만성폐쇄성폐질환 환자 사망 원인 - 한 3차 병원 연구

김범준 ( Beom Jun Kim ),홍상범 ( Sang Bum Hong ),심태선 ( Tae Sun Shim ),임채만 ( Chae Man Lim ),이상도 ( Sang Do Lee ),고윤석 ( Youn Suck Koh ),김우성 ( Woo Sung Kim ),김동순 ( Dong Soon Kim ),김원동 ( Won Dong Kim ),오연목 ( Yeo 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.60 No.5

연구배경 : 만성폐쇄성폐질환(COPD)은 45세 이상의 성인에서 국내 유병률 17.2%로 주요 질환이다. 하지만, 국내 COPD 환자의 사망원인에 대한 연구는 불충분한 상황이다. 이에 국내 COPD 환자 사망원인에 대해서 알아보고자 서울아산병원 의무기록을 후향적으로 조사하였다. 방법 : 2003년 1년간 서울아산병원에서 COPD로 진료한 1,078명의 사망여부를 통계청에 의뢰하여 총 사망자 88명을 얻었고 이중 폐결핵 후유증, 기관지확장증, 폐암 등 암 환자를 제외한 후 남은 28명의 COPD 환자 대상으로 사망원인을 분석하였다. 결과 : COPD 환자의 사망원인은 폐렴 등 호흡기 원인이 16명 (57%), 심장 원인 5명 (18%), 급사 3명 (11%), 기타 4명 (14%) 등이었다. 서울아산병원 내에서 사망한 환자와 외에서 사망한 환자의 호흡기 관련 사망이 각각 83%(10명/12명)과 38%(6명/16명)이었다 (P=0.05) FEV1이 50%예측치보다 큰 환자와 작은 환자의 호흡기 관련 사망은 각각 43%과 55%이었다 (P=0.89). 결론 : 국내 3차 병원에서 진료하는 COPD 환자의 사망 원인은 폐렴 등 호흡기 원인 다수를 차지한다. Background : Although 17% of Korean adults over the age of 45 years have chronic obstructive pulmonary disease (COPD), there is only limited data on the cause of death in COPD patients in Korea. Therefore, this retrospective study was performed to examine the cause of death in COPD patients at a referral hospital in Korea. Methods : The medical records of 28 deceased patients diagnosed as COPD in Asan Medical Center from January to December 2003 were reviewed patients had died in Asan Medical Center and 16 patients had died outside the hospital. The Korean National Statistical Office confirmed 88 deceased patients out of 1,078 patients diagnosed as COPD in Asan Medical Center in 2003. After excluding those with tuberculous destroyed lung, bronchiectasis, and lung cancer, 28 COPD patients were evaluated. Results : The causes of death were pulmonary disease including pneumonia in 16 patients (57%), cardiac disease in 5 patients (18%), sudden death in 3 patients (11%), and other causes in 4 patients (14%). The cause of death was pulmonary disease in 83% (10 out of 12 patients) and 38% (6 out of 16 patients) of patients who died in Asan Medical Center and outside the center, respectively (P=0.05). The cause of death was pulmonary disease in 43% of patients with FEV1 more than 50% of the predicted value and in 55% of patients with FEV1 less than 50% of the predicted value (P=0.89). Conclusion : Pulmonary disease is the leading cause of death in COPD patients in Korea. (Tuberc Respir Dis 2006; 60: 510-515)

만성폐쇄성폐질환과 천식의 감별진단에서 메타콜린 기관지유발검사의 의의

홍윤경 ( Yun Kyung Hong ),정치량 ( Chi Ryang Chung ),백경현 ( Kyung Hyun Paeck ),김소리 ( So Ri Kim ),민경훈 ( Kyung Hoon Min ),박성주 ( Seoung Ju Park ),이흥범 ( Heung Bum Lee ),이용철 ( Yong Chul Lee ),이양근 ( Yang Keun Rhee 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.5

