慢性阻塞性肺疾病内脂素与慢性缺氧、营养代谢之间的相关性研究

目的通过了解内脂素在COPD急性加重期和稳定期的血清水平，研究内脂素水平与慢性缺氧、营养代谢之间的关系并探讨可能存在的作用机制。方法COPD患者80例，健康对照组20例。根据病程将患者分为急性加重期和稳定期，同时根据体质量指数（BMI）和缺氧的严重程度将患者分成BMI1级、2级、3级、4级组及轻度、中度、重度缺氧组。所有研究对象测定内脂素、缺氧诱导因子-1α（HIF-1α）、血脂（TC、TG等）、血糖（GLU）、血气分析（PaCO2等）、肺功能（FEV1／FVC等）和计算BMI。结果①在COPD急性加重期血清内脂素、HIF-1α水平显著高于稳定期和健康对照组。②在COPD急性加重期，总蛋白（TP）、白蛋白（ALB）、球蛋白（GLB）、高密度脂蛋白胆固醇（HDL-c）、低密度脂蛋白胆固醇（LDL-C）、GLU与稳定期组和健康对照组比较，差异有统计学意义；TC、TG与稳定期组比较，差异有统计学意义，而BMI、Apo-A、Apo-B水平与稳定期组比较，差异无统计学意义。③血清内脂素水平分别在COPD急性加重期的BMI分组，缺氧程度分组，以及稳定期缺氧程度分组中有明显的组间差异；在稳定期的BMI分组中无组间差异。④在COPD急性加重期的相关分析中，血清内脂素水平与营养指标、缺氧指标间有相关性，而在COPD稳定期仅与HIF-1α、FEV1／FVC、PaCO2、SO2％相关。⑤以血清内脂素水平为因变量，分别以营养指标、缺氧指标为自变量进行多元逐步回归分析，在COPD急性加重期，TC、TG、GLB、GLU、HIF-1α、FEV1／FVC为影响血清内脂素水平的重要因素；在稳定期组HIF-1α、FEV1／FVC为血清内脂素水平重要的影响因素。结论①cOPD急性加重期血清内脂素水平较稳定期存在显著变化，且与缺氧诱导因子、营养指标之间存在显著相关性。②内脂素水平不仅在-定程度上可以反映当前能量平衡的状况，还与缺氧的严重程度相关，其可能通过HIF-1α途径的激活参与组织的缺氧调节，并在促进COPD病情演进的过程中有着重要的作用。

Correlation between visfatin and chronic hypoxia,nutritional metabolism with chronic obstructive pulmonary disease

Objective To investigate the change of serum visfatin level in patients with stable and acute exacerbation phases of chronic obstructive pulmonary disease （AECOPD）, and explore the function mechanism and the relationship between visfatin levels, and chronic hypoxia, nutritional metabolism with COPD. Methods Eighty patients with COPD and twenty healthy people were included in the study. According to the course of disease, those patients were divided into acute exacerbation stage and stable stage. Meanwhile, all patients were divided into four groups （BMI1, BMI2, BMI3, BMI4 groups） according to pulmonary function and three groups （the mild hypoxia group, the middle hypoxia group and severe hypoxia group） according to the severity of hypoxia. The level of visfatin, hypoxia inducible factor-1α （HIF-1α） ,blood glucose and blood lipid （TC, TG, TP, ALB, GLB, HDL-C, LDL-C, APO-A, APO-B） were measured by Enzyme Linked Immunosorbent Assay method （ELLSA）. Additionally, arterial bloodgas analysis,pulmonary function testing, height, weight and BMI were measured and calculated by same people. Results ①The serum levels of visfatin and HIF-1α were significantly higher in the AECOPD group compared with the stable COPD group and the healthy control group. ② The differences of TP, ALB,GLB, HDL-C, LDL-C and GLU among AECOPD group, the stable COPD group and the healthy control group had statistically significance. Compared with the stable COPD group, the levels of TC and TG had statistical differences, but the differences of BMI, Apo A and Apo-B had no statistically significance. ③In AECOPD, the significant differences of visfatin levels among BMI 1-BMI 4 groups, different hypoxia groups and normal control group existed statistically significance. But in stable COPD, there wasn＇t statistical differences among BMI1-BMI4 groups and the control group. ④According to the correlation analysis,it was observed that visfatin and the indexes of nutrition and hypoxia （BMI,TC, TG, TP,ALB, GLB, HDL-C, LDL-C, APO-A, APO-B, GLU, HIF-1α, FEV1/FVC, FEV1 %, PaCO2, SO2 %, PaO2） existed a significant corm＇elation in AECOPD. But in stable COPD, visfatin had correlation with HIF-1α,FEV1/FVC,PaCO2, and SO2 %. ⑤With visfatin as dependent variable,the indexes of nutrition and hypoxia as independent variable were analyzed with multivariate stepwise regression analysis. TC, TG, GLB, GLU, HIF-1α, FEV1/FVC were the important factors of influencing visfatin level in AECOPD. Furthermore, HIF-1α,FEV1/FVC were the important influencing factors in stable COPD. Conclusions ① Visfatin levels existed significant change in patients with AECOPD and stable COPD, and it had a significant correlation with HIF-1α and nutritive indexes. ②Visfatin could not only reflect the current energy balance condition in some extent, but also had a correlation with the severity of hypoxia and might take part in the regulation of hypoxia via HIF-1α pathway. In addition, visfatin might play an important role of accelerating evolution of COPD.