Objective To investigate the relationship of pulmonary surfactant protein D( SP-D) with chronic obstructive pulmonary disease ( COPD) by measuring SP-D level in serum and lung tissue of rats with COPD.Methods The rat COPD model was established by passive smoking as well as intratracheal instillation of lipopolysaccharide ( LPS) . Thirty male SD rats were randomly divided into a control group, a LPS group, and a COPD group( n =10 in each group) . The pathologic changes of lung tissue and airway were observed under light microscope by HE staining. Emphysema changes were evaluated by mean linear intercept ( MLI) of lung and mean alveolar number ( MAN) . The level of SP-D in serum was measured by enzymelinked immunosorbent assay ( ELISA) . The expression of SP-D in lung tissue was detected by Western-blot and immunohistochemistry.Results The MLI obviously increased, and MAN obviously decreased in the COPD group compared with the control group ( Plt;0.05) . There was no significant difference in the MLI and MAN between the LPS group and the control group ( Pgt;0.05) . The serum SP-D level was ( 49.59 ±2.81) ng/mL and ( 53.21±4.17) ng/mL in the LPS group and the COPD group, which was significantly higher than that in the control group [ ( 42.14±2.52) ng/mL] ( Plt;0.05) . The expression of SP-D in lung tissue was 0.56±0.01 and 0.63±0.01 in the LPS group and the COPD group, which was also obviously ber than that in the control group ( 0.39 ±0.01) ( Plt;0.05) .Meanwhile the SP-D levels in serumand lung tissue were higher in the COPD group than those in the LPS group ( Plt;0.05) . The levels of SP-D between serum and lung tissue were positively correlated in all three groups ( r=0.93, 0.94 and 0.93, respectively, Plt;0.01) .Conclusion Both the SP-D level in serum and in lung tissue increase significantly in COPD rats and correlate well each other, which suggests that SP-D may serve as a biomarker of COPD.
随着近年来对慢性阻塞性肺疾病( COPD) 的深入研究，人们逐渐揭示了其发病机制中的众多关键环节，据此开发了新型的药物和治疗手段。大量国际多中心临床研究已证明COPD 是一个可防可治的疾病，正确的治疗能够改善患者的症状，提高生活质量，乃至延缓疾病的进程。为更好地防治COPD，全球学者共同推出了《慢性阻塞性肺疾病全球倡议 ( GOLD) 》以指导广大医师规范、合理地诊断、治疗和预防COPD。然而， 在我国由于多方面的原因，COPD 的防治工作面临如下的难题。
ObjectiveTo investigate the risk factors associated with failure of weaning from invasive mechanical ventilation in gerontal patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsA retrospective study was conducted on 76 patients aged 65 years and older with AECOPD who received invasive mechanical ventilation and met the weaning criteria from July 2012 to June 2014. The subjects who passed the spontaneously breathing trial (SBT) and did not need mechanical ventilation within 48 h were enrolled into a weaning success group. The subjects who did not pass the SBT or needed mechanical ventilation again within 48 h were enrolled into a weaning failure group. The risk factors associated with failure of weaning were studied by univariate and multivariate Logistic regression analysis. ResultsThere were 53 subjects in the weaning success group and 23 in the weaning failure group. The incidences of sepsis, multiple organ dysfunction syndrome (MODS), fungal infection, hypoproteinemia, duration for mechanical ventilation > 14 d, the prevalences of aeropleura, cardiac failure, diabetes, coronary heart disease and hepatic insufficiency were higher in the weaning failure group than those in the weaning success group (P < 0.05). Logistic analysis revealed that MODS (OR=8.070), duration for mechanical ventilation > 14 d (OR=17.760), cardiac failure (OR=4.597) and diabetes (OR=13.937) were risk factors of weaning failure (P < 0.05). ConclusionMODS, duration for mechanical ventilation > 14 d, cardiac failure and diabetes were associated with the failure of weaning from invasive mechanical ventilation in gerontal patients with AECOPD.
