塞性肺病及肺系其他危急重症发作期的治疗中,临床每获显著疗效。

哮喘-慢阻肺重叠综合征患者血清SIRT1、α-SMA水平及临床意义研究

目的检测哮喘-慢阻肺重叠综合征(ACOS)患者血清沉默信息调节因子1(SIRT1)、α-平滑肌肌动蛋白(α-SMA)水平,并分析其临床意义。方法对52例ACOS患者(A组)、50例单纯哮喘患者(B组)、51例单纯慢阻肺患者(C组)、50例健康体检者(健康组)的资料进行回顾性分析。4组均检测血清SIRT1、α-SMA水平,肺功能[第1s用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC],血清炎症因子水平[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-1β(IL-1β)],气道可逆性和气道重塑指标[血清碱性成纤维生长因子(b-FGF)、基质金属蛋白酶9(MMP-9)、神经生长因子(NGF)、基质金属蛋白酶组织抑制因子1(TIMP-1)],对比4组上述指标差异;分析A组患者血清SIRT1、α-SMA水平与上述指标的相关性。结果A组血清SIRT1、α-SMA,血清TNF-α、IL-6、IL-1β水平,血清b-FGF、MMP-9、NGF、TIMP-1水平均高于其余3组,B组和C组均高于健康组,差异均有统计学意义(P均<0.05);A组FEV1%、FVC、FEV1/FVC均低于其余3组,B组和C组均低于健康组,差异均有统计学意义(P<0.05);A组与B组支气管舒张试验阳性率均高于其余2组,C组高于健康组,差异均有统计学意义(P<0.05);A组患者中血清SIRT1、α-SMA水平与FEV1%、FVC、FEV1/FVC均呈负相关性,与血清TNF-α、IL-6、IL-1β水平,血清b-FGF、MMP-9、NGF、TIMP-1水平均呈正相关性。结论在ACOS患者中血清SIRT1、α-SMA水平偏高,且均明显高于单纯哮喘和单纯慢阻肺患者,且与肺功能、血清炎症因子水平及气道重塑指标均相关。

姜桂二陈汤治疗慢性阻塞性肺疾病稳定期(寒痰阻肺型)的临床研究

目的 探讨姜桂二陈汤对慢性阻塞性肺疾病稳定期(寒痰阻肺型)患者的临床疗效。方法 选取2020年1月—2022年12月北京中医药大学房山医院肺病科诊治的慢性阻塞性肺疾病稳定期(寒痰阻肺型)患者100例,随机分为观察组和对照组。对照组患者给予以规范西医治疗,观察组在规范西医治疗同时加用姜桂二陈汤,比较两组患者临床疗效、中医症状评分、肺功能及BODE指数。结果 两组患者疗效相比观察组较优(P<0.05);治疗后,两组患者中医症状评分均明显降低,两组相比观察组较低(P<0.05);治疗后,两组患者6 min步行距离(6MWTD)较治疗前升高,且观察组高于对照组;治疗后,两组患者肺功能水平明显提高,两组相比观察组较高;BODE指数较治疗前降低,且观察组低于对照组(P<0.05)。结论 姜桂二陈汤治疗慢性阻塞性肺疾病(寒痰阻肺型),可提高患者临床疗效,缓解患者临床症状,可改善患者肺功能及肺气肿程度,增强患者运动耐量,从而改善患者预后。

穴位贴敷联合中药雾化吸入护理在老年慢性阻塞性肺疾病急性加重期患者中的应用效果

目的:探讨穴位贴敷联合中药雾化吸入护理在老年慢性阻塞性肺疾病急性加重期患者中的应用效果。方法:选取2021年6月~2023年6月北京朝阳医院收治的老年慢性阻塞性肺疾病急性加重期患者100例为研究对象,根据随机数表法分为研究组和对照组,各50例。研究采用穴位贴敷联合中药雾化吸入护理,对照组采用常规护理,比较两组中医症候积分、肺功能指标、炎症反应、免疫功能及生存质量。结果:研究组干预后咳嗽、喘息气短、咳痰、肺湿啰音中医症候积分低于对照组(P<0.05);研究组治疗有效率高于对照组(P<0.05);研究组干预后呼气峰值体积流量(PEF)、用力呼气容积/用力肺活量(FEV1/FVC)、用力呼气容积占预计值百分比(FEV1%pred)、用力肺活量占预计值百分比(FVC%pre)高于对照组(P<0.05);研究组干预后基质金属蛋白酶-9(MMP-9)、白介素-4(IL-4)、肿瘤坏死因子-α(TNF-α)低于对照组,CD4+/CD8+高于对照组(P<0.05)。结论:穴位贴敷联合中药雾化吸入护理可以改善患者临床症状,降低炎症反应,提高患者免疫功能及肺功能,提高临床治疗效果。

