Systemic inflammation and morphofunctional parameters of myocardium and vessels in patients with combined course of chronic obstructive pulmonary disease and arterial hypertension

Abstract

Introduction. Chronic obstructive pulmonary disease (COPD) is considered to be one of the most widely spread disease in the world. The main peculiarity of COPD is persistent airflow limitation that is usually progressive and associated with chronic inflammatory process in the airways. Chronic systemic inflammation is considered to play role in forming of arterial hypertension (AH) too. Systemic inflammation in COPD and AH patients is characterized by pathological increasing of neutrophils, macrophages, B- and T- cells, CD4+, CD8+ and others in small airways. This inflammation cells produce a huge amount of cytokines, chemokines, and adhesion molecules, like interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). At the same time, despite the large number of data on pathogenesis of COPD and AH, it is less known about systemic inflammation and its influence on heart and vessels in patients with combined flow of COPD and AH.

Aim. To study peculiarities and links between parameters of systemic inflammation and lesions of heart and vessels in patients with combined course of COPD and AH.

Materials and methods. A total of 98 patients with COPD, AH and with combined course of COPD and AH were examined. The patients were divided into 3 groups. The first group was formed by patients with AH (n=27) the second group was formed by patients with COPD (n=27), the third group was formed by patients with combined course of COPD and AH (n=44). Control group was formed from healthy persons of the same age and sex (n=20). All patients underwent spirography, echocardiography, ultrasound measurement of common carotid artery intimal-medial thickness and estimation of endhothelium-dependent vasodilatation. ELISA method was used to measure serum concentrations of IL-6 and TNF-α. Immunoturbidimetric method was used to measure C-reactive protein (CRP).

Results. Patients with combined course of COPD and AH had higher levels of IL-6 (p<0,01), TNF-α (p<0,01) and CRP (p<0,001) comparing with first, second and control group. The correlation links between CRP and end-diastolic diameter of left ventricle (R=+0,53; p<0,05), left ventricle mass (R=+0,45; p<0,05) and fractional area change of right ventricle (R=-0,40; p<0,05) were found. Also, there were a correlations between IL-6 and thickness of right ventricle (R=-0,38; p<0,05) and left ventricle (R=-0,39; p<0,05). The concentration of serum IL-6 correlated with vascular intima-media thickness in right (R=+0,42; p<0,05) and left (R=+0,39; p<0,05) common carotid artery. The level of TNF-α was associated with vascular intima-media thickness in right (R=+0,44; p<0,05) and left (R=+0,42; p<0,05) common carotid artery.

Conclusion. Patients with combined course of COPD and AH have increased levels of systemic inflammation biomarkers – C-reactive protein, interleukin-6 and tumor necrosis factor-α. The significant correlation links between systemic inflammation biomarkers and systolic, diastolic parameters of left and right ventricle and vascular intima-media thickness were found.

Key words: systemic inflammation, interleukin-6, tumor necrosis factor-α, C-reactive protein, chronic obstructive pulmonary disease, arterial hypertension, morfofunctional parameters of myocardium.