연구배경: COPD 환자에서 천식을 동반한 환자들이 많이 있다고 보고 되어 있었고 기관지 과민성이 높은 비율로 보고되어 메타콜린 기관지유발검사가 이두 질환을 감별에 어떤 의의가 있는지 알아보았고, 치료에 대한 도움을 얻고자 연구하였다. 방법: 전북대학교병원에서 2004년 1월부터 2004년 12월까지 메타콜린 기관지유발검사를 시행한 환자를 대상으로 전향적으로 연구하였다. 65명의 천식환자 23명의 COPD환자, 대조군에서 메타콜린 기관지유발검사를 분석하였다. 결과: 각 군의 PC(20)의 평균값은 천식군, COPD군 및 대조군에서 각각 8.1±1.16, 16.9±2.21 과 22.0±1.47 ㎎/㎖이고, 천식군, COPD군 및 대조군의 메타콜린 기관지유발검사의 양성율은 각각 65%, 30%와 9%였다. 메타콜린 기관지유발검사 양성 판정 기준을 PC(20) 16 ㎎/㎖ 이하로 가정할 때 천식군과 COPD군의 양성율은 80%와30%이었고 민감도, 특이도, 양성예측률 및 음성예측률은 각각 80%, 75%, 78%와 78%였다. 결론: 메타콜린 기관지유발검사의 양성기준을 PC(20) 16≤㎎/㎖으로 하였을 때 천식 및 COPD가 동반된 천식과 순수한 COPD의 감별에 보다 많은 도움을 줄 것으로 예상되며 궁극적으로 COPD 환자들에게 보다 개별적이고 적절한 치료적 접근에 도달할 수 있도록 해주는 진단 방법 중 하나가 될 수 있다고 생각한다. Background: Although airway hyper-responsiveness is one of the characteristics of asthma. bronchial hyper-responsiveness has also been observed to some degree in patients with chronic obstructive pulmonary disease (COPD). Moreover, several reports have demonstrated that a number of patients have both COPD and asthma. The methacholine bronchial challenge test (MCT) is a widely used method for the detecting and quantifying the airway hyper-responsiveness, and is one of the diagnostic tools in asthma. However, the significance of MCT in differentiating asthma or COPD combined with asthma from pure COPD has not been defined. The aim of this study was to determine the role of MCT in differentiating asthma from pure COPD. Method: This study was performed prospectively and was composed of one hundred eleven patients who had undergone MCT at Chonbuk National University Hospital. Sixty-five asthma patients and 23 COPD patients were enrolled and their MCT data were analyzed and compared with the results of a control group. Result: The positive rates of MCT were 65%, 30%, and 9% in the asthma, COPD, and control groups, respectively. The mean PC(20) values of the asthma, COPD, and control groups were 8.1±1.16 ㎎/㎖, 16.9±2.21 ㎎/㎖, and 22.0±1.47㎎/㎖, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of MCT for diagnosing asthma were 65%, 84%, 81%, and 69%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of MCT (ed note: please check this as I believe that these values correspond to the one PC(20) value. Please check my changes.) at the new cut-off points of PC20 ≤ 16 ㎎/㎖, were 80%, 75%, 78%, and 78%, respectively. Conclusion: MCT using the new cut-off point can be used as a more precise and useful diagnostic tool for distinguishing asthma from pure COPD. (Tuberc Respir Dis 2006; 61: 433-439)

Elevated Angiogenic Transcription Factor SOX18 in Patients with COPD and Its Association with Lung Function

