Objective: To evaluate the influencing factors of poor treatment adherence in patients with uncontrolled asthma in China. Methods: From April 2017 to April 2018, all asthma patients with uncontrolled asthma and poor compliance in 32 third-class hospitals in 28 provinces and cities of China mainland included in the "National Mobile Asthma Assessment and Management Project" were selected as the subjects. A total of 923 patients were enrolled in the study including 388 males and 535 females. By analyzing the baseline data of the patients at the initial visit when enrolled, the influencing factors of poor adherence of adult asthma was analyzed by inter-group comparison and χ2 test. Results: Poor compliance in asthma was related to the following factors: age from 59 to 68 years old, course of disease more than 20 years, low education level, non-local follow-up, having obstructive ventilation dysfunction and low awareness of the disease[P values were 0.026(t=1.20), 0.004(t=3.97), 0.001(t=4.92), 0.003(t=3.98), 0.032(t=1.22) and 0.001(t=4.99), respectively]. Totally, 243 patients (26.33%) answered all the questions about asthma correctly. Their medication adherence rating scale (MARS-A) scores were significantly higher than those who answered incompletely correctly (36.23±5.85 vs. 31.77±5.74, P=0.001). Conclusions: The adherence of adult asthma patients was affected by individual and external environment factors. Clinicians should choose individualized methods based on the characteristics of patients. Patient education should be strengthened to improve patients' awareness of the disease at the same time.

慢性阻塞性肺疾病( chronic obstructive pulmo-nary disease,COPD)是一组常见的以持续的呼吸道症状和气流受限为特征的,可以预防和治疗的疾病[1]. 主要表现为慢性咳嗽、咳痰、气短或呼吸困难等. 其病因包括吸烟、职业粉尘和化学物质、空气污染、感染因素、免疫因素及气道高反应性等,其中吸烟是重要的发病因素.

支气管扩张症(Bronchiectasis)是一种慢性呼吸系统疾病,其特征是支气管不可逆转地受损和扩张,主要表现为呼吸困难、咳嗽、咯血、精神萎靡及反复胸部不适[1 ].由于人口老龄化,以及胸部高分辨CT (HRCT)扫描的广泛使用和人们对这种疾病的更多认识,近年来国际上报道的支气管扩张症患病率有所升高[2-3].

慢性阻塞性肺疾病( chronic obstructive pulmo-nary disease, COPD) ,简称慢阻肺,是一种以持续性的呼吸道症状和气流受限为特征的可防可治的疾病,是我国最常见的慢性呼吸系统疾病之一,该病发病率高,致残率高,死亡率高,也是世界性的公共卫生挑战[1].多种细胞参与的慢性炎症是慢阻肺进展的核心机制,炎症模式之复杂提示了疾病具有异质性,近年来,嗜酸性粒细胞( eosinophils,EOS)作为COPD发病机制中的重要因子和潜在的生物标志物倍受关注,虽机制未明,但随着慢性阻塞性肺疾病全球倡议( global initiative for chronic obstructive lung disease, GOLD)的不断更新,外周血EOS已成为指导COPD患者的治疗重要参考指标[2] ,这为实现慢阻肺个性化治疗,提供了新的思路.本文就外周血EOS在慢阻肺诊疗中的研究进展作以综述.

Objective To analyze the relationship between medication compliance of patients with uncontrolled asthma and lung function,airway inflammation level, asthma control level and quality of life so as to obtain important references for improving patient compliance and asthma control level in the future. Methods Questionnaires were performed in asthma patients who did not achieve asthma control and had poor compliance in 32 third-class hospitals in 28 provinces of China mainland. All patients were tested for lung function and airway inflammation levels. So the relevant data of asthma compliance was investigated and analyzed. Results A total of 923 patients were investigated and the questionnaire recovery rate was 100%. Two hundred and forty-three（26.33%） answered cognitive related questions about asthma completely correctly. Treatment compliance in asthma patients was positively correlated with lung function and significantly negatively correlated with exhaled nitric oxide. Better treatment compliance in asthma has higher level of asthma control and quality of life. Poor compliance in asthma patients will lead to decreased lung function and elevated levels of airway inflammation, resulting in decreased asthma control and quality of life. Conclusion Asthma treatment compliance is related to lung function, airway inflammation, asthma control level and quality of life.

