慢性阻塞性肺疾病合并症及管理
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摘要
慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是全球患病率和死亡率均较高的一种疾病。年龄和吸烟与疾病呈正相关性。COPD不仅损害肺脏,也可引起肺外不良效应,出现合并症。临床试验研究显示除患有多种合并症和高龄的COPD患者外可以给予常规治疗。在临床实践指南的推荐的单病种中未涉及合并症,但合并症可以影响COPD患者的治疗及预后。因此,需要对有合并症的COPD患者进行全面的管理和医疗干预,但这种全面的分析在全球尚未建立。全面的分析包括合并症在COPD严重程度分级中的负担。而且,对于所有疾病的药物和非药物管理还应该同时包括最佳干预措施和危险因素改变。所有健康护理专家在COPD管理方面应该与其他慢性疾病专业管理人员共同努力,为合并有多种疾病的COPD患者提供一种综合治疗方法。总之,我们关注的是影响COPD患者主要的合并症及其发病机制和危险因素,还有合理的治疗方法。
The chronic obstructive pulmonary disease( COPD) is a kind of disease with higher prevalence and death rates in the world. Age and smoking are positively correlation with the disease. COPD can not only damage the lungs,but also can cause extrapulmonary adverse effects and complicatins. Clinical researches show that except fot the senile COPD patients and the COPD patients with many complications,the other COPD patients can be given routine therapy. The clinical practice guidelines recommended single diseases does not involve the complications,but complications can affect the treatment and prognosis of patients with COPD. Therefor the COPD patients with complications need for comprehensive management and medical intervention,but this kind of comprehensive analysis has not yet been extablished in the world. The comprehensive analysis includes the burden of complications in COPD severity classification. Moreover,the drug and non-drug management for all the diseases should include the best intervention measures and the changes of rik factors. All the health care experts in COPD management should work together with other chronic disease management professionals to provide a comprehensive treatment method for the COPD patients with many complications. In short we should pay much attention to the complications affecting COPD and its pathogenesis mechanism and risk factors as well as reasonable treatment methods.
The chronic obstructive pulmonary disease( COPD) is a kind of disease with higher prevalence and death rates in the world. Age and smoking are positively correlation with the disease. COPD can not only damage the lungs,but also can cause extrapulmonary adverse effects and complicatins. Clinical researches show that except fot the senile COPD patients and the COPD patients with many complications,the other COPD patients can be given routine therapy. The clinical practice guidelines recommended single diseases does not involve the complications,but complications can affect the treatment and prognosis of patients with COPD. Therefor the COPD patients with complications need for comprehensive management and medical intervention,but this kind of comprehensive analysis has not yet been extablished in the world. The comprehensive analysis includes the burden of complications in COPD severity classification. Moreover,the drug and non-drug management for all the diseases should include the best intervention measures and the changes of rik factors. All the health care experts in COPD management should work together with other chronic disease management professionals to provide a comprehensive treatment method for the COPD patients with many complications. In short we should pay much attention to the complications affecting COPD and its pathogenesis mechanism and risk factors as well as reasonable treatment methods.
引文
1 GLOD Exccutive Committee. Global strategy for the diagnosis,managment,and prevention of chronic obstructive pulmonary disease updated,2016.
2 中华人民共和国国家卫生和计划生育委员会.中国居民营养与慢性病状况报告,2015.
3 World Health Organization. Chronic obstructive pulmonary disease(COPD). 2011.
4 蔡柏蔷.应重视慢性阻塞性肺疾病的合并症问题.中华结核和呼吸杂志,2013,36:245-247.
5 Koskela J,Kilpelinen M,Kupiainen H,et al. Co-morbidities are the key nominators of the health related quality of life in mild and moderate COPD. BMC Pulm Med,2014,14:102.
6 ChoudHury G,Rabinovich R,Macnee W. Comorbidities and systemic effects of chronic obstructive pulmonary disease. Clin Chest Med,2014,35:101-130.
