2015年 · 第95卷第08期

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by persistent airflow restriction. Conditions have previously been assessed based on forced expiratory volume at the first second (FEV₁) as a percentage of estimated value (FEV₁% predicted value) and classified patients into the Global Initiative for COPD (GOLD)^[1]Grades I ~ IV. With similar FEV due to heterogeneity in patients with COPD₁Patients with % predicted values may have different clinical conditions. In 2011, GOLD recommended a new comprehensive assessment method covering the degree of airflow restriction, symptoms, acute exacerbations, and comorbidities, and divided patients into groups A, B, C, and D according to the first three. Symptom scores were assessed using the modified British Medical Research Council Dyspnea Scale (mMRC) score and the Chronic Obstructive Pulmonary Assessment Test (CAT) score, mMRC score 0 to 1 or CAT<10 were divided into the group with few symptoms, mMRC score ≥2 or CAT ≥10 were divided into the group with multiple symptoms; Acute exacerbation Acute exacerbation in the past year<2 times or hospitalization for acute exacerbation<Once was the low-risk group, and ≥2 acute exacerbations in the past year or ≥1 hospitalization due to acute exacerbations were the high-risk group; The pulmonary function was classified as GOLD, and Grade I and II were low-risk groups, and Grade III and IV were high-risk groups. If the two risk assessments are inconsistent, the higher risk method will prevail. Group A with fewer symptoms and low risk, Group B with more symptoms and low risk, Group C with fewer symptoms and high risk, and Group D with more symptoms and high risk. Comprehensive assessment method compared with FEV alone₁The % predicted value can better reflect the complexity of COPD.

Lung cancer is a malignant tumor with the highest morbidity and mortality rate in the world, and the 5-year survival rate is only 16.8%^[1]In 2010, the incidence and mortality of lung cancer ranked first among all malignant tumors in China^[2]。 Non-small cell lung cancer (NSCLC) accounts for approximately 85% of all pathological types of lung cancer, and>70% of them are diagnosed at advanced stage^[3]Systemic chemotherapy has been the main treatment option for this group of patients. At the beginning of the 21st century, with the continuous deepening of molecular biology research, NSCLC can be classified by molecular phenotype according to the different expression of various molecular markers, and new drugs can be developed targeting driving genes related to tumorigenesis and development., and carry out targeted individualized molecular targeted therapy. At present, individualized treatment based on molecular markers has moved from laboratory to clinical, and has made significant clinical progress in the treatment of patients with advanced NSCLC, which also includes clinical trials involving many Chinese doctors and Chinese patients. Gefitinib (trade name: Iressa) is a selective epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). It is the world's first small molecule targeted drug for the treatment of NSCLC. It was launched in my country in February 2005. Due to the launch of gefitinib and the development of molecular targeted therapy, the research of lung cancer in China has made leap-forward progress, and the treatment effect of patients has been significantly improved. This article will systematically review the course of molecular targeted therapy for NSCLC in China in the past ten years from four aspects: clinical research and application of targeted drugs for advanced NSCLC, detection methods and quality control of molecular targets, clinical molecular epidemiology and development of molecular diagnostic reagents.

Chronic obstructive pulmonary disease (COPD) often coexists with other diseases and has a significant impact on prognosis. Including cardiovascular disease, osteoporosis, skeletal muscle weakness, metabolic disease, bronchiectasis, depression, etc. Among them, cardiovascular disease is the main complication of COPD and is the most common and important disease coexisting with COPD^[1]。 The most important risk factors for COPD patients include smoking, age and environmental pollution. However, studies have shown that the effect of COPD on cardiovascular disease is independent of these risk factors^[2]。 According to epidemiological statistics, the probability of COPD complicated with heart failure is very high, estimated to be 11% ~55%^[3]。 In a small case-control study, COPD patients had a 70.9% probability of developing diastolic dysfunction, compared with a 27.5% probability in age-matched healthy controls^[4]。 Recent studies have shown that emphysema (including static and ambulatory emphysema), pulmonary hypertension, skeletal muscle weakness and coronary ischemia caused by COPD are closely related to the effects on cardiac function^[5]。

Chronic heart failure (CHF) is the terminal stage of many cardiovascular diseases. Because of its high hospitalization and mortality rate, it has been a difficult problem in the treatment of cardiovascular diseases. In recent years, cardiac resynchronization therapy (CRT) has received extensive attention in the industry as a new technology for the treatment of CHF. However, according to the current guideline inclusion criteria, about 30% to 40% of patients are still unresponsive to CRT^[1]。 According to statistics, about 5.1 million people in the United States suffer from CHF. If calculated according to this ratio, about 2 million patients in the United States alone do not respond to CRT. The high non-response rate has greatly limited the development and popularization of CRT technology^[2]。 Therefore, how to improve CRT reactivity has become an urgent problem today. As an important surgical inclusion index at present, QRS wave time limit has become the focus of widespread attention. The effect of QRS wave time limit on CRT responsiveness is summarized below.

Babesiosis is a species of Babesiosis parasitic in red blood cells (Babesia) zoonosis transmitted by the bite of an Ixodes tick, which can be transmitted from person to person by placental, perinatal and blood transfusion routes^[1,2]。 The disease is not uncommon in clinic and has great potential risk. The clinical manifestations of patients vary in severity, from asymptomatic or subclinical manifestations to acute fulminant infection, and even lead to death in special populations (such as the elderly, immunosuppressant therapy and HIV infected people, etc.)^[3]。 According to statistics, the mortality rate among hospitalized patients is 6% ~9%, and the mortality rate of those with a history of immunosuppressive therapy or blood transfusion is about 20%^[4,5,6,7]。 Some patients have a history of outdoor camping, such as mountaineering, hunting, boating, etc., which increases the chance of contact with ticks, resulting in an increase in tick-borne diseases, and babesiosis infection is particularly prominent. Between 2005 and 2007, 600 cases of human babesiosis were reported in the United States; 632 cases were reported in 2011^[8]。 In recent years, a few cases have also been reported in China. This article reviews the new research progress of human babesiosis as follows.

irritable bowel syndrome (IBS) is a common functional bowel disease, with abdominal pain or abdominal discomfort as the main symptom, which can improve after defecation, often accompanied by changes in defecation habits, but no structural or biochemical abnormalities that can explain the symptoms of the disease were found in relevant routine examinations^[1]。 According to the Rome III diagnostic criteria of functional gastrointestinal diseases, IBS can be divided into constipation-predominant irritable bowel syndrome (IBS-C), diarrhea-predominant irritable bowel syndrome (IBS-D), Four subtypes: mixed (IBS-M) and amorphous (IBS-U). The prevalence of IBS worldwide is 2% to 15%^[2]The prevalence of IBS in China is relatively low. According to Manning diagnostic criteria and Rome II criteria, the prevalence of IBS in Beijing is 7.26% and 0.82%, respectively^[3]Using Rome II as the diagnostic criterion, the prevalence of IBS in Guangzhou population was 5.6%^[4]。 A meta-analysis showed a global prevalence of 11.2% and 8.8% and 9.4% according to the Rome I and Rome II diagnostic criteria, respectively^[5]。