COPD早期干预的必要性与合理性.ppt

If we look at induced sputum, which is a way of enhancing inflammation in COPD that is less invasive than biopsies, you can see that the predominant inflammatory cell is the neutrophil which is not increased in most people with asthma, but you can see that in normal smokers there is also an increase in 中性粒细胞 compared with normal people. So it looks as if COPD is like an exaggeration of the inflammation that you can see in normal smokers. This increase in 中性粒细胞 is correlated with an increase in the chemokine IL-8 which you can see is increased in COPD but not in asthma and is increased to a lesser extent in normal smokers. And in fact there is a correlation between the concentration of IL-8 and the amount of airway obstruction. So the more airway obstruction, the higher IL-8, and therefore, the greater numbers of 中性粒细胞. So what I’m saying is that you have inflammation at all stages of COPD but the inflammation is getting worse as the disease progresses. 为了观察COPD的炎症，我们可以使用非侵入性的痰液诱导的方法来观察。在COPD患者的诱导痰中可以看到主要的炎症细胞是中性粒细胞，而在大多数哮喘患者，中性粒细胞并不升高。与正常人相比，正常吸烟者的中性粒细胞也是升高的。所以，COPD看起来似乎是在正常吸烟者中所能看到的炎症的放大。这种在COPD而非哮喘中看到的中性粒细胞的升高和趋化因子白介素-8(IL-8)的升高是有相关性的，而且中性粒细胞的升高在程度上低于正常吸烟者。事实上，IL-8的浓度和气道阻塞的程度之间也存在相关性。所以，气道阻塞越严重， IL-8的浓度越高，中性粒细胞的数目也更多。在这里，我想说的是在COPD的各个阶段都存在炎症，但是这种炎症是随着疾病的进展而逐步恶化的。 解读： 1.前面讲的是COPD患者气道炎症的组织病理表现，这里再看一下诱导痰的细胞学表现。 2.在COPD患者的诱导痰中看到的主要的炎症细胞是中性粒细胞，而在大多数哮喘患者，中性粒细胞并不升高。 3.与正常人相比，正常吸烟者的中性粒细胞轻度增高，而COPD患者的炎症可以看作是正常吸烟者的炎症进一步放大。 4.这种在COPD中看到的中性粒细胞的升高和趋化因子白介素-8(IL-8)的升高是有相关性的，这与哮喘有很大不同，而且中性粒细胞的升高在程度上低于正常吸烟者。 5.事实上，IL-8的浓度和气道阻塞的程度之间也存在相关性。所以，气道阻塞越严重， IL-8的浓度越高，中性粒细胞的数目也更多。 6.另外值得一提的是，在COPD的各个阶段都存在炎症，而且这种炎症随着疾病的进展而逐步恶化。 It’s a defensive reaction and the idea is that this low-grade inflammation will stimulate mucus secretion which will then protect the airways from the noxious agents. But the problem in COPD is that this inflammation has been amplified in some way so that you get the same inflammation as in normal smokers but it’s to a greater degree, so you have more 中性粒细胞, more pr