Objective:To systematically evaluate the effect and safety of additional Yupingfeng powder combined with western medicine for the stable period of chronic obstructive pulmonary disease(COPD).Method:Databases including...Objective:To systematically evaluate the effect and safety of additional Yupingfeng powder combined with western medicine for the stable period of chronic obstructive pulmonary disease(COPD).Method:Databases including Pubmed、Web of Science、Cochrane Library、CNKI、VIP、CBM and Wanfang Data base,were searched for relevant randomized controlled trials.for Chinese and English literature about randomized controlled trials of additional Yupingfeng in the treatment of COPD on stable stage which were published from the establishment of the database to December 2019.Two researchers independently screened for,selected studies according to the inclusion and exclusion criteria and extracted data.Methodological quality was evaluated using the Cochrane Risk of Bias tool.Meta-analysis was performed using Revman 5.3 software.Results:Ninetine randomized controlled trials including 1511 patients with COPD were meta-analyzed.The total sample size was 1511.The results showed that the treatment grop with additional Yupingfeng powder could improve the clinical efficacy[OR=0.26,95%CI(0.18,0.37)],FEV1 percentage of the estimated value[MD=4.61,95%CI(2.43,6.79)],6MWD[MD=43.90,95%CI(29.48,58.32)]and patient's immunity IgA[MD=0.25,95%CI(0.17,0.34)]and can mitigate cough effectively[MD=-0.34,95%CI(-0.46,-0.23)].Conclusion:Additional Yupingfeng powder combined with routine treatment for COPD has more advantages than conventional treatment alone in improving the clinical efficacy,lung function,immune function and have less adverse events.As most of the included studies in this systematic evaluation had poor quality,the evidence to support conclusion was weak,so it was necessary to conduct more multi-center clinical trials with high quality methods and rigorous design.展开更多
Objective:To investigate the effects of Tongjing xuanfei exercise on clinical symptoms,pulmonary function and exercise endurance of patients with Chronic obstructive pulmonary disease at stable stage.Methods:A total o...Objective:To investigate the effects of Tongjing xuanfei exercise on clinical symptoms,pulmonary function and exercise endurance of patients with Chronic obstructive pulmonary disease at stable stage.Methods:A total of 130 patients with Chronic obstructive pulmonary disease at stable stage from the Department of Pulmonary Diseases,Qingdao Haici Medical Group during September 2018 to September 2020 were collected and randomly divided into a observation group and a control group,with 65 patients in each group.The control group was given routine pulmonary rehabilitation nursing,and the observation group was given Tongjing Xuanfei exercise treatment combined with routine pulmonary rehabilitation nursing,12 months for treatment.The changes of symptoms and pulmonary function index were observed before and after treatment.Results:FEV1,FVC,FEV1%pred,FEV1/FVC,exercise endurance and CAT score,mMRC dyspnea index score and TCM clinical symptom score in the observation group were significantly higher than those in the control group(P<0.05).Conclusion:Tongjing Xuanfei exercise is helpful to improve the clinical symptoms,pulmonary function and exercise endurance of patients with Chronic obstructive pulmonary disease at stable stage.展开更多
