Chronic obstructive pulmonary disease:From airway inflammation to systemic inflammation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIU Huiguo , XU Yongjian

Department of Respiratory Tongji Medical College，Huazhong University of Science and Technology，Wuhan 430030，China;

Corresponding author：

Keywords：

慢性阻塞性肺疾病; 气道慢性炎; 全身慢性炎症

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慢性阻塞性肺疾病(COPD)是一种具有气流受限特征的疾病，气流受限不完全可逆，呈进行性发展，其发病与肺部对有害气体或有害颗粒尤其是吸炯引起的异常炎症反应有关。一般来说，40岁以上的患者，如果过去或现在还在吸炯有咳嗽、咳痰或气紧，就应考虑COPD可能。COPD的诊断与病情程度分级一般取决于肺功能检测所反映的气流受限程度，但是有越来越多的证据显示COPD的临床表现与气流受限程度不完全相关[1] 。因此，为了对COPD有一个全面系统的认识，还需要同时评估影像学表现、运动耐力和体重指数(BMI)。正是基于此项认识，有作者[2]认为COPD不能仅仅理解为一种肺部的慢性疾病，COPD患者常伴有全身多个系统的慢性病变，它可能是一种慢性全身性炎症综合征(chronic systemic inflammatory syndrome)o如有多个研究发现COPD可能伴有某种程度的全身炎症反应[3,4]，Gan等[5]通过荟萃分析认为，即使在稳定期COPD也有外周血中性粒细胞(尤其是活化的表型)增多、急性相反应蛋白(C反应蛋白和纤维蛋白原)、白细胞介素6(IL-6)和肿瘤坏死因子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龄化也有同样程度的全身炎症反应。

Citation： LIU Huiguo,XU Yongjian. Chronic obstructive pulmonary disease:From airway inflammation to systemic inflammation. Chinese Journal of Respiratory and Critical Care Medicine, 2007, 6(6): 410-412. doi: Copy

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.

Chinese Journal of Respiratory and Critical Care Medicine

Chronic obstructive pulmonary disease:From airway inflammation to systemic inflammation

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