AECOPD慢阻肺急性加重的预防与早期干预.pptx

慢阻肺急性加重的预防与早期干预 The Prevention of and Early Intervention on AECOPD ;;慢阻肺急性加重的定义 The definition of AECOPD;20% 非感染 Non-infection;症状和体征 Symptoms and signs;慢阻肺急性加重临床表现Clinical Manifestation of AECOPD;慢阻肺急性加重的危害 The Harm of AECOPD;Kessler R et al. CHEST 2006; 130:133–142;慢阻肺急性加重患者生活质量下降更快Life quality of AECOPD patients decrease more quickly;慢阻肺急性加重加速肺功能下降AECOPD accelerate the lung function decline;慢阻肺急性加重使慢阻肺患者死亡率增加AECOPD increase mortality in COPD patients ;慢阻肺急性加重使经济负担加重 AECOPD increase the economic burden;Tashkin D. N Engl J Med 2010; 363: 1184 Hurst et al, N Engl J Med 2010; 363: 1128-38;;早期发现;;每次急性加重都会增加再次急性加重的危险 Every exacerbation may increase the risk of recurrent acute exacerbation;既往急性加重为最佳预测指标Previous acute exacerbations are the best predictive indicators ;CAT能准确预测至第一次急性加重的时间CAT can accurately predict the time to the first acute exacerbation;CAT分值越高距第一次急性加重的时间越短The higher the CAT score, the shorter the time to first AE;CAT分值越高发生中至重度急性加重风险越高The higher the CAT score, the higher the risk of moderate-severe AE ;慢阻肺急性加重评估工具：EXACTThe assessment tool for COPD Acute Exacerbation: EXACT;Leidy NK,et al.Am J Respir Crit Care Med. 2011;183(3)：323-9.;;最长随访期内，发生至少1次加重及频繁急性加重（≥2次/年）的风险随稳定期血中炎症指标(CRP、纤维蛋白原、血白细胞计数)升高的数量增加而逐步增加 During the longest follow-up, the risk of at least one exacerbation and frequent exacerbation (≥2/year) gradually rise with the increase of the rising number of inflammatory biomarkers (CRP, fibrinogenin and white blood cell count) in stable stage. ;;AUC 0.73;慢阻肺急性加重的诱因和机制The Causes and Mechanisms of Acute Exacerbation of COPD;慢阻肺急性加重的预防The prevention of AECOPD;慢阻肺急性加重的预防——药物The prevention of AECOPD —— Medication;慢阻肺急性加重的预防——LABA The prevention of AECOPD —— LABA;慢阻肺急性加重的预防——LAMA The prevention of AECOPD —— LAMA;慢阻肺急性加重的预防-ICS+LABAThe prevention of AECOPD —— ICS+LABA;慢阻肺急性加重的预防——PDE4I The Prevention of AECOPD——PDE4I;慢阻肺急性加重的预防——抗氧化剂 The Prevention of AECOPD——Antioxidant ;每例患者的急性发作（AEs）累计发生率 The cumulative incidence of AEs in all patients