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Burden of chemotherapy-induced myelosuppression (CIM) in Chinese patients with extensive-stage small cell lung cancer (ES-SCLC): A retrospective real-world study 中国广泛期小细胞肺癌(ES-SCLC)患者化疗诱导骨髓抑制(CIM)负担:一项回顾性现实世界研究
Pub Date : 2025-09-01 DOI: 10.1016/j.pccm.2025.08.004
Kailun Fei , Wenjing Yang , Jianchun Duan , Jiachen Xu , Jie Zhao , Jie Wang , Zhijie Wang

Background

The disease burden, treatment patterns, and financial costs associated with chemotherapy-induced myelosuppression (CIM) in Chinese patients with extensive-stage small cell lung cancer (ES-SCLC) remain poorly characterized, particularly in terms of real-world evidence derived from large populations. This study aimed to describe the incidence, treatment patterns, costs, and healthcare resource utilization (HCRU) in Chinese patients with ES-SCLC who develop CIM.

Methods

Adults diagnosed with ES-SCLC who started etoposide–platinum (EP) chemotherapy for the first time between January 1, 2018 and December 31, 2022 were retrospectively identified in the Chinese National Cancer Information Database. Baseline demographic and clinical data were collected. Information on CIM-related events, treatment, costs, and HCRU during EP chemotherapy and during follow-up was assessed. Costs and HCRU were compared among patients with grade 3–4 CIM, grade 1–2 CIM, and no CIM using the Kruskal–Wallis test.

Results

In total, 7505 patients with ES-SCLC (mean age 61.2 years; 17.7 % [1332/7505] female; body mass index 23.2±3.3 kg/m2) were enrolled. After initiation of EP-based chemotherapy, 6901 patients (92.0 %) experienced at least one CIM-related event. At least one grade 3–4 CIM event occurred in 1883 patients (25.1 %) and consisted of single-lineage (neutropenia [n=609, 8.1 %], thrombocytopenia [n=85, 1.1 %], anemia [n=797, 10.6 %]), two-lineage (n=318, 4.2 %), and three-lineage (n=74, 1.0 %) events. Patients receiving immune checkpoint inhibitors (ICIs) plus EP (n=1674) had a significantly higher incidence of at least one CIM during the ICI combination therapy (87.8 % [1469/1674] vs. 82.8 % [4827/5831]; χ²=23.43, P<0.0001) and grade 3–4 CIM (25.7 % [430/1674] vs. 20.6 % [1201/5831]; χ²=19.51, P<0.0001) compared to those receiving other EP-based therapies during EP chemotherapy (n=5831). Rates of use of granulocyte colony-stimulating factor, thrombopoietin, interleukin-11, erythropoiesis-stimulating agents, and blood transfusion were 81.1 % (n=6087), 9.2 % (n=691), 12.4 % (n=927), 9.0 % (n=678), and 12.1 % (n=907), respectively. HCRU and total costs per patient were higher for those with grade 3–4 CIM than for those without CIM or grade 1–2 CIM, and significant differences in the total cost were observed across groups (H=195.54, P <0.0001).