Expression of airway mucus-associated proteins in rats with chronic obstructive pulmonary disease with a cold-dryness symptom pattern

OBJECTIVE: To reveal the effects on expression of airway mucus-associated proteins in rats with chronic obstructive pulmonary disease(COPD) and a cold-dryness symptom pattern induced by elastase and smoking.METHODS: The COPD model was established with an elastase dose into the trachea combined with exposure to smoking; the COPD model cold-dryness symptom pattern was further developed by exposure to a cold, dry environment. After 90 days,pathologic lung sections, inflammatory cytokine levels(measured by enzyme linked immunosorbent assay), m RNA and protein expression of mucus-associated proteins and aquaporins(measured by real-time polymerase chain reaction and western blots) were examined.RESULTS: Cytokines interleukin-6(IL-6), interleukin-8(IL-8), and tumor necrosis factor-α(TNF-α) in the COPD and the cold-dryness symptom pattern COPD groups were all significantly higher than in controls(each P < 0.01). IL-6 and IL-8 levels were higher in the cold-dryness symptom pattern COPD group than in the COPD group(each P < 0.05). The AQP5 m RNA expression in the cold-dryness symptom pattern COPD and COPD groups was lower than in the control group(P < 0.01), and that in the cold-dryness symptom pattern COPD group was lower than the COPD group(P < 0.05). The expression of MUC5 AC and MUC5 B m RNAs in the cold-dryness symptom pattern COPD group and COPD group was higher than in the control group(each P < 0.01), and that in the cold-dryness symptom pattern COPD group was higher than the COPD group(P < 0.01, and P < 0.05, respectively).The ratio of MUC5 AC m RNA/MUC5 B m RNA was COPD group < the cold-dryness symptom pattern COPD group < the control group. AQP4 and AQP5 protein expression in the cold-dryness symptom pattern COPD group was lower than that in the COPD group which was lower again than in the control group. MUC5 AC and MUC5 B expression in the cold-dryness symptom pattern COPD group was higher than in the COPD group and higher again than in the control group.CONCLUSION: Cold-dryness affects the expression of mucus-associated protein m RNA and its corresponding proteins, reducing the secretion of aquaporins and increasing the secretion of mucins. Imbalance in aquaporins and mucins can affect the function of mucus, increasing airway obstruction.

肺苏颗粒治疗慢性阻塞性肺疾病急性加重期痰热瘀肺证临床研究

目的观察肺苏颗粒治疗慢性阻塞性肺疾病急性加重期(AECOPD)痰热瘀肺证的临床疗效及对患者生活质量、凝血功能和免疫功能的影响。方法采用随机数字表法将120例患者分为观察组和对照组各60例。对照组予常规西医治疗,观察组在对照组基础上予肺苏颗粒口服,每次1袋,每日3次,连续7 d。观察2组临床疗效,比较2组治疗前后中医症状评分、圣乔治呼吸问卷(SGRQ)评分、凝血功能指标(纤维蛋白原、D-二聚体)、免疫功能指标(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)),并观察不良反应。结果观察组总有效率为93.10%(54/58),对照组为79.66%(47/59),2组比较差异有统计学意义(P<0.05)。与本组治疗前比较,2组治疗后中医症状积分及咳嗽、喘息、脉络瘀血评分,SGRQ评分均下降(P<0.05);2组治疗后比较,观察组上述评分均低于对照组(P<0.05)。与本组治疗前比较,2组治疗后血浆纤维蛋白原和D-二聚体含量均下降(P<0.05);2组治疗后比较,观察组血浆纤维蛋白原和D-二聚体含量均低于对照组(P<0.05)。与本组治疗前比较,2组治疗后外周血CD4^(+)和CD4^(+)/CD8^(+)均显著升高,CD8^(+)显著降低(P<0.05);2组治疗后比较,观察组外周血CD4^(+)和CD4^(+)/CD8^(+)高于对照组,CD8^(+)低于对照组(P<0.05)。2组均未出现药物相关的不良反应。结论在常规西医治疗基础上联合肺苏颗粒治疗AECOPD痰热瘀肺证可显著提高临床疗效,改善患者生活质量,利于凝血功能恢复,并增强细胞免疫功能。