7 Zoni-Berisso M,Lercari F,Carazza T,et al. Epidemiology of atrial fibrillation:European perspective. Clin Epidemiol,2014,6:213-220.
8 陈勃江,李为民.肺癌与慢性阻塞性肺疾病相关性的研究进展.中华结核和呼吸杂志,2014,37:290-293.
9 Chen WJ,Lin CC,Lin CY,et al. Pulmonary embolism in chronic obstructive pulmonary disease:a population-based cohort study. COPD,2014,11:438-443.
10 Huang B,Yang Y,ZHu J,et al. Clinical characteristics and prognostic significance of chronic obstructive pulmonary disease in patients with atrial fibrillation:results from a multicenter atrial fibrillation registry study. J Am Med Dir Assoc,2014,15:576-581.
11 周春霞,江山平.慢性阻塞性肺疾病合并心血管疾病的研究进展.中华结核和呼吸杂志,2015,38:72-75.
12 Konecny T,Park JY,Somers KR,et al. Relation of chronic obstructive pulmonary disease to atrial and ventricular arrhythmias. Am J Cardiol,2014,114:272-277.
13 Mahishalc V,Mahishalc A,Patil B,et al. Screening for diabetes mellitus in patients with chronic obstructive pulmonary disease in tertiary care hospital in India. Niger Med J,2015,56:122-125.
14 Pooler A,Beech R. Examining the relationship between anxiety and depression and exacerbations of COPD which result in hospital admission:a systematic review. Int J Chron Obstruct Pulmon Dis,2014,9:315-330.
15 Qian J,Simoni-Wastila L,Langenberg P,et al. Effects of depression diagnosis and antidepressant treatment on mortality in Medicare beneficiaries with chronic obstructive pulmonary disease. J Am Geriatr Soc,2013,61:754-761.
16 Rutten EP,Breyer MK,Spruit MA,et al. Abdominal fat mass contributes to the systemic inflammation in chronic obstructive pulmonary disease.Clin Nutr,2010,29:756-760.
17 朱敏立,焦涛,王萍.慢性阻塞性肺疾病急性加重患者焦虑抑郁状况与炎症因子变化的研究.中国煤炭工业医学杂志,2014,42:661-664.
18 Vestbo J,Hurd SS,AgustíAG,et al. Global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease:GOLD executive summary. Am J Respir Crit Care Med,2013,187:347-365.
19 Mapel DW,Marton JP. Prevalence of renal and hepatobiliary disease,laboratory abnormalities,and potentially toxic medication exposures among persons with COPD. Int J Chron Obstruct Pulmon Dis,2013,8:127-134.
20 Chen CY,Hsu TW,Mao SJ,et al. Abnormal renal resistive index in patients with mild-to-moderate chronic obstructive pulmonary disease.COPD,2013,10:216-225.
21 Doos L,Uttley J,Onyia I,et al. Mosaic segmentation,COPD and CHF multimorbidity and hospital admission costs:a clinical linkage study. J Public Health(Oxf),2014,36:317-324.
22 Miyazaki M,Nakamura H,CHubachi S,et al. Keio COPD Comorbidity Research(K-CCR)Group. Analysis of comorbid factors that increase the COPD assessment test scores. Respir Res,2014,15:13.
23 Frei A,Muggensturm P,Putcha N,et al. Five comorbidities reflected the health status in patients with chronic obstructive pulmonary disease:the newly developed COMCOLD index. J Clin Epidemiol,2014,67:904-911.
24 Petersen H,Sood A,Meek PM,et al. Rapid lung function decline in smokers is a risk factor for COPD and is attenuated by angiotensinconverting enzyme inhibitor use. Chest,2014,145:695-703.
2 中华人民共和国国家卫生和计划生育委员会.中国居民营养与慢性病状况报告,2015.
3 World Health Organization. Chronic obstructive pulmonary disease(COPD). 2011.
4 蔡柏蔷.应重视慢性阻塞性肺疾病的合并症问题.中华结核和呼吸杂志,2013,36:245-247.
