Saldías P Fernando, Díaz P Orlando, Dreyse D Jorge, Gaggero B Aldo, Sandoval A Christian, Lisboa B Carmen
Servicio de Medicina Interna, Hospital San Juan de Dios, Santiago, Chile.
Rev Med Chil. 2012 Jan;140(1):10-8. Epub 2012 Apr 12.
The etiology of acute exacerbations of chronic obstructive pulmonary disease (COPD) is heterogeneous and still under discussion. Inflammation increases during exacerbation of COPD. The identification of inflammatory changes will increase our knowledge and potentially guide therapy.
To identify which inflammatory parameters increase during COPD exacerbations compared to stable disease, and to compare bacterial and viral exacerbations.
In 85 COPD patients (45 males, mean age 68 ± 8 years, FEV1 46 ± 17% of predicted) sputum, nasopharyngeal swabs and blood samples were collected to identify the causative organism, during a mild to moderate exacerbation. Serum ultrasensitive C reactive protein (CRP), fibrinogen and interleukin 6 (IL 6), neutrophil and leukocyte counts were measured in stable conditions, during a COPD exacerbation, 15 and 30 days post exacerbation.
A total of 120 mild to moderate COPD exacerbations were included. In 74 (61.7%), a microbial etiology could be identified, most commonly Mycoplasma pneumoniae (15.8%), Rhinovirus (15%), Haemophilus influenzae (14.2%), Chlamydia pneumoniae (11.7%), Streptococcus pneumoniae (5.8%) and Gram negative bacilli (5.8%). Serum CRP, fibrinogen and IL 6, and neutrophil and leukocyte counts significantly increased during exacerbation and recovered at 30 days post exacerbation. Compared to viral exacerbations, bacterial aggravations were associated with a systemic inflammation of higher magnitude.
Biomarkers of systemic inflammation increase during mild to moderate COPD exacerbations. The increase in systemic inflammation seems to be limited to exacerbations caused by bacterial infections.
慢性阻塞性肺疾病（COPD）急性加重的病因具有异质性，仍在讨论中。COPD加重期间炎症会增加。识别炎症变化将增加我们的认识，并有可能指导治疗。
确定与稳定期疾病相比，哪些炎症参数在COPD加重期间会增加，并比较细菌和病毒引起的加重情况。
在85例COPD患者（45例男性，平均年龄68±8岁，FEV1为预测值的46±17%）中，在轻度至中度加重期间收集痰液、鼻咽拭子和血液样本以确定病原体。在稳定期、COPD加重期间、加重后15天和30天测量血清超敏C反应蛋白（CRP）、纤维蛋白原和白细胞介素6（IL-6）、中性粒细胞和白细胞计数。
共纳入120例轻度至中度COPD加重病例。在74例（61.7%）中，可以确定微生物病因，最常见的是肺炎支原体（15.8%）、鼻病毒（15%）、流感嗜血杆菌（14.2%）、肺炎衣原体（11.7%）、肺炎链球菌（5.8%）和革兰氏阴性杆菌（5.8%）。血清CRP、纤维蛋白原和IL-6以及中性粒细胞和白细胞计数在加重期间显著增加，并在加重后30天恢复。与病毒引起的加重相比，细菌引起的加重与更高程度的全身炎症相关。
在轻度至中度COPD加重期间，全身炎症的生物标志物会增加。全身炎症的增加似乎仅限于由细菌感染引起的加重。
