Karadag Fisun, Kirdar Sevin, Karul Aslihan B, Ceylan Emel
Department of Chest Diseases, School of Medicine, Adnan Menderes University, Aydin, Turkey.
Eur J Intern Med. 2008 Mar;19(2):104-8. doi: 10.1016/j.ejim.2007.04.026.
Systemic aspects of chronic obstructive pulmonary disease (COPD) include oxidative stress and altered circulating levels of inflammatory mediators and acute-phase proteins. C-reactive protein (CRP) reflects total systemic burden of inflammation in several disorders and has been shown to upregulate the production of proinflammatory cytokines. The aim of this study was to evaluate circulating CRP levels to determine the value of CRP as a biomarker of systemic inflammation and as an indicator of malnutrition or severity of COPD in stable COPD patients in comparison to the proinflammatory cytokines tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6).
Thirty-five male patients with stable COPD and 30 age- and sex-matched subjects with normal pulmonary function were admitted to the study. Serum CRP levels were measured using a commercially available kit with the turbidimetric method. Serum TNF-alpha and IL-6 concentrations were measured with ELISA kits.
Sixty percent of the patients had severe or very severe and 40% moderate COPD. Serum CRP was significantly higher in stable COPD patients than in control subjects (p<0.001), while TNF-alpha and IL-6 concentrations were not statistically different. Serum TNF-alpha was higher in severe or very severe COPD patients (p=0.046). When the COPD patients with a low BMI were compared to those with a normal-to-high BMI, there was a significant difference in CRP (p=0.034) and TNF-alpha (p=0.037).
The present study confirms that circulating CRP levels are higher in stable COPD patients and may thus be regarded as a valid biomarker of low-grade systemic inflammation. In addition, CRP is significantly higher in COPD patients with a low BMI and thus, together with TNF-alpha, may be considered an indicator of malnutrition in COPD patients.
慢性阻塞性肺疾病（COPD）的全身表现包括氧化应激以及炎症介质和急性期蛋白的循环水平改变。C反应蛋白（CRP）反映了多种疾病中炎症的总体全身负担，并且已被证明可上调促炎细胞因子的产生。本研究的目的是评估循环中CRP水平，以确定CRP作为全身炎症生物标志物以及与促炎细胞因子肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）相比，作为稳定期COPD患者营养不良或COPD严重程度指标的价值。
35例稳定期COPD男性患者和30例年龄及性别匹配、肺功能正常的受试者纳入本研究。使用市售试剂盒通过比浊法测量血清CRP水平。用ELISA试剂盒测量血清TNF-α和IL-6浓度。
60%的患者患有重度或极重度COPD，40%为中度COPD。稳定期COPD患者的血清CRP显著高于对照组（p<0.001），而TNF-α和IL-6浓度无统计学差异。重度或极重度COPD患者的血清TNF-α较高（p=0.046）。将BMI低的COPD患者与BMI正常至高的患者进行比较时，CRP（p=0.034）和TNF-α（p=0.037）存在显著差异。
本研究证实，稳定期COPD患者的循环CRP水平较高，因此可被视为低度全身炎症的有效生物标志物。此外，BMI低的COPD患者的CRP显著更高，因此，与TNF-α一起，可被视为COPD患者营养不良的指标。
