Systemic and upper and lower airway inflammation at exacerbation of chronic obstructive pulmonary disease
Systemic and upper and lower airway inflammation at exacerbation of chronic obstructive pulmonary disease
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DOI：
10.1164/rccm.200505-704oc
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发表时间：
2006-01-01
影响因子：
24.7
通讯作者：
Wedzicha, JA
中科院分区：
文献类型：
--
作者：
Hurst, JR;Perera, WR;Wedzicha, JA
基本原理：除了肺部受累，稳定的慢性阻塞性肺疾病（COPD）还与鼻腔和全身炎症有关。尽管COPD急性加重与肺部和全身炎症增加有关，但全身反应的决定因素仍然不清楚，也不知道是否有鼻腔受累。目的：研究COPD急性加重时的上气道、下气道和全身炎症。我们对41例急性发作患者的痰液、鼻洗液和血清进行了采样（东伦敦队列）进行病原微生物和炎症指标分析（痰液/鼻洗液白细胞、白细胞介素[IL]-6，IL-8和髓过氧化物酶;血清IL-6和C-反应蛋白）。数值与稳定期COPD进行比较。测量和主要结果：COPD急性加重与鼻、痰和血清炎症的相关性大于稳定期。在急性发作时，鼻洗液和血清中的炎性标志物高度相关（所有r >= 0.62，p < 0.001），但痰液中的炎性标志物不相关。上气道炎症的程度与下气道炎症的程度相关（例如，鼻洗液/痰液髓过氧化物酶; r = 0.50，p = 0.001）。全身炎症的程度与下气道炎症的程度相关（例如，血清IL-6/痰液IL-8; r = 0.35，p = 0.026），并且在存在痰液细菌病原体的情况下更大（29.0 g/dl C-反应蛋白差异，p = 0.002）。我们没有发现上呼吸道和全身compartment.Conclusions之间的关系：COPD的加重与泛气道炎症;全身炎症反应是成比例的，发生在下呼吸道和更大的细菌病原体的存在。
Rationale: In addition to pulmonary involvement, stable chronic obstructive pulmonary disease (COPD) is associated with nasal and systemic inflammation. Although exacerbations of COPD are associated with increased pulmonary and systemic inflammation, determinants of the systemic response remain obscure, and nor is it known whether there is nasal involvement.Objectives: To investigate upper airway, lower airway, and systemic inflammation at exacerbation of COPD.Methods: We sampled sputum, nasal wash, and serum from 41 exacerbations (East London cohort) for analysis of pathogenic microorganisms and inflammatory indices (sputum/nasal wash leukocytes, interleukin [IL]-6, IL-8, and myeloperoxidase; serum IL-6 and C-reactive protein). Values were compared with stable COPD.Measurements and Main Results: Exacerbation of COPD is associated with greater nasal, sputum, and serum inflammation than the stable state. At exacerbation, inflammatory markers were highly correlated within nasal wash and serum (all r >= 0.62, p < 0.001), but not sputum. The degree of upper airway inflammation correlated with the degree of lower airway inflammation (e.g., nasal wash/sputum myeloperoxidase; r = 0.50, p = 0.001). The degree of systemic inflammation correlated with the degree of lower airway inflammation (e.g., serum IL-6/sputum IL-8; r = 0.35, p = 0.026), and was greater in the presence of a sputum bacterial pathogen (29.0 g/dl C-reactive protein difference, p = 0.002). We did not find relationships between the upper airway and systemic compartments.Conclusions: Exacerbation of COPD is associated with pan-airway inflammation; the systemic inflammatory response is proportional to that occurring in the lower airway and greater in the presence of a bacterial pathogen.