BACKGROUND Under physiological conditions,sputum produced during acute exacerbation of chronic obstructive pulmonary disease(AECOPD)can move passively with the cilia in the airway;the sputum is gradually excreted from...BACKGROUND Under physiological conditions,sputum produced during acute exacerbation of chronic obstructive pulmonary disease(AECOPD)can move passively with the cilia in the airway;the sputum is gradually excreted from the depth of the airways through the stimulation of the coughing reflex on the sensory nerve on the surface of the airway.However,when the sputum is thick,the cough is weak,or the tracheal cilia are abnormal,sputum accumulation may occur and affect the exchange of oxygen and carbon dioxide in the lung.Furthermore,the presence of pathogenic microorganisms in sputum may cause or aggravate the symptoms of pulmonary infection in patients,which is the main factor leading to AECOPD.Therefore,promoting effective drainage of sputum and maintaining airway opening are key points requiring clinical attention.AIM To explore the effect of refined nursing strategies in patients with AECOPD and dysphagia.METHODS We selected 126 patients with AECOPD and difficulty of expectoration at our hospital,and divided them into a refined care group and a routine care group,with 63 cases each,using a random number table.The two groups of patients were treated with expectorant,anti-infection,oxygen inhalation,and other basic treatment measures;patients in the refined care group were given refined nursing intervention during hospitalization,and the routine care group received conventional nursing intervention.The differences in sputum expectoration,negative pressure suction rate,blood gas parameters,dyspnea score measured through the tool developed by the Medical Research Council(MRC),and quality of life were compared between the two groups.RESULTS After 7 d of intervention,the sputum expectoration effect of the refined care group was 62.30%,the effective rate was 31.15%,and the inefficiency rate was 6.56%.The sputum expectoration effect of the routine care group was 44.07%,the effective rate was 42.37%,and the inefficiency rate was 13.56%.The refined care group had better sputum expectoration than the routine care group(P<0.05).The negative pressure suction rate in the refined care group was significantly lower than that of the routine care group during the treatment(22.95%vs 44.07%,P<0.05).Before the intervention,the arterial oxygen saturation(PaO2)and arterial carbon dioxide saturation(PaCO2)values were not significantly different between the two groups(P>0.05);the PaO2 and PaCO2 values in the refined care group were comparable to those in the routine care group after 7 d of intervention(P>0.05).Before the intervention,there was no significant difference in the MRC score between the two groups(P>0.05);the MRC score of the refined care group was lower than that of the routine care group after 7 d of intervention,but the difference was not statistically significant(P>0.05).Before intervention,there was no significant difference in the symptoms,activities,disease impact,or St.George’s Respiratory questionnaire(SGRQ)total scores between the two groups(P>0.05).After 7 days of intervention,the symptoms,activities,and total score of SGRQ of the refined care group were higher than those of the routine care group,but the difference was not statistically significant(P>0.05).CONCLUSION AECOPD with thick sputum,weak coughing reflex,and abnormal tracheal cilia function will lead to sputum accumulation and affect the exchange of oxygen and carbon dioxide in the lung.Patients with AECOPD who have difficulty expectorating sputum may undergo refined nursing strategies that will promote expectoration,alleviate clinical symptoms,and improve the quality of life.展开更多
Objective:Chronic obstructive pulmonary disease (COPD) is one of the common respiratory diseases characterized by restricted airflow, incomplete reversibility, and expiratory dyspnea. It has become a major public heal...Objective:Chronic obstructive pulmonary disease (COPD) is one of the common respiratory diseases characterized by restricted airflow, incomplete reversibility, and expiratory dyspnea. It has become a major public health problem worldwide.Through the research of COPD Chinese and Western medicine pulmonary rehabilitation training by domestic and foreign scholars in the past 5 years, it is found that the emphasis on stable lung rehabilitation can delay the further deterioration of lung function in patients with COPD, effectively improve skeletal muscle fiber and structure, improve exercise capacity, improve breathing difficulties, and hope for pulmonary rehabilitation. It is one of the main methods of treatment for patients with COPD.展开更多