Conclusion

Despite the availability of supportive care for CIM in patients with ES-SCLC in China, a considerable clinical and financial burden persists. Strategies that protect bone marrow from progressing to high-grade myelosuppression could reduce the burden on patients and healthcare organizations.
背景:在中国广泛期小细胞肺癌(ES-SCLC)患者中,与化疗诱导骨髓抑制(CIM)相关的疾病负担、治疗模式和经济成本仍然缺乏特征,特别是在来自大量人群的现实世界证据方面。本研究旨在描述中国ES-SCLC并发CIM的发病率、治疗模式、成本和医疗资源利用(HCRU)。方法回顾性分析2018年1月1日至2022年12月31日期间首次开始依托泊肽-铂(EP)化疗的ES-SCLC成人患者,并从中国国家癌症信息数据库中检索。收集基线人口统计学和临床数据。评估了EP化疗期间和随访期间的cim相关事件、治疗、费用和HCRU信息。采用Kruskal-Wallis试验比较3-4级CIM、1-2级CIM和非CIM患者的成本和HCRU。结果共纳入ES-SCLC患者7505例,平均年龄61.2岁,女性17.7 %[1332/7505],体重指数23.2±3.3 kg/m2。在开始以ep为基础的化疗后,6901例患者(92.0 %)经历了至少一次cim相关事件。1883例患者(25.1% %)中至少发生了一次3-4级CIM事件,包括单系(中性粒细胞减少[n=609, 8.1 %],血小板减少[n=85, 1.1 %],贫血[n=797, 10.6 %]),双系(n=318, 4.2 %)和三系(n=74, 1.0 %)事件。接受免疫检查点抑制剂(ICIs) + EP (n=1674)的患者在ICI联合治疗期间至少有一种CIM的发生率(87.8 % [1469/1674]vs. 82.8 % [4827/5831];χ²=23.43,P<0.0001)和3-4级CIM(25.7 % [430/1674]vs. 20.6 % [1201/5831];χ²=19.51,P<0.0001)显著高于在EP化疗期间接受其他基于EP的治疗的患者(n=5831)。粒细胞集落刺激因子、血小板生成素、白细胞介素-11、促红细胞生成素和输血的使用率分别为81.1 % (n=6087)、9.2 % (n=691)、12.4 % (n=927)、9.0% (n=678)和12.1% (n=907)。3-4级CIM患者的HCRU和每位患者的总成本高于没有CIM或1-2级CIM的患者,并且各组之间的总成本存在显著差异(H=195.54, P <0.0001)。结论:尽管中国ES-SCLC患者可获得CIM支持治疗,但仍存在相当大的临床和经济负担。保护骨髓不发展为高级别骨髓抑制的策略可以减轻患者和医疗机构的负担。
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引用次数: 0
Transcriptome analysis identifies upregulation of GBP4 in sarcoidosis and pulmonary hypertension 转录组分析发现GBP4在结节病和肺动脉高压中表达上调
Pub Date : 2025-09-01 DOI: 10.1016/j.pccm.2025.08.007
Shunlian Hu , Jijin Jiang , Jiayi Wang , Qiuhong Li , Wenhui Wu , Jin-Fu Xu
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引用次数: 0
Chimeric antigen receptor-T cell therapy for lung cancer: The tumor microenvironment bottleneck and remedies to circumvent it 嵌合抗原受体- t细胞治疗肺癌:肿瘤微环境瓶颈及规避方法
Pub Date : 2025-09-01 DOI: 10.1016/j.pccm.2025.08.005
Qi Zhou , Fengfei Sun , Xinhui Wang
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引用次数: 0
Mechanisms and current advances in treating KRAS-mutated lung cancer kras突变肺癌的治疗机制及最新进展
Pub Date : 2025-09-01 DOI: 10.1016/j.pccm.2025.08.001
Cynthia Hsin-Ya Chao, Yuanpu Peter Di
Lung cancer is the leading cause of cancer-related deaths, with the highest mortality among all cancers. Despite the significant advances in cancer treatments in recent years, especially with the development of checkpoint inhibitor immunotherapy, a definitive treatment has yet to be discovered to cure lung cancer. Lung tumorigenesis involves genetic alterations in a multi-step process with heterogeneity and diversity, such that even though cigarette smoke has been widely acknowledged as a major associated risk factor, many non-smokers still develop lung cancer. Among lung cancers, 85 % are non-small cell lung carcinoma (NSCLC), with adenocarcinoma as the most prevalent NSCLC subtype, making up around 40 % of all lung cancers. The major genetic mutation drivers include the epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), and Kirsten rat sarcoma viral oncogene homolog (KRAS). While the advancement of newer-generation anti-cancer drugs has successfully treated EGFR- and ALK-associated lung cancers, KRAS mutation-associated lung cancer remains extremely challenging and has limited therapeutic options. This review outlines the etiology, epidemiology, and categorization of lung cancer, describing the current therapeutic options and limitations, with a focus on the most challenging-to-treat KRAS-mutated lung cancer. Furthermore, this paper highlights the current state and development of KRAS-mutated cancer treatment by describing the mechanisms and utilities of various KRAS-targeted therapies entering clinical trials, and it underlines the most promising treatment options.
