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Objective:To investigate the effects of body mass index (BMI) on lung function in patients with chronic obstructive pulmonary disease (COPD).Methods:A total of 3 312 patients with COPD were selected from outpatients and inpatients in Department of Gerontal Respiratory Medicine of the First Hospital of Lanzhou University from August 2016 to August 2020, including 1 103 patients in stable period and 2 209 patients in acute exacerbation period. According to body mass index (BMI), these COPD patients were divided into four groups: low weight (56 cases, 131 cases), normal weight (448 cases, 945 cases), overweight (424 cases, 773 cases) and obesity groups (175 cases, 360 cases) respectively in stable stage and in acute exacerbation stage. The lung function of inspiratory capacity (IC), vital capacity (VC), residual volume (RV)/total lung capacity (TLC), forced expiratory volume in 1 second (FEV 1), forced vital capacity (FVC), FEV 1/FVC, maximal mid-expiratory flow (MMEF), diffusing capacity of the lung for carbon monoxide (DLCO), DLCO normalized per liter alveolar volume (DLCO/VA), respiratory impedance (Zrs), respiratory resistance at 5 Hz (R5), respiratory resistance at 20 Hz (R20) and respiratory reactance at 5 Hz (X5) were measured using MasterScreen PFT in all patients, and the influence of BMI on lung function was analyzed respectively. The risk factors of impaired lung function were analyzed by ordered logistic regression with lung function grade as dependent variable and age, gender, smoking history, smoking index and BMI as independent variables (“%pred”represents the percentage of predicted value). Results:The proportion of patients with lung function grade Ⅲ/Ⅳ in acute exacerbation period (64.9%, 37%, 27.4%, 24.4%) was higher than that in stable stage (42.9%, 25.9%, 13.7%, 9.1%), while the proportion of patients with lung function grade Ⅰ in stable stage (21.4%, 34.2%, 38.2%, 40.0%) was higher than that in acute exacerbation period (7.6%, 20.0%, 25.4%, 22.8%) (all P<0.05). The IC%pred, VC%pred, FEV 1%pred, FVC%pred, FEV 1/FVC, MMEF%pred, DLCO%pred, DLCO/VA%pred and R20 in low weight group were significantly lower than other groups both in stable period and acute exacerbation period (all P<0.05). The RV/TLC was higher in low weight group than that of normal weight and overweight groups in both periods (all P<0.05). The IC%pred, FEV 1%pred, FEV 1/FVC, DLCO%pred, DLCO/VA%pred, R5 and R20 in overweight and obesity groups were higher than those of normal weight group (all P<0.05). The RV/TLC, FEV 1/FVC, DLCO%pred, DLCO/VA%pred, Zrs, R5 and R20 in obesity group were higher than those of overweight group (all P<0.05). The ordered logistic regression analysis showed that low weight was independent risk factor for impaired lung function of COPD both in stable period [ OR (95% CI) 2.316 (1.206-3.554)] and acute exacerbation period [ OR (95% CI): 2.457 (1.647-3.669)]. Conclusion:Lower BMI has an adverse effect on lung function, and it is an independent risk factor for impaired lung function in COPD patients.
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Understanding the mechanism that leads to immune dysfunction induced by SARS-CoV2 virus is crucial to develop treatment for severe COVID-19. Here, using single cell RNA-seq, we characterized the peripheral blood mononuclear cells (PBMC) from uninfected controls and COVID-19 patients, and cells in paired broncho-alveolar lavage fluid (BALF). We found a close association of decreased dendritic cells (DC) and increased monocytes resembling myeloid-derived suppressor cells (MDSC) which correlated with lymphopenia and inflammation in the blood of severe COVID-19 patients. Those MDSC-like monocytes were immune-paralyzed. In contrast, monocyte-macrophages in BALFs of COVID-19 patients produced massive amounts of cytokines and chemokines, but secreted little interferons. The frequencies of peripheral T cells and NK cells were significantly decreased in severe COVID-19 patients, especially for innate-like T and various CD8+ T cell subsets, compared to health controls. In contrast, the proportions of various activated CD4+ T cell subsets, including Th1, Th2 and Th17-like cells were increased and more clonally expanded in severe COVID-19 patients. Patients peripheral T cells showed no sign of exhaustion or augmented cell death, whereas T cells in BALFs produced higher levels of IFNG, TNF, CCL4 and CCL5 etc. Paired TCR tracking indicated abundant recruitment of peripheral T cells to the patients lung. Together, this study comprehensively depicts how the immune cell landscape is perturbed in severe COVID-19.