Objective:To study the effect of adjuvant N-acetylcysteine (NAC) effervescent tablets therapy on cardiopulmonary function and airway remodeling in patients with stable chronic obstructive pulmonary disease (COPD).Meth...Objective:To study the effect of adjuvant N-acetylcysteine (NAC) effervescent tablets therapy on cardiopulmonary function and airway remodeling in patients with stable chronic obstructive pulmonary disease (COPD).Methods: Patients with stable COPD treated in Zigong Third People's Hospital and West China Hospital, Sichuan University between May 2014 and October 2016 were selected and randomly divided into two groups, NAC group received N-acetylcysteine effervescent tablets combined with routine treatment, and control group received routine treatment. Before treatment as well as 2 weeks and 4 weeks after treatment, oxidative stress indexes and airway remodeling indexes in serum as well as inflammatory response indexes in peripheral blood were determined.Results: MDA, PC, 8-OHdG, MMP2, MMP3 and MMP9 contents in serum as well as NLRP3, ASC, p38MAPK and TREM-1 mRNA expression levels in peripheral blood mononuclear cells of both groups of patients after treatment were significantly lower than those before treatment while TAC levels as well as TIMP1 and TIMP2 contents in serum were significantly higher than those before treatment, and MDA, PC, 8-OHdG, MMP2, MMP3 and MMP9 contents in serum a well as NLRP3, ASC, p38MAPK and TREM-1 mRNA expression levels in peripheral blood mononuclear cells of NAC group after treatment were significantly lower than those of control group while TAC levels as well as TIMP1 and TIMP2 contents in serum were significantly higher than those of control group.Conclusion:Adjuvant NAC effervescent tablets treatment of stable COPD can improve the effect of oxidative stress and inflammatory response on cardiopulmonary function, and inhibit the airway remodeling caused by protease activation.展开更多
背景口服中药在慢性阻塞性肺疾病急性加重(AECOPD)的治疗中应用广泛,但相关临床试验的结局指标尚未得到统一和规范。目的通过筛选已发表的以口服中药为AECOPD治疗措施的随机对照试验(RCT),总结其文献特征和选用的结局指标情况,为中医药...背景口服中药在慢性阻塞性肺疾病急性加重(AECOPD)的治疗中应用广泛,但相关临床试验的结局指标尚未得到统一和规范。目的通过筛选已发表的以口服中药为AECOPD治疗措施的随机对照试验(RCT),总结其文献特征和选用的结局指标情况,为中医药治疗AECOPD临床试验设计和结局指标选择提供参考。方法计算机检索中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库、PubMed、Embase、Web of Science、Cochrane Library、ClinicalTrials.gov、中国临床试验注册中心,获取口服中药治疗AECOPD的RCT和临床试验注册方案,检索时限为2018年1月—2022年10月。由2位评价员独立筛选文献、提取资料后,采用定性分析的方法,对纳入研究的结局指标选择情况进行描述。结果纳入578篇文献,包含574篇已报告试验结果的RCT及4个临床试验注册方案。574篇RCT共纳入51508例患者。88篇文献在纳入标准中限定了患者的疾病分级,361篇文献在纳入标准中限定了中医证型,6篇文献报告了盲法,6篇文献提及了随访。纳入文献共涉及4030个结局指标,单篇文献结局指标数量范围为1~24个。按照结局指标的功能属性,将其归为8个指标域:中医症状/证候、症状/体征、理化检测、生活质量、远期预后、经济学评估、安全性评价、其他,报告率最高的指标域是理化检测,报告频次排名前5位的结局指标项目是:有效率(11.5%)、第1秒用力呼气容积(7.5%)、中医症状/证候评分(7.0%)、第1秒用力呼气容积/用力肺活量(6.8%)、用力肺活量(4.6%)。445篇文献报告了有效率的组成,报告率排名前5位的研究指标依次为症状(423篇)、体征(281篇)、中医证候评分(203篇)、实验室检查(89篇)、肺功能(71篇)。结论口服中药治疗AECOPD的RCT涉及的结局指标数量多、范围广,纳入的文献在不同程度上关注了口服中药对AECOPD患者的症状体征、理化检测指标、生活质量、远期预后、经济学评价和安全性结局等方面的影响。但结局指标的选择仍存在多方面的问题:结局指标主次不清;主要关注替代终点,对临床终点的关注不足;对卫生经济学指标关注不足;有效性参考来源不一、判断标准不一。研究者可参考已发表的核心指标集,合理设计结局指标,以提高中医药临床研究的质量。展开更多
Objective To observe the therapeutic effects of warming needle moxibustion on pulmonary function of elderly patients with stable chronic obstructive pulmonary disease. Method Eighty elderly patients with stable chroni...Objective To observe the therapeutic effects of warming needle moxibustion on pulmonary function of elderly patients with stable chronic obstructive pulmonary disease. Method Eighty elderly patients with stable chronic obstructive pulmonary disease were divided randomly into an acupuncture group and a drug group, with forty cases in each group. The patients in the acupuncture group were treated with warming needle moxibustion on specific acupoints. Main