肺癌是癌症相关死亡的主要原因,在所有癌症中死亡率最高。尽管近年来癌症治疗取得了重大进展,特别是随着检查点抑制剂免疫疗法的发展,但尚未发现治愈肺癌的确切治疗方法。肺肿瘤发生涉及一个多步骤的遗传改变过程,具有异质性和多样性,因此,尽管吸烟已被广泛认为是一个主要的相关危险因素,但许多非吸烟者仍会患上肺癌。在肺癌中,85% %是非小细胞肺癌(NSCLC),其中腺癌是最常见的NSCLC亚型,约占所有肺癌的40% %。主要的基因突变驱动因素包括表皮生长因子受体(EGFR)、间变性淋巴瘤激酶(ALK)和Kirsten大鼠肉瘤病毒癌基因同源物(KRAS)。虽然新一代抗癌药物的进步已经成功治疗了EGFR-和alk -相关的肺癌,但KRAS突变相关的肺癌仍然极具挑战性,治疗选择有限。这篇综述概述了肺癌的病因、流行病学和分类,描述了目前的治疗选择和局限性,重点是治疗最具挑战性的kras突变肺癌。此外,本文通过描述各种进入临床试验的kras靶向治疗的机制和效用,重点介绍了kras突变癌症治疗的现状和发展,并强调了最有希望的治疗方案。
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引用次数: 0
The value of treatable traits across the spectrum of adult asthma severity 跨越成人哮喘严重程度谱的可治疗特征的价值
Pub Date : 2025-09-01 DOI: 10.1016/j.pccm.2025.08.002
Wenwen Wu , Vanessa M. McDonald , Gang Wang , Peter Gerard Gibson
Asthma is a heterogeneous condition characterized by diverse clinical phenotypes and variable treatment responses, underscoring the limitations of the traditional “one-size-fits-all” stepwise management paradigm. The treatable traits (TTs) approach, a precision medicine framework, targets individualized, clinically relevant characteristics spanning pulmonary, extrapulmonary, and behavioral domains. This review synthesizes current evidence on the prevalence and impact of TTs across the spectrum of asthma severity—mild, moderate, and severe. Although severe asthma is associated with a greater overall burden of TTs, patients with mild-to-moderate disease frequently present with substantial trait-related challenges, including persistent symptoms and exacerbations. Key traits, such as eosinophilic inflammation, fixed airflow limitation, obesity, gastroesophageal reflux disease, and psychological comorbidities, vary in prevalence yet exert influence across all severity strata. Super-traits, including T2 inflammation and suboptimal inhaler adherence, warrant prioritization owing to their broad therapeutic implications. Optimal implementation requires tailored strategies in both primary and tertiary care, supported by multidisciplinary collaboration, patient engagement, and resource-efficient diagnostic tools. While barriers include limited clinician awareness and integration into existing workflows, enablers such as decision aids and structured education can facilitate adoption. The TTs model represents a promising pathway toward personalized asthma care, with the potential to improve outcomes across all severities.
哮喘是一种异质性疾病,其特点是不同的临床表型和不同的治疗反应,强调了传统的“一刀切”逐步管理模式的局限性。可治疗特征(TTs)方法是一种精准医学框架,针对个性化的临床相关特征,涵盖肺、肺外和行为领域。这篇综述综合了目前在哮喘严重程度(轻度、中度和重度)范围内ttt的患病率和影响的证据。虽然严重哮喘与更大的总结核结核负担相关,但轻至中度疾病患者经常出现与体征相关的重大挑战,包括持续症状和恶化。关键特征,如嗜酸性粒细胞炎症、固定气流限制、肥胖、胃食管反流疾病和心理合并症,在患病率上各不相同,但对所有严重程度的人群都有影响。由于其广泛的治疗意义,包括T2炎症和次优吸入器依从性在内的超级特征值得优先考虑。最佳实施需要在初级和三级保健中制定量身定制的战略,并得到多学科合作、患者参与和资源高效诊断工具的支持。虽然障碍包括有限的临床医生意识和对现有工作流程的整合,但决策辅助和结构化教育等推动因素可以促进采用。TTs模型代表了个性化哮喘护理的一个有希望的途径,有可能改善所有严重程度的结果。
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引用次数: 0
Burden of non-COVID-19 lower respiratory infections and etiologies in China and globally: An analysis for the global burden of disease study 2021 中国和全球非covid -19下呼吸道感染负担及其病因:2021年全球疾病负担研究分析
Pub Date : 2025-09-01 DOI: 10.1016/j.pccm.2025.08.006
Xueyan Zheng , Yongcheng Li , Dongxue Ruan , Lifeng Lin , Ruilin Meng , Dejian Zhao , Jiayin Yu , Xinyi Li , Hongjun Huang , Maigeng Zhou