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Functional cure of chronic hepatitis B (CHB) marks sustained virological inhibition and immunological control and is the ideal treatment goal recommended by the latest guidelines for the prevention and treatment of CHB in China and foreign countries. CHB patients can achieve virological inhibition with the help of long-term direct antiviral therapy, and only a small number of patients can achieve functional cure, suggesting that there is an urgent need for the combination of direct antiviral therapy and immunotherapy. At present, the best treatment strategy is targeted precise clearance of HBV-infected hepatocytes to reduce liver injury, which depends on HBV-specific immune cells in the liver. Therefore, restoring or enhancing the function of HBV-specific T cells and B cells is the key strategy for functional cure of CHB.
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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.
Subject(s)
Female , Humans , Adrenal Cortex Hormones , Asthma , China , Comorbidity , Disease Progression , Education , Food Hypersensitivity , Hospitalization , Hypertension , Inpatients , Medication Adherence , Mortality , Multivariate Analysis , Pulmonary Disease, Chronic Obstructive , Retrospective Studies , Risk Factors , Seasons , Self Care , Smoke , SmokingABSTRACT
Objective To study the inducing factors and clinical characteristics of patients hospitalized for asthma exacerbation in China. Methods Patients hospitalized for asthma exacerbation at 29 hospitals in China were retrospectively recruited during 2013-2014. Results Clinical data of 3 240 asthmatic patients were collected and analyzed including 1 369(42.3%) males and 1 871(57.7%)females. The patients hospitalized for asthma exacerbation counted for 2.95% (6 375/215 955) of all patients hospitalized during the same period. The leading six inducing factors, in sequence, were acute upper respiratory tract infection[42.3%(1 370/3 240)],changes of weather[22.8%(738/3 240)],noxious gas[(4.3% (140/3 240), allergy challenges [3.5%(115/3 240)], strenuous exercise [1.8%(57/3 240)], and air pollution [1.5%(49/3 240)].In older patients,more exacerbations were induced by weather changes,yet less sensitive to allergy challenges. As to middle-aged patients, they were less sensitive to upper respiratory tract infections,however the difference was not statistically significant(P>0.05).In winter more asthma patients were induced by upper respiratory tract infections,while in autumn more patients were induced by weather changes,strenuous exercise and air pollution.In spring and summer more patients were induced by allergy challenges, but the differences failed to achieve statistical significance (P>0.05). In northern cities more patients were induced by upper respiratory infections, whereas in southern cities more by noxious gases. Allergy challenges and air pollution tended to affect more patients in northern cities,but the difference was of no significance (P>0.05). The differences of inducing factors among patients of different gender, with or without a smoking history, and with different exacerbation severity didn't show any statistical significance. The patients with severe and life-threatening exacerbations counted for 20.1%(652/3 240).The percentage of patients older than 60 years was higher in patients with severe or life-threatening exacerbations than in whose with mild or moderate exacerbations,so did the percentage of male patients,of patients with disease duration longer than 10 years, with smoking history, and with a history of hospitalization or emergency department visits due to asthma exacerbation during the last year.Conclusion The acute upper respiratory tract infection ranks top among all the inducing factors. Senility, male gender, long duration of disease, smoking history, and a history of frequent hospital visits might be the risk factors for severe or life-threatening asthma exacerbations.
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Objective To understand the seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China.Methods This was a retrospective study which involved patients hospitalized for asthma exacerbation in 29 hospitals throughout 7 geographic areas in the mainland of China (northeast,north,central,east,south,northwest and southwest).The numbers of asthmatic patients and total inpatients of the respiratory department of each hospital were recorded.The monthly ratio of asthmatic patients to the total inpatients in every area was calculated and compared.Results During the study period,6 480 patients were admitted for asthma exacerbation,accounting for 3.14％ of all the 206 135 patients admitted to the respiratory departments in the 29 hospitals.The ratio of asthmatic patients to total inpatients in the northeast area (5.61％) was highest,and the ratio in east area was lowest (1.97％).Statistical analysis showed that the difference among different areas was significant (P＜0.000 1).In most areas,both the number and proportion of hospitalized asthmatic patients peaked in spring (February-April) and autumn (September-October).In the northeast area,east area and south area,the peaks in spring were more obvious,while in the north area and southwest area,the peaks in autumn were more obvious.In the northwest area the peaks occurred in winter (December-January) and summer (June-August),respectively.The differences in hospitalization due to asthma among different months were significant in the northeast,north,and southwest areas (P＜0.005).Conclusion The number of patients hospitalized for asthma exacerbation fluctuated with season in different areas in China.In most areas,more asthmatic patients were admitted to hospitals in spring and autumn.