高海拔地区慢性阻塞性肺疾病急性加重期中医证素关联分析

目的探讨高海拔环境下慢性阻塞性肺疾病急性加重期(AECOPD)中医实证证素与人口学特征和临床医学资料之间的相关性。方法选取2020年10月至2021年9月青海省中医院肺病科住院患者634例,收集患者资料进行中医辨证,从证型提取证素,采用多因素Logistic回归分析各证素与人口学特征和临床医学资料之间的相关性。结果证素痰与血红蛋白(Hb)[OR=0.984,95%CI(0.977~0.992),P<0.001]呈负相关;证素饮与年龄[OR=1.041,95%CI(1.004~1.081),P=0.031]、AE次数[OR=1.288,95%CI(1.032~1.608),P=0.025]、AE时间[OR=1.036,95%CI(1.009~1.064),P=0.010]、肌钙蛋白[OR=1.015,95%CI(1.003~1.028),P=0.014]、IgM[OR=2.655,95%CI(1.317~5.352),P=0.006]呈正相关;证素浊与AE时间[OR=0.918,95%CI(0.857~0.984),P=0.016]、Hb[OR=0.967,95%CI(0.947~0.987),P=0.038]呈负相关,与血氧饱和度(SaO_(2))[OR=1.088,95%CI(1.005~1.179),P=0.002]、C3[OR=21.177,95%CI(2.12~211.517),P=0.009]呈正相关;证素瘀与mMRC(4)[OR=0.127,95%CI(0.019~0.835),P=0.032]、PLT[OR=0.995,95%CI(0.991~0.998),P=0.005]呈负相关,与PaCO_(2)[OR=1.048,95%CI(1.002~1.096),P=0.039]、Hb[OR=1.018,95%CI(1.008~1.027),P<0.001]呈正相关;证素湿与Hb[OR=1.022,95%CI(1.006~1.039),P=0.007]、降钙素原(PCT)[OR=1.802,95%CI(1.056~3.076),P=0.031]呈正相关。结论AECOPD实证证素为:痰>瘀>热>饮>浊>湿,证素以“痰”“瘀”为主。年龄越大、AE次数越多、AE时间越长、肌钙蛋白增高、IgM升高,证素饮出现的可能性较大;SaO_(2)及补体C3升高,证素浊出现的可能性较大,补体C3与证素浊有显著的相关性;PaCO_(2)及Hb升高,证素瘀出现的可能性较大;Hb与PCT同时升高,证素湿出现的可能性较大。

茯苓甘草合剂辅助西药对慢性阻塞性肺疾病合并肌肉衰减患者NF-κB信号通路的影响

目的探讨茯苓甘草合剂辅助西药对慢性阻塞性肺疾病(COPD)合并肌肉衰减NF-κB信号通路的影响及分子机制。方法选取2020年8月至2022年8月COPD合并肌肉衰减患者104例,作为研究对象随机数字表法分为对照组和观察组,每组52例。对照组给予西药治疗,观察组给予西药+茯苓甘草合剂治疗。统计2组中医疗效、不良反应及治疗前后中医证候积分、NF-κB mRNA、蛋白及因子[白细胞介素-8(IL-8)、白细胞介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)]、营养状况指标[转铁蛋白(Tf)、血红蛋白(Hb)、白蛋白(ALB)]、肌肉衰减相关指标[握力试验、起立-行走计时测试(TUGT)、5次坐立试验(FTSST)、肌少症筛查问卷(SARC-F)]。结果观察组中医治疗总有效率[86.54%(45/52)]高于对照组[67.31%(35/52)](P<0.05);治疗1个月、3个月后观察组中医证候积分低于对照组(P<0.05);治疗1个月、3个月后观察组NF-κB mRNA、NF-κB蛋白、IL-8、IL-1、TNF-α低于对照组(P<0.05);治疗3个月后观察组握力高于对照组,FTSST、TUGT、SARC-F评分低于对照组(P<0.05);治疗期间,2组均未出现明显不良反应。结论茯苓甘草合剂辅助西药治疗COPD合并肌肉衰减效果确切,可通过抑制NF-κB信号通路,减轻炎性反应,改善患者营养状态,有效改善临床症状,且安全性高。

