Stabil Kronik Obstrüktif Akciğer Hastalığı Olan Hastalarda Klinik Parametreler ve İnflamasyon Belirteçlerinin Pulmoner Hipertansiyon ile İlişkisi

Yıl 2022, Cilt: 12 Sayı: 1, 6 - 14, 14.01.2022

Hüsnü Baykal Emel Bulcun

https://doi.org/10.33631/sabd.1054814

Cited By: 4

Öz

Amaç: Kronik obstrüktif akciğer hastalığı (KOAH), tamamen geri dönüşümlü olmayan ilerleyici hava akımı kısıtlaması ile karakterizedir. Bu çalışmada, KOAH hastalarında hastalık şiddeti parametreleri ve inflamasyonun PAP ile ilişkisini araştırdık.
Gereç ve Yöntemler: Kırıkkale Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Anabilim Dalı polikliniğinde tedavi görmekte olan 80 KOAH'lı hasta grubu ile uyumlu 46 kişilik kontrol grubu çalışmaya dahil edildi. Spirometri ölçümleri yapıldı (FEV1, FVC, FEV1 / FVC, MEF ve PEF). Kardiyoloji Anabilim Dalı polikliniğinde sistolik Pulmoner Arter Basıncı (sPAP) ölçümleri ve standart doppler ekokardiyografi yapıldı.
Bulgular: CRP stabil KOAH'lı hastalarda kontrol grubuna göre anlamlı olarak yüksek bulundu. KOAH hastalarının sPAP değerleri kontrol grubuna göre anlamlı derecede yüksekti. Yaş, cinsiyet ve VKİ değerleri dikkate alınarak sPAP ile Modifiye Kümülatif Hastalık Derecelendirme Ölçeği (MCIRS) puanı ile FVC% arasındaki ilişki lineer regresyon analizi ile değerlendirildi. SPAP değeri ile yaş arasında istatistiksel olarak anlamlı pozitif bir ilişki gözlendi (p=0,006). SPAP ve MCIRS skoru arasında istatistiksel olarak anlamlı bir ilişki yoktu (p=0,700). SPAP ile FVC% arasında istatistiksel olarak zayıf bir negatif ilişki gözlendi (p=0,053)
Sonuç: PAH gelişimi KOAH hastalarında morbidite ve mortaliteyi artırmaktadır. Bu nedenle KOAH'ın ileri evrelerinde olan hastalar, PAH gelişimini kontrol etmek için kullanımı kolay, hızlı ve tekrarlanabilir bir ölçüm yöntemi olan ekokardiyografi ile taranmalıdır.

Anahtar Kelimeler

Kronik obstrüktif akciğer hastalığı, inflamasyon, pulmoner hipertansiyon

Relationship of Clinical Parameters and Inflammation Markers with Pulmonary Hypertension in Patients with Stable Chronic Obstructive Pulmonary Disease

Öz

Aim: Inflammation is an important mechanism in the development of pulmonary arterial hypertension (PAH) in patients with COPD. In this study, we investigated the relationship of disease severity parameters and inflammation with PAP in COPD patients.
Material and Methods: A patient group consisting of 80 patients with stable COPD including who were obtaining treatment at the outpatient clinic of Kırıkkale University Faculty of Medicine Department of Pulmonary Medicine were included in the study along with a control group of 46 individuals who were compatible with the patient group in terms of age and gender and did not have any airway obstruction. Spirometry measurements were performed (FEV1, FVC, FEV1/FVC, MEF and PEF). Systolic pulmonary artery pressure (sPAP) measurements and standard doppler echocardiography were performed at the outpatient clinic of the department of cardiology.
Results: CRP was found to be significantly higher in patients with stable COPD compared to the control group. sPAP values of COPD patients were significantly higher than those of the control group. A statistically significant positive relationship was observed between the sPAP value and age (p = 0.006). There was no statistically significant relationship between sPAP and MCIRS score (p = 0.700). A statistically weak negative relationship was observed between sPAP and FVC% (p = 0.053)
Conclusion: Development of PAH increases morbidity and mortality. Therefore, patients with advanced stages of COPD should be screened using echocardiography, which is an easy-to-use, fast and repeatable measurement method to check for PAH development.