目的 探讨国家早期预警评分(National Early Warning Score)对社区获得性肺炎病情及预后的评估价值.方法 回顾性分析2017年9月至2019年11月于哈尔滨医科大学附属第一医院住院的CAP患者共307例,收集患者的基本资料、生命体征等.比较NEWS、CURB-65、PSI评分不同危险分层间CAP重症率及病死率的差异,并分析上述三种评分的相关性.用ROC曲线下面积,表示上述三种评分对CAP预后的判断能力,通过Kaplan-Meier曲线分析不同NEWS评分危险分层间CAP患者的生存率.结果 随着NEWS评分危险等级的提升,CAP重症率、病死率相应升高,住院期间生存率降低(P<0.05).CURB-65、PSI、NEWS评分预测CAP重症率的AUC,分别为0.932、0.928、0.958,NEWS评分对CAP重症率的预测能力相对最佳.CURB-65、PSI、NEWS评分预测CAP病死率的AUC分别为0.906、0.949、0.884,NEWS评分对CAP死亡率的预测能力相对较差,相关性分析示三个评分之间互为正相关性.结论 NEWS评分对CAP的病情严重程度及预后有一定的预测价值,且其在预测CAP重症率时具有优势.

支气管扩张症是各种原因引起的支气管树的病理性、永久性扩张,导致反复发生化脓性感染的气道慢性炎症.非囊性支气管扩张病因包括特发性、感染后、慢性阻塞性肺疾病( COPD)、过敏性支气管肺曲霉病( ABPA)、免疫缺陷、炎症肠病、类风湿关节炎、胃食管反流等,研究表示明确病因有可能导致13％的患者接受特殊护理[1].目前国内外对支气管扩张不同病因的诊疗及预后研究较少,现就支气管扩张不同病因的诊疗及预后研究进展进行归纳,以期可以从病因的角度为支气管的分层管理及治疗提供依据.有助于及时的识别支气管扩张患者,从而更好的对支气管扩张患者进行管理,改善患者预后及生活质量.

Purpose As stated in the Global Initiative for Asthma, there are still some asthmatic patients who have not achieved asthma control. Mobile is a useful tool for asthma management. We aimed to compare the advantages of mobile management with traditional management in improving adherence and control of asthma. Methods In this prospective, multicentre, randomized, controlled and parallel-group study, we enrolled patients with poor adherence and uncontrolled asthma at 32 hospitals in 28 provinces in China. Patients were randomly assigned to the mobile management or traditional management groups for 12 months. The primary endpoint was the proportion of patients with good adherence (Medication Adherence Report Scale for Asthma [MARS-A] score ≥ 45) for 6 months. This study is registered at ClinicalTrials.gov (NCT02917174). Results Between April 2017 and April 2018, 923 patients were eligible for randomization (mobile group, n = 461; traditional group, n = 462). Dropout was 84 (18.2%) in the mobile management group and 113 (24.4%) patients in the traditional management group. The proportion of patients with good adherence was significantly higher in the mobile management group than in the traditional management group (66.0% vs. 58.99%, P = 0.048). The mobile management group showed higher mean MARS-A score (at 1, 6, 9, and 12 months) and asthma control test scores (at 6 and 9 months), and lower total lost rate to follow-up within 12 months than the traditional management group. Conclusions Mobile asthma management can improve adherence and asthma control compared to traditional management. Trial Registration ClinicalTrials.gov Identifier: NCT02917174

Purpose While asthma comorbidities are associated with higher health care utilisation, lower quality of life and poorer asthma control, the impact of asthma comorbidities on hospitalisation for asthma exacerbation (H-AX) remains less recognised. We aim to analyse the impact of asthma comorbidities on H-AX. Methods Based on a national survey on asthma control and disease perception (CARN 2015 study), we analysed the impact of comorbidities on annual incidence and frequency of H-AX in China. Information on demographic characteristics, asthma comorbidities and annual incidence and frequency of H-AX were presented in this study. Results Among 3875 ambulatory asthma patients, 75.9% (2941/3875) had comorbidities, and 26.4% (1017/3858) experienced H-AX during past year. After adjusting for confounding factors such as demographic data, smoking status and asthma control, COPD [OR = 2.189, 95% CI (1.673, 2.863)] and coronary heart disease [OR = 1.387, 95% CI (1.032, 1.864)] were associated with higher annual incidence, while allergic rhinitis [OR = 0.692, 95% CI (0.588, 0.815)] was associated with lower annual incidence, of H-AX. In terms of frequency, allergic rhinitis [OR = 1.630, 95% CI (1.214, 2.187)], COPD [OR = 1.472, 95% CI (1.021, 2.122)] and anxiety [OR = 2.609, 95% CI (1.051, 6.477)] showed statistically significant correlation with frequent H-AX. Conclusions COPD and coronary heart disease were associated with higher annual incidence, while allergic rhinitis was associated with lower annual incidence of H-AX. Allergic rhinitis, COPD and anxiety were associated with frequent H-AX. Comorbidities may have an important role in the risk and frequency of annual hospitalisations due to asthma exacerbation. The goal of asthma control should rely on a multi-disciplinary treatment protocol.

