WAO News and Notes - Medical Reviews
Volume 5, Issue 12 Reviews - December 2008
Medical Journal Reviews

Reviewed by Gary Hellerman, PhD, in collaboration with Richard F. Lockey, MD, WAO Web Chief Editor.

1. NANOPARTICLE-MEDIATED CELLULAR RESPONSE IS SIZE-DEPENDENT
Nanoparticles engineered from a variety of polymers and compounds are being tested as carriers for targeted drug and DNA delivery. This report emphasizes that nanoparticles should not be viewed as inert vehicles, but rather as agents that can be fine-tuned to stimulate their entry into targeted cells to modify a specific cell response. Many important cellular processes such as apoptosis are controlled through cell-surface receptors that interact with specific ligands. Here gold nanoparticles (GNPs) 2 to 100 nm in diameter were coated with various amounts of the ErbB2 ligand herceptin. Entry of the multivalent GNPs into cancer cells and intracellular localization was determined. Greatest uptake occurred with 40-50 nm GNPs, and entry was accompanied by a concomitant increase in cancer cell death. Editor's comment: Therapeutic use of nanoparticles will become more and more widespread as their unique properties are better understood. Jiang W, et al., Nature Nanotech 2008; 3:145.

纳米粒子介导的细胞应答取决于粒子大小

从各种多聚体以及复合物设计出来的纳米粒子正被试用于携带靶向药物以及DNA。本文强调不应该简单的认为纳米粒子就是惰性载体,而应当把它看作一种介质,精确调整后可以刺激它进入靶向细胞并且调节特定的细胞应答。很多重要的细胞程序如凋亡是通过细胞表面的受体与特殊配体相互作用而得以控制的。金的纳米粒子(GNPS)直径为2-100um,表面包被了不同数量的ErbB2配体赫赛汀。测定多价GNPs进入肿瘤细胞的过程以及在细胞内的位置。40-50nmGNPs有最大摄取,伴随他们进入细胞的同时是肿瘤细胞的死亡明显增加。编者点评:随着逐渐认识纳米粒子的特性,其治疗作用越来越广泛。Jiang W, et al., Nature Nanotech 2008; 3:145.

2. EFFECT OF 17q21 VARIANTS AND SMOKING EXPOSURE IN EARLY-ONSET ASTHMA
An increased risk of asthma is associated with specific DNA variants at the 17q21 locus. Genetic, medical and demographic data from 1511 subjects were examined for correlations with time of asthma onset. Of the 36 single-nucleotide polymorphisms (SNPs) analyzed, 11 were associated with asthma (p<0.01) and 3 were strongly associated (p<0.001). There was almost a 3-fold increase in risk of early-onset (≤4 yr of age) asthma with the strongest effect in subjects exposed to environmental tobacco smoke. There was no association with late-onset asthma. Editor's comment: The fact that chromosome variants can affect early-onset but not late-onset asthma suggests a difference in the pathogenesis of the two disease types. Bouzigon E et al., New Eng J Med 2008; 359:1.

17q21突变及香烟暴露在早发性哮喘中的作用

17q21位点的某些DNA突变与哮喘危险增高相关。研究1511人的遗传背景,病史以及地理环境与哮喘起病时间的相关性。36个单核苷酸多肽性(SNP)中,11个与哮喘相关,其中3个相关性很强。早发哮喘(≤4岁)的危险增高了3倍,尤其是有环境烟草暴露的人效果最明显。而这些多态性位点与迟发哮喘没有相关性。编者点评:染色体突变可以影响早发哮喘但不会影响迟发哮喘,提示这两种疾病的病因有所不同。Bouzigon E et al., New Eng J Med 2008; 359:1.

3. SPUTUM EOSINOPHILIA, AIRWAY HYPERRESPONSIVENESS AND AIRWAY NARROWING IN YOUNG ADULTS WITH FORMER ASTHMA
Adolescents often outgrow asthma and appear to be symptom-free as young adults, but may later redevelop the disease. The question is whether those in remission are really disease free. Here, a group of 326 adults (age 21-34) were screened for asthma history and categorized according to those with current physician-diagnosed asthma, those with former asthma and those with no history of asthma. Participants who had been free of symptoms and taken no asthma medication for at least 10 years prior to the study were tested for FEV1, PC20, maximal mid-expiratory flow (MMF) and sputum eosinophilia. The results showed that former asthma patients in remission had significantly lower FEV1, PC20 and MMF and greater eosinophilia than subjects with no history of asthma. In addition, 18% of those with no history of asthma also showed decreased FEV1 and PC20. The long-term prognosis of these subjects needs to be examined. Editor's comment: This investigation brings up the question of whether treatment of symptom-free former asthmatics might prevent the reappearance of asthma. Hara J, et al., Allergology Internatl 2008; 57:211.

