Analiza sistemskih efekata inflamacije i težine bolesti kod obolelih od hronične opstruktivne bolesti pluća

Abstract

There is an abnormal inflammatory pulmonary response to harmful particles or gases in chronic obstructive pulmonary disease (COPD). Pulmonary inflammation spills over into systemic circulation which causes extra pulmonary manifestations. A large number of inflammatory mediators are involved in establishing and maintaining of inflammatory response. The aim of the research was the analysis of systemic effects of inflammation and COPD severity. The examination was done in the Clinic for Pulmonary Diseases Knez Selo, Clinical Center Niš, and it involved 85 patients with COPD in a stable phase. The patients were divided into four groups: mild, moderate, severe and very severe COPD. Serum values of C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α) and leptin were measured, BODE index was determined, and the presence of weight loss and muscle loss, muscle dysfunction and osteoporosis were determined. We found that with the increase in COPD severity, values of CRP, TNF-α and leptin varied in the range that was not statistically significant. CRP had positive, and TNF-α negative predictive influence on COPD severity. The increase in disease severity was followed by borderline statistically significant increase in frequency of underweight and borderline nutrition (p=0.05). Leptin values of underweight and normal nutrition were significantly different from leptin values of pre-obese and obese (p<0.000). Increase in disease severity was followed by significant decrease in effort tolerance (p<0.000) and increase in dyspnoa (p<0.000). We found significant negative correlation between 6MWT and COPD severity. Bone Mineral Density (BMD) was significantly decreased when COPD severity was increased (p=0.26). Osteoporosis had significant negative predictive effect on disease severity. We determined that with increase in BODE index values of CRP, TNF-α and leptin varied in the range that was not statistically significant, and that CRP had significant positive, and TNF-α negative correlation with BODE index values. It was found that with increase in BODE index the number of underweight patients was significantly increased (p<0.019) along with the frequency of osteoporosis (p=0.05), and the effort tolerance was significantly decreased (p=0.000), while dyspnoa was increased (p=0.000). In conclusion, we may say that increase in COPD severity is followed by increase in systemic effects, and that BODE index is a good indicator of disease severity and systemic effects of COPD.