目的:本研究通过对支气管扩张症生活质量问卷表(QoL-B)的信度、效度检测来评价该问卷,判断QoL-B对于支气管扩张症患者生命质量评价的优劣.方法:对符合条件的支气管扩张症患者入院后进行QoL-B及圣乔治呼吸问卷(SGRQ)调查,采集基本信息及病史,并且于2周、2个月后回访再测QoL-B.信度检测内部一致性信度及再测信度,效度检测QoL-B得分与症状相关性及与SGRQ相关性,敏感度检测患者急性加重期与稳定期的差别.结果:141例患者中36例患者接受再测信度检测,31例患者接受敏感度检测,QoL-B的内部一致性高,再测信度高.所有的项目与SGRQ的相关性高,与呼吸系统症状明显相关.结论:QoL-B问卷表现出良好的信度、效度,两周后的再测信度高,对于患者急性加重的检测敏感度高.

Purpose:The proportion of atypical pathogens in patient with AECOPD within mainland China is unknown. The objectives of this study were to determine the distribution of atypical pathogens among Chinese patients with AECOPD, to evaluate the clinical characteristics of different atypical pathogen infections, and to compare different detection methods for atypical pathogens.Patients and Methods:Specimens were collected from patients with AECOPD from March 2016 to November 2018 at eleven medical institutions in eight cities in China. Double serum, sputum, and urine samples were obtained from 145 patients. Serological and nucleic acid tests were used to assess for Mycoplasma pneumonia and Chlamydia pneumoniae; serological, urinary antigen, and nucleic acid tests were applied to detect Legionella pneumophila. The clinical characteristics of atypical pathogen-positive and -negative groups were also compared.Results:The overall positivity rate for Mycoplasma pneumoniae was 20.69% (30/145), with the highest rate being 20.00% (29/145) when determined by passive agglutination.The overall positive rates for Chlamydia pneumoniae and Legionella pneumophila were 29.66% (43/145) and 10.34% (15/145), respectively. The most common serotype of Legionella pneumophila was type 6. The maximum hospitalized body temperature, ratio of eosinophils, C-reactive protein (CRP) level, and procalcitonin (PCT) level of the Mycoplasma pneumoniae-positive group were significantly higher than those of the Mycoplasma pneumoniae-negative group. Patients in the Chlamydia pneumoniae-positive group smoked more, had higher proportions of comorbidities and frequent aggravations in the previous two years than those in the Chlamydia pneumoniae-negative group. Furthermore, the forced expiratory volume in one second to forced vital capacity (FEV1/FVC) ratio assessment of lung function was higher, and the concentration of arterial blood bicarbonate (HCO3-) was lower in the Legionella pneumophila-positive group than in the Legionella pneumophila-negative group.Conclusion:Overall, atypical pathogens play an important role in AECOPD. Regarding the testing method, serological testing is a superior method to nucleic acid testing.

慢性阻塞性肺疾病( Chronic Obstructive Pulmo-nary Disease, COPD,简称慢阻肺)是常见的呼吸系统疾病,其发病率和病死率均较高,是重要的公共卫生挑战.因感染等原因导致的慢性阻塞性肺疾病急性加重( Acute Exacerbations of Chronic Obstructive Pulmonary Disease, AECOPD,简称慢阻肺急性加重)指的是患者在短期内症状明显加重,即咳嗽、咳痰增多(痰为脓性或黏液脓性)、气短和(或)喘息加重或出现发热等症状,并需改变常规用药[1].