Background

Non-COVID-19 lower respiratory infections (LRIs) represent a persistent public health concern in China and globally. However, comprehensive assessments of their long-term spatiotemporal trends remain limited. This study aimed to quantify the burden of LRIs by age, sex, and geographic region across China and globally from 1990 to 2021.

Methods

Using standardized methodologies from the Global Burden of Disease Study 2021, we estimated LRI incidence and mortality globally and across 33 provincial-level units in China by sex, age, and year. Attributable incidence and mortality were further analyzed by underlying etiologies and risk factors, with corresponding 95 % uncertainty intervals.

Results

In 2021, LRI accounted for 343.6 (95% UI: 325.2–363.5) million episodes and 2.2 (95% UI: 2.0–2.4) million deaths worldwide, corresponding to age-standardized incidence and mortality rates of 4283.6 (95% UI: 4057.0–4524.9) episodes per 100,000 population and 28.7 (95% UI: 25.9–31.1) per 100,000 population, respectively. This reflected a decline of 32.8 % and 53.6 % since 1990. China contributed 44.7 (95% UI: 41.8–47.8) million episodes and 206,930.2 (95% UI: 171,260.9–251,990.5) deaths in 2021, with respective age-standardized rates of 2853.8 (95% UI: 2664.0–3067.6) episodes per 100,000 population and 14.0 (95% UI: 11.7–17.0) per 100,000 population. Between 1990 and 2021, the age-standardized incidence and mortality rates in China declined by 47.9 % and 76.9 % which were higher than the global average. This progress was primarily driven by reductions in children under 5 years. Older individuals ≥70 years exhibited the highest burden. In 2021, Guangdong reported the highest age-standardized incidence, while Guizhou had the highest mortality. Streptococcus pneumoniae was the leading cause of LRI-related deaths. Ambient particulate matter pollution, smoking, and low temperature were the primary risk factors, with notable sex-specific differences.