acupoints include Zusanli （足三里 ST 36）, Feishu （肺俞 BL 13） and Dingchuan （定喘 EX-B 1）. Matching acupoints include Gaohuang （膏肓 BL 43）, Xinshu （心俞 BL 15）, Dazhui （大椎 GV 14） and Fangmen （风门 BE 12）. The acupoints were punctured with even reinforcing and reducing method. Meanwhile, two moxa stick of warming needle moxibustion were applied separately at the acupoints at back and ST 36. The needles were retained for approximately 0.5 h each time. The treatment was given every other day, 3 times a week and the course of treatment was 8 weeks. Patients in the drug group were treated by seretide inhalation （50 μg salmeterol and 250 μg fluticasone propionate）, twice a day for 8 weeks. The improvement in pulmonary function and the symptom of chills and fever were compared between the two groups. Results After treatment, pulmonary function indices [forced expiratory volume in one second （FEV1）, forced expiratory volume in one second to forced vital capacity （FEVl/FVC）, forced expiratory volume in one second to predicted value ratio （FEV1%） and peak expiratory flow （PEF）] of the patients in both groups were improved significantly compared with that before treatment （P〈0.05）. There was no statistically significant difference between the two groups （all P〉0.05）. Improvement in comprehensive scores of the symptom of chill and fever in the acupuncture group was significantly superior to that in the drug group after 4 and 8 weeks of the treatment, respectively （P〈0.05）. Conclusion Warming needle moxibustion was obviously effective on the improvement in pulmonary function of elderly patients with stable chronic obstructive pulmonary disease.展开更多
目的了解1990-2019年中国慢性阻塞性肺疾病发病、患病、死亡情况及疾病负担情况,预测2020-2030年中国慢性阻塞性肺疾病发病情况,为评估和制定慢性阻塞性肺疾病相关预防治疗政策和措施提供数据支持。方法利用2019年全球疾病负担研究数据...目的了解1990-2019年中国慢性阻塞性肺疾病发病、患病、死亡情况及疾病负担情况,预测2020-2030年中国慢性阻塞性肺疾病发病情况,为评估和制定慢性阻塞性肺疾病相关预防治疗政策和措施提供数据支持。方法利用2019年全球疾病负担研究数据库(Global burden of disease study,GBD),研究分析1990-2019年中国慢性阻塞性肺疾病的发病、患病、死亡、伤残调整寿命年(DALY)、早死寿命损失年(YLL)、伤残寿命损失年(YLD)等情况。采用贝叶斯-时期-队列分析(BAPC)方法,预测2020-2030年中国慢性阻塞性肺疾病发病率。结果相对于1990年,2019年中国慢性阻塞性肺疾病粗患病率增长35.44%,标化患病率减少27.16%,粗发病率增长38.31%,标化发病率减少28.52%,粗死亡率减少30.59%,标化死亡率减少70.08%。1990-2019年中国人群因慢性阻塞性肺疾病导致的YLL率由3281.48/10万降至862.37/10万,YLD率由330.33/10万降至240.40/10万,DALY率由3611.81/10万降至1102.77/10万。2019年男性慢性阻塞性肺疾病DALY率相比于1990年降低66.56%,女性DALY率相比于1990年降低71.87%。2020-2030年中国慢性阻塞性肺疾病标化发病率预计呈下降趋势,2030年男性标化发病率预计比2020年降低31.97%,女性标化发病率预计比2020年降低27.69%。结论1990-2019年,慢性阻塞性肺疾病对中国人口造成的疾病负担总体呈下降趋势。但从患病情况和死亡情况来看,发病及死亡人数较多,中国慢性阻塞性肺疾病的疾病负担仍处于较高水平。同时预测结果显示,未来10年中国慢性阻塞性肺疾病标化发病率在下降,但是仍处于较高水平,因此进行早筛查、早预防和早治疗,及广泛开展慢阻肺相关知识普及,对于做好COPD疾病管理具有重要意义。展开更多
Background This meta-analysis evaluated the effect of noninvasive, positive pressure ventilation on severe, stable chronic obstructive pulmonary disease （COPD）. Methods PUBMED, CNKI, Wanfang, EMBASE and the Cochrane...Background This meta-analysis evaluated the effect of noninvasive, positive pressure ventilation on severe, stable chronic obstructive pulmonary disease （COPD）. Methods PUBMED, CNKI, Wanfang, EMBASE and the Cochrane trials databases were searched. Randomized controlled trials of patients with severe, stable COPD and receiving noninvasive positive pressure ventilation, compared with sham ventilation or no ventilation, were reviewed. The mortality, physiological and health related parameters were pooled to yield odds ratio （OR）, weighted mean differences or standardized mean differences （SMD）, with 95% confidence interval （CI）. Results Eight parallel and three crossover randomized controlled trials met the inclusion criteria. Pooled analysis for parallel, randomized controlled trials showed noninvasive positive pressure ventilation： （1） Did not affect the 12- or 24-month mortality （OR 0.82, 95% Ch 0.48 to 1.41）; （2） Improved the arterial carbon dioxide tension （SMD -0.88, 95% Ch -1.43 to -0.34）; （3） Did not improve forced expiratory volume in one second （SMD 0.20, 95% CI： -0.06 to 0.46）, maximal inspiratory pressure （SMD 0.01, 95% Ch -0.28 to 0.29） or 