The Significance Of The Inflammatory Response In Chronic Obstructive Pulmonary Disease-related Pulmonary Hypertension

Objective To investigate the blood percentage of neutrophils（N%）, C-reactive protein（CRP）, adiponectin（APN）, tumor necrosis factor-alpha（TNF-α） and endothelin-1（ET-1） inchronic obstructive pulmonary disease （COPD） patients with and without pulmonaryhypertension （PH）, and explore the significance of the inflammatory response inCOPD-related PH.Methods From November2011to November2012,60patients with COPD at acuteexacerbation were enrolled in Ningxia People’s Hospital. The patients were divided intoCOPD with PH group and COPD without PH group according to the pulmonary arterysystolic pressure（PASP）≥40mmHg. All patients got treatment as oxygen, anti-infection,drugs for relieving cough，sputum and asthma, and other symptomatic and supportivetreatment （average length of stay13.103.20days and13.274.36days）.22healthy personswere selected as control group at the same period. N%and serum CRP were detected byblood analyzer and turbidimetric immunoassay. Enzyme linked immunosorbent assay（ELISA） was employed to measure the levels of plasma APN, serum TNF-α and ET-1. Tocompare the levels of blood N%,CRP, APN, TNF-α and ET-1in three groups.The levels ofblood N%,CRP, APN, TNF-α and ET-1were observed before and after treatment,and thenanalysis the correlation beween the blood N%, CRP, APN, TNF-α, ET-1levels and PASP.Results1、The age, gender, body mass index （BMI）, smoking index had no significantdifference in COPD with PH group, COPD without PH group and control group （P>0.05）.2、PaO₂in COPD with PH group was lower than that in COPD without PH group, and PaCO₂was higher than that in COPD without PH group, but the difference was notstatistically significant （P>0.05）. FEV1%and FEV1/FVC in COPD with PH group werelower than those in COPD without PH group, but the difference was not statisticallysignificant （P>0.05）.3、Compared with the control group, the blood N%, plasma APN, serum CRP, TNF-α andET-1between COPD with PH group and COPD without PH group were significantly higher（all P<0.05）; the levels of APN, CRP, TNF-α and ET-1in the PH group was significantlyhigher than COPD without PH group （all P<0.01）, but the level of blood N%had nosignificant difference beween the two groups（P>0.05）.4、After treatment, compared to that before treatment, the pulmonary artery systolicpressure（PASP）, blood N%and plasma APN, serum CRP, TNF-α and ET-1levels decreasedsignificantly between COPD with PH group and COPD without PH group （all P <0.01）. Thelevels of blood N%, plasma APN, serum CRP, TNF-α and ET-1in the PH group weresignificantly higher than COPD without PH group, the difference was statistically significant（all P <0.05）.5、Before and after treatment, PASP in COPD with PH group was positively correlatedwith the blood CRP, APN, TNF-α and ET-1（r=0.482，r=0.744，r=0.614，r=0.703; r=0.493，r=0.627，r=0.538，r=0.568，P<0.01）.Conclusion Neutrophils, CRP, APN, TNF-α, and ET-1were not only involved in theinflammation of airways and lung parenchyma, but also may play a very important role in theformation of COPD-related PH. And APN may play a proinflammatory role in COPD-relatedPH.