慢性阻塞性肺疾病：從氣道慢性炎癥到全身慢性炎癥_《中國呼吸與危重監護雜志》

作者：

劉輝國 , 徐永健

華中科技大學同濟醫學院附屬同濟醫院呼吸內科衛生部呼吸病重點實驗室(湖北武漢 430030);

關鍵詞：

慢性阻塞性肺疾病氣道慢性炎全身慢性炎癥

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慢性阻塞性肺疾病(COPD)是一種具有氣流受限特征的疾病，氣流受限不完全可逆，呈進行性發展，其發病與肺部對有害氣體或有害顆粒尤其是吸炯引起的異常炎癥反應有關。一般來說，40歲以上的患者，如果過去或現在還在吸炯有咳嗽、咳痰或氣緊，就應考慮COPD可能。COPD的診斷與病情程度分級一般取決于肺功能檢測所反映的氣流受限程度，但是有越來越多的證據顯示COPD的臨床表現與氣流受限程度不完全相關[1] 。因此，為了對COPD有一個全面系統的認識，還需要同時評估影像學表現、運動耐力和體重指數(BMI)。正是基于此項認識，有作者[2]認為COPD不能僅僅理解為一種肺部的慢性疾病，COPD患者常伴有全身多個系統的慢性病變，它可能是一種慢性全身性炎癥綜合征(chronic systemic inflammatory syndrome)o如有多個研究發現COPD可能伴有某種程度的全身炎癥反應[3,4]，Gan等[5]通過薈萃分析認為，即使在穩定期COPD也有外周血中性粒細胞(尤其是活化的表型)增多、急性相反應蛋白(C反應蛋白和纖維蛋白原)、白細胞介素6(IL-6)和腫瘤壞死因子α(TNF-α)水平增加。有趣的是，其他慢性疾病如慢性心力衰竭、肥胖、糖尿病甚至正常的老齡化也有同樣程度的全身炎癥反應。

引用本文： 劉輝國,徐永健. 慢性阻塞性肺疾病：從氣道慢性炎癥到全身慢性炎癥. 中國呼吸與危重監護雜志, 2007, 6(6): 410-412. doi: 復制

1.	Rabe KF，Hurd S，Anzueto A，et al.Global strategy for the diagnosis，management，and prevention of chronic obstructive pulmonary disease：GOLD executive summary.Am J Respir Crit Care Med，2007，176：532-555.
2.	Fabbri LM，Rabe KF.From COPD to chronic systemic inflammatory syndrome?Lancet，2007，370：797-799.
3.	Agustí AG，Noguera A，Sauleda J，et al.Systemic effects of chronic obstructive pulmonary disease.Eur Respir J，2003，21：347-360.
4.	Wouters EF.Chronic obstructive pulmonary disease 5：systemic effects of COPD.Thorax，2002，57：1067-1070.
5.	Gan WQ，Man SF，Senthilselvan A，et al.Association between chronic obstructive pulmonary disease and systemic inflammation：a systematic review and a meta-analysis.Thorax，2004，59：574-580.
6.	Sevenoaks MJ，Stockley RA.Chronic Obstructive Pulmonary Disease，inflammation and co-morbidity--a common inflammatory phenotype?Respir Res，2006，7：70.
7.	Vernooy JH，Küçükaycan M，Jacobs JA，et al.Local and systemic inflammation in patients with chronic obstructive pulmonary disease：soluble tumor necrosis factor receptors are increased in sputum.Am J Respir Crit Care Med，2002，166：1218-1224.
8.	Hurst JR，Wilkinson TM，Perera WR，et al.Relationships among bacteria，upper airway，lower airway，and systemic inflammation in COPD.Chest，2005，127：1219-1226.
9.	Yanbaeva DG，Dentener MA，Creutzberg EC，et al.Systemic effects of smoking.Chest，2007，131：1557-1566.
10.	Morlá M，Busquets X，Pons J，et al.Telomere shortening in smokers with and without COPD.Eur Respir J，2006，27：525-528.
11.	Tsuji T，Aoshiba K，Nagai A.Alveolar cell senescence in patients with pulmonary emphysema.Am J Respir Crit Care Med，2006，174：886-893.
12.	Agustí A，MacNee W，Donaldson K，et al.Hypothesis：does COPD have an autoimmune component?Thorax，2003，58：832-834.
13.	Vassilakopoulos T，Katsaounou P，Karatza MH，et al.Strenuous resistive breathing induces plasma cytokines：role of antioxidants and monocytes.Am J Respir Crit Care Med，2002，166：1572-1578.
14.	Casanova C，Cote C，de Torres JP，et al.Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease.Am J Respir Crit Care Med，2005，171：591-597.
15.	Rabinovich RA，Figueras M，Ardite E，et al.Increased tumour necrosis factor-alpha plasma levels during moderate-intensity exercise in COPD patients.Eur Respir J，2003，21：789-794.
16.	Mukae H，Vincent R，Quinlan K，et al.The effect of repeated exposure to particulate air pollution（PM10） on the bone marrow.Am J Respir Crit Care Med，2001，163：201-209.
17.	Palange P，Testa U，Huertas A，et al.Circulating haemopoietic and endothelial progenitor cells are decreased in COPD.Eur Respir J，2006，27：529-541.
18.	Schols AM，Broekhuizen R，Weling-Scheepers CA，et al.Body composition and mortality in chronic obstructive pulmonary disease.Am J Clin Nutr，2005，82：53-59.
19.	Agustí A.Systemic effects of chronic obstructive pulmonary disease：what we know and what we don’t know（but should）.Proc Am Thorac Soc，2007，4：522-525.
20.	Mannino DM，Watt G，Hole D，et al.The natural history of chronic obstructive pulmonary disease.Eur Respir J，2006，27：627-643.
21.	Poulain M，Doucet M，Major GC，et al.The effect of obesity on chronic respiratory diseases：pathophysiology and therapeutic strategies.CMAJ，2006，174：1293-1299.
22.	Mancini GB，Etminan M，Zhang B，et al.Reduction of morbidity and mortality by statins，angiotensin-converting enzyme inhibitors，and angiotensin receptor blockers in patients with chronic obstructive pulmonary disease.J Am Coll Cardiol，2006，47：2554-2560.
23.	Calverley PM，Anderson JA，Celli B，et al.Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease.N Engl J Med，2007，356：775-789.

