Parr David G, White Andrew J, Bayley Darren L, Guest Peter J, Stockley Robert A
Department of Respiratory Medicine, University Hospitals of Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
Respir Res. 2006 Nov 18;7(1):136. doi: 10.1186/1465-9921-7-136.
Inflammation is considered to be of primary pathogenic importance in COPD but the evidence on which current understanding is based does not distinguish between cause and effect, and no single mechanism can account for the complex pathology. We performed a prospective longitudinal study of subjects with COPD that related markers of sputum inflammation at baseline to subsequent disease progression.
A cohort of 56 patients with chronic bronchitis was characterized in the stable state at baseline and after an interval of four years, using physiological measures and CT densitometry. Sputum markers of airway inflammation were quantified at baseline from spontaneously produced sputum in a sub-group (n = 38), and inflammation severity was related to subsequent disease progression.
Physiological and CT measures indicated disease progression in the whole group. In the sub-group, sputum myeloperoxidase correlated with decline in FEV1 (rs = -0.344, p = 0.019, n = 37). LTB4 and albumin leakage correlated with TLCO decline (rs = -0.310, p = 0.033, rs = -0.401, p = 0.008, respectively, n = 35) and IL-8 correlated with progression of lung densitometric indices (rs = -0.464, p = 0.005, n = 38).
The data support a principal causative role for neutrophilic inflammation in the pathogenesis of COPD and suggest that the measurement of sputum inflammatory markers may have a predictive role in clinical practice.
炎症被认为在慢性阻塞性肺疾病（COPD）的发病机制中具有首要的致病重要性，但目前理解所依据的证据并未区分因果关系，且单一机制无法解释复杂的病理过程。我们对COPD患者进行了一项前瞻性纵向研究，将基线时痰液炎症标志物与随后的疾病进展相关联。
一组56例慢性支气管炎患者在基线时及四年后处于稳定状态，采用生理测量和CT密度测定法进行评估。在一个亚组（n = 38）中，从自发咳出的痰液中对气道炎症的痰液标志物在基线时进行定量，炎症严重程度与随后的疾病进展相关。
生理和CT测量表明整个组病情进展。在亚组中，痰液髓过氧化物酶与第一秒用力呼气容积（FEV1）下降相关（rs = -0.344，p = 0.019，n = 37）。白三烯B4（LTB4）和白蛋白渗漏与一氧化碳弥散量（TLCO）下降相关（分别为rs = -0.310，p = 0.033；rs = -0.401，p = 0.008，n = 35），白细胞介素-8（IL-8）与肺密度指数进展相关（rs = -0.464，p = 0.005，n = 38）。
数据支持中性粒细胞炎症在COPD发病机制中起主要致病作用，并表明痰液炎症标志物的测量在临床实践中可能具有预测作用。
