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慢性阻塞性肺疾病是一种加速衰老性疾病吗?

Is Chronic Obstructive Pulmonary Disease an Accelerated Aging Disease?

作者信息

MacNee William

机构信息

Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom.

出版信息

Ann Am Thorac Soc. 2016 Dec;13 Suppl 5:S429-S437. doi: 10.1513/AnnalsATS.201602-124AW.

Abstract

Aging is one of the most important risk factors for most chronic diseases. The worldwide increase in life expectancy has been accompanied by an increase in the prevalence of age-related diseases that result in significant morbidity and mortality and place an enormous burden on healthcare and resources. Aging is a progressive degeneration of the tissues that has a negative impact on the structure and function of vital organs. The lung ages, resulting in decreased function and reduced capacity to respond to environmental stresses and injury. Many of the changes that occur in the lungs with normal aging, such as decline in lung function, increased gas trapping, loss of lung elastic recoil, and enlargement of the distal air spaces, also are present in chronic obstructive pulmonary disease (COPD). The prevalence of COPD is two to three times higher in people over the age of 60 years than in younger age groups. Indeed, COPD has been considered a condition of accelerated lung aging. Several mechanisms associated with aging are present in the lungs of patients with COPD. Cell senescence is present in emphysematous lungs and is associated with shortened telomeres and decreased antiaging molecules, suggesting accelerated aging in the lungs of patients with COPD. Increasing age leads to elevated basal levels of inflammation and oxidative stress (inflammaging) and to increased immunosenescence associated with changes in both the innate and adaptive immune responses. These changes are similar to those that occur in COPD and may enhance the activity of the disease as well as increase susceptibility to exacerbations in patients with COPD. Understanding the mechanism of age-related changes in COPD may identify novel therapies for this condition.

摘要

衰老是大多数慢性疾病最重要的风险因素之一。全球预期寿命的增加伴随着与年龄相关疾病患病率的上升,这些疾病导致了显著的发病率和死亡率,并给医疗保健和资源带来了巨大负担。衰老是组织的渐进性退化,对重要器官的结构和功能产生负面影响。肺会衰老,导致功能下降以及应对环境压力和损伤的能力降低。正常衰老过程中肺部发生的许多变化,如肺功能下降、气体潴留增加、肺弹性回缩丧失和远端气腔扩大,在慢性阻塞性肺疾病(COPD)中也存在。60岁以上人群中COPD的患病率比年轻人群高两到三倍。事实上,COPD被认为是一种加速肺衰老的疾病。COPD患者的肺部存在几种与衰老相关的机制。细胞衰老存在于肺气肿肺中,与端粒缩短和抗衰老分子减少有关,提示COPD患者肺部加速衰老。年龄增长导致基础炎症水平和氧化应激(炎症衰老)升高,并导致与固有免疫和适应性免疫反应变化相关的免疫衰老增加。这些变化与COPD中发生的变化相似,可能会增强疾病的活动,并增加COPD患者急性加重的易感性。了解COPD中与年龄相关变化的机制可能会确定针对这种疾病的新疗法。

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