摘要
目的 检测慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者急性加重期、稳定期和健康对照者血清中的中性粒细胞弹性蛋白酶（neutronphil elastase，NE）和α1-抗胰蛋白酶（alphal antitrypsin,α1-AT）的水平变化，统计分析其与肺功能指标和吸烟等危险因素的关系，探讨蛋白酶/抗蛋白酶失衡在COPD发病中的意义。方法收集2007年12月至2010年10月河北医科大学第一医院呼吸内科住院的COPD患者56例和健康对照组21名的血清标本。COPD患者又分为急性加重期30例和稳定期26例两组。采用酶联免疫吸附法检测各组血清中NE、α1-AT水平。结果 ①COPD急性加重期血清NE水平显著高于对照组，差异有统计学意义（t =3.91，P＜0.01）;COPD稳定期也高于对照组，差异有统计学意义（t =2.02，P＜0.05）；COPD急性加重期高于稳定期，差异无统计学意义（t=1.91，P＞0.05）。COPD急性加重期α1-AT血清水平显著低于对照组，差异有统计学意义（t=-4.45，P＜0.01）；稳定期也低于对照组，差异有统计学意义（t=-2.73，P＜0.05）；COPD急性加重期低于稳定期，差异有统计学意义（t =-3.19，P＜0.01）。②COPD急性加重期组α1-AT血清水平与NE呈明显负相关（r=-0.71，P＜0.01）；稳定期组两者无相关性（r=0.33,P＞0.05）。③COPD急性加重期血清NE水平与第1秒用力呼气容积占预计值百分比（FEV1％pred）呈明显负相关（r=-0.82，P＜0.01）；与RV/TLC或吸烟程度呈正相关（r=0.74,0.73，P＜0.01）。COPD稳定期血清NE水平与FEV1％ pred或RV/TLC无相关性（r=0.25，-0.23，P＞0.05）；与吸烟程度呈正相关（r=0.42，P＜0.05）。④COPD急性加重期血清α1-AT水平与FEV1％ pred呈明显正相关（r=0.86,P＜0.01）；与RV/TLC或吸烟程度呈负相关（r=-0.83，-0.80，P＜0.01）。COPD稳定期血清α1-AT水平与FEV1％ pred呈正相关（r=0.47，P＜0.05）；与RV/TLC呈负相关（r=-0.46,P＜0.05）；与吸烟程度无相关性（r =0.34,P＞0.05）。结论①NE与α1-AT的失衡在COPD发病中起重要作用。②NE分泌增多和α1-AT含量的相对不足与气道炎症及气道阻塞具有显著相关性，是肺气肿形成的重要因素。③吸烟可导致NE水平升高、α1-AT活性下降及含量相对不足，是COPD的高危因素之一。
Objective To detect the levels of neutronphil elastase （NE） and alpha1 antitrypsin （α1-AT） in serum of chronic obstructive pulmonary disease （COPD） group and health control group, and analyzed the relationship between the levels and pulmonary function indicator or quantity of smoking.Methods Fifty six cases of serum samples with COPD, and 21 cases of serum samples from health control were collected and analyzed. The COPD group was divided into two groups, one of acute exacerbation phase （AE-COPD）, and the other of stable phase （ST-COPD）. The levels of serum NE and α1-AT in aboved groups were measured by enzyme-linked immunoadsordent assay （ELISA） method.Results ①The level of NE in AE-COPD group is significantly higher than which in health control group （ t =3.91, P 〈0.01）. The level of NE in ST-COPD group is significantly higher than which in health control group（（ t =2.02, P 〈0.05）. There are no significant difference between the level in AE-COPD group with the level in ST-COPD group （ t =1.91, P 〉0.05）. The level of α1-AT in AE-COPD group are significantly worse than which in health control group（ t =-4.45, P 〈0.01 ）. There are significant difference between the level in ST-COPD with the level in health group（ t =-2.73, P 〈0. 05）, and with the level in AE-COPD group（ t =-3.19, P 〈0.01 ）. ②There is a negative correlation between the levels of NE with α1-AT in AE-COPD group （ r =-0.71, P 〈0.01）. There is no correlation between the levels of NE with α1-AT in ST-COPD group（ r =0. 33, P 〉0.05）. ③There is a negative correlatin between the levels of NE with FEV1 % pred in AE-COPD group（ r =-0.82, P 〈0.01）. There are positive correlation between the levels of NE with RV/TLC or the amount of smoking in AE-COPD （ r =0.74,0.73, P 〈0.01）. In ST-COPD group, there are no correlation between the level of NE with FEV1 % pred or RV/TLC （ r =0.25,-0.23, P 〉0.05）, and a positive correlation between the level and the amount of smoking （ r =0.42, P 〈0.05）. ④In AE-COPD group, there are a positive correlation between the level of α1-AT with FEV1 % pred （ r =0.86, P 〈0.01）, and negative correlation between the level with RV/TLC or smoking （ r =-0.83,-0.80, P 〈0.01）. In ST-COPD group, there are a positive correlation between the level of α1-AT with FEV1 %pred （ r =0.47, P 〈0.05）, and a negative correlation between the level with RV/TLC （r =-0.46, P 〈0.05）, and no correlation between the level with smoking. Conclusions① The imbalance of NE and α1-AT plays an important role in the pathogenesis of COPD. ② The incremental level of NE and the content relative shortage of α1-AT are correlated with airway inflammation and airway remodeling, and important factors in the process of forming emphysema. ③Smoking can lead to incremental level of NE and content relative shortage of α1-AT, and which is one of the risk factors of COPD.
出处
《国际呼吸杂志》
2011年第17期1285-1289,共5页
International Journal of Respiration