Conclusions

Despite marked improvements, LRIs remain a major contributor to morbidity and mortality in China, particularly among children and older adults. Addressing the residual burden will require targeted strategies, including enhanced diagnostics, expanded vaccination, air quality control, and strengthened healthcare in high-burden provinces.
背景非covid -19下呼吸道感染(LRIs)在中国和全球都是一个持续存在的公共卫生问题。然而,对其长期时空趋势的综合评估仍然有限。本研究旨在量化1990年至2021年中国和全球按年龄、性别和地理区域划分的LRIs负担。方法使用来自2021年全球疾病负担研究的标准化方法,我们按性别、年龄和年份估计了全球和中国33个省级单位的LRI发病率和死亡率。根据潜在病因和危险因素进一步分析归因发病率和死亡率,相应的不确定性区间为95% %。结果2021年,LRI在全球范围内共占343.6 (95% UI: 3.252 ~ 3.635)万例病例和2.2 (95% UI: 200 ~ 240)万例死亡,对应的年龄标准化发病率和死亡率分别为4283.6 (95% UI: 4057.0 ~ 4524.9) / 10万人口和28.7 (95% UI: 25.9 ~ 31.1)例。这反映了自1990年以来下降了32.8% %和53.6 %。2021年,中国共死亡44.7万例(95% UI: 41.8 - 4780),死亡206930.2例(95% UI: 171,260.9-251,990.5),年龄标准化率分别为每10万人2853.8例(95% UI: 2664.0-3067.6)和14.0例(95% UI: 11.7-17.0)。1990年至2021年,中国年龄标准化发病率和死亡率分别下降了47.9% %和76.9% %,高于全球平均水平。这一进展主要是由于5岁以下儿童人数的减少。年龄≥70岁的老年人负担最重。2021年,广东报告的年龄标准化发病率最高,贵州报告的死亡率最高。肺炎链球菌是lri相关死亡的主要原因。环境颗粒物污染、吸烟和低温是主要危险因素,性别差异显著。结论:尽管有明显的改善,LRIs仍然是中国发病率和死亡率的主要因素,特别是在儿童和老年人中。解决剩余负担将需要有针对性的战略,包括加强诊断、扩大疫苗接种、空气质量控制以及在高负担省份加强卫生保健。
{"title":"Burden of non-COVID-19 lower respiratory infections and etiologies in China and globally: An analysis for the global burden of disease study 2021","authors":"Xueyan Zheng ,&nbsp;Yongcheng Li ,&nbsp;Dongxue Ruan ,&nbsp;Lifeng Lin ,&nbsp;Ruilin Meng ,&nbsp;Dejian Zhao ,&nbsp;Jiayin Yu ,&nbsp;Xinyi Li ,&nbsp;Hongjun Huang ,&nbsp;Maigeng Zhou","doi":"10.1016/j.pccm.2025.08.006","DOIUrl":"10.1016/j.pccm.2025.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Non-COVID-19 lower respiratory infections (LRIs) represent a persistent public health concern in China and globally. However, comprehensive assessments of their long-term spatiotemporal trends remain limited. This study aimed to quantify the burden of LRIs by age, sex, and geographic region across China and globally from 1990 to 2021.</div></div><div><h3>Methods</h3><div>Using standardized methodologies from the Global Burden of Disease Study 2021, we estimated LRI incidence and mortality globally and across 33 provincial-level units in China by sex, age, and year. Attributable incidence and mortality were further analyzed by underlying etiologies and risk factors, with corresponding 95 % uncertainty intervals.</div></div><div><h3>Results</h3><div>In 2021, LRI accounted for 343.6 (95% UI: 325.2–363.5) million episodes and 2.2 (95% UI: 2.0–2.4) million deaths worldwide, corresponding to age-standardized incidence and mortality rates of 4283.6 (95% UI: 4057.0–4524.9) episodes per 100,000 population and 28.7 (95% UI: 25.9–31.1) per 100,000 population, respectively. This reflected a decline of 32.8 % and 53.6 % since 1990. China contributed 44.7 (95% UI: 41.8–47.8) million episodes and 206,930.2 (95% UI: 171,260.9–251,990.5) deaths in 2021, with respective age-standardized rates of 2853.8 (95% UI: 2664.0–3067.6) episodes per 100,000 population and 14.0 (95% UI: 11.7–17.0) per 100,000 population. Between 1990 and 2021, the age-standardized incidence and mortality rates in China declined by 47.9 % and 76.9 % which were higher than the global average. This progress was primarily driven by reductions in children under 5 years. Older individuals ≥70 years exhibited the highest burden. In 2021, Guangdong reported the highest age-standardized incidence, while Guizhou had the highest mortality. <em>Streptococcus pneumoniae</em> was the leading cause of LRI-related deaths. Ambient particulate matter pollution, smoking, and low temperature were the primary risk factors, with notable sex-specific differences.</div></div><div><h3>Conclusions</h3><div>Despite marked improvements, LRIs remain a major contributor to morbidity and mortality in China, particularly among children and older adults. Addressing the residual burden will require targeted strategies, including enhanced diagnostics, expanded vaccination, air quality control, and strengthened healthcare in high-burden provinces.</div></div>","PeriodicalId":72583,"journal":{"name":"Chinese medical journal pulmonary and critical care medicine","volume":"3 3","pages":"Pages 193-208"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Unraveling the mechanisms of virus-induced asthma exacerbation: epithelial injury, immune dysregulation, and novel interventions 揭示病毒诱导哮喘加重的机制:上皮损伤、免疫失调和新的干预措施
Pub Date : 2025-09-01 DOI: 10.1016/j.pccm.2025.08.003
Xizi Du , Ming Yang
Viral infections account for 60–80 % of asthma exacerbations (AE), representing a major burden in both pediatric and adult populations. The pathogenesis of virus-induced asthma exacerbation (VAE) is mechanistically complex, involving disruption of epithelial integrity, defective interferon responses, and abnormal activation of immune cells such as macrophages and innate lymphoid cells. In addition, the interplay between type 2 (T2) and non-T2 inflammation is dynamically regulated during viral infections, further amplifying airway dysfunction and remodeling. Although inhaled corticosteroids and biologics targeting T2 pathways are widely used, their efficacy in VAE is limited, especially in patients with neutrophilic or steroid-insensitive phenotypes, and virus-specific antiviral therapies for asthma are lacking. Recent advances have highlighted novel approaches targeting host immunity and epithelial-immune interactions, but most of these strategies remain in preclinical or early clinical phases, with few personalized treatment approaches available. This review summarizes insights into VAE pathogenesis and therapeutic advances, and discusses challenges and future directions in the development of targeted therapeutic strategies.
病毒感染占哮喘加重(AE)的60 - 80% %,是儿科和成人人群的主要负担。病毒诱导的哮喘加重(VAE)的发病机制复杂,涉及上皮完整性破坏、干扰素反应缺陷和免疫细胞(如巨噬细胞和先天淋巴样细胞)的异常激活。此外,在病毒感染期间,2型(T2)和非T2炎症之间的相互作用受到动态调节,进一步放大气道功能障碍和重塑。虽然吸入皮质类固醇和靶向T2通路的生物制剂被广泛使用,但它们对VAE的疗效有限,特别是对嗜中性粒细胞或类固醇不敏感表型的患者,并且缺乏针对哮喘的病毒特异性抗病毒治疗。最近的进展强调了针对宿主免疫和上皮免疫相互作用的新方法,但大多数这些策略仍处于临床前或早期临床阶段,很少有个性化的治疗方法可用。本文综述了VAE发病机制和治疗进展,并讨论了靶向治疗策略发展的挑战和未来方向。
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引用次数: 0
Clinical characteristics of patients with positive fungal pathogens during acute exacerbation of chronic obstructive pulmonary disease: A retrospective study 慢性阻塞性肺疾病急性加重期真菌病原体阳性患者的临床特征:一项回顾性研究
Pub Date : 2025-06-01 DOI: 10.1016/j.pccm.2025.02.007
Lijuan Luo , Lijun Liu , Yiming Ma , Herui Li , Zihang Zeng , Yan Chen

