Serum Cystatin C as an Inflammatory Marker in Exacerbated and Convalescent COPD Patients
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ORIGINAL ARTICLE
Serum Cystatin C as an Inflammatory Marker in Exacerbated and Convalescent COPD Patients Ming Zhang,1 Yali Li,1 Xia Yang,1 Hu Shan,1 Qiuhong Zhang,1 Zongjuan Ming,1 Yingying Xie,1 Haijuan Chen,1 Yanqin Liu,1 and Jie Zhang1,2
Abstract—Chronic obstructive pulmonary disease (COPD) is a common chronic inflammatory disease with high morbidity and mortality rates. Cystatin C (Cys C) is a sensitive indicator for various chronic inflammatory diseases. In this study, we aimed to evaluate the role of Cys C in COPD patients comparing with the other well-known inflammatory markers. Ninety patients with acute exacerbated COPD were studied and were reassessed when convalescent. Ninety controls were matched for age, gender, body mass index, smoking index, and comorbidity. Serum Cys C was significantly increased in convalescent COPD patients compared with healthy controls and further increased in COPD patients with an acute exacerbation. Serum Cys C was positively correlated with hsCRP both in the exacerbation and convalescence periods of COPD and negatively correlated with FEV1% predicted and FEV1/FVC in the convalescent COPD patients. In conclusion, serum Cys C is a positive acute-phase reactant in COPD patients and might indicate systemic inflammation during the progression of COPD. KEY WORDS: cystatin C; C-reactive protein; inflammation; pulmonary function; chronic obstructive pulmonary disease.
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a major global health problem and the fourth most common cause of death in the developed countries [1]. Globally, the estimated prevalence of COPD is 5–16 % in populations aged ≥40 years. The COPD prevalence in China, which in 2011 was reported to range 5–13 % in different provinces/ cities, could double or even triple over the next two decades [2]. COPD is characterized by a persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airway 1
Department of Respiratory Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University, No. 157 West Fifth Road, Xi’an, Shaanxi 710004, China 2 To whom correspondence should be addressed at Department of Respiratory Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University, No. 157 West Fifth Road, Xi’an, Shaanxi 710004, China. E-mail: [email protected]
and lung. Acute exacerbation of COPD (AECOPD) is not only correlated with the increase in airway inflammation but also in systemic inflammation [3]. As chronic inflammatory response plays an important role in the pathogenesis of COPD, various inflammatory markers such as white blood cells (WBCs), C-reactive protein, erythrocyte sedimentation rate, and inflammatory cytokines have been well investigated during the progression of COPD [3]. Moreover, these inflammatory markers are most likely associated with pulmonary function decline in the patients with COPD [3]. The imbalance between protease and antiprotease is involved in the pathogenesis of COPD [4] and leads to the enzymatic deg
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