Chronic bronchitis before age 50 years predicts incident airflow limitation and mortality risk.
Chronic bronchitis before age 50 years predicts incident airflow limitation and mortality risk.
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DOI：
10.1136/thx.2008.110619
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发表时间：
2009-10
期刊：
影响因子：
10
通讯作者：
Martinez FD
中科院分区：
文献类型：
--
作者：
Guerra S;Sherrill DL;Venker C;Ceccato CM;Halonen M;Martinez FD
先前关于慢性支气管炎与偶发气流限制和全因死亡率之间关系的研究提供了相互矛盾的结果，阳性结果主要是在包括年轻人的研究中报告的。我们试图确定在没有气流限制的情况下，慢性咳嗽和产痰是否与气流限制的发病、全因死亡率、CRP和IL-8的血清水平有关，以及受试者的年龄是否影响这些关系。我们在长期的图森气道阻塞性疾病流行病学研究中确定了1412名参与者，他们在入组时（1972-73）年龄为21-80岁，FEV1/FVC≥70%，无哮喘。慢性支气管炎定义为连续≥2年，且连续≥3个月，大部分时间咳嗽、有痰。气流受限发生率定义为FEV1/FVC<70%的首次随访调查。在入组调查的冷冻保存样本中测量血清IL-8和CRP水平。在调整协变量后，慢性支气管炎在入组时显著增加了<50岁受试者发生气流受限和全因死亡的风险（风险比，95% CI分别为2.2,1.3-3.8；和2.2,1.3-3.8），但在≥50岁受试者中没有增加（0.9,0.6-1.4；和1.0,0.7-1.3）。慢性支气管炎仅在年龄<50岁的受试者中与血清IL-8和CRP水平升高有关。在<50岁的成年人中，慢性支气管炎不伴有气流限制可能是吸烟对全身炎症易感性的早期标志，也是慢性阻塞性肺疾病和全因死亡的长期风险。
Previous studies on the relation of chronic bronchitis to incident airflow limitation and all-cause mortality have provided conflicting results, with positive findings reported mainly by studies that included populations of young adults. We sought to determine whether having chronic cough and sputum production in the absence of airflow limitation is associated with onset of airflow limitation, all-cause mortality, and serum levels of CRP and IL-8, and whether subjects’ age influences these relations. We identified 1412 participants in the long-term Tucson Epidemiological Study of Airway Obstructive Disease who at enrollment (1972–73) were 21–80 years old and had FEV1/FVC≥70% and no asthma. Chronic bronchitis was defined as cough and phlegm production on most days for ≥three months in ≥two consecutive years. Incidence of airflow limitation was defined as the first follow-up survey with FEV1/FVC<70%. Serum IL-8 and CRP levels were measured in cryopreserved samples from the enrollment survey. After adjusting for covariates, chronic bronchitis at enrollment increased significantly the risk for incident airflow limitation and all-cause mortality among subjects <50 years old (Hazard Ratios, 95% CI: 2.2, 1.3–3.8; and 2.2, 1.3–3.8; respectively), but not among subjects ≥50 years old (0.9, 0.6–1.4; and 1.0, 0.7–1.3). Chronic bronchitis was associated with increased IL-8 and CRP serum levels only among subjects <50 years old. Among adults <50 years old, chronic bronchitis unaccompanied by airflow limitation may represent an early marker of susceptibility to the effects of cigarette smoking on systemic inflammation and long-term risk for chronic obstructive pulmonary disease and all-cause mortality.