Interleukin 6 and airflow limitation in mustard lung patients

1
(No Transcript)
2

Highly sensitive C-reactive protein levels in
Iranian patients with pulmonary complications of
sulfur mustard poisoning its correlation with
severity of airway diseases

• S. M.Lari, D. Attaran, M. Towhidi,
• Lung Disease Tuberculosis Research Center
• Mashhad University of Medical Sciences

3
(No Transcript)
4
(No Transcript)
5
Background

• Sulfur mustard(SM) is a potent, toxic, alkylating
  agent that is able to cause serious ocular,
  neurologic, cutaneous, bone marrow, and pulmonary
  complications.
• The most common late complications of SM
  poisoning are respiratory problems.
• Mustard Lung as, a unique form of chronic
  obstructive pulmonary disease in patients with
  late respiratory complication of sulfur mustard
  poisoning.

. Ghanei M., et al. Correlation of sulfur
mustard exposure and tobacco use with expression
(immunoreactivity) of p53 protein in bronchial
epithelium of Iranian "mustard lung" patients.
Mil Med 2007 172 70-74.
6
Background

• Highly sensitive C-reactive protein (hs-CRP) is
  one of the important inflammatory markers that
  is synthesized by hepatocytes during inflammatory
  reactions.
• In the last decade, concern has grown about
  significant correlations of hs-CRP with
  myocardial infarction, unstable angina, and
  stroke.

7
Background

• It is now believed that chronic obstructive
  pulmonary disease (COPD) is a systemic condition
  that inflammatory markers ( hs-CRP, IL-6,) have
  important roles in its pathogenesis.
• Recent studies have shown that serum level of
  hs-CRP is elevated both in stable exacerbation
  states of COPD and is related to lower FEV1.
• Also, hs-CRP is a strong and independent
  predictor of future COPD outcome.

8
Aim

• The present study is the first, of which we are
  aware, that was designed to determine serum
  highly sensitive C-reactive protein and evaluate
  its correlation with lung function parameters in
  patients with chronic obstructive pulmonary
  disease due to SM poisoning.

9
Methods and Materials

• Between April and September 2008, all the
  chemical war gassed veterans with stable COPD who
  attended to the pulmonary clinic of Ghaem
  hospital, in Mashhad, Iran, were entered into
  this current cross- sectional study.
• All patients had validated documents of sulfur
  mustard gas exposure and suffered from
  complications of sulfur mustard poisoning.
• Also 30 nonsmoker, healthy men were enrolled into
  this study as a control group and their age and
  body mass index (BMI) were matched to the
  subjects.

10
Inclusion criteria

• post-bronchodilator FEV1/FVC lt 0.7 after 400 µg
  of inhaled albuterol
• validated documents of sulfur mustard gas
  exposure and suffered from complications of
  sulfur mustard poisoning
• Non-smoking

11
Exclusion Criteria

• If their FEV1 increased more than 12 and 200 ml
  after bronchodilator
• If they had asthma , bronchiectasis, tuberculosis
  , active pulmonary infections, cardiovascular
  diseases, diabetes mellitus or other confounding
  inflammatory diseases, such as malignancy,
  arthritis, connective tissue diseases, and
  inflammatory bowel disease
• If they had exacerbation of disease or
  hospitalization during the last 2 months.
• Those patients who had taken aspirin, statins
  were excluded.

12
Methods Material

• One chest physician visited all the subjects and
  the following items were recorded
• BMI
• SGRQ
• Spirometry
• MMRC scale
• 6MWT
• ABG
• Blood sample for hs-CRP

13
Results

• The mean serum hs-CRP levels were significantly
  higher in the patients than in the controls (9.4
  6.78 SD versus 3.9 1.92 SD mg/l, plt0.001).
• Out of 50 patients in the case group, 32 (64)
  had high serum hs-CRP levels ( 5 mg/l).

14
Clinical and pathophysiological parameters of 50
patients with mustard lung
Values Clinical Pathophysiological parameters
46.3 9.18 Age (yrs)
17.00 6.00 Duration of disease(yrs)
58.9817.51 FEV1(Pred.)
62.149.70 FEV1/FVC
327.886.96 6MWD(m)
27.32 3.30 BMI
75.1 12.00 PaO2(mmHg)
94.03 3.45 SaO2()
45.379.50 PaCo2(mmHg)
56.23 14.31 Total SGRQ Score
9.406.78 hs-CRP(mg/l)
42 Inhaled corticosteroid therapy ( of patients)
15
(No Transcript)
16
Frequency of GOLD staging in patients
17
Correlation of hs-CRP GOLD satges
18
Correlations between hs-CRP and FEV-1
19
Celli BR, et al. The Body-Mass Index, Airflow
Obstruction, Dyspnea , Exercise Capacity Index in
Chronic Obstructive Pulmonary Disease. NEJM 2004
3501005-1012.
BODE Index
20
Correlation of hs-CRP with lung function
parameters
P value Correlation Coefficient(r) Variable
0.71 0.06 Age
0.056 0.27 BMI
0.60 0.082 Duration of disease
0.010 -0.32 FEV1
0.001 0.45 GOLD
0.70 -0.06 PaO2
0.009 0.37 PaCo2
0.330 0.07 BODE
0.85 0.2 Total SGRQ score

21
Conclusion

• The present study demonstrates that chronic lung
  disease in patients with respiratory complication
  of SM poisoning is associated with systemic
  inflammation and that level of inflammatory
  markers (hs-CRP) is correlated with the severity
  of airway disease.
• Serum hs-CRP significantly correlates with GOLD,
  FEV1, FEV1 percent predicted, and PaCo2.

22
Conclusion

• In this study we found that, despite the
  exclusion of smoking, cardiovascular diseases,
  infections, and other important inflammatory
  conditions, hs-CRP levels are raised in SM
  patients and that significant differences in the
  mean hs-CRP levels exist between patients and
  controls .
• Hs-CRP may have an important role as an
  inflammatory marker of disease severity in
  mustard lung patients as it does in other COPD
  patients.

23

• Thank You
• larish851_at_mums.ac.ir