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1、CHRONICOBSTRUCTIVELUNGDISEASE (COPD)CHENGUOZHONG DepartmentofRespiratoryDiseaseDefinitionCOPDisapreventableandtreatablediseasewithsomesignificant（重大的）extrapulmonary（肺外）effectsThechronic慢性的airflowlimitationcharacteristicisnotfullyreversiable可逆的Tobeaprogressivediseaseandtoassociatewith
2、anabnormalinflammatory炎性responseofthelungtonoxious有害的particles微粒orgasesThechronicairflowlimtationofCOPDiscausedbyamixtureofsmallairwaydisease(obstructivebronchiolitis)andparenchymal實質(zhì)性destruction(emphysema)Epidemiologly病理學COPDisaleadingcauseofmorbidity發(fā)病率andmortalitywordwideandresulti
3、naneconomicandsocialburdenCOPDprevalence盛行的,morbidity發(fā)病率,andmortality死亡率varyacrosscountriesandacrossdifferentgroupswithincountriesbut,ingeneral,aredirectlyrelatedtotheprevalenceoftobaccosmoking,althoughairpollutionresultingfromtheburningofwoodandotherbiomassfuelshasalsobeenidentifieda
4、saCOPDriskfactorTheprevalenceandburdenofCOPDincreaseinthecomingdecadesduotocontinuedexposure暴露toCOPDriskfactorsandthechangingagestructureCOPDaffectsabout16millionAmericansandisfourthmostcommoncauseofdeathintheUSLessthan6%ofthepopulationinmostnationaldataand8.2%ofadultsover40yearsinchi
5、na21-2Exposuretoparticlesandgases:totalburdenofinhaling吸1.Tobaccosmoke2.Occupationaldusts:organic有機的andinorganic3.Indoorairpollution:fromheatingandcookingwithbiomass生物的inpoorlyventeddwellings4.OutdoorairpullutionFiskfactorsforCOPDGenes:apolygenicdiseasesusceptibility易感性,deficiencyofal
6、pha-1antitrypsinLunggrowthanddevelopmentImbalancebetweenoxidantsandantioxidants,proteasesandantiproteases氧化劑GenderandageRespiratory呼吸的infectionsSocioeconomicstatus社會經(jīng)濟地位NutritionAirwayhyperresponsiveness:asthmaFiskfactorsforCOPDPathogenesis發(fā)病機制Chronicinflammationandstructuralchangesre
7、sultingfromrepeatedinjuryandrepair1.Proximal近端airway(﹥2mminternaldiameter)2.Peripheralairway(﹤2mminternaldiameter)3.Lungparenchyma實質(zhì)(respiratorybronchiolesandalveoli)4.Pulmonaryvasculature血管分布Inflammatorycellsinvolvingmacrophages,neutrophils,andlymphocytesInflammatorymediatorsinvolvin
8、gchem
