慢性阻塞性肺疾病患者的左心室功能障碍与全身炎症的关系。
Left ventricular dysfunction in relation with systemic inflammation in chronic obstructive pulmonary disease patients.
机构信息
Department of Chest Diseases, Adnan Menderes University School of Medicine, Aydin, Turkey.
Department of Cardiology, Adnan Menderes University School of Medicine, Aydin, Turkey.
出版信息
Korean J Intern Med. 2019 May;34(3):569-578. doi: 10.3904/kjim.2017.366. Epub 2018 Oct 29.
BACKGROUND/AIMS: Most important cause of mortality in chronic obstructive pulmonary disease (COPD) patients is known to be cardiovascular disease (CVD). The objective of the present study was to evaluate the echocardiographic parameters in COPD patients with or without pre-diagnosed CVD and to investigate the relationship between echocardiographic parameters and systemic inflammation markers.
METHODS
A total of 60 stable COPD patients (23 patients with CVD, group 1; 37 patients without CVD, group 2) and 21 healthy controls (group 3) were included in the study. Six-minute walking test (6MWT), COPD assessment test (CAT), and Body mass index, airflow Obstruction, Dyspnea, and Exercise (BODE) index results were recorded. High-sensitivity C-reactive protein (HsCRP), interleukin 8 (IL-8), fetuin-A, Clara cell protein (CCL-16), N-terminal pro-brain natriuretic peptide levels were studied in serum. Parameters of left and right ventricular systolic and diastolic function were measured by echocardiography.
RESULTS
Patients with COPD had higher levels of systemic inflammation markers and lower level of inflammation inhibitor fetuin-A. When three groups were compared, group 1 had lower 6MWT result. HsCRP was highest in group 2 while other inflammatory markers were similar in groups 1 and 2. Regarding echocardiographic parameters, left ventricular ejection fraction (LVEF) was lower and left ventricle end-diastolic diameter (LVED), left ventricle end-systolic diameter (LVES) diameters were higher in group 1. The aortic diameter was higher in COPD patients. Fetuin-A was correlated with diameter of aorta and LVES. LVEF, LVED, and LVES were found to be correlated with functional parameters of COPD cases.
CONCLUSION
In COPD, left ventricular functions are affected as well as right ventricle before prominent clinical findings of cardiac disease and these echocardiographic parameters correlate with functional parameters of COPD patients.
背景/目的：慢性阻塞性肺疾病（COPD）患者死亡的最重要原因已知是心血管疾病（CVD）。本研究的目的是评估有或无预先诊断的 CVD 的 COPD 患者的超声心动图参数，并研究超声心动图参数与全身炎症标志物之间的关系。
方法
共纳入 60 例稳定的 COPD 患者（23 例合并 CVD，第 1 组；37 例无 CVD，第 2 组）和 21 例健康对照者（第 3 组）。记录 6 分钟步行试验（6MWT）、COPD 评估测试（CAT）、体重指数、气流阻塞、呼吸困难和运动（BODE）指数结果。研究血清中超敏 C 反应蛋白（hsCRP）、白细胞介素 8（IL-8）、胎球蛋白 A、克拉拉细胞蛋白（CCL-16）、N 端脑钠肽前体水平。通过超声心动图测量左、右心室收缩和舒张功能的参数。
结果
COPD 患者的全身炎症标志物水平较高，炎症抑制剂胎球蛋白 A 水平较低。三组比较时，第 1 组 6MWT 结果较低。第 2 组 hsCRP 最高，而第 1 组和第 2 组的其他炎症标志物相似。在超声心动图参数方面，第 1 组左心室射血分数（LVEF）较低，左心室舒张末期直径（LVED）、左心室收缩末期直径（LVES）较大。COPD 患者的主动脉直径较高。胎球蛋白 A 与主动脉直径和 LVES 直径相关。LVEF、LVED 和 LVES 与 COPD 患者的功能参数相关。
结论
在 COPD 中，在出现明显的心脏病临床发现之前，左心室功能以及右心室也会受到影响，这些超声心动图参数与 COPD 患者的功能参数相关。
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