我们如何认识COPD急性加重课件.ppt

* * COPD在气道慢性炎症的基础上，在微生物、污染等诱发因素的作用下，气道炎症加剧，引起支气管狭窄，水肿，粘液分泌增加，从而导致呼气性气流受限，肺动态过度充气，出现急性加重症状。另一方面，肺部炎症溢出，导致全身性的炎症反应。 COPD exacerbations are associated with increased upper and lower airway and systemic inflammation. The airway inflammatory responses cause oedema, bronchospasm, and increased sputum production, leading to worsening airflow limitation and development of dynamic hyperinflation, which is a main cause of dyspnoea, the most common symptom of an exacerbation. Systemic inflammation increases at exacerbation and although the causes of this response in COPD are not clear, there is probably a spill-over of inflammatory markers from the lungs. Reference Wedzicha JA, Seemungal TA. COPD exacerbations: defining their cause and prevention. Lancet. 2007;370:786-796. Hurst J.R. et al. Susceptibility to Exacerbation in Chronic Obstructive Pulmonary Disease ECLIPSE N Engl J Med 2010;363:1128-38 * * Indeed, the inflammatory response may contribute to the pathogenesis of disease, as pathogens may use the inflammatory responses to enhance their proliferation and infection of new hosts. Thus inhibition of inflammation may improve not only the symptoms that are direct consequences of inflammation, but may also have a beneficial effect on the infection itself. 对6个随机、安慰剂对照，涵盖1741例患者，随访期至少6个月，观察ICS预防COPD急性加重作用的临床试验进行meta分析，吸入激素使COPD急性加重减少24%(95%CI, 20%-28%)。 In 6 placebo-controlled trials (1741 patients) with at least a 6-month follow-up period,inhaled corticosteroids led to a 24% reduction inCOPDexacerbations (95%CI, 20%-28%). * 对9个随机、安慰剂对照，4198例患者，随访期至少3个月，观察LABA预防COPD急性加重作用的临床试验进行meta分析，LABA使COPD急性加重减少21%(95%CI, 10%-31%)。 Nine placebo-controlled clinical trials (4198 patients with moderate to severe COPD and followed up for 3 months) demonstrated a 21% reduction (95% CI, 10%-31%) inCOPD exacerbation rates. * 试验设计： 140位具有中重度COPD的当前和既往吸烟者(平均年龄, 64 yr)参加了这项随机双盲，为期3个月的活检研究，试验前1周支气管活检，研究第三个月再次活检，进行对比舒利迭?50/500μg bid (n=67,平均FEV1 58.4%，可逆性3.9%)和安慰剂 bid (n=73,平均FEV1 59.3%，可逆性3