( Shinhee Park ),( An-soo Jang ),( Pureun-haneul Lee ),( Ae-rin Baek ),( Jong-sook Park ),( June-hyuk Lee ),( Sung-Woo Park ),( Do-jin Kim ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Objectives The SRY-related high-mobility group box 18 (SOX18) is an angiogenic transcription factor involved in tissue injury, wound healing and development of vessels. The expression of SOX18 is increased in acute lung injury and asthma exacerbation, but the role of SOX18 in chronic obstructive pulmonary disease (COPD) has not been studied. To investigate the relationship between SOX18 and COPD, we evaluated the relationship between SOX18 with the clinical parameters of COPD, including lung functions and exacerbations. Methods We recruited a cohort of 30 patients with COPD and 25 healthy controls, and compared their clinical parameters, including lung function. We measured the plasma SOX18 level of healthy controls and COPD patients who were in stable and exacerbated state. Results The COPD patients were all males, and predominantly smokers; their baseline lung function was lower than the healthy controls. The mean SOX18 plasma level was 0.0272 ± 0.0145 ng/mg in the control group, 0.1574 ± 0.0692 ng/mg in the stable COPD group (COPD-ST) and 0.2336 ± 0.1921 ng/mg in the exacerbated COPD (COPD-EXA) group. The plasma SOX18 level was significantly higher in both COPD-ST and COPD-EXA groups compared to healthy control group. The plasma SOX18 level was inversely correlated with BMI, FVC, and FEV1 of COPD patients (r = -0448, P < 0.001, r = -0.511, P < 0.001, and r = 0.607, P < 0.001, respectively). Conclusions The plasma SOX18 level was increased in COPD patients regardless of exacerbation and negatively correlated with lung function. These findings suggest that SOX18 may play a role in pathogenesis of COPD.

Association of Tight Junction Protein Claudin-4 with the Lung Function and Exacerbation of COPD Patients

( Shinhee Park ),( An-soo Jang ),( Pureun-haneul Lee ),( Ae-rin Baek ),( Jong-sook Park ),( June-hyuk Lee ),( Sung-Woo Park ),( Do-jin Kim ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Objectives Chronic obstructive pulmonary disease (COPD) imposes a major healthcare burden. A tight junction protein, claudin-4 (CLDN4), may play a protective role in acute lung injury, but its role in COPD is unclear. To investigate the relationship between CLDN4 and COPD, we evaluated the association of CLDN4 with the clinical parameters of COPD, including exacerbations. Methods We analyzed a cohort of 30 patients with COPD and 25 healthy controls, and evaluated their clinical parameters, including lung function. The plasma CLDN4 level in stable and exacerbated COPD was measured. Results The COPD patients were all males, and predominantly smokers; their initial lung function was poorer than the healthy controls. The mean CLDN4 plasma level was 0.0219 ± 0.0205 ng/mg in the control group, 0.0086 ± 0.0158 ng/mg in the stable COPD group (COPD-ST) and 0.0917 ± 0.0871 ng/mg in the exacerbated COPD (COPD-EXA) group. The plasma CLDN4 level was significantly lower in the COPD-ST than control group, but was significantly elevated in the COPD-EXA group. The plasma CLDN4 level was inversely correlated with FVC and FEV1 in the COPD-EXA group (r = 0.506, P = 0.001 and r = 0.527, P < 0.001, respectively). Conclusions The plasma CLDN4 level is closely correlated with COPD exacerbations and decreased lung function. This suggests that CLDN4 has potential as a severity marker for COPD.

Sleep in Chronic Respiratory Disease: Two different Obstructive Airway Diseases

( Sei Won Lee ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.0

Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are two major airway obstructive diseases. The prevalence of OSA is reported 1~7% and that of COPD is about 3~30% depending on regions. Their prevalence increases with ageing, and their overlap reaches to at least 1~5%, relatively common in general population. It is an important issue how these two diseases affect each other. Among clinical features of COPD, rostral fluid shift and cigarette smoke can promote OSA. Meanwhile, Low body mass index, hyperinflation, diminished REM sleep and medication such as theophylline can be protective for OSA. Sleep efficiency is usually decreased in COPD than normal population, and sleep efficiency also decreased as disease severity among patients with COPD. The sleep quality of is typically poor in COPD. REM and slow wave sleep decreases, and daytime fatigue also increased accordingly. Decreased daytime activity, nicotine, hypoxia, depression, and hypoxia are the possible etiologies of insomnia in COPD. When combined with OSA lung inflammation also increased. These sleep disturbances are associated with adverse outcomes in COPD. Therefore, the management of sleep disorders is quite important in COPD. Poor lung function and high apnea hypopnea index (AHI) are both predictors of mortality in COPD and OSA, respectively. With adjustment, AHI is still significantly associated with the survival. For diagnosis, clinical suspicion is important. Questionnaire such as stop BANG, NoSAS can be performed. Considering these two diseases are common, polysomnography, pulmonary function test and nocturnal SpO2 monitoring can be done whenever suspected. The principle of treatment is the management of each disease. Bronchodilators for small airway, the major treatment of COPD, is effective in nocturnal desaturation. CPAP for upper airway, the major treatment of OSA, is also effective to improve survival in patients with overlap (COPD + OSA). If treated appropriately with CPAP, the patients with overlap syndrome are almost the same as COPD patients without OSA. Despite theoretical benefit of oxygen during sleep, nocturnal oxygen fails in showing clinical benefit in patients with COPD. Meanwhile, noninvasive positive pressure ventilation proved definite improvement in mortality and emergency room visit in hypercapnic patients with COPD. In summary, overlap (COPD + OSA) is common. Sleep efficiency is decreased in COPD. Both OSA and COPD increased systemic inflammation. The principle of treatment for each disease (bronchodilator / CPAP) is the same in overlap. BIPAP should be considered for hypercapnic or recently exacerbated COPD patients.