既往有哮喘史的青壮年人的痰嗜酸细胞,气道高反应性,以及气道狭窄情况

哮喘患者在青年时期哮喘缓解,成人阶段似乎没有症状,但后来可能再次发病。问题就在于是否缓解的患者真的就没病了。筛查326个成人是否有哮喘病史,将其分为三组:目前被医生诊断为哮喘的,以前有哮喘的,从没有哮喘的。对于研究前至少有10年无症状且未用哮喘控制药物的,测定其FEV1,PC20,最大呼气中期流速(MMF)以及痰嗜酸细胞。结果显示与无哮喘患者相比,处于缓解期的哮喘患者FEV1,PC20,以及MMF明显比较低,而嗜酸细胞明显较多。另外,18%无哮喘的人也同样表现出FEV1及PC20低。这些人的长期预后有待研究。编者点评:本研究提出一个问题:是否对那些无症状的哮喘患者进行治疗可以防止哮喘再发。Hara J, et al., Allergology Internatl 2008; 57:211.

4. RAPID EFFECT OF INHALED CICLESONIDE (CIC) IN ASTHMA
The purpose of this clinical trial was to determine how quickly CIC acted to decrease airway hyperresponsiveness (AHR), exhaled nitric oxide and eosinophilia in subjects with mild persistent asthma (FEV1≥70%). In this double-blind, placebo-controlled, crossover study, CIC was administered at 320 µg qd and 640 µg bid. Single doses of CIC gave significant reductions in AHR within 2.5 hr of administration, and there was no drop in serum cortisol and few oropharyngeal adverse events. Editor's comment: The rapid improvement in FEV1 within a few hours of CIC inhalation by subjects with mild asthma is impressive. Erin EM, et al., Chest 2008; 134:740.

吸入环索耐得(CIC)对哮喘的快速疗效

该临床试验目的是明确在轻度持续性哮喘患者中CIC降低气道高反应性(AHR)呼出气一氧化氮以及嗜酸细胞的效果有多快。该双盲,安慰剂对照,交叉研究中,CIC的用法为320ugqd以及640ugbid。单剂CIC在用药2.5小时内显著降低AHR,血皮质醇无降低,很少有口咽部的不良反应。编者点评:轻度哮喘患者吸入CIC后短短数小时内FEV1的快速改善令人惊讶。Erin EM, et al., Chest 2008; 134:740.

5. ADRENAL SUPPRESSION IN BRONCHIECTASIS AND THE IMPACT OF INHALED CORTICOSTEROIDS (ICS)
A potential side effect of ICS is suppression of the hypothalamic-pituitary-adrenal axis resulting in a measurable decrease in serum cortisol. In this study, a group of 50 bronchiectasis patients, 33 of whom were on ICS, were tested for adrenal suppression using the short Synacthen test (SST) and for quality of life by the St George's respiratory questionnaire. Of the patients on ICS, 48.5% had adrenal impairment. These patients were more likely to report fatigue, dizziness, nausea, and vomiting than the non-suppressed group. The authors advocate caution in prescribing ICS for bronchiectasis patients, speculating that the presence of damaged airway walls may enhance systemic drug uptake. The dynamic SST for adrenal insufficiency is simple and effective and should be more widely used to monitor effects of ICS use. Editor's comment: This important finding in patients with bronchiectasis may also be applicable to other inflammatory airway diseases such as COPD and asthma in which ICS are commonly used. Holme J, et al., Eur Resp J 2008; 32:1047.

支气管扩张患者肾上腺功能低下以及吸入糖皮质激素(ICS)的影响

ICS的一个潜在副作用就是抑制下丘脑-垂体-肾上腺轴,导致血清皮质醇水平降低。本研究中,50名支气管扩张患者,33名在用ICS治疗,用SST测试肾上腺的抑制情况以及用St George’s呼吸问卷评价生活质量。ICS治疗的患者中,48.5%肾上腺受损,与未发生肾上腺抑制的患者比较,这些患者易于出现疲劳,眼花,恶心,呕吐。考虑到气道壁的损伤可能会增加药物的全身吸收,作者建议对支气管扩张患者谨慎使用ICS。动态SST很容易有效的评估肾上腺功能的不足,应该更广泛用于监测ICS的疗效。编者点评:在支气管扩张患者的这些重要发现也许可适用于其它气道炎症疾病,如COPD以及哮喘,ICS是这些疾病的常用治疗。Holme J, et al., Eur Resp J 2008; 32:1047.

