Increased systemic inflammation is a risk factor for COPD exacerbations
Increased systemic inflammation is a risk factor for COPD exacerbations
复制标题
DOI：
10.1378/chest.07-1342
复制
发表时间：
2008-02-01
期刊：
影响因子：
9.6
通讯作者：
Wouters, Entiel F. M.
中科院分区：
文献类型：
--
作者：
Groenewegen, Karin H.;Postma, Dirkje S.;Wouters, Entiel F. M.
背景：慢性阻塞性肺病的特点是呼吸系统症状的发作性增加，即所谓的恶化。慢性阻塞性肺病加重与局部和全身炎症的增加有关。对先前发表的一项研究的数据进行分析，以确定急性加重的预测因素，特别是全身性炎症。目的：确定基线测量的全身炎症状态升高是否与COPD患者急性加重的发生有关。方法：前瞻性记录1年内中度（需要口服强的松龙）和重度恶化（需要住院治疗）的发生情况。在研究开始时，测定肺功能值（FEV1、FVC、功能残余量、肺对一氧化碳的弥散量[DLCO]）和血清c反应蛋白、纤维蛋白原、脂多糖结合蛋白、肿瘤坏死因子α及其可溶性受体（可溶性TNF受体55和75）作为全身炎症标志物的水平。结果：对314例患者进行了277人年的随访分析：186例患者发生了411次恶化（374例中度和37例重度）。多变量分析显示，较高的初始纤维蛋白原水平和较低的FEV1预示着较高的中度和重度恶化率。严重恶化的其他独立预测因子是较高的研究前严重恶化次数和较低的DLCO。较高的研究前中度加重次数是中度加重率的唯一额外独立危险因素。结论：本研究表明，除肺功能损害外，以纤维蛋白原水平升高为表现的全身性炎症是COPD加重的独立危险因素。全身炎症的衰减可能为COPD患者的管理提供新的视角，以减轻加重的负担。
Background: COPD is characterized by episodic increases in respiratory symptoms, so-called exacerbations. COPD exacerbations are associated with an increase in local and systemic inflammation. Data of a previously published study in a well-characterized COPD cohort were analyzed to define predictive factors of acute exacerbations, particularly focusing on systemic inflammation.Objective: To determine if an elevated systemic inflammatory status measured at baseline is related to the occurrence of acute exacerbations in patients with COPD.Methods: The occurrence of moderate (requiring oral prednisolone) and severe exacerbations (requiring hospitalization) was prospectively recorded over 1 year. At the beginning of the study, lung function values (FEV1, FVC, functional residual capacity, and diffusion capacity of the lung for carbon monoxide [DLCO]) and serum levels of C-reactive protein, fibrinogen, lipopolysaccharide binding protein, tumor necrosis factor (TNF)-alpha, and its soluble receptors (soluble TNF receptors 55 and 75) as markers of systemic inflammation were determined.Results: Two hundred seventy-seven person-years of follow-up were analyzed in the total group of 314 patients: 186 patients were responsible for 411 exacerbations (374 moderate and 37 severe). Multivariate analyses showed that a higher initial fibrinogen level and a lower FEV1 predicted a higher rate of both moderate and severe exacerbations. Additional independent predictors of a severe exacerbation were a higher number of prestudy severe exacerbations and lower DLCO. A higher number of prestudy moderate exacerbations was the only additional independent risk factor for the rate of moderate exacerbations.Conclusion: This study demonstrates that besides lung function impairment systemic inflammation manifested by elevated fibrinogen levels is an independent risk factor for exacerbations of COPD. Attenuation of systemic inflammation may offer new perspectives in the management of COPD patients to reduce the burden of exacerbations.