Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark.
Am J Respir Crit Care Med. 2012 Nov 15;186(10):982-8. doi: 10.1164/rccm.201206-1113OC. Epub 2012 Sep 13.
Patients with chronic obstructive pulmonary disease (COPD) have evidence of systemic inflammation that may be implicated in the development of comorbidities.
To test the hypothesis that elevated levels of three inflammatory biomarkers are associated with increased risk of comorbidities in COPD.
We examined 8,656 patients with COPD from two large Danish population studies and during a median 5 years' follow-up recorded hospital admissions due to major comorbidities as endpoints.
We measured baseline C-reactive protein (CRP), fibrinogen, and leukocyte count, and recorded admissions due to ischemic heart disease, myocardial infarction, heart failure, type II diabetes, lung cancer, pneumonia, pulmonary embolism, hip fracture, and depression for all participants. Multifactorially adjusted risk of ischemic heart disease was increased by a factor of 2.19 (95% confidence interval, 1.48-3.23) in individuals with three biomarkers elevated (CRP > 3 mg/L, fibrinogen > 14 μmol/L, and leukocyte count > 9 × 10(9)/L) versus individuals with all three biomarkers at or below these limits. Corresponding hazard ratios were 2.32 (1.34-4.04) for myocardial infarction, 2.63 (1.71-4.04) for heart failure, 3.54 (2.03-6.19) for diabetes, 4.00 (2.12-7.54) for lung cancer, and 2.71 (2.03-3.63) for pneumonia. There were no consistent differences in risk of pulmonary embolism, hip fracture, or depression as a function of these three biomarkers.
Simultaneously elevated levels of CRP, fibrinogen, and leukocyte count are associated with a two- to fourfold increased risk of major comorbidities in COPD. These biomarkers may be an additional tool for clinicians to conduct stratified management of comorbidities in COPD.
慢性阻塞性肺疾病（COPD）患者存在全身炎症的证据，这可能与合并症的发生有关。
验证假设，即三种炎症生物标志物水平升高与 COPD 患者合并症风险增加相关。
我们检查了来自两个丹麦大型人群研究的 8656 名 COPD 患者，在中位 5 年的随访期间，以主要合并症的住院为终点。
我们测量了基线 C 反应蛋白（CRP）、纤维蛋白原和白细胞计数，并记录了所有参与者因缺血性心脏病、心肌梗死、心力衰竭、2 型糖尿病、肺癌、肺炎、肺栓塞、髋部骨折和抑郁症而住院的情况。与所有三种标志物均处于或低于这些限值的个体相比，三种标志物升高（CRP > 3mg/L、纤维蛋白原> 14μmol/L 和白细胞计数> 9×109/L）的个体，缺血性心脏病的风险增加了 2.19 倍（95%置信区间，1.48-3.23）。相应的心肌梗死危险比为 2.32（1.34-4.04），心力衰竭为 2.63（1.71-4.04），糖尿病为 3.54（2.03-6.19），肺癌为 4.00（2.12-7.54），肺炎为 2.71（2.03-3.63）。作为这三种生物标志物的函数，肺栓塞、髋部骨折或抑郁症的风险没有一致的差异。
CRP、纤维蛋白原和白细胞计数同时升高与 COPD 主要合并症的风险增加 2 至 4 倍相关。这些生物标志物可能是临床医生对 COPD 合并症进行分层管理的额外工具。