6. TOLL-LIKE RECEPTOR 4 POLYMORPHISMS AND ASPERGILLOSIS IN STEM CELL TRANSPLANTATION
Patients receiving allogeneic bone marrow transplant therapy are at increased risk of infection by opportunistic pathogens such as Aspergillus. This report looked at polymorphisms in the TLR-2, -3, -4 and -9 genes of the donors in relation to aspergillosis risk in recipients of allogeneic transplants. Only the TLR-4 SNP was a significant risk factor. TLR-4 recognizes bacterial lipopolysaccharide and the variant allele confers weaker immunoresponsiveness that may make an individual more susceptible to aspergillosis. Presence of the TLR-4 SNP in the recipient did not increase the risk. Editor's comment: The finding of a TLR-4 mutation in transplant donors that increases the incidence of aspergillosis in recipients is surprising because TLR-4 recognizes bacterial lipopolysaccharide. This suggests other microbial products may bind to TLR-4. Bochud P-Y et al., New Eng J Med 2008; 359:1766. (editorial: Pamer, pp. 1836)

Toll样受体4(TLR-4)的多态性与干细胞移植后的曲霉菌感染相关

6.异体骨髓移植的患者发生机会性感染如曲霉菌感染的危险增高。本研究探寻移植供体的TLR-2,-3,-4以及-9基因多态性与异体移植受体发生曲霉菌感染的危险性的关系。只有TLR-4的SNP是明显的危险因素。TLR-4识别细菌脂多糖,其突变基因型的免疫抑制作用低,使得移植受体易于发生曲霉菌感染。而移植受体TLR-4 的SNP不会增加这种危险。编者点评:移植供体的TLR-4突变增加受体曲霉菌感染的危险,这一现象令人惊讶因为TLR-4识别的是细菌的脂多糖。提示我们另有微生物成分能与TLR-4结合。Bochud P-Y et al., New Eng J Med 2008; 359:1766. (editorial: Pamer, pp. 1836)

7. AGEING AND THE IMMUNE SYSTEM
A series of review articles appeared in the August 2008 Current Allergy & Clinical Immunology that focus on the topics of immunosenescence¹, asthma and allergic diseases in the elderly² and inflammation, immunity and Alzheimer's disease (AD)³. As the average age of the world's population increases, the effects of ageing on the body's systems become more and more important. Immunosenescence, the gradual decline in immune response with advancing years is partly due to thymic insufficiency but also in large part to environment, diet, stress, exercise, infections, smoking and other factors that may be controllable. Improved vaccines are one answer to reduced immunocompetence in the elderly, but studies need to be done to define immunoprotective interventions that can be done to prolong the longevity of the immune system. Asthma and rhinitis present special problems in the elderly because of complications in diagnosis, comorbid conditions and potential drug interactions. Immune components of Alzheimer's disease are still being elucidated. Anti-amyloid therapies are being tested but remain experimental. The one characteristic feature tying immune responsiveness to AD, Parkinson's and other neurodegenerative disorders is the inflammatory status. Inflammation in the brain may be affected by age-related immune system changes in the periphery. Editor's comment: Research focused on understanding the ageing process as it relates to the immune system and new ways to intervene prophylactically and therapeutically should be one of the major goals of medical science in this century. ¹Kalula SZ, et al., Curr Allergy Clin Immunol 2008; 21:126-130. ²De Villiers L, et al., 120. ³Combrinck M, et al., 132.

