COPD患者不同构型脂联素水平变化的研究

发布时间：2018-06-21 14:03

本文选题：不同构型脂联素 + 慢性阻塞性肺疾病　；参考：《山西医科大学》2012年硕士论文

【摘要】：研究背景慢性阻塞性肺疾病（chronic obstructive pulmonarydisease，COPD）以气道、肺实质和肺血管的慢性炎症以及氧化应激为主要发病特征。COPD患者常合并其他疾病，如心血管疾病，骨质疏松以及体重丢失等，然而其因果关系尚不清楚。脂联素是一种由脂肪组织分泌的大分子蛋白质，并发挥抗炎，心血管保护以及抗肥胖作用。在血清中，脂联素以全长结构[三倍体，六倍体以及高等分子量体（high molecular weight，HMW）]和球型结构域（globular adiponectin，gAd）存在。球型结构域主要激活脂联素受体1，而脂联素受体2主要由脂联素全长结构激活。目的通过测定COPD患者不同构型脂联素的水平，以研究脂联素与体重丢失，肺功能程度，缺氧，慢性肺源性心脏病以及系统性炎症和氧化应激的相关性。方法选择2010年1月至2011年6月的COPD急性加重（acute exacerbationof chronicobstructive pulmonary disease，AECOPD）住院患者118例作为AECOPD组，其中男83例，女35例。选择随访的稳定期COPD患者57例作为稳定期COPD组，其中男55例，女2例。选择同期门诊健康体检者66例作为健康对照组，其中男29例，女37例。AECOPD组患者和稳定期COPD组患者根据有无低氧血症、慢性肺源性心脏病、不同程度肺功能以及体重指数（BMI）分为不同亚组。应用酶联免疫吸附法测定所有研究对象血清HMW、gAd、TNF-α、IL-6以及氧化应激因子4-羟基壬烯醛（4-hydroxynonenal，4-HNE）的水平。结果1 COPD患者血清脂联素水平的改变（1）控制年龄，性别，以及BMI后，AECOPD患者，HMW、gAd水平（6.78±1.41、31.19±13.69）均显著高于健康对照组（5.26±1.38、20.30±13.89）和稳定期COPD组（6.28±1.43、19.14±14.12），差异有统计学意义（P均＜0.01）。稳定期COPD患者脂联素HMW（6.28±1.43）显著高于健康对照组（5.26±1.38），差异有统计学意义（P＜0.01）。但稳定期COPD患者血清gAd水平（19.14±14.12）与健康对照组（20.30±13.89）差异无统计学意义（P＞0.05），只有下降趋势。（2）血清HMW水平：AECOPD组患者，不缺氧组患者[7.35（6.66-8.19）]明显高于缺氧组患者[6.86（5.95-7.46）]，差异有统计学意义（P＜0.05）；肺心病组[6.91（6.15-7.65）]与无肺心病组[6.67（5.41-7.68）]相比，差异无统计学意义（P＞0.05）；低体重组[7.09（6.62-7.94）]、正常体重组[6.73（6.16-7.55）]以及高体重组[6.74（4.94-7.38）]差异无统计学意义（P＞0.05）。稳定期COPD组患者，轻中度肺功能组[6.20（5.50-6.78）]与重度肺功能组[6.45（5.36-7.59）]相比，差异无统计学意义（P＞0.05）；低体重组[6.06（5.14-6.84）]，正常体重组[6.39（5.44-7.12）]以及高体重组[6.12（5.31-6.90）]相比，差异无统计学意义（P＞0.05）。（3）血清gAd水平：AECOPD组患者，不缺氧组[27.85（21.70-31.44）]与缺氧组患者[28.58（20.08-39.10）]相比，差异无统计学意义（P＞0.05）；无肺心病组[31.63（25.50-51.36）]显著高于肺心病组[27.23（19.71-35.75）]患者，差异有统计学意义（P＜0.05）；低体重组[32.28（22.26-42.90）]、正常体重组[27.95（22.33-42.38）]以及高体重组[25.95（16.95-36.65）]相比，差异无统计学意义（P＞0.05），只有降低趋势。稳定期COPD组患者，轻中度肺功能组[14.05（11.58-24.01）]与重度肺功能组[15.85（13.40-21.68）]相比，差异无统计学意义（P＞0.05）只有增高趋势。低体重组[16.65（14.20-20.40）]、正常体重组[15.2（512.60-25.24）]以及高体重组[13.25（11.63-18.75）]相比，差异无统计学意义（P＞0.05），只有降低趋势（见表4）。 2 COPD患者脂联素与各指标的相关性（1）稳定期COPD患者中，发现脂联素HMW与TNF-α，4-HNE呈正相关（r=0.580, P＜0.01，r=0.291, P=0.028）（见表5）。（2）稳定期COPD患者，脂联素HMW与RV%呈负相关（r=-0.321, P=0.030）。但未发现脂联素gAd与肺功能参数的相关性。但在gAd＜26 ng/ml（n=50）时，其与FEV1%，FEV1/FVC呈负相关（r=-0.302, P=0.041；r=-0.293, P=0.048）。（见表5）（3）在控制心脏彩超的操作医师后，AECOPD患者，当HMW＞6μg/ml（n=40）时，发现脂联素HMW与右室舒末内径呈负相关（r=-0.467, P=0.002）；当gAd＞23 ng/m（ln=30）时，其与右室流出道呈负相关（r=-0.513, P=0.004）。（见表5）结论AECOPD患者血清脂联素HMW以及gAd水平显著增高。稳定期COPD患者血清脂联素HMW水平也显著增高，然而，gAd水平只发现下降趋势。稳定期COPD患者，脂联素HMW与RV%呈负相关。gAd与FEV1%，FEV1/FVC呈负相关。3.AECOPD患者，脂联素HMW与右室舒末内径呈负相关。gAd与右室流出道呈负相关。
