COPD??????????????? - PowerPoint PPT Presentation

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COPD???????????????

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... COPD Chronic Obstructive Pulmonary ... Invasive pulmonary aspergillosis in patients with chronic ... – PowerPoint PPT presentation

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Title: COPD???????????????


1
COPD???????????????
  • ???????????
  • ??? ???

2
? ?
  • ??
  • COPD????????
  • ???????
  • ??
  • ??
  • ??????

3
COPD???
  • Chronic Obstructive Pulmonary Disease (COPD) is a
  • preventable and treatable disease
    characterized by airflow limitation that is not
    fully reversible .The airflow limitation is
    usually progressive and is associated with an
    abnormal inflammatory response of the lung to
    noxious particles or gases, primarily caused by
    cigarette smoking, although COPD affects the
    lungs, it also produces significant systemic
    consequences.

4
AECOPD??? 1
  • ????????????
  • ????,??????????
  • ?????????????
  • ???5????????????????????????????????????????2
    0???

Anthonisen(1987?)
5
ATS/ERS Position Paper , Eur Resir J,
2004,23932 Rodriguez-Roisin R, Chest.
2000117398S-401S
AECOPD??? 2
  • COPD ?????????????????,?????????,???????????

6
AECOPD ???
20 ???
80 ??
???? ???????
  • ?????
  • 40 - 50
  • ????
  • 30 - 40
  • ??????
  • 5 - 10
  • ???

Sethi et al. Chest 2000117380s-385s
7
AECOPD???
  • ??
  • 2/3?AECOPD??????????
  • ????????40-60
  • ?????????????????????????????,?30-50
  • ????????????????????????????????????,?10-15

8
AECOPD???
  • ??????
  • ???????????,?5-15
  • ??
  • ???????????????????????????????,?30
  • ???
  • ??

9
???????
  • ??????????????????????????????????
  • ??
  • ??
  • ???
  • ?????????????
  • ?????????
  • ?????????
  • ????(???????)

10
??????
  • ?? ????, ?????,
    ?????,??
  • ?????,???? ??????,????
    ???????


  • ?,?????
  • ?? ?????? ???????????CGD
    ???????
  • ?????
    ????,??????????? ??????

  • GVHD ????????
  • ???? ??-?? ??-??
    ??-??

?????
?????????
IPA?????
IPA?????
11
? ?
  • COPD????????
  • ???????
  • ??
  • ??

12

COPD??IPA??????
  • ????
  • ?????????
  • ??????(????????????????????,????????????????)
  • ????(?????CMV??)
  • ?????????????
  • ??????(????,???????)

13
COPD??IPA??????
  • ???????
  • ??????????
  • ?????????,???????????????,???????
  • ?????,????????????,????????
  • ?????CO2??????????????????????
  • ???,????,??????????????????????????

???,???.??????????????????????.?????????2009?4??32
??4?295-297
14
COPD??????????
  • ???
  • ??????
  • ??????????
  • ?????????
  • ????????
  • ??????????

Wouter Meersseman,Fungal infections in COPD.
Presented at 4th Trends in Medical Mycology
(TIMM), Athens, Grace, Oct.18-21, 2009
15
??--COPD????IPA?????
  • ????????
  • ???????????,????????,?????????????????????????????
    ??????,????????????????????????????,?????IPA????
  • ??????????????????

???,???.??????????????????????.?????????2009?4??32
??4?295-297
16
??--COPD????IPA????
  • ?????????(????????????????????)
  • ????????????????????????
  • ????????,???,?????????????,????(????91??)
  • ??????????,????????GM??????????????????????
  • ??????

17
??--COPD??IPA??????
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
???????????? ???????
CT?????????
22
??--COPD????IPA?????
  • ???????????????????????????,????????(???????????
    ????)

23
??--COPD????IPA?????
  • ???????,???????????,?????????????????????????????(
    ???????,??????????????,????)
  • ?????????????????,?????,?????
  • ??????????

24
COPD??IPA???
P.Bulpa,A.Dive and Y.Sibille. Invasive pulmonary
aspergillosis in patients with chronic
obstructive pulmonary disease. Eur Respir J
200730782-800
25
BALGM??????GM??
Wouter Meersseman, Katrien Lagrou, Johan
Maertens,et al., Galactomannan in Bronchoalveolar
Lavage Fluid-A Tool for Diagnosing Aspergillosis
in Intensive Care Unit Patients. Am J Respir Crit
Care Med Vol 177. pp 27-34, 2008
26
???????COPD??IPA?????
??--COPD??IPA?????
  • 2009?5?19th ECCMID??

Guinea J, Torres-Narbona M, Gijón P, et al.,
Pulmonary aspergillosis in patients with chronic
obstructive pulmonary disease incidence, risk
factors, and outcome. Clin Microbiol Infect
200915(Suppl.4)P1747
27
???????
  • ???????????(COPD)???,???????(IPA)??????,?????????
    ,????????????????COPD??IPA???????????,??????????
  • ????????????1999?11??2008?3????57?COPD??IPA?????,
    ???????????????????/?????????????????????