6-minute walk distance （SMD 0.17, 95% Ch -0.16 to 0.50）; （4） Subgroup analysis showed noninvasive positive pressure ventilation improved the arterial carbon dioxide tension in hypercapnic patients. Pooled analysis for crossover randomized controlled trials did not show improvement in arterial blood gas or forced expiratory volume in one second with noninvasive positive pressure ventilation. Conclusions Noninvasive positive pressure ventilation improves the arterial carbon dioxide tension but does not improve the mortality, pulmonary function, or exercise tolerance and should be cautiously used in severe stable chronic obstructive pulmonary disease.展开更多
基金National Science and Technology Major Projects of Sudden Severe Acute Respiratory Infectious Diseases Treatment New Technology research and the New Scheme(No.2017 zx10204401)。
文摘Objective:To systematically evaluate the effect and safety of additional Yupingfeng powder combined with western medicine for the stable period of chronic obstructive pulmonary disease(COPD).Method:Databases including Pubmed、Web of Science、Cochrane Library、CNKI、VIP、CBM and Wanfang Data base,were searched for relevant randomized controlled trials.for Chinese and English literature about randomized controlled trials of additional Yupingfeng in the treatment of COPD on stable stage which were published from the establishment of the database to December 2019.Two researchers independently screened for,selected studies according to the inclusion and exclusion criteria and extracted data.Methodological quality was evaluated using the Cochrane Risk of Bias tool.Meta-analysis was performed using Revman 5.3 software.Results:Ninetine randomized controlled trials including 1511 patients with COPD were meta-analyzed.The total sample size was 1511.The results showed that the treatment grop with additional Yupingfeng powder could improve the clinical efficacy[OR=0.26,95%CI(0.18,0.37)],FEV1 percentage of the estimated value[MD=4.61,95%CI(2.43,6.79)],6MWD[MD=43.90,95%CI(29.48,58.32)]and patient's immunity IgA[MD=0.25,95%CI(0.17,0.34)]and can mitigate cough effectively[MD=-0.34,95%CI(-0.46,-0.23)].Conclusion:Additional Yupingfeng powder combined with routine treatment for COPD has more advantages than conventional treatment alone in improving the clinical efficacy,lung function,immune function and have less adverse events.As most of the included studies in this systematic evaluation had poor quality,the evidence to support conclusion was weak,so it was necessary to conduct more multi-center clinical trials with high quality methods and rigorous design.
基金This work was supported by the 2019 Qingdao Industry Cultivation Program Science and Technology Benefit to the people special Project(No.19-6-1-12-nsh).
文摘Objective:To investigate the effects of Tongjing xuanfei exercise on clinical symptoms,pulmonary function and exercise endurance of patients with Chronic obstructive pulmonary disease at stable stage.Methods:A total of 130 patients with Chronic obstructive pulmonary disease at stable stage from the Department of Pulmonary Diseases,Qingdao Haici Medical Group during September 2018 to September 2020 were collected and randomly divided into a observation group and a control group,with 65 patients in each group.The control group was given routine pulmonary rehabilitation nursing,and the observation group was given Tongjing Xuanfei exercise treatment combined with routine pulmonary rehabilitation nursing,12 months for treatment.The changes of symptoms and pulmonary function index were observed before and after treatment.Results:FEV1,FVC,FEV1%pred,FEV1/FVC,exercise endurance and CAT score,mMRC dyspnea index score and TCM clinical symptom score in the observation group were significantly higher than those in the control group(P<0.05).Conclusion:Tongjing Xuanfei exercise is helpful to improve the clinical symptoms,pulmonary function and exercise endurance of patients with Chronic obstructive pulmonary disease at stable stage.
