临床指标与气道炎症标志物对预示COPD病情的意义

Roles of clinical indices and airway inflammation markers in confirming AECOPD and predicting severity

目的研究慢性阻塞性肺疾病(COPD)急性发作与缓解期,部分临床指标(FEV1%、SRGQ、吸烟指数、血气)及气道炎症标记物(CRP、IL-6)的变化与相关性,探讨这些终点指标对证实急性发作和预测急性发作严重性的价值。方法分析COPD急性发作住院患者治疗前后圣乔治呼吸调查问卷(SGRQ)和肺功能、血气及血与痰CRP、痰IL-6、细菌谱的变化。结果急性发作期间SGRQ评分、痰量及血和/或痰CRP、IL-6增加,肺功能下降;FEV1%与SGRQ、吸烟指数、血、痰CRP及痰IL-6浓度高度负相关(P<0.05或0.01);而血、痰CRP及痰IL-6浓度分别与吸烟指数、每日痰量显著正相关(P<0.05或0.01);血CRP与痰CRP、IL-6及痰CRP与IL-6分别正相关(P<0.01)。两组痰菌均以革兰阴性菌为主,重度组百分率显著高于中度组(P<0.05)。结论SGRQ、吸烟指数、血CRP及痰炎症指标(CRP、IL-6)结合痰量变化可有效地证实COPD急性发作或病情演变。

Objective To investigate the changes and correlations between some clinical indices （FEV1% predicted, St George ＇s Respiratory Questionnaire（ SRGQ）, smoking index, arterial blood gas tensions） and airway inflammation markers （C-reactive protein （CRP）, interleukin-6） during acute exacerbations of chronic obstructive pulmonary disease （AECOPD） and clinical stable state and to explore the value of the end-point indicators on confirming acute exacerbations and predicting their severity. Methods Changes of SRGQ and FEV1% predicted, arterial blood gas tensions and CRP, IL-6 concentrations in blood and/or sputum as well as bacteria spectrum in sputum were analyzed in subjects for AECOPD requiring hospital admissions. Results During AECOPD, SGRQ, sputum volume and CRP, IL-6 in blood and/or sputum increased, FEV1% Pred were declined. There were significant negative correlations between FEV1% and SGRQ, smoking index, CRP, IL-6 concentrations in blood and/or sputum （P 〈0. 05 or 0. 01 ）, while CRP, IL-6 concentrations in blood and/or sputum were positively correlated with smoking index, daily sputum volume, respectively （P 〈0. 05 or 0. 01 ）. Moreover, there were significant positive correlations between the concentrations of CRP in blood and/or sputum and IL-6, CRP and IL-6 in sputum, respectively （P 〈 0. 01 ）. Gram-negative bacteria in sputum were predominant at two groups, while the positive percentage of gram-negative bacteria was significantly higher in the severe group than that in the moderate group （ P 〈 0. 05 ）. Conclusion SGRQ, smoking index, Plasma CRP as well as sputum biomarkers such as CRP, IL-6 combining with the change of sputum volume can be used to confirm AECOPD or to assess exacerbation severity.