Does airway colonization cause systemic inflammation in bronchiectasis?

Son dönemde yapılan çalışmalar kronik obstrüktif akciğer hastalığı ve astım gibi kronik hava yolu hastalıklarında eşlik eden bir sistemik inflamatuvar yanıtın varlığını göstermiştir. Hava yollarında kronik bakteriyel kolonizasyon ve buna ikincil hava yolu inflamasyonu ve ilerleyici hava yolu hasarı ile karakterize bir hastalık olan bronşektazide, sistemik inflamatuvar yanıtın var olup olmadığı bilinmemektedir. Bu çalışmada bronşektazide hava yolundaki bakteriyel kolonizasyon ve sistemik inflamasyon arasındaki ilişkinin değerlendirilmesi amaçlanmıştır. Klinik olarak stabil olan bronşektazi hastaları (n= 50) ile yaş ve cinsiyete göre eşleştirilmiş kontrol grubunda (n= 30) serum inflamasyon parametreleri [beyaz küre sayısı, eritrosit sedimentasyon hızı, C-reaktif protein (CRP), fibrinojen, interlökin-8, tümör nekroz faktörü-α ve leptin] değerlendirilmiştir. Ayrıca, bronşektazili hasta grubunda hava yolu bakteriyel kolonizasyonuna göre alt analiz yapılmıştır. Bronşektazili hasta ve kontrol grupları arasında serum inflamasyon parametreleri seviyeleri açısından fark saptanmamıştır. Ancak bronşektazili hasta grubu hava yolu bakteriyel kolonizasyonuna göre değerlendirildiğinde median (çeyrekler arası aralık-ÇAA) beyaz küre sayısı, CRP ve fibrinojen seviyeleri hava yolu kolonizasyonu olan hastalarda (n= 14) olmayanlara göre belirgin derecede yüksek olarak saptanmıştır [sırasıyla 8.2 (6.4-9.5) ve 6.4 (5.8-7.7) x 103/mm3, 0.91 (0.45-1.29) ve 0.42 (0.30-0.77) mg/dL, 433.5 (390.3-490.3) ve 392.0 (327.0-416.0) mg/dL; p< 0.05]. Bu çalışmada tüm bronşektazi grubunda, kontrol hastaları ile karşılaştırıldığında, sistemik inflamatuvar parametrelerde artış saptanmamıştır. Ancak hastalar hava yolunda bakteriyel kolonizasyon varlığına göre değerlendirildiklerinde kolonize hastalarda beyaz küre, CRP ve fibrinojen seviyelerinin yüksek olduğu gözlenmiştir. Bu bulgular stabil bronşektazi hastalarında gelişen kronik hava yolu kolonizasyonunun sistemik inflamasyona neden olabileceğini desteklemekedir.

Bronşektazide hava yolu kolonizasyonu sistemik inflamasyona neden olur mu?

Recent evidence suggests the presence of accompanying systemic inflammation in chronic inflammatory airway diseases such as chronic obstructive pulmonary disease and asthma; however little is known regarding the presence of systemic inflammation in bronchiectasis. Although bronchiectasis was initially considered a stationary process, chronic bacterial colonization causes airway inflammation and progressive airway damage. The aim of this study was to determine the level of systemic inflammation in bronchiectasis patients and identify its relationship with colonization. White blood cell (WBC) count, erythrocyte sedimentation rate, serum C-reactive protein (CRP), plasma fibrinogen, interleukin-8, tumor necrosis factor-α and leptin levels were determined in clinically stable bronchiectasis patients (n= 50), and age- and sex-matched controls. Bronchiectasis patients were also analyzed according to colonization in sputum samples. There was no significant difference between bronchiectasis and control groups with respect to inflammatory markers but median (interquartile range-IQR) WBC count, CRP and fibrinogen levels were significantly higher in colonized patients (n= 14) when compared to non-colonized patients [8.2 (6.4-9.5) vs. 6.4 (5.8-7.7) x 103/mm3, 0.91 (0.45-1.29) vs. 0.42 (0.30-0.77) mg/dL, 433.5 (390.3-490.3) vs. 392.0 (327.0-416.0) mg/dL, respectively; p< 0.05]. There was no evidence supporting the presence of systemic inflammation in the overall bronchiectasis group when compared to controls. However, elevated WBC count, CRP and fibrinogen levels in patients with colonization suggest the presence of a systemic inflammatory response in clinically stable bronchiectasis patients with colonization.

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