• 第三軍醫(yī)大學(xué)新橋醫(yī)院呼吸內(nèi)科;

慢性阻塞性肺疾病( COPD) 被定義為一種慢性肺部“炎癥”性疾病。COPD 的炎癥反應(yīng)由吸煙、大氣污染等有害顆粒或氣體所誘發(fā), 主要累及小氣道和肺實(shí)質(zhì), 導(dǎo)致慢性支氣管炎和氣道阻塞; 同時(shí)還導(dǎo)致肺實(shí)質(zhì)的破壞, 引起肺氣腫, 最終形成不能完全可逆的氣流受限。吸煙是COPD 發(fā)病的主要危險(xiǎn)因素。雖然, 戒煙可以改變COPD 的自然病程, 減緩肺功能的下降速率。但是, 戒煙后COPD炎癥并不能完全消除, COPD疾病進(jìn)程也不會(huì)因此而“止步”。近年的研究發(fā)現(xiàn)部分COPD 患者停止吸煙后, 炎癥反應(yīng)仍在相當(dāng)長的時(shí)間內(nèi)持續(xù)存在[1] 。這些現(xiàn)象提示COPD 炎癥過程一旦啟動(dòng), 似乎就難以終止。COPD 炎癥發(fā)生發(fā)展的機(jī)制還遠(yuǎn)未闡明。

引用本文： 王長征. 認(rèn)識(shí)COPD 炎癥: 我們還需要知道得更多. 中國呼吸與危重監(jiān)護(hù)雜志, 2009, 09(5): 415-417. doi: 復(fù)制

