慢性阻塞性肺疾病合并症及其炎症机制的临床研究

The Clinical Study of Comorbidities and Systemic Inflammation in COPD

目的评估慢性阻塞性肺疾病(COPD)合并症与临床指标的相关性并探讨其炎症机制。方法纳入220例COPD稳定期患者,收集临床资料和采集血液样本。分析COPD合并症与临床指标及血浆炎症介质水平之间的关系。结果 COPD主要合并症为高血压、代谢综合征及糖尿病、骨质疏松、支气管扩张、外周血管疾病。Charlson合并症指数(Charlson comorbidity index,CCI)评分较高(≥4)组血浆白细胞介素(IL)-6水平高于CCI评分较低(<4)组(P=0.011);CCI评分较高组COPD患者年龄趋高龄、病程更长、症状评分(mMRC评分与CAT评分)均更高,上一年急性加重次数更多、肺功能更差,与CCI评分较低组相比,差异均具有统计学意义(P<0.05)。血浆IL-6、IL-8及上一年住院次数与CCI及年龄校正后CCI正相关(r<0.3,P<0.05)。COPD合并症与全身炎症介质水平存在低度正相关(r<0.3,P<0.05)。结论 CCI评分较高组具有更严重的症状、功能障碍、炎症因子水平及急性加重入院次数;COPD合并症可能通过全身慢性炎症反应发挥作用的机制值得进一步研究。

Objectives To assess the association between chronic obstructive pulmonary disease(COPD)comorbidities and clinical characteristics,and to explore the inflammation mechanism.Methods 220 stable COPD patients were included.Clinical characteristics and comorbidities were recorded,and blood samples were collected.The relationship among the number and type of comorbidities,Charlson comorbidity index(CCI),clinical characteristics and the levels of plasma inflammatory markers[interleukin(IL)-6,high sensitivity C-reaction protein(hs-CRP),tumor necrosis factor-α(TNF-α),IL-8]were studied.Results The top five comorbidities were hypertension,metabolic syndrome and diabetes osteoporosis,bronchiectasis and peripheral vascular diseases.The level of plasma IL-6was greater in higher CCI score(≥4)group compared with lower CCI score(<4)group(P=0.011).Levels of IL-6and IL-8and the number of hospitalization in prior year were positively correlated with CCI and age adjusted CCI(r<0.03,P<0.05).There was a correlation between the COPD comorbidities and systemic inflammatory response(r<0.3,P <0.05).Conclusion Patients with a higher CCI score had more severe symptoms,functional impairment and higher level of inflammatory factors and high frequency of hospital admission due to acute exacerbation.The mechanism by which COPD may play a role in systemic inflammatory response deserves further study.