CAJ | 학술논문

目的初步探讨稳定期慢性阻塞性肺疾病(COPD)气道炎症与系统性炎症的关系.方法入选符合中华医学会呼吸病学分会2007年COPD指南的稳定期COPD患者35例.检测肺功能、痰定量细菌培养及痰细胞计数与分类、测定血浆纤维蛋白原、血清C反应蛋白(C-reactive protein,CRP)水平,分析气道炎症与系统性炎症关系.结果 ①19例患者存在下呼吸道细菌定植(l0wer airway bacterialcolonization,LABC).LABC阳性组痰中性粒细胞、淋巴细胞均明显高于阴性组(P=0.008及P=0.011).②LABC阳性组与阴性组的血清CRP和血浆Fbg水平均无明显差异(P值均＞0.05).③LABC定植量与血清CRP、血浆Fbg水平均无明显相关性(P值均＞0.05).④血清CRP、血浆Fbg水平与痰中性粒细胞、淋巴细胞均无显著相关(P值均＞0.05).⑤FEV1占预计值百分比(FEV1%pred)与血清CRP水平无显著相关(r=-0.230,P=0.292),FEV1%pred与血浆Fbg水平呈明显负相关(r=-0.571,P=0.014).结论 54.29%的稳定期COPD患者存在LABC,LABC是气道慢性炎症的重要原因之一;气道炎症可能不是引起系统性炎症的原因,但本研究因样本量偏少,此结论尚待进一步研究证实;系统性炎症与肺功能障碍有密切的关系.
목적 초보탐토은정기만성조새성폐질병(COPD)기도염증여계통성염증적관계.방법 입선부합중화의학회호흡병학분회2007년COPD지남적은정기COPD환자35례.검측폐공능、담정량세균배양급담세포계수여분류、측정혈장섬유단백원、혈청C반응단백(C-reactive protein,CRP)수평,분석기도염증여계통성염증관계.결과 ①19례환자존재하호흡도세균정식(l0wer airway bacterialcolonization,LABC).LABC양성조담중성립세포、림파세포균명현고우음성조(P=0.008급P=0.011).②LABC양성조여음성조적혈청CRP화혈장Fbg수평균무명현차이(P치균＞0.05).③LABC정식량여혈청CRP、혈장Fbg수평균무명현상관성(P치균＞0.05).④혈청CRP、혈장Fbg수평여담중성립세포、림파세포균무현저상관(P치균＞0.05).⑤FEV1점예계치백분비(FEV1%pred)여혈청CRP수평무현저상관(r=-0.230,P=0.292),FEV1%pred여혈장Fbg수평정명현부상관(r=-0.571,P=0.014).결론 54.29%적은정기COPD환자존재LABC,LABC시기도만성염증적중요원인지일;기도염증가능불시인기계통성염증적원인,단본연구인양본량편소,차결론상대진일보연구증실;계통성염증여폐공능장애유밀절적관계.
Objective The aim of this prospective study was to investigate the association between airway inflammation and systemic inflammation in stable patients with chronic obstructive pulmonary disease (COPD). Methods A total of 35 stable patients with COPD were enrolled in this study. Induced sputum and blood samples were obtained from all of the patients for sputum quantitative bacterial cultures,sputum cell counts,analysed the plasma levels of fibrinogen (Fbg) and the serum levels of high sensitivity C- reactive protein (CRP). Results ①There were 19 COPD patients with lower airway bacterial colonization (LABC). Patients with LABC had significantly greater relative neutrophil counts number in the sputum than those without LABC ( P =0. 008). Similarly,the number of lymphocyte in the sputum was correlated with LABC ( P =0. 011). ②The serum levels of CRP and the plasma levels of Fbg were measured. Subjects with colonized COPD had not significantly greater absolute CRP levels in the serum and Fbg levels in the plasma than the subjects with noncolonized COPD ( P ＞0. 05). ③There were no significant relationship between the number of LABC and the levels of CRP in the serum ( P ＞0. 05) , or between the number of LABC and the levels of Fbg in the plasma ( P ＞0. 05).④There was no significant relationship between the number of neutrophil or lymphocyte in the sputum,and the levels of CRP in the serum or Fbg in the plasma ( P ＞0. 05). ⑤There was no significant relationship between CRP and FEV1 % predicted (FEV1 % pred) ( r = -0. 230, P =0. 292),while there was a negative association between Fbg and FEV1 % pred ( r = - 0. 571, P = 0.014). Conclusions LABC,which is one of the most important origins of airway inflammation in COPD, was 54. 29% in stable patients with COPD. Airway inflammation may not be the cause which leads to systemic inflammation. However,this conclusion needs to be confirmed by further studies because of small subjects in this study. Systemic inflammation is related with lung function impairment.