文摘BACKGROUND Under physiological conditions,sputum produced during acute exacerbation of chronic obstructive pulmonary disease(AECOPD)can move passively with the cilia in the airway;the sputum is gradually excreted from the depth of the airways through the stimulation of the coughing reflex on the sensory nerve on the surface of the airway.However,when the sputum is thick,the cough is weak,or the tracheal cilia are abnormal,sputum accumulation may occur and affect the exchange of oxygen and carbon dioxide in the lung.Furthermore,the presence of pathogenic microorganisms in sputum may cause or aggravate the symptoms of pulmonary infection in patients,which is the main factor leading to AECOPD.Therefore,promoting effective drainage of sputum and maintaining airway opening are key points requiring clinical attention.AIM To explore the effect of refined nursing strategies in patients with AECOPD and dysphagia.METHODS We selected 126 patients with AECOPD and difficulty of expectoration at our hospital,and divided them into a refined care group and a routine care group,with 63 cases each,using a random number table.The two groups of patients were treated with expectorant,anti-infection,oxygen inhalation,and other basic treatment measures;patients in the refined care group were given refined nursing intervention during hospitalization,and the routine care group received conventional nursing intervention.The differences in sputum expectoration,negative pressure suction rate,blood gas parameters,dyspnea score measured through the tool developed by the Medical Research Council(MRC),and quality of life were compared between the two groups.RESULTS After 7 d of intervention,the sputum expectoration effect of the refined care group was 62.30%,the effective rate was 31.15%,and the inefficiency rate was 6.56%.The sputum expectoration effect of the routine care group was 44.07%,the effective rate was 42.37%,and the inefficiency rate was 13.56%.The refined care group had better sputum expectoration than the routine care group(P<0.05).The negative pressure suction rate in the refined care group was significantly lower than that of the routine care group during the treatment(22.95%vs 44.07%,P<0.05).Before the intervention,the arterial oxygen saturation(PaO2)and arterial carbon dioxide saturation(PaCO2)values were not significantly different between the two groups(P>0.05);the PaO2 and PaCO2 values in the refined care group were comparable to those in the routine care group after 7 d of intervention(P>0.05).Before the intervention,there was no significant difference in the MRC score between the two groups(P>0.05);the MRC score of the refined care group was lower than that of the routine care group after 7 d of intervention,but the difference was not statistically significant(P>0.05).Before intervention,there was no significant difference in the symptoms,activities,disease impact,or St.George’s Respiratory questionnaire(SGRQ)total scores between the two groups(P>0.05).After 7 days of intervention,the symptoms,activities,and total score of SGRQ of the refined care group were higher than those of the routine care group,but the difference was not statistically significant(P>0.05).CONCLUSION AECOPD with thick sputum,weak coughing reflex,and abnormal tracheal cilia function will lead to sputum accumulation and affect the exchange of oxygen and carbon dioxide in the lung.Patients with AECOPD who have difficulty expectorating sputum may undergo refined nursing strategies that will promote expectoration,alleviate clinical symptoms,and improve the quality of life.
基金Shanghai Shenkang hospital development center(No.16CR4021A).
文摘Objective:Chronic obstructive pulmonary disease (COPD) is one of the common respiratory diseases characterized by restricted airflow, incomplete reversibility, and expiratory dyspnea. It has become a major public health problem worldwide.Through the research of COPD Chinese and Western medicine pulmonary rehabilitation training by domestic and foreign scholars in the past 5 years, it is found that the emphasis on stable lung rehabilitation can delay the further deterioration of lung function in patients with COPD, effectively improve skeletal muscle fiber and structure, improve exercise capacity, improve breathing difficulties, and hope for pulmonary rehabilitation. It is one of the main methods of treatment for patients with COPD.
文摘Objective:To study the effect of adjuvant N-acetylcysteine (NAC) effervescent tablets therapy on cardiopulmonary function and airway remodeling in patients with stable chronic obstructive pulmonary disease (COPD).Methods: Patients with stable COPD treated in Zigong Third People's Hospital and West China Hospital, Sichuan University between May 2014 and October 2016 were selected and randomly divided into two groups, NAC group received N-acetylcysteine effervescent tablets combined with routine treatment, and control group received routine treatment. Before treatment as well as 2 weeks and 4 weeks after treatment, oxidative stress indexes and airway remodeling indexes in serum as well as inflammatory response indexes in peripheral blood were determined.Results: MDA, PC, 8-OHdG, MMP2, MMP3 and MMP9 contents in serum as well as NLRP3, ASC, p38MAPK and TREM-1 mRNA expression levels in peripheral blood mononuclear cells of both groups of patients after treatment were significantly lower than those before treatment while TAC levels as well as TIMP1 and TIMP2 contents in serum were significantly higher than those before treatment, and MDA, PC, 8-OHdG, MMP2, MMP3 and MMP9 contents in serum a well as NLRP3, ASC, p38MAPK and TREM-1 mRNA expression levels in peripheral blood mononuclear cells of NAC group after treatment were significantly lower than those of control group while TAC levels as well as TIMP1 and TIMP2 contents in serum were significantly higher than those of control group.Conclusion:Adjuvant NAC effervescent tablets treatment of stable COPD can improve the effect of oxidative stress and inflammatory response on cardiopulmonary function, and inhibit the airway remodeling caused by protease activation.
