الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Chronic Obstructive Lung Disease (COPD), a common
preventable and treatable disease, characterized by persistent respiratory
symptoms and airflow limitation that is due to airway and/or alveolar
abnormalities usually caused by significant exposure to noxious
particles or gases.
Metabolic Syndrome is a complex disorder defined by the
presence of abdominal obesity, namely waist circumference above
cutoff values with ethnicity specifications or body mass index (BMI)
[30 kg/m2, in addition to any two of the following criteria: elevated
triglyceride level, elevated blood pressure, high blood glucose or insulin
resistance and atherogenic dyslipidemia [54].
Development of both COPD and MetS includes common risk
factors that may cross-relate in the individual patient.
Notably, a link between obesity, MetS and COPD is increasingly
recognized; epidemiological data confirm the relationship between these
conditions [151]. Impairment of lung function is strongly related to
central obesity.
Moreover, a recent large study found that airway obstruction is
directly related to the presence of MetS (low high-density lipoprotein
cholesterol, high triglycerides, high fasting glycemia, high blood
pressure and large waist circumference), whereas central obesity is the
strongest predictor of lung function impairment for both forced
expiratory volume in the first second (FEV1) and forced vital capacity
(FVC).
Both COPD and MetS share a low-grade systemic inflammatory
profile in both stable and acute phase.
CRP and ESR were used in many studies for years ,CRP is more
sensitive than ESR in detecting inflammatory process due to its rapid
changes in response to inflammation [110].
The aim of the present work was to study the incidence of
metabolic syndrome in COPD patients and to evaluate the role of CRP
as an inflammatory marker in COPD patients with or without metabolic
syndrome.
This prospective case-control study was carried out on thirty
patients with stable COPD who were recruited from the outpatient
clinic of the Chest hospital in Shebin El Kom and twenty healthy
subjects that served as control group.
Pulmonary function tests (FEV1, FVC, FEV1/FVC) were
measured according to the American Thoracic Society criteria.
COPD was diagnosed using GOLD criteria: postbronchodilator
FEV1/ FVC ratio less than 70%. COPD staging was done according to
GOLD (2014) criteria.
All of the study population, after having a written informed
consent, were subjected to history taking, clinical examination,
anthropometric measurements, fasting blood glucose, complete blood
picture, complete liver and kidney functions, LDH, HDL-cholesterol,
triglycerides, serum uric acid and CRP.
Patients were subclassified according to the presence or absence
of MetS which was defined as abdominal obesity (waist circumference
of 95 cm in males and 80 cm in females) plus any two of the four
following criteria:
a) Increased blood pressure (130/85 mmHg);
b) Insulin resistance (fasting plasma glucose (FPG)≥100 mg);
c) Increased triglyceride levels (≥ 150 mg/dl);
d) Reduced HDL–cholesterol level (< 40 mg/dl for men, <
50 mg/dl for women) according to the International Diabetes
Federation (IDF) criteria.
There was no statistically significant difference between both
patients and controls regarding age(51.23±5.00 and 50.45±5.41 years
respectively)
There were no statistically significant differences between both
patient and control groups regarding body mass index (BMI), BMI
classification and waist circumference.
There was a highly statistically significant difference in systolic
blood pressure, and a statistically significant difference in diastolic
blood pressure.
There were highly statistically significant differences between
both patient and control groups regarding cholesterol and fasting blood
sugar level, and statistically significant differences regarding HDL and
LDL levels. However, there was no statistically significant difference
regarding triglycerides level.
Highly statistically significant differences were found between
both patient and control groups regarding CRP and uric acid levels and
the prevalence of metabolic syndrome.
No statistically significant difference between different GOLD
stages regarding the prevalence of metabolic syndrome or CRP level
was described. But there was a significant positive correlation between
pack.year index and CRP level.
Abdominal obesity, hypertension and hyperglycemia were
significantly higher in COPD patients
Within the COPD group who had no significant difference in
pack.year index CRP was significantly higher in patients with MetS.
CRP level didn’t vary significantly in patients with and without
MetS of different GOLD stages.
The receiver operating characteristics (ROC) curve for CRP to
predict the presence of MetS in patients with COPD demonstrated that
a cut-off point for CRP >14 mg/L can detect the presence or absence of
MetS in patients with COPD with a sensitivity of (95% CI) 88.89 %
(65.3 - 98.6) and a specificity of (95% CI) 83.33 % (51.6 - 97.9)