細胞介質與蛋白酶對於慢性阻塞性肺疾病的影響及相關處置的探討

Cell-Derived Mediators and Cell-Related Proteases on the Progression of COPD: Effect and Management

林永芳(Yung-Fang Lin) ； 劉哲育(Jey-Yuh Liu)

《呼吸治療》 7卷1期 (2008/01) Pp. 111-129

https://doi.org/10.6269/JRT.2008.7.1.09

摘要

慢性阻塞性肺疾病(chronic obstructive pulmonary disease; COPD)是一種融合了複雜的徴候(signs)與症狀(symptoms)的疾病，包含有慢性支氣管炎與肺氣腫，吸菸是造成COPD主要原因。令人驚訝的是，沒有有效的藥物能夠改善COPD的進行，對於COPD的發生，只有所知不多的分子機轉。臨床上COPD患者可依其病史、呼吸困難狀況、藥物以及氧氣使用情形來評估其嚴重程度後，再使用支氣管擴張劑、抗生素、類固醇、氧氣、胸腔復健(pulmonary rehabilitation)甚至呼吸器支持(ventilatory support)。然而，這些大多是依賴guideline提示來處置COPD，所以較缺乏明確的治療目標(targeted therapy)。本篇主要介紹細胞介質(mediator)與蛋白酶(protease)在COPD形成中所扮演的角色，了解它們在COPD的進行時，會影響到呼吸道重塑(airway remodeling)、肺結構受損，及生理功能改變；除了戒菸是最有效的延緩COPD的惡化，以及預防COPD的發展外，我們希望，未來若能透過像介質拮抗劑(mediator antagonists)、蛋白酶抑制劑(protease inhibitors)及抗發炎藥物的有效輔助，來阻止COPD的劇變(exacerbation)以及提高COPD患者的生活品質。

關鍵字

慢性阻塞性肺疾病 ； 介質拮抗劑 ； 蛋白酶抑制劑 ； 趨化因子

並列摘要

Chronic obstructive pulmonary disease (COPD) is a complex mix of signs and symptoms in patients with chronic bronchitis and emphysema. It is a disease that largely result from tobacco smoking. There are no effective drug therapies for COPD that can significantly alter disease progression, and little is known of the underlying molecular mechanisms that are responsible for it occurrence. The clinical treatment of COPD involves diagnostic assessment and use of bronchodilators, systemic corticosteroids, and antibiotics; for patients who are sick enough to be hospitalized, oxygen therapy, pulmonary rehabilitation and mechanical ventilation may also be used. However, clinical practice guideline for the management of patients with COPD that deficient about new biological targeted therapy approaches. The cell-derived mediators and cell-related proteases play a role in development of COPD is demonstrated through our literature review present. Understanding it for effect airway remodeling, pulmonary structure damage, and physiological function change in the progression of COPD. Smoking cessation is the most cost-effective intervention to prevent the development and stop the progression of COPD. We hope that future research about mediator antagonists, protease inhibitors and anti-inflammation drugs will provide effective aides in stopping exacerbation of COPD and to improve life of quality in patients with COPD.

並列關鍵字

chronic obstructive pulmonary disease COPD ； mediator antagonists ； protease inhibitors ； chemokines