Yang Xia, Xu Yali, Jin Jianmin, Li Ruimin, Liu Xiaofang, Sun Yongchang
Department of Respiratory Medicine, Beijing Tongren Hospital, Capital Medical University.
Department of Respiratory Medicine, Beijing Tongren Hospital, Capital Medical University; Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2017 Feb 20;12:655-662. doi: 10.2147/COPD.S124248. eCollection 2017.
Bronchiectasis revealed by high-resolution computed tomography (HRCT) is common in chronic obstructive pulmonary disease (COPD), but the causes and risk factors remain to be determined. Chronic rhinosinusitis (CRS) is closely associated with bronchiectasis or COPD, but whether it is associated with comorbid bronchiectasis in COPD (COPD-Bx) is unknown.
Patients with stable COPD were enrolled consecutively and evaluated for the presence of CRS by questionnaire and paranasal sinus computed tomography. The presence and severity of bronchiectasis on lung HRCT were evaluated by the Smith and severity scores. COPD symptoms were evaluated by COPD Assessment Test (CAT) and Modified British Medical Research Council Questionnaire. The sputum cell differentials and concentrations of interleukin (IL)-6, IL-8, IL-5, matrix metalloproteinases-9 (MMP-9), and tissue inhibitor of matrix metalloproteinases-1 were measured.
We enrolled 136 patients with stable COPD, of which 66 (48.5%) were diagnosed with CRS according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) criteria. The prevalence of bronchiectasis was 57.6% in patients with CRS, but 37.1% in those without CRS (=0.017). COPD-Bx patients with CRS showed a significantly higher severity score of bronchiectasis than those without CRS (=0.034). COPD patients with CRS had a higher percentage of eosinophils, higher levels of IL-8, IL-6, and MMP-9 in sputum as compared to those without CRS. In COPD-Bx patients with CRS, the percentage of eosinophils and the levels of IL-6 and MMP-9 in sputum were increased as compared to those without CRS. In all the subjects, Sino-Nasal Outcome Test-20 correlated with CAT score (=0.315, <0.01) and in COPD patients with CRS, Lund-MacKay scores correlated with forced expiratory volume in 1 s (% pred) (=-0.251, <0.05).
CRS was associated with COPD-Bx and this was probably due to increased airway inflammation.
高分辨率计算机断层扫描（HRCT）显示的支气管扩张在慢性阻塞性肺疾病（COPD）中很常见，但其病因和危险因素仍有待确定。慢性鼻-鼻窦炎（CRS）与支气管扩张或COPD密切相关，但它是否与COPD合并支气管扩张（COPD-Bx）相关尚不清楚。
连续纳入稳定期COPD患者，通过问卷调查和鼻窦计算机断层扫描评估CRS的存在情况。通过史密斯评分和严重程度评分评估肺部HRCT上支气管扩张的存在情况和严重程度。通过COPD评估测试（CAT）和改良英国医学研究委员会问卷评估COPD症状。检测痰液细胞分类以及白细胞介素（IL）-6、IL-8、IL-5、基质金属蛋白酶-9（MMP-9）和基质金属蛋白酶组织抑制剂-1的浓度。
我们纳入了136例稳定期COPD患者，其中66例（48.5%）根据欧洲鼻窦炎和鼻息肉立场文件（EPOS）标准被诊断为CRS。CRS患者中支气管扩张的患病率为57.6%，而无CRS患者中为37.1%（P=0.017）。合并CRS的COPD-Bx患者支气管扩张严重程度评分显著高于无CRS患者（P=0.034）。与无CRS的COPD患者相比，合并CRS的COPD患者痰液中嗜酸性粒细胞百分比更高，IL-8、IL-6和MMP-9水平更高。在合并CRS的COPD-Bx患者中，与无CRS患者相比，痰液中嗜酸性粒细胞百分比以及IL-6和MMP-9水平升高。在所有受试者中，鼻窦结局测试-20与CAT评分相关（r=0.315，P<0.01），在合并CRS的COPD患者中，伦德-麦凯评分与第1秒用力呼气量（%预计值）相关（r=-0.251，P<0.05）。
CRS与COPD-Bx相关，这可能是由于气道炎症增加所致。