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Objective To understand the seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China.Methods This was a retrospective study which involved patients hospitalized for asthma exacerbation in 29 hospitals throughout 7 geographic areas in the mainland of China (northeast,north,central,east,south,northwest and southwest).The numbers of asthmatic patients and total inpatients of the respiratory department of each hospital were recorded.The monthly ratio of asthmatic patients to the total inpatients in every area was calculated and compared.Results During the study period,6 480 patients were admitted for asthma exacerbation,accounting for 3.14％ of all the 206 135 patients admitted to the respiratory departments in the 29 hospitals.The ratio of asthmatic patients to total inpatients in the northeast area (5.61％) was highest,and the ratio in east area was lowest (1.97％).Statistical analysis showed that the difference among different areas was significant (P＜0.000 1).In most areas,both the number and proportion of hospitalized asthmatic patients peaked in spring (February-April) and autumn (September-October).In the northeast area,east area and south area,the peaks in spring were more obvious,while in the north area and southwest area,the peaks in autumn were more obvious.In the northwest area the peaks occurred in winter (December-January) and summer (June-August),respectively.The differences in hospitalization due to asthma among different months were significant in the northeast,north,and southwest areas (P＜0.005).Conclusion The number of patients hospitalized for asthma exacerbation fluctuated with season in different areas in China.In most areas,more asthmatic patients were admitted to hospitals in spring and autumn.
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Objective To explore the relationship between coagulation/anticoagulation imbalance and oxidative stress in the patients with chronic obstructive pulmonary disease during acute exacerbation (AECOPD)before and after treatment.Methods Plasma tissue factor(TF)and tissue factor pathway inhibitor(TFPl)activity was detected by chromogenic assay in 28 AECOPD patients before and after treatment as well as in 30 healthy controls.The total antioxidative capacity(TAC),malondialdehyde (MDA)and gtutathione peroxidase(GSH-PX)in plasma were measured in both groups.Results The levels of plasma TF and TFPI,and their ratio(TF/TFPI)in AECOPD patients before treatment were significantly higher than those after treatment(all P<0.0 1),the latter were still higher than those in the healthy persons(all P<0.01).The levels of the TAC and GSH-PX in plasma in AECOPD patients before treatment were significantly lower than those after treatment(all P<0.01),the latter were still lower than those in the healthy persons(all P<0.01).The plasma MDA in AECOPD patients before treatment was significantly higher than that after treatment(P<0.0 1),which was still higher than that in the healthy persons(P<0.05).There were negative correlations between TF/TFPI ratio and TAC(r=-0.518.P<0.01),GSH-PX(r=-0.454,P<0.05),PaO2(r=-0.511,P<0.01)respectively and a positive correlation between TF/TFPI ratio and the percentage of neutrophils(r=0.379,P<0.05)in AECOPD patients before treatment.There still were negative correlations between TF/TFPI ratio and TAC (r=-0.420,P<0.05),FEV1% to predicted(r=-0.480,P<0.05)respectively,and a positive correlation between TF/TFPI ratio and MDA(r=0.45 1,P<0.05)in AECOPD patients after treatment.Conclusions There existed coagulation/anticoagulation imbalance and oxidation/antioxidation imbalance before and after treatment in AECOPD patients and their relationship was explored.
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AIM: To investigate the effects of genistein on the expression of nuclear factor-?B (NF-?B) and the levels of tumor necrosis factor-? (TNF-?) in peripheral blood mononuclear cells (PBMCs) of asthma patients. METHODS: PBMCs were isolated from blood samples of 32 asthma patients and 31 healthy persons, which was divided into control groups, dexamethasone-treated groups and genistein-treated groups. The expression of NF-?B was analyzed by immunocytochemical staining. The level of TNF-? was measured by radioimmunoassay. RESULTS: The percentage of NF-?B-positive cells in PBMCs and the level of TNF-? in PBMCs culture supernatants were significantly higher in asthma patients than in healthy persons (all P
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AIM: To investigate the antioxidant status and the oxidative damage of cellular macromolecules in patients with Graves' disease. METHODS: Fasting plasma level of total antioxidant capacity (TAC), and the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were measured in 31 patients with untreated Graves' disease and 31 treated Graves' disease. DNA damage of peripheral blood mononuclear cell (PBMC) was detected by single cell gel electrophoresis assay (expressed in comet percentage). In addition, thiol group (SH) and malondialdehyde (MDA) were measured. 31 age-matched healthy subjects were studied as a control group. RESULTS: Plasma TAC, SOD and GSH-Px were significantly lower in patients with untreated Graves' disease compared to the controls (P
