《Lancetgt;杂志2007年9月9589号的封面以“目前在中国人口中估计有超过190万死于从不吸烟的被动吸烟者”为警示，并组织了一期慢性阻塞性肺疾病(COPD)专辑，涉及内容广泛且颇具新意。
Objective To analyse the content and structure of the health management policy text for chronic obstructive pulmonary disease (COPD) in China, and to provide a reference for the optimization and improvement of subsequent relevant policies. Methods We searched for relevant policy documents on COPD health management at the national level from January 2017 to December 2023, constructed a two-dimensional analysis framework for policy tools and chronic disease health management processes, coded and classified policy texts, and used content analysis method to analyze policy texts. Results Twenty-four policy texts were included. There were 183 codes for policy tool dimension, with supply based, environmental based, and demand based tools accounting for 43.72%, 47.54%, and 8.74%, respectively. There were 124 codes for the dimension of health management processes, with health information collection and management accounting for 12.10%, risk prediction accounting for 14.52%, intervention and treatment accounting for 66.13%, and follow-up and effectiveness evaluation accounting for 7.26%. Conclusions At present, the proportion of policy tools related to the management of COPD in China needs to be dynamically adjusted. Environmental tools should be appropriately reduced, the internal structure of supply tools should be optimized, the driving effect of demand tools should be comprehensively enhanced, the coupling of COPD health management processes should be strengthened, and the relevant policy system and overall quality should be continuously improved.
Objective To study polyuria during mechanical ventilation in patients with chronic obstructive pulmonary disease ( COPD) and its possible mechanisms. Methods The plasma and urine concentrations of cystatin C ( CyC) were measured by enzyme immunometric assay in 26 COPD patients who received mechanical ventilation at timepoints of 0 h, 24 h, 48 h, 72 h and 1 week. And plasma levels of atrial natriuretic factor ( ANF ) , antidiuretic hormone ( ADH) and aldosterone ( ALD) were detected byradioimmunoassay at the same time-point. The urine volume was recorded every day. The samples of 30 healthy volunteers were measured as control. Results Polyuria phenomenon was found in majority of patients in 24 to 72 hours after mechanical ventilation. At 0h, the concentrations of plasma CyC, urine CyC,plasma ANF, ADH and ALD were all increased significantly compared with those of the control, respectively [ ( 4. 87 ±0. 51) mg/L vs ( 1. 29 ±0. 27) mg/L, ( 0. 58 ±0. 13) mg/L vs ( 0. 07 ±0. 02) mg/L, ( 37. 02 ±4. 35) pmol /L vs ( 22. 51 ±1. 18) pmol /L, ( 8. 61 ±1. 43) pmol /L vs ( 0.94 ±0. 34) pmol /L, ( 925. 4 ±142. 7) pmol /L vs ( 297. 5 ±135. 8) pmol /L, all P lt; 0. 01] , then decreased gradually after mechanical ventilation. The levels of plasma CyC and ANF at 24 h, plasma ADH at 72 h, and urine CyC at 1 week were similar to those of the control( all P gt;0. 05) , respectively, except the level of plasma ALD was still higher by 1 week( P lt; 0. 05) . Conclusions Polyuria is not a rare phenomenon for COPD patients receiving mechanical ventilation. Polyuria is related to the readjustment and mal-adaptation of ADH and reninangiotensin-aldosterone-systems during mechanical ventilation.
ObjectiveTo translate the King’s Brief Interstitial Lung Disease (K-BILD) to Chinese, so as to provide an well reliability and validity assessment instrument for health status of patients with interstitial lung disease.MethodsBrislin’s transition model, six expert’s panel and pre-survey were used for initial Chinese version of K-BILD. Items analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), internal consistency reliability and test-retest reliability were used for validity and reliability test with 122 respondents.ResultsTen-item Chinese version of K-BILD were proved to have great psychometric qualities, two factors were extracted by EFA, which could explain 63.35% of the total variance. Furthermore, the CFA demonstrates the fit indices of two-factors mode: χ2/df=0.797, RMSEA=0.000, NFI=0.848, IFI=1.048, CFI=1.000, TLI=1.071. Cronbach’s α and Guttman Split-half were 0.893 and 0.861, respectively. Besides, the test-retest reliability of the scale was 0.805.ConclusionThe Chinese version of K-BILD scale has good validity and reliability, which is applicable for health status assessment in patient with interstitial lung disease.
