Department of Pulmonary Rehabilitation, Ospedale Villa Pineta, University of Modena and Reggio Emilia, Modena, Italy.
Servicio de Neumología, Hospital Universitario y politecnico La Fe, CIBERES, Valencia, Spain.
Chest. 2013 Apr;143(4):1009-1017. doi: 10.1378/chest.12-1684.
Several clinical studies have evaluated the role of COPD in patients with community acquired pneumonia (CAP). We investigated the systemic inflammatory response of patients with CAP (CAP 1 COPD) and patients without associated COPD (CAP only).
Clinical, microbiologic, and immunologic data were collected from 367 prospective patients on admission to hospital during a 3-year period. Comparative analyses were performed between patients with CAP 1 COPD (n 5 117) and those with CAP only (n 5 250) and between patients with and without domiciliary use of inhaled corticosteroids (ICSs) and oral corticosteroids.
Detailed characteristics of clinical severity and prognosis (mortality on hospitalization and at 30 and 90 days) were similar between the CAP 1 COPD and CAP-only groups. The readmission rate and the frequency of previous pneumonia were higher in the group of patients with CAP 1 COPD. On day 1 (admission to hospital), patients with CAP 1 COPD had significantly lower serum levels of tumor necrosis factor- a , IL-1, and IL-6 compared with the CAP-only group; levels of the remaining inflammatory biomarkers (C-reactive protein, procalcitonin, IL-8, and IL-10) were similar at days 1 and 3. The exclusion of patients with domiciliary use of ICS and oral corticosteroids confirmed lower levels of TNF- a on day 1 in patients with CAP 1 COPD. Finally, lower levels of IL-6 were found only among those patients with COPD who were currently using ICS.
Our prospective study demonstrates a different, disease-specific, early inflammatory pattern between patients with CAP with and without associated COPD. These findings are not completely corticosteroid mediated.
几项临床研究已经评估了慢性阻塞性肺病（COPD）在社区获得性肺炎（CAP）患者中的作用。我们调查了 CAP 患者（CAP+COPD）和不伴相关 COPD 的 CAP 患者（仅 CAP）的全身炎症反应。
在 3 年期间，从 367 名住院患者中收集了临床、微生物学和免疫学数据。对 CAP+COPD 患者（n=117）和仅 CAP 患者（n=250）以及使用吸入性皮质类固醇（ICSs）和口服皮质类固醇的患者与不使用这些药物的患者进行了比较分析。
CAP+COPD 组和仅 CAP 组之间临床严重程度和预后（住院期间和 30 天及 90 天的死亡率）的详细特征相似。CAP+COPD 组患者的再入院率和既往肺炎频率较高。在第 1 天（住院时），与仅 CAP 组相比，CAP+COPD 患者的血清肿瘤坏死因子-α、IL-1 和 IL-6 水平明显较低；第 1 天和第 3 天的其余炎症生物标志物（C 反应蛋白、降钙素原、IL-8 和 IL-10）水平相似。排除在家中使用 ICS 和口服皮质类固醇的患者后，证实了 CAP+COPD 患者在第 1 天的 TNF-α水平较低。最后，仅在当前使用 ICS 的 COPD 患者中发现 IL-6 水平较低。
我们的前瞻性研究表明，CAP 合并和不合并 COPD 的患者之间存在不同的、特定于疾病的早期炎症模式。这些发现并非完全由皮质类固醇介导。
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