Pant Sushil, Walters Eugene H, Griffiths Anne, Wood-Baker Richard, Johns David P, Reid David W
Cardio-Respiratory Research Group, Menzies Research Institute, University of Tasmania, Australia.
Respirology. 2009 May;14(4):495-503. doi: 10.1111/j.1440-1843.2009.01517.x.
There are few data on the short-term natural history of airway inflammation during severe episodes of acute exacerbation of COPD (AECOPD). An observational study was performed to determine how rapidly conventional treatment improves airway inflammation in patients admitted to hospital with AECOPD.
Twenty-four consecutive patients with AECOPD were recruited and changes in sputum inflammatory indices were assessed after 2 and 4 days of treatment. The primary end-points included presence of bacteria and viruses, changes in sputum total cell counts (TCC) and polymorphonuclear leukocyte (PMN) differential counts, and levels of secretory leukocyte protease inhibitor (SLPI), IL-8 and TNF-alpha.
All patients received oral corticosteroids and 17 (71%) were also treated with oral antibiotics. A bacterial or viral pathogen was isolated from 12 patients (50%), and Aspergillus fumigatus was isolated from one. A positive bacterial culture was associated with increased sputum TCC and PMN count (P < 0.05), as well as higher levels of IL-8 and TNF-alpha (P < 0.05), and a trend towards lower sputum SLPI levels (P = 0.06). Sputum PMN numbers fell by 70% within the first 48 h of admission (P < 0.05), accompanied by an increase in sputum SLPI (P < 0.001) and reductions in the levels of TNF-alpha (P < 0.005) and IL-8 (P = 0.06), with no further significant change at 4 days.
Conventional treatment for severe AECOPD is associated with rapid reduction of neutrophilic inflammation and improvement in anti-protease defences.
关于慢性阻塞性肺疾病急性加重（AECOPD）严重发作期间气道炎症的短期自然史的数据较少。进行了一项观察性研究，以确定常规治疗能多快改善因AECOPD入院患者的气道炎症。
连续招募了24例AECOPD患者，并在治疗2天和4天后评估痰液炎症指标的变化。主要终点包括细菌和病毒的存在情况、痰液总细胞计数（TCC）和多形核白细胞（PMN）分类计数的变化，以及分泌型白细胞蛋白酶抑制剂（SLPI）、白细胞介素-8（IL-8）和肿瘤坏死因子-α（TNF-α）的水平。
所有患者均接受口服皮质类固醇治疗，17例（71%）还接受了口服抗生素治疗。从12例患者（50%）中分离出细菌或病毒病原体，从1例患者中分离出烟曲霉。阳性细菌培养与痰液TCC和PMN计数增加（P < 0.05）、IL-8和TNF-α水平升高（P < 0.05）以及痰液SLPI水平呈降低趋势（P = 0.06）相关。入院后最初48小时内痰液PMN数量下降了70%（P < 0.05），同时痰液SLPI增加（P < 0.001），TNF-α（P < 0.005）和IL-8水平降低（P = 0.06），4天时无进一步显著变化。
重度AECOPD的常规治疗与中性粒细胞炎症的快速减轻和抗蛋白酶防御功能的改善有关。