衰老及免疫系统

2008年8月Current Allergy & Clinical Immunology 杂志刊登了一系列专刊讨论老年人的免疫衰老,哮喘,过敏性疾病以及炎症,免疫及老年痴呆(AD)。随着地球人类的平均年龄的增加,衰老对人体的影响越来越突出。免疫衰老,是指随着年龄增加免疫应答逐渐衰退,部分原因是胸腺功能不足但主要原因是环境,饮食,压力,运动,感染,吸烟以及其它可控制的因素。老年人免疫力降低可以通过改良的疫苗来予以补偿,但有必要研究一些免疫保护措施来延长免疫系统的寿命。哮喘以及鼻炎在老年人而言是特殊问题,因为诊断,共病情况以及潜在的药物相互作用等问题都比较复杂。老年痴呆的免疫系统异常仍在研究之中。抗淀粉物质的治疗仍处于试验阶段。AD,帕金森以及其它神经系统退行性疾病的一个共同特点是炎症。脑组织炎症可能受到外周器官年龄相关的免疫系统改变的影响。编者点评:由于衰老与免疫系统相关,并且与新的预防性及治疗性手段相关,应该重点研究,并成为本世纪主要的医学研究方向。¹Kalula SZ, et al., Curr Allergy Clin Immunol 2008; 21:126-130. ²De Villiers L, et al., 120. ³Combrinck M, et al., 132.

8. ANALYSIS OF SAFETY, RISK FACTORS AND PRETREATMENT METHODS DURING RUSH HYMENOPTERA VENOM IMMUNOTHERAPY (VIT)
VIT is a safe and effective method of inducing tolerance in persons with a history of sting reactions, but severe adverse events (SAEs) do occur. This retrospective study examined records from a single institution of 118 patients with a history of anaphylactic reaction undergoing a 5-day rush VIT and found side effects in 18 (15.2%) with SAEs in 7 (5.9%). The number of reactions was highest on the 4th day (100 µg/ml allergen) and highest among females. All patients received H1 receptor antagonist and 45 also received H2 antagonist. Those pretreated with H1 antagonist alone had fewer systemic effects than those getting both H1 and H2 antagonists. Editor's comment: Rush VIT is less costly and time-consuming than conventional VIT and warrants additional studies to enhance tolerogenesis without causing potentially severe reactions. Gorska L et al., Internatl Arch Allergy Immunol 2008; 147:241.

膜翅目毒液(VIT)冲击式免疫治疗的安全性,危险因素以及预防治疗方案的分析

VIT可以安全有效的诱导曾有膜翅目叮蛰反应的患者产生耐受,但严重副反应(SAEs)实有发生。本回顾性研究对来自一个机构的118名有严重过敏反应病史并且接受了5天VIT冲击治疗的患者的病案进行分析,发现有18人(15.2%)发生副反应,而严重副反应有7(5.9%)人。反应在治疗第四天(100 µg/ml allergen)最高,女性最高。所有患者接受H1受体阻断剂,还有45人接受了H2阻断剂。单用H1阻断剂的人发生系统反应较用H1及H2阻断剂的人要少。编者点评:VIT冲击治疗比传统的VIT治疗费时少,在不增加潜在严重反应的情况下,有必要做其它试验来提高耐受性。Gorska L et al., Internatl Arch Allergy Immunol 2008; 147:241.

9. FLUTICASONE PROPIONATE (FP) REDUCES BACTERIAL AIRWAY EPITHELIAL INVASION
COPD patients receiving FP experience less severe bacterial exacerbations but the mechanism is unknown. Both S. pneumoniae (S. p.) and H. influenzae (H. i.) enter bronchial epithelial cells through binding to platelet activating factor receptor (PAFR). PAFR is elevated in the airways of COPD patients. These individuals are also commonly infected with S. p. and H. i. In this study, cultured human epithelial cell lines, A549 and 16HBE14o-, were treated with various doses of FP then challenged with S. p. or H. i. PAFR levels and intracellular bacterial loads were reduced by FP. FP (10 µg/mouse) was also tested on mice prior to inoculation with S. p. and reduced lung colonization nearly 50%. Similar results were obtained when cells or mice were pretreated with a PAFR antagonist rather than FP. Editor's comment: Further studies need to be undertaken to pinpoint the mechanism of FP action on PAFR and to examine long-term effects. Barbier M et al., Eur Resp J 2008; 32:1283.

丙酸氟替卡松(FP)减少细菌对气道上皮的入侵

COPD患者用FP治疗后较少发生细菌诱发的疾病严重恶化,但其机制尚未明确。肺炎链球菌(S. p.)及流感嗜血杆菌(H. i.)通过与血小板活化因子受体(PAFR)结合而侵入气道上皮细胞。COPD患者气道中PAFR水平增高。这些人常感染S.p.>以及

H.i。 本研究中,培养得到的人上皮细胞簇,A549及16HBE14o-,用不同剂量的FP治疗,然后用S.p.及 H.i.激发。PAFR水平及胞内细菌载量因FP降低。另外在用S.p.刺激老鼠之前用FP预处理,几乎将S.p.的肺内定植降低了50%,细胞或小鼠用PAFR拮抗剂预处理后也得到了相似的结果。编者点评:需要有进一步的研究明确FP对PAFR的作用机制,并且验证长期疗效。 Barbier M et al., Eur Resp J 2008; 32:1283.