5 Koskela J,Kilpelinen M,Kupiainen H,et al. Co-morbidities are the key nominators of the health related quality of life in mild and moderate COPD. BMC Pulm Med,2014,14:102.
6 ChoudHury G,Rabinovich R,Macnee W. Comorbidities and systemic effects of chronic obstructive pulmonary disease. Clin Chest Med,2014,35:101-130.
7 Zoni-Berisso M,Lercari F,Carazza T,et al. Epidemiology of atrial fibrillation:European perspective. Clin Epidemiol,2014,6:213-220.
8 陈勃江,李为民.肺癌与慢性阻塞性肺疾病相关性的研究进展.中华结核和呼吸杂志,2014,37:290-293.
9 Chen WJ,Lin CC,Lin CY,et al. Pulmonary embolism in chronic obstructive pulmonary disease:a population-based cohort study. COPD,2014,11:438-443.
10 Huang B,Yang Y,ZHu J,et al. Clinical characteristics and prognostic significance of chronic obstructive pulmonary disease in patients with atrial fibrillation:results from a multicenter atrial fibrillation registry study. J Am Med Dir Assoc,2014,15:576-581.
11 周春霞,江山平.慢性阻塞性肺疾病合并心血管疾病的研究进展.中华结核和呼吸杂志,2015,38:72-75.
12 Konecny T,Park JY,Somers KR,et al. Relation of chronic obstructive pulmonary disease to atrial and ventricular arrhythmias. Am J Cardiol,2014,114:272-277.
13 Mahishalc V,Mahishalc A,Patil B,et al. Screening for diabetes mellitus in patients with chronic obstructive pulmonary disease in tertiary care hospital in India. Niger Med J,2015,56:122-125.
14 Pooler A,Beech R. Examining the relationship between anxiety and depression and exacerbations of COPD which result in hospital admission:a systematic review. Int J Chron Obstruct Pulmon Dis,2014,9:315-330.
15 Qian J,Simoni-Wastila L,Langenberg P,et al. Effects of depression diagnosis and antidepressant treatment on mortality in Medicare beneficiaries with chronic obstructive pulmonary disease. J Am Geriatr Soc,2013,61:754-761.
16 Rutten EP,Breyer MK,Spruit MA,et al. Abdominal fat mass contributes to the systemic inflammation in chronic obstructive pulmonary disease.Clin Nutr,2010,29:756-760.
17 朱敏立,焦涛,王萍.慢性阻塞性肺疾病急性加重患者焦虑抑郁状况与炎症因子变化的研究.中国煤炭工业医学杂志,2014,42:661-664.
18 Vestbo J,Hurd SS,AgustíAG,et al. Global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease:GOLD executive summary. Am J Respir Crit Care Med,2013,187:347-365.
19 Mapel DW,Marton JP. Prevalence of renal and hepatobiliary disease,laboratory abnormalities,and potentially toxic medication exposures among persons with COPD. Int J Chron Obstruct Pulmon Dis,2013,8:127-134.
20 Chen CY,Hsu TW,Mao SJ,et al. Abnormal renal resistive index in patients with mild-to-moderate chronic obstructive pulmonary disease.COPD,2013,10:216-225.
21 Doos L,Uttley J,Onyia I,et al. Mosaic segmentation,COPD and CHF multimorbidity and hospital admission costs:a clinical linkage study. J Public Health(Oxf),2014,36:317-324.
22 Miyazaki M,Nakamura H,CHubachi S,et al. Keio COPD Comorbidity Research(K-CCR)Group. Analysis of comorbid factors that increase the COPD assessment test scores. Respir Res,2014,15:13.
23 Frei A,Muggensturm P,Putcha N,et al. Five comorbidities reflected the health status in patients with chronic obstructive pulmonary disease:the newly developed COMCOLD index. J Clin Epidemiol,2014,67:904-911.
24 Petersen H,Sood A,Meek PM,et al. Rapid lung function decline in smokers is a risk factor for COPD and is attenuated by angiotensinconverting enzyme inhibitor use. Chest,2014,145:695-703.