Anahtar Kelimeler

Chronic obstructive pulmonary disease, inflammation, pulmonary arterial hypertension

Kaynakça

• Jeffrey PK. Remodelling in asthma and chronic obstructive lung disease. Am J Respir Crit Care Med. 2001; 164(10 Pt 2): 28-38.
• M Fabbri L, F Rabe K. From COPD to chronic systemic inflammatory syndrome? Lancet. 2007; 370(9589): 797-9.
• Fabbri LM, Luppi F, Beghe B. Rabe KF. Complex chronic comorbidities of COPD. Eur Respir J. 2008; 31(1): 204-12.
• Tilemann L, Gindner L, Meyer F, Szecsenyi J, Schneider A. Differences in local and systemic inflammatory markers in patients with obstructive aitways disease. Prim Care Respir J. 2011 20 (4); 407-14.
• Agusti AG. COPD, a multicomponent disease: implications for management. Respir Med. 2005; 99(6): 670-82.
• Galie N, Torbicki A, Barst R, Dartevelle P, Haworth S, Higenbottam T, et al. Guidelines on diagnosis and treatment of pulmonary arterial hypertension. The tsac force on diagnosis and t6. reatment of pulmonary arterial hypertension of the european society og cardiology. Eur Heart J. 2004; 25: 2243-78.
• Clinical classification of pulmonary hypertension. Venice 2003.
• Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J. 2009; 33(5): 1165-85.
• GrossNJ. Extrapulmonary effects of chronic obstructive pulmonary disease. Curr Opin Pulm Med. 2001; 321(7): 84-92.
• Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of COPD (Updated 2013). In; 2013.
• Ong KC, Earnest A, Lu SJ. A multidimensional grading system (BODE index) as predictor of hospitalization for COPD. Chest. 2005; 128(6): 3810-6.
• Gross NJ. Chronic obstructive pulmonary disease outcome measurements: what's important? What's useful? Proc Am Thorac Soc. 2005; 2(4): 267-71; 290-1.
• Ardelean DL, Iulia L, Popescu R, Didilescu C, Dinescu S, Olteanu M et al. Evaluation of COPD patients using CAT-COPD assessment test CAT. Pneumologia. 2012; 61(4): 221-9.
• Miller MD, Paradis CF, Houck PR, Mazumdar S, Stack JA, Rifai AH, et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the cumulative ıllness rating scale. Psychiatry research. 1992; 41(3): 237-48.
• Miller MD, Towers A. A manual of guidelines for scoring the cumulative ıllness rating scale for geriatrıcs (CIRS-G) Pennsylvania: University of Pittsburgh School of Medicine. May 1991. Department of Geriatric Psychiatry Western Psychiatric Institute and Clinic 3811 O'Hara Street Pittsburgh, Pennsylvania 15213.
• Sin DD, Man PSF. Chronic obstructive pulmonary disease: A novel risk factor for cardiovascular disease. Can J Physiol Pharmacol. 2005; 83(1): 8-13.
• Sin DD, Anthonisen NR, Soriano JB, Agusti AG. Mortality in COPD: role of comorbitidies. Eur Respir J. 2006; 28(6): 1245-57.
• Rennard SI. Clinical approach to patients with chronic obstructive pulmonary disease and cardiovascular disease. Proc Am Thorac Soc. 2005; 2(1): 94-100.
• Nathan C. Nitric oxide as a secretory product of mammalian cells. FASEB J.1992; 6(12): 3051-64.
• Celli BR, Cote CG, Marin JM, et al. The body mass index, airflow obstruction, dyspnea and exercise capacity index in chronic obstructive pulmonary disease. New England Journal of medicine. 2004; 350(10): 1005-12.
• Chaouat A, Bugnet AS, Kadaoui N, Schott R, Enache I, Ducolone A, et al. Severe pulmonary hypertension and chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2005; 172(2): 189-94.
• Chaouat A, Naeije R, Weitzenblum E. Pulmonaiy hypertension in COPD. Eur Respir J. 2008; 32(5): 1371-85.
