Department of Respiratory Medicine, the Second Affiliated Hospital of Jilin University, Changchun, Jilin, China.
PLoS One. 2013 May 31;8(5):e57678. doi: 10.1371/journal.pone.0057678. Print 2013.
Patients with chronic obstructive pulmonary disease (COPD) commonly suffer from acute exacerbations (AECOPD) and display varying disease severity. However, there is no available biomarker for the classification of AECOPD. This study is aimed at investigating the sputum cellular profiles to classify patients with AECOPD.
A total of 83 patients with AECOPD and 26 healthy controls were recruited. Their demographic and clinical characteristics were recorded, and their lung function was examined. The phenotypes of sputum inflammatory cells were characterised, and the concentrations of sputum and serum amyloid-A (SAA), C-reactive protein (CRP), interleukin-6 (IL-6), and matrix metalloproteinase-9 (MMP-9) were measured. Based on the sputum inflammatory cell profiles, individual patients were categorized into one of the four subgroups with inflammatory eosinophilic, neutrophilic, paucigranulocytic, and mixed granulocytic AECOPD. Most AECOPD patients were reevaluated within 12-14 months after discharge.
There were 10 (12%) eosinophilic, 36 (43%) neutrophilic, 5 (6%) mixed granulocytic, and 32 (39%) paucigranulocytic AECOPD patients. The patients with mixed granulocytic or neutrophilic AECOPD had a higher BODE score, more sputum inflammatory cells, lower lung function, and longer hospital stay, accompanied by higher concentrations of sputum MMP-9, IL-6 and CRP, and serum SAA, IL-6 and CRP. Notably, 83% of patients with neutrophilic AECOPD displayed evidence of bacterial infection and many of them responded poorly to standard therapies. In addition, patients with mixed granulocytic or neutrophilic stable COPD remained at lower lung functions and higher levels of inflammation.
Patients with AECOPD display heterogeneous inflammation, and the profiles of sputum inflammatory cells may be used as valuable biomarkers for the classification of AECOPD patients.
慢性阻塞性肺疾病（COPD）患者常患有急性加重（AECOPD），并表现出不同的疾病严重程度。然而，目前尚无用于 AECOPD 分类的生物标志物。本研究旨在通过研究痰细胞谱来对 AECOPD 患者进行分类。
共招募了 83 例 AECOPD 患者和 26 例健康对照者。记录了他们的人口统计学和临床特征，并检查了他们的肺功能。对痰炎症细胞的表型进行了特征描述，并测量了痰和血清淀粉样蛋白 A（SAA）、C 反应蛋白（CRP）、白细胞介素 6（IL-6）和基质金属蛋白酶 9（MMP-9）的浓度。根据痰炎症细胞谱，将个别患者分为炎症性嗜酸性粒细胞、中性粒细胞、少粒细胞和混合粒细胞性 AECOPD 四个亚组之一。大多数 AECOPD 患者在出院后 12-14 个月内进行了重新评估。
10 例（12%）为嗜酸性粒细胞性 AECOPD，36 例（43%）为中性粒细胞性 AECOPD，5 例（6%）为混合粒细胞性 AECOPD，32 例（39%）为少粒细胞性 AECOPD。混合粒细胞性或中性粒细胞性 AECOPD 患者 BODE 评分较高，痰炎症细胞较多，肺功能较低，住院时间较长，同时痰 MMP-9、IL-6 和 CRP 以及血清 SAA、IL-6 和 CRP 浓度较高。值得注意的是，83%的中性粒细胞性 AECOPD 患者存在细菌感染证据，且其中许多患者对标准治疗反应不佳。此外，混合粒细胞性或中性粒细胞性稳定 COPD 患者的肺功能仍然较低，炎症水平仍然较高。
AECOPD 患者表现出异质性炎症，痰炎症细胞谱可作为 AECOPD 患者分类的有价值的生物标志物。