Background

Fungal infections in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients are poorly understood and often result in a poor prognosis. This study aimed to investigate the distribution of common fungi and the clinical features of AECOPD patients positive for fungal pathogens.

Methods

Data were collected from inpatients with AECOPD at the Second Xiangya Hospital of Central South University from January 2016 to December 2019. The enrolled patients were divided into an infection group and a colonization group, and clinical data were compared between the two groups. A 1:1 propensity score matching (PSM) process was employed to ensure balanced samples to analyze the impact of positive fungal pathogens on the clinical features of AECOPD patients. The incidence of acute exacerbations one year after discharge was determined via telephone follow-up.

Results

The most frequently isolated fungal pathogen was Candida albicans (164/395, 41.5 %), followed by Aspergillus (93/395, 23.5 %). After propensity score matching, 68 patients were equally divided into the infection and colonization groups. There was no significant difference in clinical manifestations between the infection and colonization groups (P > 0.05). Patients in the infection group had significantly higher procalcitonin (PCT) values (0.2 [0.1, 0.7] ng/ml vs. 0.1 [0, 0.1] ng/ml; P = 0.003) and lower albumin/globulin ratios (1.1 [0.6, 1.3] vs. 1.1 [1.0, 1.3], P = 0.047) than those in the colonization group. The antibiotic treatment (12.5 [11.0, 19.0] days vs. 10.0 [8.0, 14.0] days; P = 0.002) and hospitalisation duration (18.0 [14.7, 22.5] days vs. 11.0 [8.0, 16.0] days; P < 0.001) in the infection group was significantly longer than that in the colonization group. In addition, more patients in the colonization group received non-invasive mechanical ventilation (76.5 % [26/34] vs. 47.1 % [16/34]; P = 0.013). Compared with the colonization group, more patients in the infection group underwent bronchoscopy (29.4 % [10/34] vs. 2.9 % [1/34]; P = 0.003). Using multivariable analysis, we found that bronchoscopy (OR: 1.350, 95 % CI: 1.020–1.771, P = 0.034) and duration of antibiotics used (OR: 1.318, 95 % CI: 1.090–1.560, P = 0.004) were risk factors for pulmonary fungal infection in AECOPD patients.