Guinea J, Torres-Narbona M, Gijón P, et al.,
Pulmonary aspergillosis in patients with chronic
obstructive pulmonary disease incidence, risk
factors, and outcome. Clin Microbiol Infect
200915(Suppl.4)P1747
28
????
  • 57????????71.9
  • ?????????????(P lt 0.05)
  • ????(OR 38.5 95 CI 2.7500)
  • ???3??????????(OR 16.4 95 CI 1.63166.7)
  • ?????COPD??(OR 50 95 CI 2.71,000)
  • ???????????????????(OR 46.5 95 CI 3.2668.1)

Guinea J, Torres-Narbona M, Gijón P, et al.,
Pulmonary aspergillosis in patients with chronic
obstructive pulmonary disease incidence, risk
factors, and outcome. Clin Microbiol Infect
200915(Suppl.4)P1747
29
???????????
Guinea J, Torres-Narbona M, Gijón P, et al.,
Pulmonary aspergillosis in patients with chronic
obstructive pulmonary disease incidence, risk
factors, and outcome. Clin Microbiol Infect
200915(Suppl.4)P1747
30
????
  • COPD??IPA???????(gt70)
  • ??????????,????????????????

Guinea J, Torres-Narbona M, Gijón P, et al.,
Pulmonary aspergillosis in patients with chronic
obstructive pulmonary disease incidence, risk
factors, and outcome. Clin Microbiol Infect
200915(Suppl.4)P1747
31
VERTIGO??????????????
  • 2009?TIMM????

Wouter Meersseman. Fungal infections in COPD.
Presented at 4th Trends in Medical Mycology
(TIMM), Athens, Grace, Oct.18-21, 2009
32
Vertigo????????
41????????????????(????)???????
Cadranel J, et al. Phase II trial of voriconazole
for treatment of chronic pulmonary aspergillosis.
ATS May 2009
33
Vertigo????????
Cadranel J, et al. Phase II trial of voriconazole
for treatment of chronic pulmonary aspergillosis.
ATS May 2009
34
Vertigo??????
  • ????????
  • ????400mg 12?? 1?,?2?
  • ????200 mg ??2?
  • ????6??,?????????3????,?????12??

Cadranel J, et al. Phase II trial of voriconazole
for treatment of chronic pulmonary aspergillosis.
ATS May 2009
35
Vertigo??6????
Cadranel J, et al. Phase II trial of voriconazole
for treatment of chronic pulmonary aspergillosis.
ATS May 2009
36
Vertigo??6????
CNPA????????? CCPA?????????
Cadranel J, et al. Phase II trial of voriconazole
for treatment of chronic pulmonary aspergillosis.
ATS May 2009
37
??????
????????CPA??IPA???????????,??????????????,???????
??????
Juliette Camuset,Hilario Nunes,Marie-Christine
Dombret,et al.,Treatment of Chronic Pulmonary
Aspergillosis by Voriconazole in
Nonimmunocompromised Patients. CHEST131,5
MAY,20071435-1441
38
??????????COPD??IPA
  • 2009???COPD????

Florence Ader,Anne-Lise Bienvenu,Blandine
Rammaert,et al., ReviewManagement of invasive
aspergillosis in patients with COPD Rational use
of voriconazole. International Journal of COPD
20094 279-287
39
????
  • ???????IPA?????????
  • ????????COPD??IPA?????????,??
  • COPD??IPA??????
  • ???????????????

Florence Ader,Anne-Lise Bienvenu,Blandine
Rammaert,et al., ReviewManagement of invasive
aspergillosis in patients with COPD Rational use
of voriconazole. International Journal of COPD
20094 279-287
40
????(1)
  • COPD??IPA????????????
  • ??????????????????,????
  • ??????,???????,CT???????????????
  • ?????????????????????,???????????????????????BAL??
    ???????????????????50
  • ?????????????/?BAL?GM?PCR?G??????????,????????????
    ?
  • COPD?????????????????????????GM???BAL?????????????

Florence Ader,Anne-Lise Bienvenu,Blandine
Rammaert,et al., ReviewManagement of invasive
aspergillosis in patients with COPD Rational use
of voriconazole. International Journal of COPD
20094 279-287
41
????(2)
  • ????????COPD??IPA???????
  • ??????????????,?IPA??????
  • ???????????????90-96,????????
    (???????????????????11?2)
  • ?????????????????????,????????????????
  • ????????IPA?????????6 mg/kg IV/12h?2??????,??4
    mg/kg /12h,???????200 mg /12h?????????,???????????
    ????????
  1. Florence Ader,Anne-Lise Bienvenu,Blandine
    Rammaert,et al., ReviewManagement of invasive
    aspergillosis in patients with COPD Rational use
    of voriconazole. International Journal of COPD
    20094 279-287
  2. Capitano B, Protoski BA, Husain S, et al.
    Intrapulmonary penetration of voriconazole in
    patients receiving an oral prophylactic regimen.
    Antimicrob Agents Chemother. 2006501878-188

42
? ?
  • ??????
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