文摘背景口服中药在慢性阻塞性肺疾病急性加重(AECOPD)的治疗中应用广泛,但相关临床试验的结局指标尚未得到统一和规范。目的通过筛选已发表的以口服中药为AECOPD治疗措施的随机对照试验(RCT),总结其文献特征和选用的结局指标情况,为中医药治疗AECOPD临床试验设计和结局指标选择提供参考。方法计算机检索中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库、PubMed、Embase、Web of Science、Cochrane Library、ClinicalTrials.gov、中国临床试验注册中心,获取口服中药治疗AECOPD的RCT和临床试验注册方案,检索时限为2018年1月—2022年10月。由2位评价员独立筛选文献、提取资料后,采用定性分析的方法,对纳入研究的结局指标选择情况进行描述。结果纳入578篇文献,包含574篇已报告试验结果的RCT及4个临床试验注册方案。574篇RCT共纳入51508例患者。88篇文献在纳入标准中限定了患者的疾病分级,361篇文献在纳入标准中限定了中医证型,6篇文献报告了盲法,6篇文献提及了随访。纳入文献共涉及4030个结局指标,单篇文献结局指标数量范围为1~24个。按照结局指标的功能属性,将其归为8个指标域:中医症状/证候、症状/体征、理化检测、生活质量、远期预后、经济学评估、安全性评价、其他,报告率最高的指标域是理化检测,报告频次排名前5位的结局指标项目是:有效率(11.5%)、第1秒用力呼气容积(7.5%)、中医症状/证候评分(7.0%)、第1秒用力呼气容积/用力肺活量(6.8%)、用力肺活量(4.6%)。445篇文献报告了有效率的组成,报告率排名前5位的研究指标依次为症状(423篇)、体征(281篇)、中医证候评分(203篇)、实验室检查(89篇)、肺功能(71篇)。结论口服中药治疗AECOPD的RCT涉及的结局指标数量多、范围广,纳入的文献在不同程度上关注了口服中药对AECOPD患者的症状体征、理化检测指标、生活质量、远期预后、经济学评价和安全性结局等方面的影响。但结局指标的选择仍存在多方面的问题:结局指标主次不清;主要关注替代终点,对临床终点的关注不足;对卫生经济学指标关注不足;有效性参考来源不一、判断标准不一。研究者可参考已发表的核心指标集,合理设计结局指标,以提高中医药临床研究的质量。
文摘Objective To observe the therapeutic effects of warming needle moxibustion on pulmonary function of elderly patients with stable chronic obstructive pulmonary disease. Method Eighty elderly patients with stable chronic obstructive pulmonary disease were divided randomly into an acupuncture group and a drug group, with forty cases in each group. The patients in the acupuncture group were treated with warming needle moxibustion on specific acupoints. Main acupoints include Zusanli （足三里 ST 36）, Feishu （肺俞 BL 13） and Dingchuan （定喘 EX-B 1）. Matching acupoints include Gaohuang （膏肓 BL 43）, Xinshu （心俞 BL 15）, Dazhui （大椎 GV 14） and Fangmen （风门 BE 12）. The acupoints were punctured with even reinforcing and reducing method. Meanwhile, two moxa stick of warming needle moxibustion were applied separately at the acupoints at back and ST 36. The needles were retained for approximately 0.5 h each time. The treatment was given every other day, 3 times a week and the course of treatment was 8 weeks. Patients in the drug group were treated by seretide inhalation （50 μg salmeterol and 250 μg fluticasone propionate）, twice a day for 8 weeks. The improvement in pulmonary function and the symptom of chills and fever were compared between the two groups. Results After treatment, pulmonary function indices [forced expiratory volume in one second （FEV1）, forced expiratory volume in one second to forced vital capacity （FEVl/FVC）, forced expiratory volume in one second to predicted value ratio （FEV1%） and peak expiratory flow （PEF）] of the patients in both groups were improved significantly compared with that before treatment （P〈0.05）. There was no statistically significant difference between the two groups （all P〉0.05）. Improvement in comprehensive scores of the symptom of chill and fever in the acupuncture group was significantly superior to that in the drug group after 4 and 8 weeks of the treatment, respectively （P〈0.05）. Conclusion Warming needle moxibustion was obviously effective on the improvement in pulmonary function of elderly patients with stable chronic obstructive pulmonary disease.
