The role of proteinase inhibitor imbalance in pathogenesis of systemic inflammation and vascular hemostatic reactions in patients with exacerbation of chronic obstructive pulmonary disease

The authors of the paper analyzed the mechanisms of systemic inflammation and activation of hemostatic reactions in patients with exacerbation of chronic obstructive pulmonary disease (COPD). Main group included 74 patients with the signs of infectioninduced COPD exacerbation. Main group was divided into two subgroups. Subgroup 1 consisted of 25 patients who received antioxidant therapy with Nacetylcysteine as a part of combination treatment; the rest 49 patients (subgroup 2) received traditional therapy. Control group included 36 individuals, all nonsmokers, who had never been diagnosed with chronic diseases of respiratory organs, neither with rheumatic and oncological diseases. The proteinase inhibitor imbalance was evaluated by immunoenzyme methods for detection of matrix metalloproteinases (MMPs), MMP 1 and MMP9; tissue inhibitor of MMPs (TIMP1); and neutrophilactivating peptide, NAP2. The treatmentdependent changes in endothelin1 and Ddimer levels were studied in both groups. Levels of Creactive peptide and interleukin6 were studied as indicators of systemic inflammation activity. The content of MMPs in peripheral blood was elevated in patients with COPD exacerbation. Data showed that MMP9 level negatively correlated with Creactive protein concentration. Unlike traditional treatment, antioxidant therapy led to decrease in interleukin6 and increase in MMP9 levels associated with attenuated Ddimer content and reduced thrombogenic risk.