de Torres Juan P, Pinto-Plata Victor, Casanova Ciro, Mullerova Hanna, Córdoba-Lanús Elizabeth, de Fuentes Mercedes Muros, Aguirre-Jaime Armando, Celli Bartolome R
Respiratory Research Unit, Departments, Hospital Ntra Sra de Candelaria, Tenerife, Spain.
Pulmonary and Critical Care Department, Caritas St Elizabeth's Medical Center, Boston, MA.
Chest. 2008 Jun;133(6):1336-1343. doi: 10.1378/chest.07-2433. Epub 2008 Mar 13.
Serum levels of C-reactive protein (CRP) are increased in patients with COPD and correlate modestly with variables predictive of outcomes. In epidemiologic studies, CRP level is associated with all-cause mortality in patients with mild-to-moderate disease.
To determine if CRP levels are associated with survival in patients with moderate to very severe COPD in comparison with other well-known prognostic parameters of the disease.
In 218 stable patients with COPD, we measured baseline serum CRP level, BODE (body mass index, obstruction, dyspnea, and exercise capacity) index and its components, arterial oxygenation (Pao(2)), inspiratory capacity (IC) to total lung capacity (TLC) ratio, and Charlson comorbidity score. We followed up the patients over time and evaluated the strength of the association between the variables and all-cause mortality.
During the follow-up time (median, 36 months; 25th to 75th percentiles, 24 to 50 months), 54 patients (25%) died. CRP levels were similar between survivors and the deceased (median, 3.8 mg/L; 95% confidence interval, 1.9 to 8.1; vs median, 4.5 mg/L; 95% confidence interval, 2.1 to 11.5; p = 0.22) and was not significantly associated with survival.
In this population of patients with clinically moderate to very severe COPD, the level of CRP level was not associated with survival compared with other prognostic clinical tools such as the BODE index, modified Medical Research Council scale, 6-min walk distance, percentage of predicted FEV(1), IC/TLC ratio < 0.25, and Pao(2). Other long-term studies of well-characterized patients with COPD could help determine the exact role of CRP levels as a biomarker in patients with clinical COPD.
慢性阻塞性肺疾病（COPD）患者血清C反应蛋白（CRP）水平升高，且与预测预后的变量存在一定相关性。在流行病学研究中，CRP水平与轻至中度疾病患者的全因死亡率相关。
与其他已知的COPD疾病预后参数相比，确定CRP水平是否与中度至极重度COPD患者的生存率相关。
在218例稳定期COPD患者中，我们测量了基线血清CRP水平、BODE（体重指数、气流阻塞、呼吸困难和运动能力）指数及其组成部分、动脉血氧合（Pao₂）、吸气容量（IC）与肺总量（TLC）之比以及Charlson合并症评分。我们对患者进行长期随访，并评估这些变量与全因死亡率之间关联的强度。
在随访期间（中位数为36个月；第25至75百分位数为24至50个月），54例患者（25%）死亡。存活者与死亡者的CRP水平相似（中位数为3.8mg/L；95%置信区间为1.9至8.1；与之相比，中位数为4.5mg/L；95%置信区间为2.1至11.5；p = 0.22），且与生存率无显著相关性。
在这群临床诊断为中度至极重度COPD的患者中，与其他预后临床工具如BODE指数、改良医学研究委员会量表、6分钟步行距离、预计第一秒用力呼气容积百分比、IC/TLC比值<0.25以及Pao₂相比，CRP水平与生存率无关。其他针对特征明确的COPD患者的长期研究可能有助于确定CRP水平作为临床COPD患者生物标志物的确切作用。