• National Heart, Lung and Blood Instutute. Morbidity and mortality: chartbook cardiovascular, lung and blood diseases. Bethesda, MD: US Departement, of health and Human Services, Public Health Services, : National Instutute of Health: 2003.
• Rubin LJ. Pathology and pathophysiology of primary pulmonary hypertension. Am J Cardiol. 1995; 75(3): 51A-54A
• Milat LJ, Whitley J, Leiper JM, Jeimes LD, Siragy MH,Carey RM, et al. Evidence for dysregulation of dimethylarginine dimethylaminohydrolase 1 in chronic hypoxia-induced pulmonary hypertension. Circulation. 2003; 108(12): 1493-8.
• Elwing J, Panos RJ. Pulmonary hypertension associated with COPD. International Journal of COPD. 2008; 3(1): 55-70.
• Siafakas NM, Vermeire P, Pride NB, Paoletti P, Gibson J, Howard P, et al. Optimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task Force. Eur Respir J. 1995; 8(8): 1398-420.
• Peinado VI, Barbera JA, Abate P, Ramirez J, Roca J, Santos S, et al. Inflammatory reaction in pulmonary muscular arteries of patients with mild chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999; 159(5 Pt 1) :1605-11.
• Fisher MR, Criner GJ, Fishman AP. Estimating pulmonary artery pressures by echocardiography in patients with emphysema. Eur Respir J. 2007; 30(5): 914-21. Oswald-Mammosser M, Weitzenblum E, Quoix E, Moser G, Chaouat A, Charpentier C, et al. Prognostic factors in COPD patients receiving longterm oxygen therapy. Importance of pulmonary artery pressure. Chest. 1995; 107(5): 1193-8.
• Kessler R, Faller M, Fourgaut G, Mennecier B, Weitzenblum E. Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999; 159(1): 158-64.
• Melek M, Esen O, Esen OM, Barutcu I, Fidan F, Onrat E, et al. Tissue doppler evaluation of tricuspid annulus for estimation of pulmonary artery pressure in patients with COPD. COPD. 2006; 184(3): 121-31.
• Ceylan E. Cardiopulmonary exercise testing. Journal of Clinical and Experimental Investigations. 2014; 5 (3): 504-9.
• Şen E. Exercise physiology and exercise tests, Toraks Cerrahisi Bülteni. 2017; 10: 29-36
• Redelmeier DA, Bayoumi AM, Goldstein RS, Guyatt GH. Interpreting small differences in functional status: the six minute walk test in chronic lung disease patients. Am J Respir Crit Care Med. 1997; 155(4): 1278-82.
• Rich S, Dantzker DR, Ayres SM, Bergofsky EH, Brundage BH, Detre KM, et al. Primary pulmonary hypertension. A national prospective study. Ann Intern Med. 1987; 107(2): 216-23.
• Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. ATS/ERS Task Force: Interpretative strategies for lung function tests. Eur Respir J. 2005; 26(5): 948-68.
• Fabbri LM, Romagnoli M, Corbetta L, Casoni G, Busljetic K, Turato G, et al. Differences in airway injlamation in patients with fixed airflow obstruction deu to asthma or cronic obstructive lung disease. Am J Respir Crit Care Med. 2003; 167(3): 418-24.
• Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006; 367(9524): 1747-57.
• Sanchez-Marteles M, Cecilio-Irazola A, Vano-Sanchis D, Nuviala-Mateo R, Serrano-Martínez S, Perez-Calvo J J. NT-proBNP in chronic obstructive pulmonary disease patients. An Sist Sanit Navar. 2009; 32(2): 235-41. https://doi.org/10.23938/ASSN.0162.
• Yanbaeva DG, Dentener MA, Spruit MA, Houwing-Duistermaat JJ, Kotz D, Passos VL, et al. IL6 and CRP haplotypes are associated with COPD risk and systemic inflammation: a case- control study. BMC Med Genet. 2009; 9: 10-23.