1. Willemse BWM, ten Hacken NHT, Rutgers B, et al. Effect of 1-year smoking cessation on airway inflammation in COPD and asymptomatic smokers. Eur Respir J, 2005, 26: 835-845.
2. Matzinger P. The danger model: a renewed sense of self. Science,2002, 296: 301-305.
3. Parker LC, Prince LR, Sabroe I. Translational mini-review series on Toll-like receptors: networks regulated by Toll-like receptors mediate innate and adaptive immunity. Clin Exp Immunol, 2007, 147: 199-207.
4. Di Stefano A, Caramori G, Oates T, et al. Increased expression of nuclear factor-B in bronchial biopsies from smokers and patients with COPD. Eur Respir J, 2002, 20: 556-563.
5. Jiang D, Liang J, Li Y, et al. The role of Toll-like receptors in noninfectious lung injury. Cell Res, 2006, 16: 693-701.
6. Agusti A, MacNee W, Donaldson K, et al. Hypothesis: Does COPD have an autoimmune component? Thorax, 2003, 58: 832-834.
7. Lee SH, Goswami S, Grudo A, et al. Antielastin autoimmunity in tobacco smoking-induced emphysema. Nat Med, 2007, 13: 567-569.
8. Feghali-Bostwick CA, Gadgil AS, Otterbein LE, et al. Autoantibodies in Patients with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med, 2008, 177: 156-163.
9. van der Strate BW, Postma DS, Brandsma CA, et al. Cigarette Smoke-induced Emphysema: A Role for the B Cell? Am J Respir Crit Care Med, 2006, 173: 751-758.
10. Prummel MF, WiersingaWM. Smoking and risk of Graves’disease. JAMA, 1993, 269: 479-482.
11. Papadopoulos NG, Alamanos Y, Voulgari PV, et al. Does cigarette smoking influence disease expression, activity and severity in early rheumatoid arthritis patients? Clin Exp Rheumatol, 2005, 23: 861 -866.
12. Cosio MG, Saetta M, Agusti A. Immunologic Aspects of Chronic Obstructive Pulmonary Disease. N Engl J Med, 2009, 360: 2445-2454.
13. BarcelóB, Pons J, Ferrer JM, et al. Phenotypic characterisation of T-lymphocytes in COPD: abnormal CD4 + CD25 + regulatory T-lymphocyte response to tobacco smoking. Eur Respir J, 2008, 31 :555-562.
14. Lomas DA, Silverman EK, Edwards LD, et al. Serum surfactant protein D is steroid sensitive and associated with exacerbations of COPD. Eur Respir J, 2009, 34: 95-102.
15. Vestbo J, Anderson W, Coxson HO, et al. Evaluation of COP Dlongitudinally to identify predictive surrogate end-points ( ECLIPSE) . Eur Respir J, 2008, 31: 869-873.
16. Buhling F, Lieder N, Reisenauer A, et al. Antiinflammatory function of tiotropium mediated by suppression of acetylcholine-induced release of chemotactic activity. Eur Respir J, 2004, 24: 318 s.
17. Powrie DJ, Wilkinson TMA, Donaldson GC, et al. Effect of tiotropium on sputum and serum inflammatory markers and exacerbations in COPD. Eur Respir J, 2007, 30: 472-478.
18. Bourbeau J, Christodoulopoulos P, Maltais F, et al. Effect of salmeterol / fluticasone propionate on airway inflammation in COPD:a randomised controlled trial. thorax, 2007, 62: 938-943.
19. Barnes NC, Qiu YS, Pavord ID, et al. on behalf of the SCO30005 Study Group Antiinflammatory Effects of Salmeterol /Fluticasone Propionate in Chronic Obstructive Lung Disease. Am J Respir Crit Care Med, 2006, 173: 736-743.
20. 王長征. 藥物治療能改變慢性阻塞性肺疾病患者肺功能的下降速率嗎? 中國呼吸與危重監(jiān)護(hù)雜志, 2009, 8: 1-2.
21. Celli BR, Thomas NE, Anderson JA, et al. Effect of Pharmacotherapy on Rate of Decline of Lung Function in Chronic Obstructive Pulmonary Disease: Results from the TORCH Study. Am J Respir Crit Care Med, 2008, 178: 332-338.
  1. 1. Willemse BWM, ten Hacken NHT, Rutgers B, et al. Effect of 1-year smoking cessation on airway inflammation in COPD and asymptomatic smokers. Eur Respir J, 2005, 26: 835-845.
  2. 2. Matzinger P. The danger model: a renewed sense of self. Science,2002, 296: 301-305.
  3. 3. Parker LC, Prince LR, Sabroe I. Translational mini-review series on Toll-like receptors: networks regulated by Toll-like receptors mediate innate and adaptive immunity. Clin Exp Immunol, 2007, 147: 199-207.
  4. 4. Di Stefano A, Caramori G, Oates T, et al. Increased expression of nuclear factor-B in bronchial biopsies from smokers and patients with COPD. Eur Respir J, 2002, 20: 556-563.
  5. 5. Jiang D, Liang J, Li Y, et al. The role of Toll-like receptors in noninfectious lung injury. Cell Res, 2006, 16: 693-701.
  6. 6. Agusti A, MacNee W, Donaldson K, et al. Hypothesis: Does COPD have an autoimmune component? Thorax, 2003, 58: 832-834.
  7. 7. Lee SH, Goswami S, Grudo A, et al. Antielastin autoimmunity in tobacco smoking-induced emphysema. Nat Med, 2007, 13: 567-569.
  8. 8. Feghali-Bostwick CA, Gadgil AS, Otterbein LE, et al. Autoantibodies in Patients with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med, 2008, 177: 156-163.
  9. 9. van der Strate BW, Postma DS, Brandsma CA, et al. Cigarette Smoke-induced Emphysema: A Role for the B Cell? Am J Respir Crit Care Med, 2006, 173: 751-758.
  10. 10. Prummel MF, WiersingaWM. Smoking and risk of Graves’disease. JAMA, 1993, 269: 479-482.
  11. 11. Papadopoulos NG, Alamanos Y, Voulgari PV, et al. Does cigarette smoking influence disease expression, activity and severity in early rheumatoid arthritis patients? Clin Exp Rheumatol, 2005, 23: 861 -866.
  12. 12. Cosio MG, Saetta M, Agusti A. Immunologic Aspects of Chronic Obstructive Pulmonary Disease. N Engl J Med, 2009, 360: 2445-2454.
  13. 13. BarcelóB, Pons J, Ferrer JM, et al. Phenotypic characterisation of T-lymphocytes in COPD: abnormal CD4 + CD25 + regulatory T-lymphocyte response to tobacco smoking. Eur Respir J, 2008, 31 :555-562.
  14. 14. Lomas DA, Silverman EK, Edwards LD, et al. Serum surfactant protein D is steroid sensitive and associated with exacerbations of COPD. Eur Respir J, 2009, 34: 95-102.
  15. 15. Vestbo J, Anderson W, Coxson HO, et al. Evaluation of COP Dlongitudinally to identify predictive surrogate end-points ( ECLIPSE) . Eur Respir J, 2008, 31: 869-873.
  16. 16. Buhling F, Lieder N, Reisenauer A, et al. Antiinflammatory function of tiotropium mediated by suppression of acetylcholine-induced release of chemotactic activity. Eur Respir J, 2004, 24: 318 s.
  17. 17. Powrie DJ, Wilkinson TMA, Donaldson GC, et al. Effect of tiotropium on sputum and serum inflammatory markers and exacerbations in COPD. Eur Respir J, 2007, 30: 472-478.
  18. 18. Bourbeau J, Christodoulopoulos P, Maltais F, et al. Effect of salmeterol / fluticasone propionate on airway inflammation in COPD:a randomised controlled trial. thorax, 2007, 62: 938-943.
  19. 19. Barnes NC, Qiu YS, Pavord ID, et al. on behalf of the SCO30005 Study Group Antiinflammatory Effects of Salmeterol /Fluticasone Propionate in Chronic Obstructive Lung Disease. Am J Respir Crit Care Med, 2006, 173: 736-743.
  20. 20. 王長征. 藥物治療能改變慢性阻塞性肺疾病患者肺功能的下降速率嗎? 中國呼吸與危重監(jiān)護(hù)雜志, 2009, 8: 1-2.
  21. 21. Celli BR, Thomas NE, Anderson JA, et al. Effect of Pharmacotherapy on Rate of Decline of Lung Function in Chronic Obstructive Pulmonary Disease: Results from the TORCH Study. Am J Respir Crit Care Med, 2008, 178: 332-338.

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