Objective To evaluate the efficacy and safety of Salviae miltiorrhizae Injection (include Danshen Injection and Fufang Danshen Injection) for chronic cor pulmonale. Design A systematic review of randomized clinical trials. Method Randomized trials comparing Salviae miltiorrhizae Injection plus routine treatment versus muting treatment alone were identified by electronic and manual searches. No blinding and language limitations were applied. The Jadad scale assessed the methodological quality of trials. Results Thirty randomized trials (n=2 161) were identified. The methodological quality of all trials included was low. The combined results (RR and 95%CI) of symptom scores was 1.20 (1.15 to 1.26). Because of the significant heterogeneity, many other markers of the blood rheology can not be combined. The reason for heterogeneity should include the differences among cases and studies. Because of lacking enough studies, the conclusions about mortality and oxidants/antioxidants markers were not b. Only a few studies had reported adverse events. Conclusions Based in the review, Salviae miltiorrhizae Injection may have positive effect on symptom scores in patients with chronic cor pulmonale. But for mortality, the markers of blood rheology and oxidants/antioxidants, there is no reliable conclusion. However, the evidence is not b due to the general low methodological quality, the variations among studies and experimental markers themselves, and lacking of more relevant and important markers. Further large trials are needed.
ObjectiveTo explore the feasibility and clinical application value of low attenuation areas (LAA) scoring system in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).MethodsA total of 380 patients with AECOPD were included. Clinical data including general information, laboratory examinations and treatments during hospitalization were collected. According to the high-resolution computed CT (HRCT) imaging performance, the patients were divided into bronchitis phenotype and emphysema phenotype. The clinical data between these two groups were compared to analyze the differences between different phenotypes and the feasibility of LAA scoring system.ResultsIn patients of bronchitis phenotype, the levels of body mass index, C-reactive protein, interleukin-6, procalcitonin, neutrophil-to-lymphocyte ratio, and eosinophil counts on admission were higher than those of emphysema phenotype (P<0.05). Patients with emphysema phenotype had a higher proportion of male, a higher smoking index, higher cystatin C levels and lower bilirubin levels on admission (P<0.05), the rates of using mechanical ventilation and systemic glucocorticoids were higher as also (P<0.05). LAA scores had a positive correlation with the use of mechanical ventilation and systemic glucocorticoids and cystatin C levels, and a negative correlation with interleukin-6 levels (P<0.05).ConclusionsFor patients with AECOPD, using LAA scoring system to classify different phenotype through HRCT has relevant accuracy and clinical practicability. The LAA scoring system might help to evaluate the patient's condition and prognosis to a certain extent.
Objective To investigate the clinical value of plasma copeptin in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Ninety patients with AECOPD admitted between October 2013 and November 2015 were recruited as an AECOPD group, and 40 healthy subjects underwent physical examination simultaneously were recruited as a control group. According to patient history and severity, the AECOPD patients were divided into 3 groups: grade Ⅰ group (25 cases), grade Ⅱ group (45 cases) and grade Ⅲ group (20 cases). Plasma copeptin level was measured by enzyme-linked immunosorbent assay (ELISA). The changes of copeptin, the total counts of white blood cells (WBC), and C-reactive protein (CRP) of the AECOPD patients were compared before and after treatment. Then the correlations between plasma levels of copeptin and severity of AECOPD were evaluated. Results The plasma level of copeptin in the AECOPD group was higher than that in the control group [(16.4±5.2) pmol/L vs. (5.7±2.8) pmol/L, P<0.05), and gradually increased with the severity of AECOPD. For the AECOPD patients both before and after treatment, the copeptin concentrations were positive correlated with the plasma CRP concentrations and the total counts of WBC in blood (both P<0.05). Conclusions The plasma levels of copeptin gradually increase with the severity of AECOPD. The changes of plasma copeptin may be as an indicator for the severity of AECOPD.
Objective To investigate the serum level of surfactant protein D ( SP-D) in patients with chronic obstructive pulmonary disease ( COPD) and its clinical significance. Methods Serumlevels of SP-D in patients with acute exacerbations of COPD ( n = 29) , stable COPD ( n = 26) , and control subjects ( n = 19 ) were measured by ELISA. Multiple regression modeling was performed to determine the independent relationship between SP-D and lung function variables. Results The serum SP-D levels were significantly increased in the patients who experienced an acute exacerbation [ ( 70. 6 ±20. 7) ng/mL] compared with the patients with stable COPD and the control subjects [ ( 47. 9 ±13. 3) ng/mL and ( 31. 2 ±11. 4) ng/mL] ( both P lt; 0. 01) . The serum SP-D levels in the patients with stable COPD increased significantly than the control subjects ( P lt; 0. 01) . Smoking index and staging of COPD were positively related to SP-D level. Serum SP-D levels were also found to be inversely related to FEV1% pred in stable COPD. Conclusion Serum SP-D may be a potential diagnostic and staging biomarker for COPD.
