超敏C反应蛋白在慢性阻塞性肺疾病并发肺动脉高压中的意义

The Value of High-sensitivity C-reactive Protein in Chronic Obstructive Pulmonary Disease Patients combined with Pulmonary Hypertension

目的:慢性阻塞性肺疾病(COPD)是一种慢性炎症过程,患者体内多种炎性蛋白质都表现出升高的趋势。然而,系统性炎症在COPD继发肺动脉高压的发病机制中的潜在作用尚未被确定。本研究中,我们的目的是调查COPD并发肺动脉高压和不伴有肺动脉高压两组患者循环中C反应蛋白(CRP)和白细胞介素6(IL-6)的水平所反映的系统性炎症的程度。方法:通过彩色多普勒超声心动图检查测定安静状态下收缩期肺动脉压(SPAP),按照测定结果将38例患者分为COPD肺动脉高压组:SPAP≥30mmHg;COPD肺动脉压正常组:SPAP<30mmHg。hs-CRP测定方法为胶乳免疫增强比浊法;IL-6浓度测定采用酶联免疫分析法。结果:本研究中17例患者并发肺动脉高压,21例患者无肺动脉高压。肺动脉高压患者的血清CRP水平(中位数5.5mg/L,P25-P75为1.6mg/L^15.0mg/L)显著高于不伴有肺动脉高压者的血清CRP水平(中位数2.0mg/L,P25-P75为0.8mg/L^3.0mg/L),P=0.016。两组之间血清IL-6的水平未发现明显差异(中位数10.1pg/ml,P25-P758.3pg/ml^11.9pg/ml,比中位数10.3pg/ml,P25-P758.9pg/ml^38.7pg/ml。p=0.632)。血清CRP对数转换值与SPAP之间有显著线性关系(r=0.794,P=0.026)。结论:COPD患者的肺动脉压力增加与较高的血清CRP水平有关,进一步证实了低度系统性炎症在COPD肺动脉高压的发病机理中发生致病作用的可能性。

Objective COPD is a chronic systemic disorder that is associated with increases of inflammatory proteins in systemic circulation. However, the potential role of systemic inflammation in pulmonary hypertension secondary to COPD has not yet been identified. In this study, our aim was to investigate the degree of systemic inflammation that reflected by the levels of C-reactive protein （CRP） and interleukin （IL）-6 in COPD patients with and without pulmonary hypertension. Methods Systolic pulmonary artery pressure （SPAP）in quiet state were assessed by color Doppler echocardiography. We have divided patients into those without pulmonary hypertension （systolic Ppa 〈 30 mmHg） and those with pulmonary hypertension （systolic Ppa≥30 mmHg ）. High-sensitivity serum CRP levels were assessed by latex--enhanced immunonephelometric assay . IL-6 levels were measured using commei＇cially available enzyme-linked immunosorbent assay . Results Pulmonary hypertension was present in 17 patients and was absent in 21 patients. In patients with pulmonary hypertension, serum CRP levels were significantly higher than in those patients without hypertension （median, 5.5 mg/L [ 25th to 75th percentile, 1.6 mg/L ～15.0 mg/ L] vs 2.0 mg/L [25th to 75th percentile, 0.8 mg/L～3.0 mg/L; p = 0. 016]. No differences were seen in serum IL-6 between the two groups （median, 10. 1 pg/ml [ 25th to 75th percentile, 8.3 pg/ml ～ 11.9 pg/ml] vs 10.3 pg/ml [25th to 75th percentile, 8.9 pg/ml ～ 38.7 pg/ml, p = 0. 632 ）. A significant linear relationship was observed between log-transformed serum CRP level and SPAP in the whole group（ r = 0. 794 ,p = 0.026 ）. Conclusion The increased pulmonary artery pressure in pa- tients with COPD are associated with higher serum levels of CRP, further confirming the possibility of a pathogenetic role for low-grade systemic inflammation in the pathogenesis of pulmonary hypertension secondary to COPD patients.