[预防医学]5-气道及全身性炎症在COPD.pptVIP

问题1 以下哪项是导致COPD炎症最重要的危险因素？ A. 细菌感染 B. 营养不良 C. 吸烟 D. 遗传 问题2 以下哪项药物具有抗COPD炎症的作用？ A. LABA; B. 长效抗胆碱能药物； C. ICS； D. ICS+LABA * * Correlation between the FEV1 and sputum levels of (A) IL-8 (COPD, r = -0.836, p 0.001; control, r = 0.093, p = 0.723) or (B) sTNF-R55 (COPD, r = 0.519, p = 0.033; control, r = 0.213, p = 0.411) in patients with COPD (closed diamond) and healthy smokers (open diamond). * * * 全身炎症的证据表现为：血循环中炎症细胞增多、细胞因子、炎症介质水平升高，这些炎症标志与肺内的改变相似，所以血循环中的炎症细胞、细胞因子、炎症介质升高 与肺部的炎症有关。 COPD稳定期仍有低度的CRP水平的持续升高，这是COPD全身性炎症的重要标志。 * CRP levels in our cohort were significantly higher (nearly 3 fold greater) in COPD subjects compared to healthy controls. In the third bar, we have removed those COPD patients with known cardiovascular risk (a diagnosis of IHD, HTN, DM or hypercholesterolaemia)- the CRP relationship remains. Mean FEV1%Pred in 4-month periods for low plasma fibrinogen and sputum IL-6 group patients (circles and thin line) and for high plasma fibrinogen and sputum IL-6 group patients (squares and thick line) against time from recruitment of each patient Mean plasma fibrinogen levels over 4-month intervals in infrequent (circles and thin-line exacerbators ( 2.52/yr) and frequent (box and thick line) exacerbators ( 2.52/yr), against time from recruitment of each patient. Bars are 2 x SE. Error bars increase in size with time, as not all patients participated in the study for 7.33 years. These data are unadjusted for the presence of an exacerbation. Dahl M et al. C-reactive Protein As a Predictor of Prognosis in Chronic Obstructive Pulmonary Disease American Journal of Respiratory and Critical Care Medicine Vol 175. pp. 250-255, (2007)  * 130 stable COPD patients * COPD全身炎症由肺部“溢出”至血循环，是全身炎症的重要原因。但不能完全解释COPD的全身炎症，因为戒烟后的COPD患者仍持续存在肺部和全身炎症反应。 * 局部的免疫反应 * * 140 current and former smokers (mean age, 64 yr) with moderate to severe disease, randomized in a 13-wk double-blind study to placebo (n = 73) or salmeterol/fluticasone p