ObjectiveTo systematically evaluate the efficacy and safety of procalcitonin guided algorithms of antibiotic therapy in acute exacerbation chronic obstructive pulmonary disease (AECOPD). MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 6, 2016), CBM, CNKI, VIP, and WanFang Data from the date of their establishment to July 2016, to collect randomized controlled trials (RCTs) about procalcitonin guided antibiotics therapy in patients with AECOPD. References of the included literature were also searched manually for additional studies. The literature screening, data extraction and bias risk assessment of the included studies were completed by two reviewers independently. Statistical analysis was conducted using RevMan 5.2 software. ResultsA total of ten RCTs involving 1 071 patients were included. The results of meta-analysis indicated that compared with the standard treatment group, the antibiotic prescription rate (RR=0.70, 95% CI 0.55 to 0.89, P=0.004), the rate of duration of antibiotic >10 days (RR=0.38, 95% CI 0.26 to 0.56, P<0.000 01) and the superinfection rate (RR=0.23, 95% CI 0.09 to 0.58, P=0.002) were significantly lower in the procalcitonin-guided treatment group. There were no statistical differences in clinical effective rate (RR=0.98, 95% CI 0.91 to 1.06, P=0.61), hospital mortality (RR=0.84, 95% CI 0.52 to 1.73, P=0.43), and the rate of need for intensive care (RR=0.77, 95% CI 0.40 to 1.47, P=0.43). ConclusionProcalcitonin guided antibiotics therapy may reduce antibiotic exposure and superinfection rate in patients with AECOPD. In addition, due to the low methodological quality and limited quantity of the included studies, larger sample-size, and high quality RCTs are needed to verify the above conclusion.
目的 探讨Ｃ反应蛋白(CRP)在慢性阻塞性肺疾病急性加重期(AECOPD)患者治疗前、后的变化和临床意义。方法 纳入2008年1月-9月住院治疗的80例AECOPD患者，分别测定应用抗生素治疗前后CRP、白细胞计数(WBC)、中性粒细胞百分比(N%)、血沉和体温，并比较这些指标的变化情况。结果 AECOPD患者在感染期CRP总阳性率为100.00%，显著高于治疗前WBC、N%、血沉和体温的阳性率(Plt;0.05)；也显著高于感染控制后(Plt;0.05)。 结论 CRP作为细菌性感染的敏感指标之一，也可作为指导临床及时、正确使用或评价抗生素疗效的一个指标。
Objective To investigate the risk factors for secondary pulmonary fungal infection in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). And a visual tool using nomogram was developed and validated to assist in the clinical prediction of the probability of pulmonary fungal infection occurrence in AECOPD patients. Methods A retrospective cohort study method was used to collect AECOPD patients hospitalized in the Department of Respiratory, The First Affiliated Hospital of Chengdu Medical College from January 2021 to December 2021 as a training set. And AECOPD patients between January 2020 and December 2020 were collected as a validation set. Independent risk factors were determined through univariate, Lasso regression analyses. and multivariable logistic, A nomogram prediction model was constructed with these independent risk factors, and the nomogram was evaluated by receiver operating characteristic area under the curve (AUC), calibration curve, and decision curve analysis (DCA). Results The use of glucocorticoid, combined use of antibiotics, duration of antibiotic use and hypoalbuminemia were independent risk factors for secondary pulmonary fungal infection in AECOPD patients (all P<0.05). The training set and validation set of the constructed prediction model had an AUC value of 0.915 [95%CI: 0.891 - 0.940] and 0.830 [95%CI: 0.790 - 0.871], respectively. The calibration curve showed that the predicted probability was in good agreement with the actual observed probability of pulmonary fungal infection in AECOPD patients. The corresponding decision curve analysis (DCA) indicated the nomogram had relatively ideal clinical utility. Conclusions The result showed that the use of glucocorticoid, combined use of antibiotics, prolonged antibiotic therapy and hypoalbuminemia was independent risk factors for pulmonary fungal infection in AECOPD patients. The clinical prediction model for secondary pulmonary fungal infection in AECOPD patients constructed in this study has strong predictive power and clinical practicability.
