Perez T, Mal H, Aguilaniu B, Brillet P-Y, Chaouat A, Louis R, Muir J-F, Similowski T, Berger P, Burgel P-R, Chambellan A, Chanez P, Devillier P, Escamilla R, Marthan R, Wallaert B, Aubier M, Roche N
Service de pneumologie et immuno-allergologie, hôpital Calmette, CHRU de Lille, boulevard du Professeur-J.-Leclercq, Lille, France.
Rev Mal Respir. 2011 Feb;28(2):192-215. doi: 10.1016/j.rmr.2010.08.011. Epub 2011 Feb 12.
The objective of the present article is to review available data on possible links between phenotypes and inflammatory profiles in patients with chronic obstructive pulmonary disease (COPD).
Chronic bronchitis is associated with proximal bronchial inflammation and small airway inflammation with remodeling at the site of obstruction. CT scanning enables patients to be phenotyped according to the predominantly bronchial or emphysematous nature of the morphological abnormality. Exacerbations, in a context of persistently elevated baseline inflammation, are associated with increased inflammation and a poor prognosis. Long-term studies have correlated inflammatory markers (and anti-inflammatory drug effects) with dynamic hyperinflation, possibly confirming that inflammation promotes hyperinflation. The inflammatory cell count in the pulmonary arterial walls correlates with the severity of endothelial dysfunction. The risk of developing pulmonary hypertension would seem to increase with low-grade systemic inflammation. The role of low-grade systemic inflammation in COPD co-morbidities, and in nutritional and muscular involvement in particular, remains a matter of debate. Regular physical exercise may help reduce this inflammation.
In COPD, many aspects of the clinical phenotype are related to inflammation. Better knowledge of these relationships could help optimize current and future treatments.
本文的目的是回顾慢性阻塞性肺疾病（COPD）患者表型与炎症特征之间可能联系的现有数据。
慢性支气管炎与近端支气管炎症以及阻塞部位伴有重塑的小气道炎症相关。CT扫描能够根据形态学异常主要是支气管性还是肺气肿性对患者进行表型分类。在基线炎症持续升高的情况下，急性加重与炎症增加及预后不良相关。长期研究已将炎症标志物（以及抗炎药物作用）与动态肺过度充气相关联，这可能证实炎症促进肺过度充气。肺动脉壁中的炎症细胞计数与内皮功能障碍的严重程度相关。肺动脉高压的发生风险似乎会随着低度全身炎症而增加。低度全身炎症在COPD合并症中，尤其是在营养和肌肉受累方面的作用仍存在争议。规律的体育锻炼可能有助于减轻这种炎症。
在COPD中，临床表型的许多方面都与炎症有关。更好地了解这些关系有助于优化当前和未来的治疗。
