العلاقة بين مستوى ال CRP في المصل وخطورة الداء الرئوي الساد المزمن (COPD ) عند المرضى في حالة الاستقرار
Abstract
مقدمة: الداء الرئوي الانسدادي المزمن (COPD) هو مرض رئوي انسدادي مترقي يتميّز بوجود التهاب جهازي.
الهدف : هدفت هذه الدراسة إلى تحرّي ما إذا كانت مستويات البروتين الارتكاسي C (CRP) المصلية مرتفعةً عند مرضى COPD , و تحديد وجود ترافق بين مستويات CRP و وظائف الرئة و الخصائص السريرية الأخرى .
المواد والطرق : إنّ هذه دراسة حالة – شاهد أجريت في مشفى تشرين الجامعي , اللاذقية , سوريا في الفترة الزمنية الممتدة ما بين آذار 2017 و آذار 2018 . شملت الدراسة 100 مريض COPD و 40 شاهد . تم قياس مستويات CRP و إجراء وظائف الرئة (spirometry) للمجموعتين .تم تقدير أعراض COPD عند كل مريض باختبار تقييم (CATو مقياس الزلة التنفسية حسب مجمع البحث الطبي المعدّل (mMRC) . كذلك تم تقييم سوابق السورات الحادة و استخدام الستيروئيدات الإنشاقية (ICS) . تم تصنيف المرضى وفقاً لتصنيف GOLD لعام 2011 .
النتائج : كانت مستويات CRP أعلى عند المرضى (44مريض مع قيمة CRP مرتفع أي بنسبة
44%) بالمقارنة مع الشاهد(مريضين مع قيمة CRP مرتفع أي بنسبة 2%) , و الفرق كان هاماً من الناحية الإحصائية (P = 0.0001) . وجدنا ترافقاً بين تراكيز CRP المصلية و كل من :
مجموعات التصنيف حسب GOLD2011 (p=0.04) , نسبة الحجم الزفيري الأقصى في الثانية الأولى (FEV1) من القيمة المتوقعة (r = -0.6) , نسبة السعة الحيوية القسرية (FVC) من القيمة المتوقعة
( r = -0.4) , عدد السورات الحادة في العام السابق (r = 0.5) , سلم mMRC (r = 0.2), واستبيان )CAT (r = 0.2 , وكمية التدخين (r=0.4 )
امتلك المرضى المعالجين ب ICS مستويات CRP أخفض من المرضى بدون ICS p=0.01)).
الخلاصة : إنّ CRP يمكن أن يكون واسماً جهازياً للحدثية الالتهابية التي تحدث عند مرضىCOPD .
Introduction : Chronic obstructive pulmonary disease (COPD) is a progressive pulmonary disease characterized by systemic inflammation.
Aim : We aimed to investigate if CRP levels are increased in stable COPD patients, and if there is an association between CRP levels and pulmonary function tests and clinical characteristics.
Materials and Methods :This is a case – control study conducted in Tishreen University Hospital , Lattakia , Syria during the period between March 2017 and March 2018 . 100 subjects of COPD and 40 controls were recruited . CRP levels were determined and pulmonary function tests were performed in both the groups. The symptoms of COPD in each patient were estimated by the COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) dyspnea scale. The parameters of pulmonary function (FEV1 and FVC), history of exacerbation and inhaled corticosteroids (ICS) use were also evaluated. Patients were classified according to GOLD 2011 Grading Classification
Results : CRP was higher in study group(44%) than the normal controls(2%) , the difference was statistically significant with ‘p’ value of 0.0001) p=)
Correlation was found with the following variables: GOLD2011 group (p= 0.04), forced expiratory volume in one second FEV1 predicted
(r = -0. 6), forced vital capacity FVC predicted (r = -0.4), number of acute exacerbations in the past year (r = 0. 5), British medical Research Council dyspnoea scale (r = 0. 2), COPD assessment test score Cat (r= 0.2), Patients using ICS had lower CRP levels than patients without ICS use (P=0.01)
Conclusion : CRP may be a systemic marker of the inflammatory process that occurs in patients with COPD.
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