한국인에서 만성폐쇄성폐질환과 인체 폐 표면 활성제 단백-A 유전자 대립형질의 상관관계

나주옥 ( Joo Ock Na ),오명호 ( Myung Ho Oh ),최재성 ( Jae Sung Choi ),서기현 ( Ki Hyun Seo ),김용훈 ( Yong Hoon Kim ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.60 No.6

연구배경: 만성 폐쇄성폐 질환(이하 COPD)은 기도의 만성적인 염증이 특징인 질환이다. COPD의 발생에는 흡연 외에도 환경적, 유전적인 인자가 복합적으로 작용 한다. 폐 표면 활성제 단백-A(이하 SP-A)는 급성기 반응물질(acute phase reactant molecule)과 유사한 구조 및 기능을 가진 것으로 연구되어져 폐의 숙주방어와 염증반응에 중요하게 관여하는 것으로 알려졌다. 이에 저자들은 폐에서 염증 반응 및 면역에 관여하는 SP-A와 COPD군과의 유전자 대립형질을 비교분석하여 SP-A가 COPD의 병인에 관여하는 지를 밝히고자 본 연구를 시행하였다. 방법: 2004년 10월부터 2004년 12월까지 순천향대학교 천안병원 호흡기 내과에서 COPD로 진단되어 치료 받고 있는 환자 19명과, 순천향대학교 천안병원 신생아실에 입원한 정상 신생아 20명을 대조군으로 하여 PCR-cRFLP 방법을 사용하여 아미노산 염기 서열의 차이에 의해 SP-A의 유전자형을 연구 하였다. 결과: 1) COPD군의 SP-A1 유전자 대립형질은 대조군에 비해 6A2, 와 6A(18)이 통계적으로 유의하게 높은 빈도를 보였고, 6A3, 6A4는 낮은 빈도를 보였다. 2) COPD군의 SA-A2 유전자 대립형질 중 1A0는 대조군에 비해 통계적으로 낮은 빈도를 보였고, 1A2는 대조군에 비해 유의하게 높은 빈도를 보였다. 3) SP-A1의 50번째 nucleotide가 GG인 경우 COPD군에서 통계적으로 의미 있게 높았고, SP-A2의 9번째 nucleotide가 CC인 경우 COPD군에서 통계적으로 의미 있게 높았다. 결론: 우리나라에서는 SP-A의 특정 대립형질(inducer : 6A2, 6A(18), 1A2 & protector : 6A3, 6A4, 1A0)에 차이를 보이는 경우 COPD가 발생될 가능성이 높은 것을 알 수 있었고, 특히 SP-A1의 50번째 염기서열이 GG인 경우와, SP-A2의 9번째 염기서열이 CC인 경우에 COPD 발생 가능성이 높을 것으로 예측된다. Backgrounds: This study investigated whether or not a polymorphism in the gene encoding the surfactant protein A(SP-A) has any bearing on the individual susceptibility to the development of chronic obstructive pulmonary disease(COPD) in a genetically homogenous Korean population. Methods: The genotypes of 19 COPD patients and 20 healthy neonates as controls were tested using a polymerase chain reaction followed by restriction fragment length polymorphism analysis for the SP-A gene. Results: The specific frequencies of the 6A2 and 6A18 alleles of SP-A1 and the 1A2 allele of SP-A2 were much higher in the COPD group than control group (p<0.05). However, the frequencies of the 6A3 and 6A4 alleles of SP-A1 and the 1A0 allele of SP-A2 in the COPD group were significantly lower than the control group. In the COPD group, the frequencies of the +50 locus genotypes GG of SP-A1 and the +9 locus genotypes CC of SP-A2 were 85.0% and 60.6%, respectively, and 19.7% and 24.8% in the control group, respectively. The frequencies of the polymorphic genotypes or alleles showed a statistically significant difference between the COPD group and the control group (P<0.05). Conclusion: A genetic polymorphism in SP-A is associated with the development of COPD in the Korean population. (Tuberc Respir Dis 2006; 60: 638-644)

