慢深刻认识慢阻肺急性加重及治疗目标精选.pptVIP

关键信息： COPD 和哮喘的特征都是基础的慢性炎症，但两种疾病所涉及的主要炎症细胞和炎症介质有所不同。1 哮喘患者中，气道炎症的特征是嗜酸性粒细胞数量增多，嗜酸性粒细胞活性增强。CD4+ 和 2型T-辅助细胞(Th2)的数量也增多，Th2-产生的细胞因子和白介素(IL-4, IL-5 and IL-13)也增多。与哮喘有关的其他炎症介质包括肿瘤坏死因子(TNF)-? 和嗜酸性趋化因子RANTES。1,2?5 对COPD中炎症过程的认识不如哮喘那么清楚。在稳定期的COPD中，嗜中性粒细胞和巨噬细胞的炎症为主，主要淋巴细胞是 CD8+ T-细胞。与稳定期COPD的炎症有关的炎症介质有IL-8, 白三烯B4 (LTB-4)和TNF-?。另外，也存在弹性蛋白酶等蛋白溶解酶，这些酶可以破坏气道组织，维持气道炎症。1,6?9 COPD急性加重期的炎症模式与稳定期有所不同。COPD急性加重期所见的炎症与哮喘更相似；主要细胞类型是嗜酸性粒细胞，当然嗜中性粒细胞的水平也升高。另外，CD4+ T细胞的数量也增多，RANTES的表达上调，这与哮喘中的情况一样。6,10,11 对哮喘和COPD中炎症模式的充分理解，了解这些炎症在COPD急性加重期间的变化情况，我们就可以更好地评价抗炎药物（如，吸入皮质类固醇激素[ICS]）在针对COPD的基础病理生理进行治疗时的作用。 参考文献 Jeffery PK. Structural and inflammatory changes in COPD: A comparison with asthma. Thorax 1998;53:129–36. Barnes PJ. Mechanisms in COPD: Differences from asthma. Chest 2000;117(2 Suppl):10S–14S. Bousquet J, Jeffery PK, Busse WW, et al. Asthma. From bronchoconstriction to airways inflammation and remodeling. Am J Respir Crit Care Med 2000;161:1720–45. Kips JC. Cytokines in asthma. Eur Respir J Suppl 2001;34:24s–33s. Jeffery PK, Wardlaw AJ, Nelson FC, et al. Bronchial biopsies in asthma. An ultrastructural, quantitative study and correlation with hyperreactivity. Am Rev Respir Dis 1989;140:1745–53. Saetta M, Di Stefano A, Maestrelli P, et al. Airway eosinophilia in chronic bronchitis during exacerbations. Am J Respir Crit Care Med 1994;150:1646–52. Keatings VM, Collins PD, Scott DM, et al. Differences in interleukin-8 and tumor necrosis factor-alpha in induced sputum from patients with chronic obstructive pulmonary disease or asthma. Am J Respir Crit Care Med 1996;153:530–4. Woolhouse IS, Bayley DL, Stockley RA. Sputum chemotactic activity in chronic obstructive pulmonary disease: Effect of alpha(1)-antitrypsin deficiency and the role of leukotriene B(4) and interleukin 8. Thorax 2002;57:709–14. OShaughnessy TC, Ansari TW, Barnes NC, et al. Inflammation in bronchial biopsies of subjects with chronic bronchitis: Inverse relationship of CD8+ T lymphocytes with FEV1. Am J Respir Crit Care Med