1. Rabe KF，Hurd S，Anzueto A，et al.Global strategy for the diagnosis，management，and prevention of chronic obstructive pulmonary disease：GOLD executive summary.Am J Respir Crit Care Med，2007，176：532-555.
2. Fabbri LM，Rabe KF.From COPD to chronic systemic inflammatory syndrome?Lancet，2007，370：797-799.
3. Agustí AG，Noguera A，Sauleda J，et al.Systemic effects of chronic obstructive pulmonary disease.Eur Respir J，2003，21：347-360.
4. Wouters EF.Chronic obstructive pulmonary disease 5：systemic effects of COPD.Thorax，2002，57：1067-1070.
5. Gan WQ，Man SF，Senthilselvan A，et al.Association between chronic obstructive pulmonary disease and systemic inflammation：a systematic review and a meta-analysis.Thorax，2004，59：574-580.
6. Sevenoaks MJ，Stockley RA.Chronic Obstructive Pulmonary Disease，inflammation and co-morbidity--a common inflammatory phenotype?Respir Res，2006，7：70.
7. Vernooy JH，Küçükaycan M，Jacobs JA，et al.Local and systemic inflammation in patients with chronic obstructive pulmonary disease：soluble tumor necrosis factor receptors are increased in sputum.Am J Respir Crit Care Med，2002，166：1218-1224.
8. Hurst JR，Wilkinson TM，Perera WR，et al.Relationships among bacteria，upper airway，lower airway，and systemic inflammation in COPD.Chest，2005，127：1219-1226.
9. Yanbaeva DG，Dentener MA，Creutzberg EC，et al.Systemic effects of smoking.Chest，2007，131：1557-1566.
10. Morlá M，Busquets X，Pons J，et al.Telomere shortening in smokers with and without COPD.Eur Respir J，2006，27：525-528.
11. Tsuji T，Aoshiba K，Nagai A.Alveolar cell senescence in patients with pulmonary emphysema.Am J Respir Crit Care Med，2006，174：886-893.
12. Agustí A，MacNee W，Donaldson K，et al.Hypothesis：does COPD have an autoimmune component?Thorax，2003，58：832-834.
13. Vassilakopoulos T，Katsaounou P，Karatza MH，et al.Strenuous resistive breathing induces plasma cytokines：role of antioxidants and monocytes.Am J Respir Crit Care Med，2002，166：1572-1578.
14. Casanova C，Cote C，de Torres JP，et al.Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease.Am J Respir Crit Care Med，2005，171：591-597.
15. Rabinovich RA，Figueras M，Ardite E，et al.Increased tumour necrosis factor-alpha plasma levels during moderate-intensity exercise in COPD patients.Eur Respir J，2003，21：789-794.
16. Mukae H，Vincent R，Quinlan K，et al.The effect of repeated exposure to particulate air pollution（PM10） on the bone marrow.Am J Respir Crit Care Med，2001，163：201-209.
17. Palange P，Testa U，Huertas A，et al.Circulating haemopoietic and endothelial progenitor cells are decreased in COPD.Eur Respir J，2006，27：529-541.
18. Schols AM，Broekhuizen R，Weling-Scheepers CA，et al.Body composition and mortality in chronic obstructive pulmonary disease.Am J Clin Nutr，2005，82：53-59.
19. Agustí A.Systemic effects of chronic obstructive pulmonary disease：what we know and what we don’t know（but should）.Proc Am Thorac Soc，2007，4：522-525.
20. Mannino DM，Watt G，Hole D，et al.The natural history of chronic obstructive pulmonary disease.Eur Respir J，2006，27：627-643.
21. Poulain M，Doucet M，Major GC，et al.The effect of obesity on chronic respiratory diseases：pathophysiology and therapeutic strategies.CMAJ，2006，174：1293-1299.
22. Mancini GB，Etminan M，Zhang B，et al.Reduction of morbidity and mortality by statins，angiotensin-converting enzyme inhibitors，and angiotensin receptor blockers in patients with chronic obstructive pulmonary disease.J Am Coll Cardiol，2006，47：2554-2560.
23. Calverley PM，Anderson JA，Celli B，et al.Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease.N Engl J Med，2007，356：775-789.

《中國呼吸與危重監護雜志》

慢性阻塞性肺疾病：從氣道慢性炎癥到全身慢性炎癥

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《中國呼吸與危重監護雜志》

慢性阻塞性肺疾病：從氣道慢性炎癥到全身慢性炎癥

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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