10. THE SAFETY OF LONG-ACTING β-AGONISTS (LABAs) AMONG PATIENTS WITH ASTHMA USING INHALED CORTICOSTEROIDS (ICS)
Several studies support the claim that LABAs increase mortality in asthma patients, but much of these data come from cases in which ICS were not used regularly in combination with LABAs. In this review, a search was done for blinded, randomized, controlled trials of patients using ICS with or without concomitant LABAs. Analysis of 62 such studies involving over 29,000 participants revealed 3 asthma-related deaths and 2 asthma-related intubations, all among those using LABAs. These numbers were too low to permit statistical analysis. The risk of hospitalization or serious adverse affects was not increased with LABA use in those patients regularly using ICS. Editor's comment: Because of the low incidence of mortality, caution is advised in forming conclusions based on these data in comparison to other published analyses. Jaeschke R et al., Am J Respir Crit Care Med 2008; 178: 1009.

长效β-激动剂(LABAs)对用ICS的哮喘患者的影响。

某些研究认为LABAs增加哮喘患者的死亡率,但大多是因为其中的某些病例没有规律的将ICS与LABAs同时使用。本综述回顾了针对以ICS治疗或同时合并LABAs治疗的患者的双盲,随机,对照试验研究。分析了62个此类试验,超过29,000名患者,发现有3例哮喘相关的死亡及2例哮喘相关的气管插管,都发生于用LABAs的患者。但这些数值太少,不足以进行统计分析。常规用ICS的患者住院危险或严重副反应未随LABA使用增加。 编者点评:由于死亡率低,建议在以这些数据为基础而作出结论时谨慎为好。Jaeschke R et al., Am J Respir Crit Care Med 2008; 178: 1009.

11. ASSOCIATION OF ANGIOTENSIN I-CONVERTING ENZYME (ACE) GENE POLYMORPHISMS WITH ASPIRIN INTOLERANCE IN ASTHMATICS (AIA)
AIA affects 5-10% of asthmatics and is associated with increased leukotriene levels. An additional pathway involving ACE may contribute to AIA. A cohort of 581 Korean asthmatics (81 with AIA) and 181 healthy controls were screened for a panel of mutations in the ACE gene. No correlation between a specific single nucleotide polymorphism (SNP) in the ACE gene and the presence of asthma was seen. Among those with AIA there was a significantly greater frequency of two ACE promoter mutations. AIA patients homozygous for the promoter SNPs showed a larger drop in FEV1 after aspirin challenge than those with the normal alleles. Fusing the mutant promoter sequence to a luciferase reporter resulted in a significant decrease in luciferase activity compared to a normal promoter, which suggests that those who are homozygous for this mutation produce less ACE and may have accumulations of inflammatory mediators that predispose them to AIA. Editor's comment: This new information on genetic susceptibility to AIA may be useful in designing new therapies. Kim T-H et al., Clin Experimental Allergy 2008; 38:1727.

血管紧张素转换酶(ACE)基因多态性与阿司匹林不耐受哮喘(AIA)的关系

AIA影响5-10%的哮喘患者,与白三烯水平增高相关。另一个与ACE相关的途径也可能引起AIA。581个韩国哮喘患者(81人有AIA),181人为健康对照,筛查ACE基因的突变。没有发现ACE基因的任何SNP与哮喘相关。AIA的患者中,两个ACE启动子突变的频率尤其高。启动子SNPs为纯合子的AIA患者,比正常基因型的患者在用阿司匹林激发试验后FEV1降低幅度更大。将突变的启动子序列与荧光酶素报告子融合,导致荧光酶素活性显著降低,提示该突变为纯合子的患者,ACE的产生少,因此炎症介质累积,导致易发生AIA。编者点评:AIA的基因易感性的新发现可能对设计新的治疗方法有用。Kim T-H et al., Clin Experimental Allergy 2008; 38:1727.