[Abstract]:Background chronic obstructive pulmonary disease (chronic obstructive pulmonarydisease, COPD) with chronic inflammation of the airway, pulmonary parenchyma and pulmonary vessels and oxidative stress is the main pathogenesis of.COPD patients often associated with other diseases, such as cardiovascular disease, osteoporosis and loss of weight, but the causal relationship is not clear. Adiponectin is one of the diseases. Large molecular proteins secreted by adipose tissue and play an anti-inflammatory, cardiovascular protection and anti obesity effect. In serum, adiponectin exists in a full-length structure [triploid, six ploidy, high molecular weight, HMW) and globular adiponectin, gAd. The sphere domain mainly activates adiponectin. Body 1, adiponectin receptor 2 is mainly activated by the full length structure of adiponectin.
Objective to determine the correlation of adiponectin to body weight loss, pulmonary function, hypoxia, chronic pulmonary heart disease, and systemic inflammation and oxidative stress by measuring the level of different adiponectin in COPD patients.
Methods 118 hospitalized patients with acute exacerbationof ChronicObstructive pulmonary disease (AECOPD) from January 2010 to June 2011 were selected as AECOPD group, including 83 males and 35 females. 57 cases of stable COPD patients were selected as the stable COPD group, including 55 males and 2 women. 6 patients were selected in the same period of health check-up 6. 6 cases were used as a healthy control group, of which 29 were male, 37 women in.AECOPD and group COPD in stable period were divided into different subgroups based on hypoxemia, chronic pulmonary heart disease, different pulmonary function and body mass index (BMI). The serum HMW, gAd, TNF- a, IL-6, and oxidative stress were measured by enzyme linked immunosorbent assay. The level of factor 4- hydroxy nonenal (4-hydroxynonenal, 4-HNE).