Objective To explore the effect of budesonide nebulization in the treatment of mechanically ventilated patients with chronic obstructive pulmonary disease(COPD).Methods A total of 25 intubated and ventilated COPD patients complicated with respiratory failure was randomly divided into two groups.The control group consisted of 12 patients received salbutamol nebulization on the routine treatment.The budesonide group consisted of 13 patients received budesonide plus salbutamol nebulization on the routine treatment.Variables such as tumor necrosis factor-α(TNF-α) and interleukin-8(IL-8) in the bronchoalveolar lavage fluid(BALF) ， incidence of ventilation-associated lung injury(VALI) ， days of mechanical ventilation ，， days of hospitalization and survival rate were measured and compared.Results The survival rate and incidence of VALI were not different significantly between the two groups.However ， the levels of TNF-α and IL-8 in BALF of the control patients were significantly lower than those in the budesonide group[ （ 1.2±0.2 ） mg/L vs （ 1.5±0.4 ） mg/L ，（ 85.7±26.5 ）（ 125.6±30.4 ）， both Plt;0.05).And the days of mechanical ventilation and hospitalization were statistically shorter in the budesonide group compared with the control group[ (7.2±2.5 ） d vs （ 10.5±6.2 ） d ， (10.5±4.7 ） d vs (15.8±6.6 ） d ， both Plt;0.05].Conclusion Our data suggest that nebulization of budesonide can suppressed the pulmonary inflammation and decreased days of the mechanical ventilation and hospitalization in mechanically ventilated COPD patients.
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
ObjectiveTo observe the effects of perindopril on expression level of phosphatidylinositol 3-kinase (PI3K) and lung function in rats with obstructive pulmonary disease (COPD),and investigate the therapeutic effects of perindopril on COPD. MethodsSixty male SD rats were randomly divided into a control group,a COPD group,and a perindopril group,with 20 rats in each group. The rat model of COPD was established by intratracheal instillation of lipopolysachride and exprosure to cigarette smoke in the COPD group and the perindopril group. The rats in the perindopril group were intragastricly infused with perindopril additionally. All rats were sacrificed after 28 days. The lung function was observed and PI3K protein expression was detected using Western blot method. The pathologic changes of the lung tissue and airway were observed by HE staining. ResultsHE staining revealed that the rat COPD model was successfully established. The COPD group appeared obvious emphysema which was allievated significantly in the perindopril group. Pulmonary function indices in the COPD group and the perindopril group were significantly decreased compared with the control group with VE value decreased by 40% and 22%,PEP value decreased by 33% and 15%,and FEV0.3 value decreased by 18% and 7%,respectively. The expression of PI3K was significantly increased in the COPD group and the perindopril group than the control group,but more significantly in the COPD group (P<0.05). ConclusionPerindopril can significantly improve lung function in rats with COPD possibly through down-regulation of PI3K expression in the lung.
Objective To investigate the therapeutic effects of thyroid hormone replacement on critically ill COPD patients with low serum thyroid hormone. Methods Sixty-seven critically ill patients with acute exacerbation of COPD ( AECOPD) , and complicated with respiratory and/ or heart failure and low serum thyroid hormone, admitted from July 2008 to June 2011, were recruited for the study. They were randomly divided into an intervention group ( n = 34) and a control group ( n = 33) . The control group received conventional treatment and the intervention group received conventional treatment plus additional thyroid hormone replacement therapy. Results Compared with the control group, the overall efficacy of the intervention group was not significantly different ( 88. 2% vs. 81. 8% , P gt; 0. 05) , while average effective time was significantly shorter [ ( 9. 6 ±2. 5) d vs. ( 12. 3 ±2. 8) d, P lt; 0. 05] . The post-treatment serum FT3 , FT4 , TT4 , and h-TSH levels were significantly higher in the intervention group than those in the control group, and significantly higher than baseline ( P lt;0. 05) . Conclusions For AECOPD patients complicated with respiratory and/or heart failure and low serum thyroid hormone, thyroid hormone supplement at low dosage will help to improve serumthyroid hormone level, and promote early recovery.
Objective To analyze the relationship of serum IL-17, IL-8 levels and BODE index in patients with stable COPD, and investigate the clinical value of serum IL-17 and IL-8 in evaluating disease severity and prognosis. Methods A comparative study was performed in40 clinically stable COPD patients and 40 matched healthy individuals. The serum levels of IL-17 and IL-8 in both groups were measured. Correlation analysis was performed between serum IL-17, IL-8 levels and BODE index in the patients with stable COPD. Results The serumlevels of IL-17 and IL-8 in the COPD group were ( 114. 02 ±34. 84) pg/mL and ( 102. 67 ±31. 55) pg/mL, increased significantly compared with those in the healthy group which were ( 73. 22 ±14. 66) pg/mL and ( 35. 36 ±5. 04) pg/mL ( P lt;0. 05) respectively. Both of serum IL-17 and IL-8 levels were positively correlated with BODE index in the patients with stable COPD ( r = 0. 782, r = 0. 924, P lt;0. 001) . Conclusions High levels of serumIL-17 and IL-8 implies active inflammation in patients with stable COPD. Detection of serumIL-17 and IL-8 can help evaluate disease severity and prognosis.