12. DACLIZUMAB (DAC) IMPROVES ASTHMA CONTROL IN PATIENTS WITH MODERATE TO SEVERE PERSISTENT ASTHMA
DAC is a humanized antibody specific for CD25, the IL-2R alpha subunit. DAC blocks binding of IL-2 to its receptor inhibiting subsequent signaling events. In this randomized, double-blind, placebo-controlled multicenter trial, patients with moderate to severe persistent asthma on ICS were switched to an equivalent dose of triamcinolone acetate acetonide (TAA) during the run-in period and given i.v. injections of DAC (90 subjects) or placebo (30 subjects) every 2 weeks during the study. After the first 12 weeks, the TAA dose was tapered 25% every two weeks for 12-20 weeks. Changes in FEV1, frequency and severity of asthma exacerbations, PEF, use of rescue medication and symptom scores were monitored. DAC treatment resulted in significant improvements in FEV1 and daytime symptom scores, decreased use of rescue meds, lower numbers of peripheral eosinophils and reduced eosinophilic cationic protein. The frequency of common adverse events was similar for DAC and placebo groups; however, 5 of 6 patients experiencing severe adverse events were on DAC. Editor's comment: While DAC improved asthma symptoms, the study needs to be repeated to confirm these results and to evaluate the potential safety issues. Busse WW et al., Am J Resp Crit Care Med 2008; 178:1002.

达珠单抗改善中重度哮喘患者的哮喘控制

达珠单抗是CD25,IL-2R alpha亚基的特异性人抗体。DAC阻断IL-2和其受体的结合,抑制后续的信号传导。本随机,双盲,安慰剂对照多中心试验中,ICS治疗的中重度哮喘患者在筛选期用同等剂量的醋酸去炎松(TAA)治疗,治疗期每两周静脉注射DAC(90人)或安慰剂(30人)。第一个12周时,TAA剂量每2周减少25%,减量阶段为12-20周。FEV1变化,哮喘恶化的频率及严重性,PEF,急救药物的使用,以及症状积分都进行了监控。DAC治疗引起FEV1的显著改善,日间症状积分改善,急救药的使用减少,外周血嗜酸细胞降低,嗜酸细胞阳离子蛋白降低。常见的不良反应的发生率在DAC组及安慰剂组是相似的。然而,发生过严重副反应的6名患者中,5名是DAC治疗的。编者点评:DAC虽然改善哮喘症状,但需要重复研究以确定这些结论,并评价安全性问题。Busse WW et al., Am J Resp Crit Care Med 2008; 178:1002.

Translated by Qing, Manli PUMCH allergy department

13. THE OBESITY PARADOX IN PATIENTS WITH PERIPHERAL ARTERY DISEASE (PAD) 外周动脉疾病患者的肥胖的问题
In contrast to the general population, overweight patients with PAD have lower mortality than underweight patients. This report classified 2392 PAD patients undergoing vascular surgery into groups according to their BMI and whether they had COPD. Death from all causes was the outcome measured and follow-up was from about 2 to 8 years. Nearly 50% of the patients had evidence of COPD. Underweight patients (2.6% of the total) were more likely to have moderate to severe COPD (40% of the group) and to be smokers. COPD was present in 25% of the overweight group and 22% of the obese group. After adjusting for a number of factors, the underweight subjects were 1.42 times as likely as normal weight subjects to die, while the underweight and obese patients were 0.73 and 0.68 times as likely to die, respectively, than normals. This inverse BMI relationship to mortality was eliminated when the data were corrected for COPD severity. 与普通人群相比,超重的PAD患者比低体重的患者死亡率低。2392名血管手术的PAD患者根据BMI及是否有COPD分组。终点为全因死亡,随访时间为2-8 ½年几乎50%的患者有COPD表现。低体重的患者更容易发生中重度COPD,且为吸烟者。25%的超重者有COPD,22%的肥胖者有COPD。调节很多因素后,低体重的人死亡危险是正常体重的人的1.42倍,而超重的人及肥胖的人比正常人死亡危险分别为0.73及0.68。纠正COPD严重性后,这种BMI与死亡率的相反关系消失Editor's comment: The results of this interesting study suggest that spirometry measurements on PAD patients might be useful for identifying undiagnosed COPD. Galal W et al., Chest 2008; 134:925. 编者点评:这个有意思的研究的结果提示PAD患者测定肺功能可能有助于识别未被诊断的COPD。Galal W et al., Chest 2008; 134:925

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