흡연상태가 40세 이상 남성의 만성폐쇄성폐질환 유병가능성에 미치는 영향: 제5기 국민건강영양조사를 기반으로

정인숙,정인경 대한임상건강증진학회 2014 Korean Journal of Health Promotion Vol.14 No.4

Background: This is a study of the prevalence of chronic obstructive pulmonary disease (COPD), which showshigh mortality worldwide, and the effects of smoking on COPD by using data from the Korea National Healthand Nutrition Examination Survey V. Methods: FEV1/FEV6<0.73 was used as a diagnostic criterion of COPD. Frequency analysis for prevalence, descriptivestatistics for general characteristics and ventilation rate according to age-specifications, and complexsample logistic regression analysis for the effect of smoking on COPD prevalence were used. IBM SPSSStatistics 21 Standard, Complex Samples for Medical Science(Windows) was used for data analysis(α=0.05). Results: Prevalence of COPD was 11.6±0.5% of Koreans in their forties or over, and 17.5±0.8% in males, and6.2±0.5% in females. There was significant increase of COPD prevalence with age increment. Before adjustingfor age and smoking index(SI), the COPD possibilities of past and current-smokers compared with non-smokingmales were (odds ratio [OR] 2.112 [95% confidence interval [CI] 1.551-2.875]) and (OR 1.834 [95% CI1.319-2.551]) respectively. After adjustments with age and SI, the COPD possibility of current-smoking was2.099 (1.382-3.188) times higher and for past-smoking was 1.463 (1.012-2.115) times higher than non-smoking. The P-value of each group was significant. The regression coefficients (B) of current-smoking and past-smokingwere 0.741 and 0.380 respectively. The prevalence of COPD increased 1.102 (1.090-1.115) times for every1 year of age increase, and 1.012 (1.007-1.018) times for every 1 SI increase (P<0.001). Conclusions: After adjusting for age and SI, the prevalence of COPD in smokers was higher than non-smokers. And current-smoking had a higher OR and higher B than past-smoking. 연구배경: 국민건강영양조사 제5기 건강검진조사 자료를활용하여 COPD 유병률과, 흡연상태가 이 질병발생에 미치는 영향을 조사하였다. 방법: COPD 진단기준은 FEV1/FEV6<0.73, 흡연이 COPD유병률에 미치는 영향은 복합표본설계 로지스틱회귀분석을 하였다. 결과: 40세 이상 COPD 유병률은 11.6±0.5%였고, 남성은17.5±0.8%, 여성은 6.2±0.5%였다. 남성의 보정 전 COPD유병가능성은 현재흡연자는 OR 1.834 (95% CI 1.319-2.551),과거흡연자는 OR 2.112 (95% CI 1.551-2.875)였다. 연령과흡연지수를 보정한 현재흡연자의 유병가능성은 2.099(1.382-3.188)배 과거흡연자는 1.463 (1.012-2.115)배였으며각 군의 유의도는 0.001과 0.043으로 유의하였다(현재흡연의 회귀계수는 0.741±0.213, 과거흡연은 0.380±0.188). 연령 1세 증가시마다 유병가능성이 1.102 (1.090-1.115)배 증가하였고, 흡연지수가 1 pack*year 증가시마다 1.012 (1.007-1.018)배 증가하였다(P<0.001). 결론: 연령과 흡연량 보정 후, 흡연자의 COPD 유병가능성이 높았다. 또한 현재흡연자는 과거흡연자보다 승산비와 회귀계수가 더 높았다.

