Raised CRP levels mark metabolic and functional impairment in advanced COPD
Raised CRP levels mark metabolic and functional impairment in advanced COPD
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DOI：
10.1136/thx.2005.041996
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发表时间：
2006-01-01
期刊：
影响因子：
10
通讯作者：
Schols, AMWJ
中科院分区：
文献类型：
--
作者：
Broekhuizen, R;Wouters, EFM;Schols, AMWJ
背景：c反应蛋白（CRP）常被用作急性全身性炎症的临床标志。由于低级别炎症在慢性阻塞性肺疾病（COPD）等慢性疾病中很明显，因此已经开发了新的方法来提高CRP检测在较低范围内的敏感性。一项研究旨在探讨高敏CRP在COPD中对局部和全身损害、残疾和残疾标志物的鉴别价值。方法：测定102例临床稳定期COPD （GOLD II - IV期）患者血浆CRP水平、白细胞介素6 （IL-6）水平、体成分、静息能量消耗（REE）、运动能力、健康状况和肺功能。正常与升高CRP水平的临界值为4.21 mg/l。结果：102例患者中48例CRP水平升高。在这些患者中，IL-6 （p< 0.001）和REE（经无脂质量调整，p = 0.002）较高，最大（p = 0.040）和次最大运动能力（p = 0.017）和6分钟步行距离（p = 0.014）较低。CRP水平升高的患者SGRQ症状评分（p = 0.003）较低，支气管扩张剂后FEV1 （p = 0.031）和可逆性（p = 0.001）也较低。回归分析还显示，当校正FEV1、年龄和性别后，CRP是体重指数（p = 0.044）和脂肪质量指数（p = 0.016）的显著预测因子。结论：高敏CRP是COPD患者呼吸系统症状引起的能量代谢、功能能力受损和窘迫的标志。
Background: C-reactive protein (CRP) is often used as a clinical marker of acute systemic inflammation. Since low grade inflammation is evident in chronic diseases such as chronic obstructive pulmonary disease ( COPD), new methods have been developed to enhance the sensitivity of CRP assays in the lower range. A study was undertaken to investigate the discriminative value of high sensitivity CRP in COPD with respect to markers of local and systemic impairment, disability, and handicap.Methods: Plasma CRP levels, interleukin 6 (IL-6) levels, body composition, resting energy expenditure (REE), exercise capacity, health status, and lung function were determined in 102 patients with clinically stable COPD ( GOLD stage II - IV). The cut off point for normal versus raised CRP levels was 4.21 mg/l.Results: CRP levels were raised in 48 of 102 patients. In these patients, IL-6 ( p< 0.001) and REE ( adjusted for fat-free mass, p = 0.002) were higher while maximal ( p = 0.040) and submaximal exercise capacity ( p = 0.017) and 6 minute walking distance ( p = 0.014) were lower. The SGRQ symptom score ( p = 0.003) was lower in patients with raised CRP levels, as were post-bronchodilator FEV1 ( p = 0.031) and reversibility ( p = 0.001). Regression analysis also showed that, when adjusted for FEV1, age and sex, CRP was a significant predictor for body mass index ( p = 0.044) and fat mass index ( p = 0.016).Conclusions: High sensitivity CRP is a marker for impaired energy metabolism, functional capacity, and distress due to respiratory symptoms in COPD.