Conclusion

Candida albicans and Aspergillus are the common fungi isolated from patients with AECOPD. The clinical manifestations of AECOPD patients with fungal infection are nonspecific. AECOPD patients with positive fungal isolation who have undergone bronchoscopy and used antibiotics for a longer duration are more likely to have fungal infection.
慢性阻塞性肺疾病急性加重期(AECOPD)患者的真菌感染尚不清楚,且往往导致预后不良。本研究旨在探讨真菌病原菌阳性AECOPD患者的常见真菌分布及临床特征。方法收集2016年1月至2019年12月中南大学湘雅第二医院住院AECOPD患者的数据。将入组患者分为感染组和定植组,比较两组患者的临床资料。采用1:1倾向评分匹配(PSM)方法确保样本平衡,分析真菌病原体阳性对AECOPD患者临床特征的影响。出院后1年急性加重发生率通过电话随访确定。结果最常见的真菌病原菌为白色念珠菌(164/395,41.5 %),其次为曲霉(93/395,23.5 %)。经倾向评分匹配后,68例患者平均分为感染组和定植组。感染组与定植组的临床表现差异无统计学意义(P >; 0.05)。感染组患者降钙素原(PCT)值显著升高(0.2 [0.1,0.7]ng/ml vs. 0.1 [0,0.1] ng/ml;P = 0.003),白蛋白/球蛋白比值(1.1 [0.6,1.3]vs. 1.1 [1.0, 1.3], P = 0.047)低于定殖组。抗生素治疗组(12.5 [11.0,19.0]d vs. 10.0 [8.0, 14.0] d;P = 0.002)和住院时间(18.0[14.7,22.5]天vs. 11.0[8.0, 16.0]天;P <; 0.001),感染组明显长于定殖组。此外,定植组更多患者接受无创机械通气(76.5% % [26/34]vs. 47.1% % [16/34]; = 0.013页)。与定植组相比,感染组接受支气管镜检查的患者较多(29.4 % [10/34]vs. 2.9 % [1/34]; = 0.003页)。通过多变量分析,我们发现支气管镜检查(OR: 1.350, 95 % CI: 1.020-1.771, P = 0.034)和抗生素使用时间(OR: 1.318, 95 % CI: 1.090-1.560, P = 0.004)是AECOPD患者肺部真菌感染的危险因素。结论白色念珠菌和曲霉菌是AECOPD患者中常见的真菌。真菌感染的AECOPD患者临床表现无特异性。真菌分离阳性的AECOPD患者接受过支气管镜检查并使用抗生素的时间较长,更容易发生真菌感染。
{"title":"Clinical characteristics of patients with positive fungal pathogens during acute exacerbation of chronic obstructive pulmonary disease: A retrospective study","authors":"Lijuan Luo ,&nbsp;Lijun Liu ,&nbsp;Yiming Ma ,&nbsp;Herui Li ,&nbsp;Zihang Zeng ,&nbsp;Yan Chen","doi":"10.1016/j.pccm.2025.02.007","DOIUrl":"10.1016/j.pccm.2025.02.007","url":null,"abstract":"<div><h3>Background</h3><div>Fungal infections in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients are poorly understood and often result in a poor prognosis. This study aimed to investigate the distribution of common fungi and the clinical features of AECOPD patients positive for fungal pathogens.</div></div><div><h3>Methods</h3><div>Data were collected from inpatients with AECOPD at the Second Xiangya Hospital of Central South University from January 2016 to December 2019. The enrolled patients were divided into an infection group and a colonization group, and clinical data were compared between the two groups. A 1:1 propensity score matching (PSM) process was employed to ensure balanced samples to analyze the impact of positive fungal pathogens on the clinical features of AECOPD patients. The incidence of acute exacerbations one year after discharge was determined via telephone follow-up.</div></div><div><h3>Results</h3><div>The most frequently isolated fungal pathogen was <em>Candida albicans</em> (164/395, 41.5 %), followed by <em>Aspergillus</em> (93/395, 23.5 %). After propensity score matching, 68 patients were equally divided into the infection and colonization groups. There was no significant difference in clinical manifestations between the infection and colonization groups (<em>P</em> &gt; 0.05). Patients in the infection group had significantly higher procalcitonin (PCT) values (0.2 [0.1, 0.7] ng/ml <em>vs</em>. 0.1 [0, 0.1] ng/ml; <em>P</em> = 0.003) and lower albumin/globulin ratios (1.1 [0.6, 1.3] <em>vs</em>. 1.1 [1.0, 1.3], <em>P</em> = 0.047) than those in the colonization group. The antibiotic treatment (12.5 [11.0, 19.0] days <em>vs</em>. 10.0 [8.0, 14.0] days; <em>P</em> = 0.002) and hospitalisation duration (18.0 [14.7, 22.5] days <em>vs</em>. 11.0 [8.0, 16.0] days; <em>P</em> &lt; 0.001) in the infection group was significantly longer than that in the colonization group. In addition, more patients in the colonization group received non-invasive mechanical ventilation (76.5 % [26/34] <em>vs</em>. 47.1 % [16/34]; <em>P</em> = 0.013). Compared with the colonization group, more patients in the infection group underwent bronchoscopy (29.4 % [10/34] <em>vs</em>. 2.9 % [1/34]; <em>P</em> = 0.003). Using multivariable analysis, we found that bronchoscopy (OR: 1.350, 95 % CI: 1.020–1.771, <em>P</em> = 0.034) and duration of antibiotics used (OR: 1.318, 95 % CI: 1.090–1.560, <em>P</em> = 0.004) were risk factors for pulmonary fungal infection in AECOPD patients.