Impact of bronchiectasis on clinical outcome and medical utilization in COPD patients

김유림,( Kyungjoo Kim ),( Seung Won Ra ),( Chin Kook Rhee ) 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-

With use of computed tomography, bronchiectasis(BE) is not uncommon finding in chronic obstructive pulmonary disease (COPD) patients, but there has not fully understood the clinical aspects of COPD with BE. We aimed to investigate the effect of BE on prognosis and medical utilization in patients with COPD. From the Health Insurance Review and Assessment(HIRA) data from 2011 to 2015, we identified COPD patients and checked the co-existence of BE. Exacerbation and medical utilization were compared between COPD with BE (COPD-BE) and COPD without BE group. Of 263,747 COPD patients, 19,285 (7.3%) were classified as COPD-BE and 244,462(92.7%) as COPD without BE. The percentages of hospitalization including emergency room visits and intensive care unit admission were higher in COPD-BE group (36.0%vs.26.1%,p<0.001; 6.3% vs. 5.0%, p <0.001), and the co-existence of BE was found to be a crucial factor for moderate to severe exacerbation in multivariate analysis( incidence rate ratio [IRR] 1.29; 95% CI 1.271-1.319; p<0.001). Exacerbation with the need for antibiotics was significantly higher in COPD-BE group. Days and costs during medical utilization were also higher in patients with COPD-BE, compared to those with COPD without BE(17.43±29.67vs.13.44±24.82 days, p<0.001; 2024.77±4903.85 vs. 1473.45±4346.24 USD, p<0.001). Age, gender, insurance type, co-existence of BE, and medications were found to be important factors for exacerbation and medical costs in multiple linear regression. COPD patients with BE demonstrated worse outcomes and higher medical costs than COPD patients without BE.

Implications of Managing Chronic Obstructive Pulmonary Disease in Cardiovascular Diseases

( Kartik Deshmukh ),( Arjun Khanna ) 대한결핵 및 호흡기학회 2021 Tuberculosis and Respiratory Diseases Vol.84 No.1

Globally, cardiovascular diseases and chronic obstructive pulmonary disease (COPD) are the leading causes of the non-communicable disease burden. Overlapping symptoms such as breathing difficulty and fatigue, with a lack of awareness about COPD among physicians, are key reasons for under-diagnosis and resulting sub-optimal care relative to COPD. Much has been published in the past on the pathogenesis and implications of cardiovascular comorbidities in COPD. However, a comprehensive review of the prevalence and impact of COPD management in commonly encountered cardiac diseases is lacking. The purpose of this study was to summarize the current knowledge regarding the prevalence of COPD in heart failure, ischemic heart disease, and atrial fibrillation. We also discuss the real-life clinical presentation and practical implications of managing COPD in cardiac diseases. We searched PubMed, Scopus, EMBASE, and Google Scholar for studies published 1981-May 2020 reporting the prevalence of COPD in the three specified cardiac diseases. COPD has high prevalence in heart failure, atrial fibrillation, and ischemic heart disease. Despite this, COPD remains under-diagnosed and under-managed in the majority of patients with cardiac diseases. The clinical implications of the diagnosis of COPD in cardiac disease includes the recognition of hyperinflation (a treatable trait), implementation of acute exacerbations of COPD (AECOPD) prevention strategies, and reducing the risk of overuse of diuretics. The pharmacological agents for the management of COPD have shown a beneficial effect on cardiac functions and mortality. The appropriate management of COPD improves the cardiovascular outcomes by reducing hyperinflation and preventing AECOPD, thus reducing the risk of mortality, improving exercise tolerance, and quality of life.