Results the changes of serum adiponectin level in 1 COPD patients
(1) after the control of age, sex, and BMI, the level of AECOPD, HMW, and gAd (6.78 + 1.41,31.19 + 13.69) were significantly higher than those in the healthy control group (5.26 + 1.38,20.30 + 13.89) and the stable COPD group (6.28 + 1.43,19.14 + 14.12), and the difference was statistically significant (P < 0.01). The adiponectin HMW (6.28 + 1.43) in the stable phase COPD was significantly higher than that in the healthy control group (5.2. 6 + 1.38), the difference was statistically significant (P < 0.01), but the level of serum gAd (19.14 + 14.12) in the stable COPD patients and the healthy control group (20.30 + 13.89) had no statistical significance (P > 0.05), only the decline trend.
(2) serum HMW level: AECOPD group, [7.35 (6.66-8.19) in no anoxic group was significantly higher than [6.86 (5.95-7.46) in anoxic group (P < 0.05); [6.91 (6.15-7.65) in cor pulmonale group) was not significantly different from [6.67 (5.41-7.68) in cor pulmonale group (P > 0.05). There was no significant difference between the body weight group [6.73 (6.16-7.55)] and the high body recombinant [6.74 (4.94-7.38)] (P > 0.05). There was no significant difference between the stable stage COPD group, the mild and moderate lung function group [6.20 (5.50-6.78)] and the severe lung function group [6.45 (P > 0.05) (P > 0.05), and the low body recombination [6.06 (4.94-7.38), and the normal weight group. There was no significant difference between the high body recombinant [6.12 (5.31-6.90)] and the high body recombinant (P > 0.05).
(3) serum gAd level: AECOPD group, no hypoxia group [27.85 (21.70-31.44)] compared with [28.58 (20.08-39.10) in anoxia group, there was no statistical difference (P > 0.05), no pulmonary heart disease group [31.63 (25.50-51.36) was significantly higher than that of pulmonary heart disease group [27.23 (19.71-35.75)] patients, the difference was statistically significant (P < 0.05); 42.90)] there was no significant difference between normal weight group [27.95 (22.33-42.38)] and high body recombinant [25.95 (16.95-36.65)], and there was no significant difference (P > 0.05), only decreasing trend. There was no significant difference between the patients of stable COPD group, mild to moderate lung function group [14.05 (11.58-24.01)] and severe lung function group [15.85 (13.40-21.68)] (P > 0.05). There was no significant difference between the high trend, the low body recombinant [16.65 (14.20-20.40)], the normal weight group [15.2 (512.60-25.24)] and the high body recombinant [13.25 (11.63-18.75)] (P > 0.05), only the decreasing trend (see Table 4).
Association of 2 COPD adiponectin with each index
(1) in stable COPD patients, adiponectin HMW was positively correlated with TNF- alpha and 4-HNE (r=0.580, P < 0.01, r=0.291, P=0.028) (see Table 5).
(2) there was a negative correlation between adiponectin HMW and RV% (r=-0.321, P=0.030) in stable COPD patients (r=-0.321, P=0.030). But there was no correlation between adiponectin gAd and pulmonary function parameters. But when gAd < 26 ng/ml (n=50), it was negatively correlated with FEV1%, FEV1/FVC (r=-0.302, table 5).
(3) after the operation of cardiac color Doppler ultrasound, AECOPD patients, when HMW > 6 g/ml (n=40), found that the adiponectin HMW was negatively correlated with the right ventricular diastolic diameter (r=-0.467, P=0.002); when gAd > 23 ng/m (ln=30), it was negatively correlated with the right ventricular outflow tract (r=-0.513, P=0.004). (see Table 5)
Conclusion the level of serum adiponectin HMW and gAd increased significantly in patients with AECOPD. The level of serum adiponectin HMW in patients with stable COPD was also significantly higher, but the level of gAd was only decreasing. In stable COPD patients, the adiponectin HMW and RV% were negatively correlated with.GAd and FEV1%, FEV1/FVC showed negative correlation, and the adiponectin and right ventricular diastolic diameter was negative. The related.GAd was negatively correlated with the right ventricular outflow tract.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.9

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