文摘目的了解1990-2019年中国慢性阻塞性肺疾病发病、患病、死亡情况及疾病负担情况,预测2020-2030年中国慢性阻塞性肺疾病发病情况,为评估和制定慢性阻塞性肺疾病相关预防治疗政策和措施提供数据支持。方法利用2019年全球疾病负担研究数据库(Global burden of disease study,GBD),研究分析1990-2019年中国慢性阻塞性肺疾病的发病、患病、死亡、伤残调整寿命年(DALY)、早死寿命损失年(YLL)、伤残寿命损失年(YLD)等情况。采用贝叶斯-时期-队列分析(BAPC)方法,预测2020-2030年中国慢性阻塞性肺疾病发病率。结果相对于1990年,2019年中国慢性阻塞性肺疾病粗患病率增长35.44%,标化患病率减少27.16%,粗发病率增长38.31%,标化发病率减少28.52%,粗死亡率减少30.59%,标化死亡率减少70.08%。1990-2019年中国人群因慢性阻塞性肺疾病导致的YLL率由3281.48/10万降至862.37/10万,YLD率由330.33/10万降至240.40/10万,DALY率由3611.81/10万降至1102.77/10万。2019年男性慢性阻塞性肺疾病DALY率相比于1990年降低66.56%,女性DALY率相比于1990年降低71.87%。2020-2030年中国慢性阻塞性肺疾病标化发病率预计呈下降趋势,2030年男性标化发病率预计比2020年降低31.97%,女性标化发病率预计比2020年降低27.69%。结论1990-2019年,慢性阻塞性肺疾病对中国人口造成的疾病负担总体呈下降趋势。但从患病情况和死亡情况来看,发病及死亡人数较多,中国慢性阻塞性肺疾病的疾病负担仍处于较高水平。同时预测结果显示,未来10年中国慢性阻塞性肺疾病标化发病率在下降,但是仍处于较高水平,因此进行早筛查、早预防和早治疗,及广泛开展慢阻肺相关知识普及,对于做好COPD疾病管理具有重要意义。
基金This study was supported by grants from the Natural Science Foundation of Jiangsu Province （No. BK2009318 and No. SBK201123521）, China Postdoctoral Science Foundation （No. 20100471844 and No. 201104792）, and Medical Technology Innovation Foundation of Nanjing Military Command （No. 09Z028）.
文摘Background This meta-analysis evaluated the effect of noninvasive, positive pressure ventilation on severe, stable chronic obstructive pulmonary disease （COPD）. Methods PUBMED, CNKI, Wanfang, EMBASE and the Cochrane trials databases were searched. Randomized controlled trials of patients with severe, stable COPD and receiving noninvasive positive pressure ventilation, compared with sham ventilation or no ventilation, were reviewed. The mortality, physiological and health related parameters were pooled to yield odds ratio （OR）, weighted mean differences or standardized mean differences （SMD）, with 95% confidence interval （CI）. Results Eight parallel and three crossover randomized controlled trials met the inclusion criteria. Pooled analysis for parallel, randomized controlled trials showed noninvasive positive pressure ventilation： （1） Did not affect the 12- or 24-month mortality （OR 0.82, 95% Ch 0.48 to 1.41）; （2） Improved the arterial carbon dioxide tension （SMD -0.88, 95% Ch -1.43 to -0.34）; （3） Did not improve forced expiratory volume in one second （SMD 0.20, 95% CI： -0.06 to 0.46）, maximal inspiratory pressure （SMD 0.01, 95% Ch -0.28 to 0.29） or 6-minute walk distance （SMD 0.17, 95% Ch -0.16 to 0.50）; （4） Subgroup analysis showed noninvasive positive pressure ventilation improved the arterial carbon dioxide tension in hypercapnic patients. Pooled analysis for crossover randomized controlled trials did not show improvement in arterial blood gas or forced expiratory volume in one second with noninvasive positive pressure ventilation. Conclusions Noninvasive positive pressure ventilation improves the arterial carbon dioxide tension but does not improve the mortality, pulmonary function, or exercise tolerance and should be cautiously used in severe stable chronic obstructive pulmonary disease.