CAP病情研究的最新进展揭示了系统生物学的重要性,系统生物学旨在通过计算工具及高通量技术来提供生物过程的全系统视图,包括基因组学、转录组学、代谢组学、蛋白质组学等.从整体角度整合生物系统诸多联系来研究复杂生物过程的机制有利于发现CAP病情相关的标志物,其未来价值不容忽视.社区获得性肺炎( community-acquired pneu-monia,CAP)是感染性死亡的主要原因.研究发现,其住院患者及重症监护病房患者死亡率分别为5％～10％、25％ ～30％ [1].为了能够降低患者死亡风险,临床医生需要选择合适的预测工具评价病情,以便于提高患者治愈机率,寻找能够准确预测CAP病情的指标是迫切的需要.系统生物学是21 世纪预测肺部疾病的重要手段,在运用系统思维了解疾病机制过程中,部分标志物已经被发现对CAP病情评估的价值.因此,本文主要就当前病情评估现状及系统生物学在发现相关标志物中的应用进行综述,揭示CAP病情评估的最新进展.

目的 探讨持续气道正压通气(CPAP)对早期阿尔茨海默病(AD)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的睡眠障碍及神经心理的影响.方法 纳入2019年5月至2020年12月诊断的早期AD合并OSAHS患者42例,随机分为CPAP联合治疗组(20例)和单纯药物治疗组(22例).采用蒙特利尔认知功能评分量表(MoCA)、简易精神状态量表(MMSE)和霍普金斯词语学习测验(HVLT)评估神经认知功能变化;9条目患者健康问卷(PHQ9)评估抑郁情绪状态;多导睡眠图评价睡眠特征和呼吸参数;Epworth嗜睡量表(ESS)和匹茨堡睡眠质量指数(PSQI)评估患者的主观睡眠状况.分别比较使用CPAP治疗3个月后CPAP联合治疗组自身及其与单纯药物治疗组两组间的睡眠状况、认知功能及情绪的变化情况.结果 治疗3个月后,CPAP联合治疗组的ESS、PSQI和PHQ9评分较治疗前明显降低,MoCA、MMSE、HVLT(总分和延迟回忆)较治疗前明显增高(均P＜0.05),呼吸暂停低通气指数较治疗前明显降低(P＜0.05),最低血氧饱和度明显升高(P＜0.05),治疗前后的睡眠结构参数的差异无统计学意义(P＞0.05).治疗3个月后,CPAP联合治疗组患者的ESS、PSQI和PHQ9评分较单纯药物治疗组明显降低(均P＜0.05),而两组认知评分差异无统计学意义(P＞0.05).结论 CPAP连续治疗3个月可显著缓解早期AD合并OSAHS患者的低通气和缺氧程度,改善日间嗜睡及抑郁状态,认知功能有明显改善,而睡眠结构紊乱无明显变化.

慢性阻塞性肺疾病(chronic obstructive pulmo-nary disease,COPD,简称慢阻肺)是一种进行性且不可治愈的呼吸系统疾病,主要损害呼吸道及肺实质,肺血管病变也是该疾病重要部分[1].肺动脉高压(pulmonary artery hypertension,PH)定义为海平面、静息下,右心导管测量肺动脉平均压(mPAP)≥25 mmhg(1 mm Hg=0. 133 kPa),是一种病因复杂的功能性疾病,可导致右心室后负荷增加、右心肥大及心力衰竭[2].PH是慢阻肺病程中严重并发症,与更短的生存期、更多医疗资源需求直接关联.但是,不乏有慢阻肺合并肺动脉高压(COPD-PH)患者因症状隐匿、临床缺乏检测方法等而贻误诊治.本综述主要从血清学生物标志物方面探讨COPD-PH研究进展,希望有助于COPD-PH的临床诊治.

Background: The clinical use of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARB) in patients with COVID-19 infection remains controversial. Therefore, we performed a meta-analysis on the effects of ACEI/ARB on disease symptoms and laboratory tests in hypertensive patients infected with COVID-19 virus and those who did not use ACEI/ARB. Methods: We systematically searched the relevant literatures from Pubmed, Embase, EuropePMC, CNKI, and other databases during the study period of 31 December 2019 (solstice, 15 March 2020), and analyzed the differences in symptoms and laboratory tests between patients with COVID-19 and hypertension who used ACEI/ARB drugs and those who did not. All statistical analyses were performed with REVMAN5.3. Results: We included a total of 1808 patients with hypertension diagnosed with COVID-19 in six studies. Analysis results show that ACEI/ARB drugs group D-dimer is lower (SMD = −0.22, 95%CI: −0.36 to −0.06), and the chances of getting fever is lower (OR = 0.74, 95%CI: 0.55 to 0.98). Meanwhile, laboratory data and symptoms were not statistical difference, but creatinine tends to rise (SMD = 0.22, 95% CI: 0.04 to 0.41). Conclusion: We found that the administration of ACEI/ARB drugs had positive effect on reducing D-dimer and the number of people with fever. Meanwhile it had no significant effect on other laboratory tests (creatinine excepted) or symptoms in patients with COVID-19, while special attention was still needed in patients with renal insufficiency.

