慢性阻塞性肺疾病诊治指南2016.ppt

* * * * * * 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 * * * * * * * * * * /doi/abs/10.1164/ajrccm-conference.2012.185.1_MeetingAbstracts.A2944 * * 慢性阻塞性肺疾病全球倡议 (GOLD)2016年解读 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): COPD的定义 (GOLD2016) 慢性阻塞性肺疾病（COPD），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。急性加重和合并症对患者个体的整体疾病严重程度产生影响。 ? 2014 Global Initiative for Chronic Obstructive Lung Disease 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 慢阻肺属于全身性疾病 Fabbri LM, Luppi F, Beghe B, and Rabe KF - Eur Respir J 2008;31:204-212 吸烟 污染物 代谢性症状 2型糖尿病 骨质疏松 局部及全身性炎症 心血管事件 肌肉无力或萎缩 TNF-α 及 IL-6 COPD的危险因素 基因 年龄和性别 肺组织生长和发育 接触有害颗粒 社会经济地位 哮喘/支气管高反应性 慢性支气管炎 感染 上楼梯时气促 明显 有吸烟嗜好者 咳嗽、咳痰 中老年患者，若有吸烟嗜好，出现咳嗽、痰多、气促症状时、需怀疑COPD可能 2016 GOLD 慢阻肺的诊断 症状 呼吸困难 进行性加重, 常活动时加重, 持续存在 慢性咳嗽： 间歇性或无症状, 任何类型慢性咳嗽 咳嗽合并咳痰 危险因素 吸烟和被动吸烟 空气污染 吸水烟、室内生物燃料 职业粉尘和化学物质 慢阻肺家族史 肺功能检查 吸入支气管扩张剂后，FEV1/FVC0.70 2016 GOLD COPD 吸水烟、室内生物燃料造成的空气