Pinto-Plata Victor M, Livnat Guy, Girish Mirle, Cabral Howard, Masdin Phil, Linacre Paul, Dew Rick, Kenney Lawrence, Celli Bartolome R
Division of Pulmonary and Critical Care Medicine, St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA.
Chest. 2007 Jan;131(1):37-43. doi: 10.1378/chest.06-0668.
Systemic inflammation in patients with COPD may worsen during exacerbations, but there is limited information relating levels of systemic inflammatory markers with symptoms and physiologic changes during an exacerbation
We measured dyspnea using the visual analog scale, pulmonary function tests, hemograms, and plasma levels for interleukin (IL)-6, IL-8, leukotriene B(4) (LTB4), tumor necrosis factor-alpha, and secretory leukocyte protease inhibitor (SLPI) in 20 patients on admission to a hospital for exacerbation of COPD (ECOPD), 48 h later (interim), and 8 weeks after hospital discharge (recovery).
Dyspnea was present in all patients. Inspiratory capacity improved faster than FEV(1). Compared to recovery, there was a significant increase in the mean (+/- SD) hospital admission plasma levels of IL-6 (6.38 +/- 0.72 to 2.80 +/- 0.79 pg/mL; p = 0.0001), IL-8 (8.18 +/- 0.85 to 3.72 +/- 0.85 pg/mL; p = 0.002), and LTB4 (8,675 +/- 1,652 to 2,534 +/- 1,813 pg/mL; p = 0.003), and the percentages of segmented neutrophils (79 to 69%; p < 0.02) and band forms (7.3 to 1.0%; p < 0.01) in peripheral blood, with no changes in TNF-alpha and SLPI. There were significant correlations between changes in IL-6 (r = 0.61; p = 0.01) and IL-8 (r = 0.56; p = 0.04) with changes in dyspnea and levels of IL-6 (r = -0.51; p = 0.04) and TNF-alpha (r = -0.71; p < 0.02) with changes in FEV(1.)
Hospitalized patients with ECOPDs experience significant changes in systemic cytokine levels that correlate with symptoms and lung function. An ECOPD represents not only a worsening of airflow obstruction but also increased systemic demand in a host with limited ventilatory reserve.
慢性阻塞性肺疾病（COPD）患者的全身炎症在急性加重期可能会恶化，但关于全身炎症标志物水平与急性加重期症状及生理变化之间关系的信息有限。
我们使用视觉模拟量表、肺功能测试、血常规和血浆白细胞介素（IL）-6、IL-8、白三烯B4（LTB4）、肿瘤坏死因子-α以及分泌型白细胞蛋白酶抑制剂（SLPI）水平，对20例因COPD急性加重（ECOPD）入院的患者在入院时、48小时后（中期）和出院8周后（恢复期）进行了测量。
所有患者均有呼吸困难。吸气能力的改善比第1秒用力呼气容积（FEV1）更快。与恢复期相比，入院时血浆IL-6（6.38±0.72至2.80±0.79 pg/mL；p = 0.0001）、IL-8（8.18±0.85至3.72±0.85 pg/mL；p = 0.002）和LTB4（8675±1652至2534±1813 pg/mL；p = 0.003）的平均（±标准差）水平显著升高，外周血中中性分叶核粒细胞百分比（79%至69%；p < 0.02）和杆状核粒细胞百分比（7.3%至1.0%；p < 0.01）升高，而肿瘤坏死因子-α和SLPI无变化。IL-6（r = 0.61；p = 0.01）和IL-8（r = 0.56；p = 0.04）的变化与呼吸困难的变化之间存在显著相关性，IL-6（r = -0.51；p = 0.04）和肿瘤坏死因子-α（r = -0.71；p < 0.02）的变化与FEV1的变化之间存在显著相关性。
住院的ECOPD患者全身细胞因子水平发生显著变化，这些变化与症状和肺功能相关。ECOPD不仅代表气流阻塞的恶化，还代表通气储备有限的宿主全身需求增加。