PURPOSE:Details of patients hospitalized for asthma exacerbation in mainland China are lacking. To improve disease control and reduce economic burden, a large sample survey among this patient population is indispensable. This study aimed to investigate the clinical characteristics and outcomes of such patients.METHODS:A retrospective study was conducted on patients hospitalized for asthma exacerbation in 29 hospitals of 29 regions in mainland China during the period 2013 to 2014. Demographic features, pre-admission conditions, exacerbation details, and outcomes were summarized. Risk factors for exacerbation severity were analyzed.RESULTS:There were 3,240 asthmatic patients included in this study (57.7% females, 42.3% males). Only 28.0% used daily controller medications; 1,287 (39.7%) patients were not currently on inhaled corticosteroids. Acute upper airway infection was the most common trigger of exacerbation (42.3%). Patients with severe to life-threatening exacerbation tended to have a longer disease course, a smoking history, and had comorbidities such as hypertension, chronic obstructive pulmonary disease (COPD), and food allergy. The multivariate analysis showed that smoking history, comorbidities of hypertension, COPD, and food allergy were independent risk factors for more severe exacerbation. The number of patients hospitalized for asthma exacerbation varied with seasons, peaking in March and September. Eight patients died during the study period (mortality 0.25%).CONCLUSIONS:Despite enhanced education on asthma self-management in China during recent years, few patients were using daily controller medications before the onset of their exacerbation, indicating that more educational efforts and considerations are needed. The findings of this study may improve our understanding of hospital admission for asthma exacerbation in mainland China and provide evidence for decision-making.

支气管扩张的特征是慢性全身炎症,通常与合并症共存,包括心脑血管疾病、慢性阻塞性肺疾病、胃食管反流、类风湿关节炎等,共病的存在会导致支气管扩张患者住院及死亡风险增加,也导致医疗负担加重及治疗难度的加大.目前,对于共病的性质、患病率及对疾病严重程度和结果的影响知之甚少.加强对支气管扩张共病的研究,有助于更全面地评估患者病情及预后,也有助于简易、及时识别更为严重的支气管扩张患者,从而更好地对支气管扩张进行分层管理,最终改善患者的生活质量.

目的 研究空气污染物之间的相互作用及大气污染对气流阻塞性疾病患者的健康影响.方法 通过统计学相关分析研究空气污染物之间的相互作用及空气污染情况对气流阻塞性疾病患者健康效应的影响.结果 空气中污染物AQI、PM2.5、PM10、SO2、NO2、CO的浓度与慢阻肺患者及哮喘患者住院情况有显著正相关性.结论 空气中污染物之间存在相关性.空气污染对人体健康造成的影响是多种污染物相互作用后共同产生.空气污染对气流阻塞性疾病患者存在不良影响,并且存在滞后性及累积性.

目的 探讨血小板平均体积联合APACHEⅡ评分对肺栓塞病情及预后的评估价值.方法 采用回顾性研究方法,选取2010年7月至2017年11月于哈尔滨医科大学附属第一医院确诊为肺栓塞并住院的患者共171例,其中高危组(50例)、中危组(59例)和低危组(62例),根据预后情况分为存活组(147例)与死亡组(24例).收集患者的基本资料、MPV值,计算患者APACHEⅡ评分的得分.比较不同组间血MPV值和APACHEⅡ评分之间的差异,评价MPV水平和APACHEⅡ评分用于肺栓塞患者病情严程度及预后的临床价值.结果 随着肺栓塞患者病情严重程度的增加,APACHEⅡ评分指标水平逐渐升高(P<0.05);对于患者预后而言,死亡组患者有着更高的APACHEⅡ得分(P<0.05).ROC曲线分析显示,当APACHEⅡ评分=22分为最佳临界值,其曲线下面积为0.8715(95％CI 0.814～0.928),预测患者不良预后的敏感度和特异度分别为100.0％和67.0％.相关性分析显示,血MPV值与APACHEⅡ评分并无相关性.血MPV值与肺栓塞患者病情严重程度及预后无统计学关系(P=0.6547 vs P=0.3279).结论 APACHEⅡ评分可以用于肺栓塞患者病情严重程度及预后的评估,而血MPV值与肺栓塞患者的病情无明确相关性,两者联合并不能提高对肺栓塞病情及预后的评估效能.