Objective To investigate the effects of smoking intensity, duration and cessation on mRNA and protein expressions of matrix metalloproteinase-9 ( MMP-9) in tracheal epitheliumof rats, and the relationship between smoking or smoking cessation and airway remodeling in chronic obstructive pulmonary disease ( COPD) . Methods Forty Wistar rats were randomly divided into 5 groups, ie. a normal control group, a long termheavy smoking group, a short termheavy smoking group, a long termlight smoking group,and a smoking cessation group which was exposed to room air for 10 weeks after long term heavy smoking.The expressions of MMP-9 mRNA and protein in tracheal epithelium of rats were detected by in situ hybridization and munohistochemistry respectively. Results ( 1) The pathological changes of emphysema were observed in the lung tissue of every smoking rat, and were most sever in the long term heavy smoking group. ( 2) Compared with the normal control group [ ( 0. 88 ±0. 88) PU, ( 2. 80 ±1. 66) PU] , the expressions of MMP-9 mRNA and proteins in tracheal epithelium were remarkable elevated in the long term heavy smoking group [ ( 22. 01 ±2. 86) PU, ( 20. 81 ±2. 46) PU] , the short term heavy smoking group [ ( 14. 94 ±3. 46) PU, ( 13. 68 ±2. 00) PU] , the long term light smoking group [ ( 6. 92 ±2. 71) PU,( 8. 84 ±1. 80) PU] and the smoking cessation group [ ( 19. 00 ±3. 36) PU, ( 14. 82 ±1. 74) PU] ( P lt;0. 01) . Compared with the long term heavy smoking group, the expressions of MMP-9 in tracheal epithelium were decreased in other three smoking groups ( P lt; 0. 05) . Conclusions Smoking could increase the expression of MMP-9 in tracheal epithelium and cause trachea damage and remodeling with intensity and duration in rats. Smoking cessation could decrease the MMP-9 expression and alleviate trachea remodeling,suggesting its role in the prevention of COPD.
Objective To investigate the impact of using low limit of normal( LLN) for FEV1 /FVC ratio and fixed ratio ( 70% ) as cut-off point in the qualitative diagnosis on the prevalence of chronic obstructive pulmonary disease( COPD) . Methods An epidemiological study was carried out in preoperative patients who received pulmonary function test in Zhongshan hospital fromNovember 6, 2007 to December 30, 2007. 339 patients were enrolled and diagnosed as COPD by different diagnostic criteria as follows: ①GOLD criteria; ②FEV1 /FVC
Objective To investigate the prethrombotic state and effect of anticoagulation therapy in patients with chronic obstructive pulmonary disease(COPD) and ventilator-associated pneumonia (VAP)．Methods Forty-six COPD patients were divided into VAP group(25 cases)and non-VAP group (21 cases)．The VAP group were randomly subdivided into two groups：group A(conventional therapy group，n=13)，group B(conventional therapy+anticoagulation therapy group，n=12)．The D-dimer (DD)，fibfinogen(FIB)，pulmonary artery pressure(PAP)and the time of weaning were compared between these groups．Results In the COPD patients，the levels of DD，FIB and PAP were significantly increased in VAP group compared with non-VAP group[(0．50±0．26)mg／L，(3．67 ±0．88) L，(31．71 ± 5．66)mm Hg vs(0．23±0．12)mg／L，(1．56±0．45) L，(15．28 ±2．84)mm Hg，respectively，all Plt; 0．05]．In the COPD patients with VAP，the levels of DD，the content of FIB，PAP and mortality were significantly lower in group B with shorter time of weaning compared with group A[(0．22±0．16)mg／L， (1．56±1．17)g／L，(16．00±2．48)him Hg，8．33％ and(4．00±1．41)d vs(O／41±0．09)mg／L，(3．66± 1．03) L，(28．00±0．85)mm Hg，15．4％ and(10．76±3．35)d，respectively，all Plt;0．05]． Conclusions Prethrombotic state exists in COPD patients with VAP．Aggressive anticoagulation on base of routine therapy，by ameliorating microcireulation，call shorten the time of weaning and reduce the mortalit in these patient