强力枇杷露对慢性阻塞性肺疾病急性加重期患者的临床疗效及肺功能和IL-6、CRP、PCT水平的影响

【目的】探讨强力枇杷露对慢性阻塞性肺疾病急性加重期(AECOPD)患者的临床疗效及肺功能和白细胞介素6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)水平的影响。【方法】将80例痰热阻肺型AECOPD患者随机分为观察组和对照组,每组各40例。对照组患者给予西医常规治疗,观察组患者在对照组的基础上给予强力枇杷露治疗,疗程为5 d。观察2组患者治疗前后中医证候(咳嗽、咳痰、气短和喘息)评分、肺功能指标[第1秒最大呼气容积(FEV1)及其与用力肺活量(FVC)的比值(FEV1/FVC)]、血气指标[动脉血氧分压(PaO_(2))、血氧饱和度(SaO_(2))和动脉二氧化碳分压(PaCO_(2))]及炎症因子IL-6、CRP、PCT水平的变化情况,并评价2组患者的临床疗效和安全性。【结果】(1)疗效方面,治疗5 d后,观察组的总有效率为95.00%(38/40),对照组为77.50%(31/40),组间比较(χ2检验),观察组的疗效明显优于对照组(P<0.05)。(2)中医证候评分方面,治疗后,2组患者的咳嗽、咳痰、气短、喘息等中医证候评分均较治疗前降低(P<0.05),且观察组的降低幅度均明显优于对照组(P<0.05)。(3)肺功能方面,治疗后,2组患者的FEV1/FVC、FEV1等肺功能指标均较治疗前改善(P<0.05),且观察组的改善幅度均明显优于对照组(P<0.05)。(4)血气指标方面,治疗后,2组患者的PaO_(2)、SaO_(2)水平均较治疗前升高(P<0.05),PaCO_(2)水平均较治疗前降低(P<0.05),且观察组对PaO_(2)、SaO_(2)水平的升高幅度及对PaCO_(2)水平的降低幅度均明显优于对照组(P<0.05)。(5)炎症因子方面,治疗后,2组患者血清IL-6、CRP、PCT水平均较治疗前降低(P<0.05),且观察组的降低幅度均明显优于对照组(P<0.05)。(6)安全性方面,观察组的不良反应发生率为10.00%(4/40),对照组为7.50%(3/40),组间比较,差异无统计学意义(P>0.05)。【结论】强力枇杷露治疗痰热阻肺型AECOPD患者疗效显著,能有效改善患者临床症状,调节患者肺功能和血气指标,抑制炎症反应,且具有较高的安全性。

基于态靶辨治理论诊疗慢性阻塞性肺疾病

慢性阻塞性肺疾病是常见的呼吸系统气道慢性病,严重影响患者的生活质量。传统的中医辨证论治体系存在对疾病的发生发展规律认识不足,对检查化验指标改善欠佳的问题。仝小林院士经过多年的临床实践,提出“态靶辨治”的现代中医诊疗体系,并将其用于慢性疾病临床诊疗过程中。基于此,以“态靶辨治”理论为指导,结合临床经验与现代药理学研究成果,将慢性阻塞性肺疾病发病过程分为“痰、阻、瘀、衰”四态(四期),每态下进行分证,并结合治疗靶点,确定各阶段相应的靶方靶药,构建慢性阻塞性肺疾病的态靶辨治体系,为提高该病的中医治疗效果提供新的路径。