Influences of low molecular weight heparin therapy on lung function, coagulation function and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease complicated with lung cancer / 中华内分泌外科杂志

Objective:To investigate the influences of low molecular weight heparin therapy on lung function, coagulation function and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease complicated with lung cancer.Methods:Sixty patients with acute exacerbation of chronic obstructive pulmonary disease complicated with lung cancer were gathered and randomly grouped into a routine group (30 cases) and a heparin group (30 cases). The patients in the routine group were given symptomatic treatment, and the patients in the heparin group were given low molecular weight heparin treatment on the basis of the symptomatic treatment, 4 100 iu/12 h. The coagulation function [activated partial thromboplastin time (APTT), prothrombin time (PT), D-dimer], blood gas analysis indexes [blood oxygen saturation (SaO 2), carbon dioxide partial pressure (PaCO 2), blood oxygen partial pressure (PaO 2) ], vascular endothelial function [nitric oxide (NO), endothelin 1 (ET-1), intercellular adhesion molecule-1 (ICAM-1) ], lung function [forced expiratory volume in first second (FEV1), forced vital capacity (FVC), ratio of FEV1 to predicted value (FEV1%) ], C-reactive protein (CRP), dyspnea (mMRC score) and survival were compared. Results:Compared with those before treatment, the levels of APTT [ (18.46±1.87) vs (11.58±1.25) s, (18.11±1.82) vs (15.57±1.58) s],PT[ (29.53±3.01) vs (22.57±2.36) s, (29.14±2.93) vs (25.48±2.61) s], D-dimer [ (842.59±85.12) vs (435.62±44.57) g/L, (846.63±84.75) vs (551.79±55.64) g/L],PaCO 2[ (58.79±5.92) vs (42.53±4.26) mmHg, (59.14±5.96) vs (50.38±5.07) mmHg],ET-1[ (106.78±10.72) vs (65.37±6.64) ng/L, (105.96±10.61) vs (72.53±7.31) ng/L],ICAM-1[ (231.48±23.35) vs (142.63±14.57) μg/L, (228.79±23.12) vs (165.48±16.72) μg/L], CRP [ (80.39±18.53) vs (9.77±2.08) mg/L, (80.64±19.17) vs (14.86±3.16) mg/L] and mMRC [ (2.64±0.31) vs (1.42±0.22) points, (2.71±0.34) vs (1.78±0.27) points] in both groups were greatly decreased after treatment ( P<0.05), and compared with the routine group, the heparin group were greatly lower ( P<0.05). Compared with those before treatment, the levels of SaO 2[ (0.54±0.15) vs 0.82±0.24) mmHg, (0.56±0.16) vs (0.67±0.20) mmHg],PaO 2[ (56.32±5.65) vs (80.47±8.12) mmHg, (56.89±5.72) vs (72.13±7.25) mmHg],NO[ (54.31±5.46) vs (96.78±10.02) μmol/L, (53.27±5.35) vs (85.64±8.62) μmol/L],FEV1[ (1.21±0.32) vs (1.89±0.45) %, (1.25±0.34) vs (1.57±0.41) %],FVC[ (3.41±0.35) vs (3.78±0.42) L, (3.37±0.32) vs (3.56±0.36) L],FEV1%[ (80.74±8.15) vs (88.46±8.75) %, (79.53±8.02) vs (83.82±8.41) %] in the two groups after treatment were greatly increased ( P<0.05), and compared with the routine group, the heparin group were greatly increased ( P<0.05). A 3-year follow-up of the patients showed that there were 11 survivors in the heparin group (accounting for 36.67%), which was more than that of the conventional group (7 survivors, accounting for 23.33%) ( χ2=8.310, P=0.004) . Conclusion:Low molecular weight heparin can effectively enhance the coagulation function, pulmonary function and vascular endothelial function, regulate blood gas indexes, ameliorate dyspnea in patients with acute exacerbation of chronic obstructive pulmonary disease and lung cancer, and improve patient prognosis.

Correlation between expressions of myeloperoxidase and eosinophil cationic protein in sputum and clinical features of asthma-chronic obstructive pulmonary disease overlap / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the role of myeloperoxidase(MPO)and eosinophilic cationic protein(ECP)in the airway inflammation and their correlation with clinical feature in asthma-COPD overlap (ACO) patients.</p><p><b>METHODS</b>Twenty patients with COPD, 20 with asthma, 20 with ACO and 20 control subjects underwent pulmonary function test for measurement of forced expiratory volume in 1 second (FEV), forced vital capacity (FVC), peak expiratory flow (PEF), and maximum midexpiratory flow (MMF). COPD assessment test (CAT) was used to evaluate the clinical symptoms of the patients with COPD and ACO. The asthma control test (ACT) was used to evaluate the asthma control in the patients with asthma and ACO. Induced sputum samples were collected from the subjects for analysis of neutrophil and eosinophil ratios, and enzyme-linked immunosorbent assay was used to determine the expression levels of MPO and ECP in the sputum.</p><p><b>RESULTS</b>No significant difference was observed in the CAT scores between ACO group and COPD group (> 0.05). Compared with the asthma group, the patients with ACO had significantly lower ACT scores and lower FEV, PEF and MMF ( < 0.05). The patients with ACO had significantly higher FVC and sputum eosinophil ratio than those with COPD ( < 0.05), and a higher sputum neutrophil ratio than those with asthma ( < 0.01). In ACO group, the MPO level in sputum was significantly higher than that in the asthma group ( < 0.05), while sputum ECP level was significantly higher than that in both the asthma group and COPD group ( < 0.05 or 0.01). In ACO group, sputum MPO level was positively correlated with sputum neutrophil ratio (=0.8358, < 0.01) but was not correlated with CAT score or FEV (> 0.05); sputum ECP level was positively correlated with sputum eosinophil ratio (=0.4666, < 0.05) and was inversely correlated with ACT score (=-0.4966, < 0.05) and FEV (=-0.4610, < 0.05).</p><p><b>CONCLUSIONS</b>Both neutrophilic and eosinophilic inflammations occur in the airway of patients with ACO, and their sputum ECP level is negatively correlated with asthma control and obstructive airflow limitation.</p>