Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Elevated C-reactive Protein Levels are a Sign of Pulmonary Arterial Hypertension in AECOPD

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

  • Kim, So Ri (Department of Internal Medicine, Airway Remodeling Laboratory, Chonbuk National University Medical School) ;
  • Choe, Yeong Hun (Department of Internal Medicine, Airway Remodeling Laboratory, Chonbuk National University Medical School) ;
  • Lee, Ka Young (Department of Internal Medicine, Airway Remodeling Laboratory, Chonbuk National University Medical School) ;
  • Min, Kyung Hoon (Department of Internal Medicine, Airway Remodeling Laboratory, Chonbuk National University Medical School) ;
  • Park, Seoung Ju (Department of Internal Medicine, Airway Remodeling Laboratory, Chonbuk National University Medical School) ;
  • Lee, Heung Bum (Department of Internal Medicine, Chonbuk National University Medical) ;
  • Lee, Yong Chul (Department of Internal Medicine, Airway Remodeling Laboratory, Chonbuk National University Medical School) ;
  • Rhee, Yang Keun (Department of Internal Medicine, Chonbuk National University Medical)
  • 김소리 (전북대학교 의과대학 내과학교실) ;
  • 최영훈 (전북대학교 의과대학 내과학교실) ;
  • 이가영 (전북대학교 의과대학 내과학교실) ;
  • 민경훈 (전북대학교 의과대학 내과학교실) ;
  • 박성주 (전북대학교 의과대학 내과학교실) ;
  • 이흥범 (전북대학교 의과대학 내과학교실) ;
  • 이용철 (전북대학교 의과대학 내과학교실) ;
  • 이양근 (전북대학교 의과대학 내과학교실)
  • Received : 2007.12.24
  • Accepted : 2008.01.31
  • Published : 2008.02.28
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Abstract

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 ($PaO_2$), 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 $37.6{\pm}7.4mg/L$ and $19.9{\pm}6.6mg/L$, respectively (P<0.05). However, there was no significant difference of the mean values of $PaO_2$ between patients with pulmonary arterial hypertension and without pulmonary arterial hypertension statistically ($77.8{\pm}3.6mmHg$ versus $87.2{\pm}6.0mmHg). Conclusion: We conclude that higher serum levels of CRP can be a sign for pulmonary arterial hypertension in AECOPD patients.

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 $37.6{\pm}7.4mg/L$ 와 $19.9{\pm}6.6mg/L$ 통계적으로 의미 있게 폐동맥고혈압 환자군에서 높았지만, 동맥혈 산소분압은 양 군간 의미 있는 차이를 보이지 않았다($77.8{\pm}3.6mmHg$ vs. $87.2{\pm}6.0mmHg$). 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.

Keywords

References

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