</div></div><div><h3>Conclusion</h3><div><em>Candida albicans</em> and <em>Aspergillus</em> are the common fungi isolated from patients with AECOPD. The clinical manifestations of AECOPD patients with fungal infection are nonspecific. AECOPD patients with positive fungal isolation who have undergone bronchoscopy and used antibiotics for a longer duration are more likely to have fungal infection.</div></div>","PeriodicalId":72583,"journal":{"name":"Chinese medical journal pulmonary and critical care medicine","volume":"3 2","pages":"Pages 111-119"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Crescent jugular dual-lumen catheter for adult veno-venous extracorporeal membrane oxygenation in China: Multicenter initial experience 新月形颈静脉双腔导管用于中国成人静脉-静脉体外膜氧合:多中心初步经验
Pub Date : 2025-06-01 DOI: 10.1016/j.pccm.2025.05.003
Han Zhang , Gang Liu , Xiaojun Liu , Yang Yan , Xiaozu Liao , Junmeng Zheng , Songqiao Liu , Zhen Guo , Jian Rong , Fangqiang Song , Chunyao Wang , Zan Chen , Chengbin Zhou , Man Huang , Bingyang Ji
{"title":"Crescent jugular dual-lumen catheter for adult veno-venous extracorporeal membrane oxygenation in China: Multicenter initial experience","authors":"Han Zhang ,&nbsp;Gang Liu ,&nbsp;Xiaojun Liu ,&nbsp;Yang Yan ,&nbsp;Xiaozu Liao ,&nbsp;Junmeng Zheng ,&nbsp;Songqiao Liu ,&nbsp;Zhen Guo ,&nbsp;Jian Rong ,&nbsp;Fangqiang Song ,&nbsp;Chunyao Wang ,&nbsp;Zan Chen ,&nbsp;Chengbin Zhou ,&nbsp;Man Huang ,&nbsp;Bingyang Ji","doi":"10.1016/j.pccm.2025.05.003","DOIUrl":"10.1016/j.pccm.2025.05.003","url":null,"abstract":"","PeriodicalId":72583,"journal":{"name":"Chinese medical journal pulmonary and critical care medicine","volume":"3 2","pages":"Pages 141-143"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Achieving remission in severe asthma 实现严重哮喘的缓解
Pub Date : 2025-06-01 DOI: 10.1016/j.pccm.2025.05.001
Sarita Thawanaphong , Santi Nolasco , Parameswaran Nair
Severe asthma affects 5–10 % of asthma patients worldwide, imposing a significant burden due to an increased risk of mortality, impaired quality of life, and substantial economic costs. Recent advancements in biologic therapies have transformed asthma management by targeting specific inflammatory pathways, particularly type 2 inflammation. Biologic treatments such as omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab have demonstrated efficacy in reducing exacerbations, improving lung function, and achieving clinical remission in a subset of patients. This review provides an overview of the mechanisms of action, indications, and treatment efficacy of biologics used in asthma management. We also explore the concept of asthma remission and the potential for achieving it through biologic therapies and complementary strategies, including optimized inhaler use, macrolides, and bronchial thermoplasty. In addition, we discuss how to choose among these treatments wisely and examine the limitations of each biologic therapy. Despite these advancements, clinical remission rates remain modest, underscoring the need for refined patient selection. Emerging tools such as airway biomarkers, proteomics, and advanced imaging techniques offer promising avenues to improve diagnosis and personalize treatment approaches. Future research focused on making advanced biomarkers more accessible and feasible for point-of-care testing will enhance treatment precision. The next step will be integrating a multiomics approach into personalized asthma management for severe disease, further improving asthma control, achieving sustained remission, and ultimately reducing the burden of severe asthma.
严重哮喘影响全世界哮喘患者的5 - 10% ,由于死亡风险增加、生活质量受损和巨大的经济成本,造成了重大负担。生物疗法的最新进展通过针对特定的炎症途径,特别是2型炎症,改变了哮喘的治疗。生物治疗如omalizumab, mepolizumab, reslizumab, benralizumab和dupilumab已被证明在减少急性发作,改善肺功能和实现临床缓解的一部分患者中有效。本文综述了用于哮喘治疗的生物制剂的作用机制、适应症和治疗效果。我们还探讨了哮喘缓解的概念,以及通过生物疗法和补充策略(包括优化吸入器使用、大环内酯类药物和支气管热成形术)实现哮喘缓解的潜力。此外,我们还讨论了如何明智地选择这些治疗方法,并检查了每种生物治疗的局限性。尽管取得了这些进展,但临床缓解率仍然不高,这强调了对患者进行精细选择的必要性。新兴工具,如气道生物标志物、蛋白质组学和先进的成像技术,为改善诊断和个性化治疗方法提供了有希望的途径。未来的研究重点是使先进的生物标志物更容易获得和可行,以提高治疗精度。下一步将是将多组学方法整合到严重疾病的个性化哮喘管理中,进一步改善哮喘控制,实现持续缓解,并最终减轻严重哮喘的负担。
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Chinese medical journal pulmonary and critical care medicine
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