Objective To investigate the prevalence and risk factors of venous thromboembolism ( VTE) in patients with acute exacerbation of COPD ( AECOPD) . Methods The patients with AECOPD admitted fromJune 2006 to February 2010 in Beijing Tongren Hospital were included for analysis. VTE was investigated in all patients ( whether or not clinically suspected) by a standardized algorithm based on D-dimer testing, 4-limb venous ultrasonography, and the patients with clinically suspected pulmonarythromboembolism ( PTE) received ventilation/perfusion scan and ( or) computed tomography pulmonary angiography ( CTPA) . Results The total number of patients with AECOPD was 282, and the prevalence of VTE was 6% ( 17 /282) . Among the hypoxemia group( n = 84) , there were 16 patients with DVT with a prevalence of VTE of 19. 1% ( 16/84) in which 3 cases developed with PTE. In the non-hypoxemia group ( n =198) , the prevalence of VTE was 0. 5% ( 1/198) , and there was no case with PTE. The incidence of VTE in the hypoxemia group was significantly higher than that in the non-hypoxemia group( P lt; 0. 01) .Logistic analysis showed that lower PaO2 was the risk factor for VTE ( P lt; 0. 01 ) . Conclusions The incidence of VTE in AECOPD was 6% , mainly in the form of lower limb DVT. Hypoxemia was the risk factor for VTE in patients with AECOPD.
Objective To develop and validate a nomogram model that can be used to predict the prognosis of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with type II respiratory failure. Methods A retrospective analysis was conducted on the clinical data of 300 hospitalized AECOPD patients in the People’s Hosipital of Leshan from August 2016 to December 2021. Patients were grouped into a training cohort (n=210) and a validation cohort (n=90) in a 7:3 ratio. The variables for the patients in the training cohort were selected using the least absolute shrinkage and selection operator (LASSO), followed by multivariate logistic regression analysis to identify independent risk factors of poor prognosis in AECOPD with type II respiratory failure, and a nomogram model was constructed. Receiver operating characteristic (ROC) curves were plotted for the training and validation cohorts, and the area under ROC curve (AUC) was calculated.The model was validated by conducting the Hosmer-Lemeshow test, drawing calibration curves, and performing decision curve analysis(DCA).ResultsCardiovascular disease, lymphocyte percentage, and red cell distribution width-standard deviation(RDW-SD) were identified as independent risk factors of poor prognosis for AECOPD patients with type II respiratory failure (P<0.05). The AUC values for the training and validation cohorts were 0.742 (95%CI: 0.672-0.812) and 0.793 (95%CI: 0.699-0.888), respectively. The calibration curves of the two cohorts are close to the desirable curves.The Hosmer-Lemeshow test P-values were greater than 0.05, indicating good clinical practicality. The DCA curve indicates that the model has good clinical value. Conclusions The clinical prediction model, based on factors such as cardiovascular disease, lymphocyte percentage, and RDW-SD, showed good predictive value for AECOPD patients complicated by type II respiratory failure.
ObjectiveTo study the clinical features, predictive factors and short-term prognosis of active pulmonary tuberculosis in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsThis study enrolled patients hospitalized for AECOPD in ten tertiary hospitals of China from September 2017 to July 2021. AECOPD patients with active pulmonary tuberculosis were included as case group, AECOPD patients without pulmonary tuberculosis were randomly selected as control group from the same hospitals and same hospitalization period as the patients in case group, at a ratio of 4:1. The basic information, comorbidities, clinical manifestations and auxiliary examinations, and adverse in-hospital outcomes between the two groups were compared.ResultsA total of 14007 inpatients with AECOPD were included in this study, and 245 patients were confirmed to have active pulmonary tuberculosis, with an incidence rate of 1.75%. In terms of basic information, the proportions of male and patients with history of acute exacerbation in the past year in the case group were higher than those in the control group (P<0.05), and the age and body mass index (BMI) were lower than those of the control group (P<0.05); in terms of comorbidities, the proportions of patients with hypertension and diabetes in the case group were lower than those in the control group (P<0.05). In terms of clinical manifestations, the prevalence of fever and hemoptysis in case group was higher than that of control group (P<0.05); as for laboratory examinations, the levels of hemoglobin, platelet count, serum albumin, inflammatory markers [erythrocyte sedimentation rate (ESR), C reactive protein] and the proportion of positive TB-IGRA were higher than that of control group (P<0.05). The prevalence of pulmonary bullae, atelectasis and bronchiectasis in the case group was higher than that in the control group. After multivariate logistic regression analysis, hemoptysis (OR= 3.68, 95%CI 1.15-11.79, P=0.028), increased ESR (OR=3.88, 95%CI 2.33-6.45, P<0.001), atelectasis (OR = 3.23, 95%CI 1.32-7.91, P=0.01) were independent predictors of active pulmonary tuberculosis in patients with AECOPD. In terms of in-hospital outcomes, there was a trend of higher hospital mortality than the control group (2.3% vs. 1%), but the difference was not statistically significant. However, the case group had longer hospital stay [9 d (6~14) vs. 7 d (5~11), P<0.001] and higher hospital costs [15568 ¥ (10618~21933) vs. (13672 ¥ (9650~21473), P=0.037]. ConclusionIt is not uncommon for AECOPD inpatients to be complicated with active pulmonary tuberculosis, which increases the length of hospital stay and hospitalization costs. When AECOPD patients present with hemoptysis, elevated ESR, and atelectasis, clinicians should be highly alert to the possibility of active pulmonary tuberculosis.