慢性阻塞性肺疾病诊治指南2017ppt教案.pptVIP

第六 慢阻肺与合并症 肺癌是 COPD 患者常见合并症，也是主要的死亡原因。 心血管疾病是 COPD 患者常见和重要的合并症。 骨质疏松和抑郁/焦虑也是 COPD 患者常见和重要的合并症，但是这些疾病常被漏诊。这些合并症会使患者健康状况变差，使疾病病情恶化。 胃食管反流病（GERD）会导致 COPD 急性加重风险增高和健康状况的恶化。 当 COPD 是患者多重病症之一时，应尽可能简化治疗、减少用药。 小结 谢 谢！ * * * * * * * * * * * * The central role of inflammation in comorbidity is associated with chronic obstructive pulmonary disease (COPD). Inflammation appears to play a central role in the pathogenesis of COPD and other conditions that are increasingly being recognised as systemic inflammatory diseases. As part of the chronic inflammatory process, tumour necrosis factor (TNF)-a receptor polymorphisms are associated with increased severity of disease, possibly due to enhanced TNF-a effects. Also, C-reactive protein (CRP) levels can be increased directly by TNF-a and other cytokines. Elevated CRP and fibrinogen may be crucial in the pathogenesis of cardiovascular disease. Reactive oxygen species released as a result of COPD may enhance the likelihood of a patient developing cardiovascular disease, diabetes and osteoporosis. IL: interleukin; ?: unknown; +ve: positive * * * * 若年龄40岁的患者出现以下任一表现，应考虑COPD诊断，病进行肺功能检测，这些指征不能确诊COPD，但同时出现多个临床指标可增加COPD诊断的可能性。肺功能检测是的必备条件 * * * * * * * * lobal Initiative for Chronic bstructiveungisease G OLD ? 2014 Global Initiative for Chronic Obstructive Lung Disease 慢性阻塞性肺疾病全球倡议(GOLD): GOLD 的目标 提高医疗工作者、医疗机构及公共对COPD的认知 提高诊断、管理及预防 减少发病和死亡 促进科研 ? 2014 Global Initiative for Chronic Obstructive Lung Disease 2017GOLD更新概要 一、定义和概述 二、诊断与评估 三、预防和维持治疗证据支持 四、稳定期管理 五、急性加重期管理 六、COPD与合并症 一、COPD的定义和概述 --定义(GOLD2017) GOLD2016是一种可预防和治疗的常见疾病，以渐进性持续气流受限为特征，通常与气道或肺对有毒颗粒或气体的慢性炎症反应增强有关。 ? 2014 Global Initiative for Chronic Obstructive Lung Disease GOLD?2017?将?COPD?定义为一种常见、可预防、可治疗的疾病。COPD?主要是因为显著暴露于有毒颗粒或气体导致气道和/或肺泡异常，典型的临床表现为持续性呼吸系统症状和气流受限。 定义 (GOLD2017) ? 2014 Global Initiative for Chronic Obstructive Lung Disease 最常见的症状： 呼吸困难、咳嗽和/或咳痰。 定义 (GOLD2017) ? 2014 Globa