الفهرس 
Introduction and Aim of the work
External and Environmental Risk FactorsOnly 14 pages are availabe for public view
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Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of chronic morbidity and mortality. Tobacco smoking is the primary cause and major risk factor for the development of COPD. COPD is currently the fourth-leading cause of death in the world. In Egypt, more than 1% of total population suffers from COPD. Thus, it is important to periodically carryout sensitive and reliable measures to pick up the earliest stage of that disease. This is performed to apply vaccination, other therapies, or even smoke cessation in early stages of COPD for improving the patient’s quality of life.
The present study aimed to 1-evaluate serum levels of MDA, and activities of GPx, and SOD in COPD patients. This assessment is in order to elucidate the alteration and perturbation of oxidant/antioxidant balance in such disease. 2-estimate the serum levels of some inflammatory indices that reflect the severity of COPD as hs-CRP and sICAM-1. 3-estimate the serum levels of SP-D in COPD patients. Also studying the correlation between that surfactant with the severity of COPD measured by routine pulmonary function tests, hs-CRP, sICAM-1, and oxidant/antioxidant parameters. 4-carry out receiver operating characteristics (ROC) curve for SP-D in a trial to evaluate its utility as a possible potential biomarker reflecting the severity and exacerbation of COPD.
This analytic cross- sectional study was carried out on 64 COPD male patients. Those patients were recruited from Chest Outpatient Clinic and the Department of Chest Diseases, Assiut University Hospital, Egypt from October, 2009 to September, 2010. All patients were smokers and the age of the patients ranged from 45-75 years old. Depending on severity, patients with COPD were diagnosed and classified according to GOLD classification (2008) into four stages; I,II,III, and IV. In addition, twenty six male apparently healthy, age matched volunteers were included in this study as a control group. The control group was sub-classified into 14 smoker normal individual, and 12 non-smoker normal individual.
All patients were subjected to medical history taking, physical examination, chest X-ray, arterial blood gas analysis including pH, arterial O2 tension (PaO2), arterial CO2 tension (PaCO2) and O2 saturation, and pulmonary function tests including FVC, FEV1, FEV1/FVC ratio, and FEF 25-75% was performed by spirometry in the laboratory.
Then determination of serum levels of SP-D, sICAM-1, hs-CRP and MDA as well as activities of SOD and GPx were performed. SP-D, sICAM-1, and hs-CRP levels were measured by ELISA kits in Medical Biochemistry Department, while, SOD and GPx activities and MDA level were measured by spectrophotometric method.
The result showed a significant decrease in FEV1 L/S, FEV1%, FVC L/S and FVC% in stage IV compared to either stage I, II or III. Also, there was a significant decrease in FEV1/FVC%, FEF25-75 L/S and FEF 25-75% in stage IV compared to either stage I or II. As regard the arterial blood gases of COPD patients, there was a significant decrease in PaO2 and O2 saturation in stage IV compared to stage I, II or III.
The current study demonstrated a significant increase in mean serum levels of SP-D, sICAM-1, hs-CRP, and MDA in COPD patients as compared to control group. There was a significant increase in their serum levels which correlated to increasing of the severity of COPD, and the great increase was observed in stage IV. Meanwhile, a significant decrease in activities of SOD, and GPx in COPD patients was showed as compared to control group. Moreover, the significant decrease in the serum levels of the former enzymes was related to the severity of COPD, and the great decrease of their activities was observed in stage IV.
The study showed that SP-D was positively correlated with sICAM-1, hs-CRP, and MDA. Also, hs-CRP was positively correlated with sICAM-1 and MDA. In contrast, hs-CRP was negatively correlated with SOD and GPx. On the other hand, there were negative correlations between SP-D and both SOD and GPx. In addition, MDA was negatively correlated with SOD and GPx, but, it was positively correlated with sICAM-1.
from ROC curve, our data suggested that SP-D is a possible novel biomarker to identify of COPD, since it’s released from the affected organs of COPD which is lung, so, may be a promising lung specific biomarker to track clinical health outcomes of patients with COPD.
In conclusion, the severity of COPD was assessed by measuring routine pulmonary function tests, oxidant/antioxidant balance, and some inflammatory indices. The values of such indices which expressing the severity of the disease may be related to lung surfactant SP-D. The present results from SP-D ROC curve showed that sensitivity= 90.6% and specificity= 100%, thus, the investigation of SP-D as a biomarker of COPD patients may help in evaluating the severity of the disease and predicting the prognosis of COPD in early stages.Recommendations
1- The present study recommend complete smoking prohibiting. As smoking is the primary cause of COPD, smoking cessation for COPD patients in early stage improves the patient’s quality of life.
2- Because of the availability of hs-CRP as a measure of inflammation, it could be accompanied during evaluation of the pulmonary function tests by spirometry. This may help the clinician to measure the severity, exacerbation, and prognosis of COPD.
3- Oxidative stress is a pathological cause of COPD, which leads to increase in inflammation. Thus, the measurement of oxidant/ antioxidant parameters as well as inflammatory indices may be important tools in monitoring the disease activity. Moreover, our work directs the COPD patients towards using of antioxidant therapy.
4- from our data, it could be suggested that SP-D is a possible biomarker that reflects severity of COPD, since it is released from the affected organ in COPD which is the lung. Thus, it may be effective to follow up the severity, exacerbation, and therapeutic response in COPD patients.