만성 폐쇄성 폐질환 급성 악화 시 C-반응단백과 폐동맥 고혈압의 관계

김소리 ( So Ri Kim ),최영훈 ( Yeong Hun Choe ),이가영 ( Ka Young Lee ),민경훈 ( Kyung Hoon Min ),박성주 ( Seoung Ju Park ),이흥범 ( Heung Bum Lee ),이용철 ( Yong Chul Lee ),이양근 ( Yang Keun Rhee ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.2

연구배경: COPD 환자에서 혈청 C-반응단백은 증가하는 것으로 알려져 있으며 이러한 변화는 급성 악화 시 보다 두드러진다. 폐동맥 고혈압은 COPD의 흔한 합병증 중 하나이며, C-반응단백은 전신적 심혈관계 질환 발생 위험과 밀접한 관련이 있다고 알려져 왔다. 하지만, COPD에서 이차적으로 발생하는 폐동맥 고혈압에 대한 C-반응단백의 영향에 대해서는 연구가 미비한 상태이다. 방법: 본 연구는 AECOPD에 대해 입원 치료를 시작한 72명의 환자를 대상으로 전향적으로 연구하였다. 환자들은 AECOPD에 대한 즉각적인 치료를 받았고 입원 2일 또는 3일째 실내 환기 하에서 혈청 C-반응단백, 동맥혈 산소 분압, 폐동맥 고혈압에 대한 이환 여부 등에 대한 검사를 시행 받았다. 결과: 폐동맥 고혈압에 이환된 환자는 47명으로 전체 환자 중 65.3%에 달하였다. COPD의 중증도가 심할수록 폐동맥 고혈압의 이환율과 C-반응단백 평균치가 증가하였고, C-반응단백 평균치가 증가할수록 평균 우심실 수축압 역시 증가하는 것을 관찰할 수 있었다. 폐동맥 고혈압 환자군과 비환자군에서 C-반응단백은 각각 37.6±7.4 mg/L 와 19.9±6.6 mg/L 통계적으로 의미 있게 폐동맥고혈압 환자군에서 높았지만, 동맥혈 산소분압은 양 군간 의미 있는 차이를 보이지 않았다(77.8±3.6 mmHg vs. 87.2±6.0 mmHg). 결론: 본 연구는 COPD의 급성 악화 시 증가된 C-반응 단백은 폐동맥 고혈압의 이환 여부와 밀접한 관련이 있는 것을 보여 주고 있으며, 이는 COPD의 예후에 심혈관계 질환의 이환 여부가 중요하다는 점을 감안할 때 C-반응단백의 COPD에 대한 독립적 예후인자로서의 가능성을 시사해 준다. Background: In chronic obstructive pulmonary disease (COPD) patients, the serum levels of C-reactive protein (CRP) are elevated and an increase of CRP is more exaggerated in the acute exacerbation form of COPD (AECOPD) than in stable COPD. Pulmonary arterial hypertension is a common complication of COPD. An increased level of CRP is known to be associated with the risk of systemic cardio-vascular disorders. However, few findings are available on the potential role of CRP in pulmonary arterial hypertension due to COPD. Methods: This study was performed prospectively and the study population was composed of 72 patients that were hospitalized due to AECOPD. After receiving acute management for AECOPD, serum CRP levels were evaluated, arterial oxygen pressure (PaO2), was measured, and the existence of pulmonary arterial hypertension under room air inhalation was determined in the patients. Results: The number of patients with pulmonary arterial hypertension was 47 (65.3%)., There was an increased prevalence of pulmonary arterial hypertension and an increase of serum CRP levels in patients with the higher stages of COPD (e.g., patients with stage 3 and stage 4 disease; P<0.05). The mean serum CRP levels of patients with pulmonary arterial hypertension and without pulmonary arterial hypertension were 37.6±7.4 mg/L and 19.9±6.6 mg/L, respectively (P<0.05). However, there was no significant difference of the mean values of PaO2 between patients with pulmonary arterial hypertension and without pulmonary arterial hypertension statistically (77.8±3.6 mmHg versus 87.2±6.0 mmHg). Conclusion: We conclude that higher serum levels of CRP can be a sign for pulmonary arterial hypertension in AECOPD patients. (Tuberc Respir Dis 2008;64:125-132)