RESUMO
The aim of this study was to assess the expression levels of induced sputum interleukin (IL)-8 and IL-10 levels in patients with acute exacerbated chronic obstructive pulmonary disease (AECOPD) complicated with chronic cor pulmonale (CCP) at high altitude, and to evaluate the intervention effects of an inhaled corticosteroid (ICS) and a ß2-adrenoceptor agonist in this disease. A total of 186 patients with AECOPD complicated with CCP were randomly divided into three groups, with 62 cases in each. With regard to the two treatment groups, group A was treated with salmeterol/fluticasone (50 µg/250 µg, respectively) by airway inhalation twice daily, while group B received budesonide (1 mg) as a spray inhalation, twice daily. The routine treatment group (group C) received only routine treatment. The levels of IL-8 and IL-10 in the induced sputum and the predicted percentage of forced expiratory volume in one second (FEV1%pred), partial pressure of oxygen in arterial blood (PaO2) and partial pressure of carbon dioxide in arterial blood (PaCO2) were examined on admission and at a stable stage two weeks following treatment. Forty healthy volunteers served as a control group (group D). Compared with group D values, the IL-8 induced sputum level and the PaCO2 were significantly increased, while the level of IL-10, FEV1%pred and the PaO2 were markedly decreased in the three COPD groups prior to treatment. Following treatment, the induced sputum IL-8 level and the PaCO2 were significantly decreased, while the induced sputum IL-10 level, FEV1%pred and the PaO2 were markedly increased in the three treatment groups compared with the values pre-therapy (all P<0.01). The post-treatment parameters were significantly different among the three groups (P<0.01). The results indicate that IL-8 and IL-10 are involved in the airway inflammation of AECOPD complicated by CCP. Treatment with an ICS was demonstrated to be a successful method of reducing the local expression of IL-8 and increasing the local expression of IL-10; however, ICS combined with a long-acting ß2-adrenoceptor agonist (LABA) was more effective than the sole administration of ICS in patients with AECOPD complicated by CCP at high altitude.
RESUMO
OBJECTIVE: To assess the prognostic risk factors in the patients with acute exacerbation of chronic cor pulmonale (AEHACCP) and obstructive sleep apnea-hypopnea syndrome (OSAHS) in high altitude area. METHODS: The relations between neck circumference (Nc), body mass index (BMI), arterial blood gases, polysomnography (PSG) parameters and prognosis from 66 patients with AEHACCP and OSAHS (31 survivors, 35 non-survivors) were studied by one variable analysis and multivariable Logistic regression analysis. RESULTS: The results of one variable analysis showed that in patients with AEHACCP and OSAHS, Nc> or =45 cm, BMI > or =28 kg/m(2) , arterial oxygen partial pressure (PaO(2))< or =40 mm Hg (1 mm Hg= 0.133 kPa), mean pulmonary arterial pressure (mPAP)> or =45 mm Hg, apnea-hypopnea index (AHI)> or = 40 times/h, sleep mean arterial oxygen saturation (MSaO(2))< or =0.70, percentage of the duration of SaO(2)<0.70 during sleep(T(70) )> or =50% and difference between basic and minimum SaO(2) during sleep(Delta SaO(2))> or = 0.20 were closely correlated with prognosis. The Logistic regression models showed that Nc> or =45 cm [odds ratio (OR)=6.781, 95% confidence interval (95%CI)=1.153-17.502, P=0.007], BMI> or =28 kg/m(2) (OR=7.562, 95%CI=1.012-23.457, P=0.004), mPAP> or =45 mm Hg (OR=6.991, 95%CI=1.353-20.155, P=0.003), AHI> or =40 times/h (OR=7.258, 95%CI=1.526-18.022, P=0.006), MSaO(2)< or =0.70 (OR=6.488, 95%CI=1.562-26.878, P=0.008), T(70) > or =50% (OR=5.593, 95%CI=1.265-21.589, P=0.008) and Delta SaO(2)> or =0.20 (OR=6.551, 95%CI=1.495-18.920, P=0.007) were independent significant risk factors in prognosis of patients with AEHACCP and OSAHS. CONCLUSION: The patients with AEHACCP and OSAHS, Nc> or =45 cm, BMI> or =28 kg/m(2), mPAP> or =45 mm Hg, AHI> or = 40 times/h, MSaO(2)< or =0.70, T(70) > or =50% and Delta SaO(2)> or =0.20 are risk factors leading to a rise in mortality. It is important to use these parameters to guide clinical therapy, and to judge the prognosis so as to reduce the mortality of patients with AEHACCP and OSAHS by monitoring the above risk factors in clinical practice.