在 COPD 患者中，局部炎症先于全身炎症发生。

Local inflammation occurs before systemic inflammation in patients with COPD.

机构信息

Department of Respiratory Medicine, The Second Xiangya Hospital, Central-South University, Changsha, Hunan, China.

出版信息

Respirology. 2010 Apr;15(3):478-84. doi: 10.1111/j.1440-1843.2010.01709.x. Epub 2010 Feb 24.

DOI:10.1111/j.1440-1843.2010.01709.x

PMID:20210891

Abstract

BACKGROUND AND OBJECTIVE

COPD is associated not only with an abnormal inflammatory response in the lung but also with systemic inflammation, including systemic oxidative stress, activation of circulating inflammatory cells and increased circulating levels of inflammatory cytokines. Understanding the nature and course of systemic inflammation in COPD is important given the potential for anti-inflammatory therapy. This study explored whether local and systemic inflammation occur concurrently in patients with COPD.

METHODS

Forty-four patients with stable COPD, 10 smoking controls and 10 non-smoking controls were enrolled in this observational study. Induced sputum and peripheral blood samples were obtained simultaneously for measurement of inflammatory cell numbers and the concentrations of IL-6 and CRP.

RESULTS

The total number of cells in the sputum total cell number, percentage of neutrophils and the concentration of IL-6 were significantly higher in smoking controls and patients with COPD than in non-smoking controls (P < 0.05 and P < 0.01, respectively). As the disease stage progressed, airway inflammatory cells and IL-6 levels increased. CRP levels in sputum were significantly higher in stage II, III and IV COPD patients than in smoking and non-smoking controls (P < 0.01). However, the peripheral WCC and percentage of neutrophils were similar in patients with COPD, smoking and non-smoking controls. Circulatory concentrations of IL-6 and CRP in stages III and IV COPD patients were significantly higher than in smoking and non-smoking controls (P < 0.05 and P < 0.01, respectively). Additionally, there were positive correlations between sputum and blood IL-6 and CRP levels (r = 0.566, P < 0.01 and r = 0.443, P < 0.01, respectively).

CONCLUSIONS

The increase in the inflammatory cell population and IL-6 and CRP levels in the airway may occur earlier than in the peripheral blood, and reflect the degree of airflow limitation better than do peripheral blood measurements. Systemic inflammation may be present in patients with severe or very severe COPD.

摘要

背景与目的

COPD 不仅与肺部异常炎症反应有关，还与全身炎症有关，包括全身氧化应激、循环炎症细胞激活和循环中炎症细胞因子水平升高。鉴于抗炎治疗的潜在可能性，了解 COPD 患者全身炎症的性质和过程非常重要。本研究探讨了 COPD 患者是否同时存在局部和全身炎症。

方法

本观察性研究纳入了 44 例稳定期 COPD 患者、10 例吸烟对照者和 10 例非吸烟对照者。同时采集诱导痰和外周血样，用于测量炎症细胞数量以及 IL-6 和 CRP 的浓度。

结果

与非吸烟对照者相比，吸烟对照者和 COPD 患者的痰总细胞数、中性粒细胞百分比和 IL-6 浓度均显著升高（P<0.05 和 P<0.01）。随着疾病分期进展，气道炎症细胞和 IL-6 水平增加。Ⅱ、Ⅲ和Ⅳ期 COPD 患者的痰 CRP 水平显著高于吸烟和非吸烟对照者（P<0.01）。然而，COPD 患者、吸烟对照者和非吸烟对照者的外周 WCC 和中性粒细胞百分比相似。Ⅲ和Ⅳ期 COPD 患者的循环 IL-6 和 CRP 浓度明显高于吸烟和非吸烟对照者（P<0.05 和 P<0.01）。此外，痰和血中 IL-6 和 CRP 水平之间呈正相关（r=0.566，P<0.01 和 r=0.443，P<0.01）。