肌抑制素与慢性阻塞性肺疾病患者的营养不良

Objective To investigate the prevalence and severity of malnutrition in patients with stable chronic obstructive pulmonary disease (COPD) , analyze serum levels of myostatin, tumor necrosis factor alpha (TNFα) and C reactive protein (CRP) , and investigate the relationship between serum myostatin and malnutrition in COPD. Methods Seventy-one patients with stable COPD and 60 age-matched healthy volunteers were recruited in this study. Pulmonary function was tested in all of the subjects and the severity of malnutrition was evaluated by a multiple-parameter malnutritional index (MNI). Based on the MNI scores, patients with COPD were divided into group Ⅰ (MNI≥5 score) and group Ⅱ (MNI ＜ 5 score) , the former represents the patients with severe or very severe malnutrition while the latter represents the patients with mild or without malnutrition. Serum concentration of myostatin, TNFα and CRP were measured by enzyme-linked immunosorbent assay. Results The MNI score was significantly elevated in patients with COPD [(7. 75 ±3. 86)score] compared with the controls [(1. 13 ±0. 96)score; P＜0.001],and 55 patients (77%) in COPD group Ⅰ showed MNI ≥ 5 (9. 30 ± 3. 01) score. Serum myostatin concentration was significantly elevated in COPD group Ⅰ [(12. 18 ±4. 76)μg/L] than in COPD group Ⅱ [(9. 73 ±2.85) μgL] and controls [(7.93 ±2.35) μg/L], with each P ＜ 0.001. Serum TNFα concentration was also significantly elevated in patients with COPD compared with the controls (P ＜ 0. 001).Pearson correlation analysis showed that serum myostatin levels were significantly correlated with MNI scores (r = 0. 438, P - 0. 000) and TNFa levels (r = 0. 234, P = 0. 041) in COPD group (combined group I and Ⅱ) while MNI scores were correlated inversely with BMI in COPD group (r = - 0. 530, P = 0. 000) . After stratified with subgroups, the correlation between myostatin levels and MNI scores was more significant and the correlation coefficient was higher (r =0.464, P =0.000) in COPD group I patients. Moreover,myostatin levels were inversely correlated with BMI (r = - 0. 287, P = 0. 034) and forced expiratory volume in one second of the predicted value (r = - 0. 264, P = 0. 049) in COPD group I patients. Conclusions Malnutrition commonly and substantially exists in patients with COPD; serum myostatin concentration is significantly elevated and is correlated with the severity of malnutrition in the patients. The elevation of serum myostatin may contribute to malnutrition in COPD patients.     

肌抑制素与慢性阻塞性肺疾病患者的营养不良

Objective To investigate the prevalence and severity of malnutrition in patients with stable chronic obstructive pulmonary disease (COPD) , analyze serum levels of myostatin, tumor necrosis factor alpha (TNFα) and C reactive protein (CRP) , and investigate the relationship between serum myostatin and malnutrition in COPD. Methods Seventy-one patients with stable COPD and 60 age-matched healthy volunteers were recruited in this study. Pulmonary function was tested in all of the subjects and the severity of malnutrition was evaluated by a multiple-parameter malnutritional index (MNI). Based on the MNI scores, patients with COPD were divided into group Ⅰ (MNI≥5 score) and group Ⅱ (MNI ＜ 5 score) , the former represents the patients with severe or very severe malnutrition while the latter represents the patients with mild or without malnutrition. Serum concentration of myostatin, TNFα and CRP were measured by enzyme-linked immunosorbent assay. Results The MNI score was significantly elevated in patients with COPD [(7. 75 ±3. 86)score] compared with the controls [(1. 13 ±0. 96)score; P＜0.001],and 55 patients (77%) in COPD group Ⅰ showed MNI ≥ 5 (9. 30 ± 3. 01) score. Serum myostatin concentration was significantly elevated in COPD group Ⅰ [(12. 18 ±4. 76)μg/L] than in COPD group Ⅱ [(9. 73 ±2.85) μgL] and controls [(7.93 ±2.35) μg/L], with each P ＜ 0.001. Serum TNFα concentration was also significantly elevated in patients with COPD compared with the controls (P ＜ 0. 001).Pearson correlation analysis showed that serum myostatin levels were significantly correlated with MNI scores (r = 0. 438, P - 0. 000) and TNFa levels (r = 0. 234, P = 0. 041) in COPD group (combined group I and Ⅱ) while MNI scores were correlated inversely with BMI in COPD group (r = - 0. 530, P = 0. 000) . After stratified with subgroups, the correlation between myostatin levels and MNI scores was more significant and the correlation coefficient was higher (r =0.464, P =0.000) in COPD group I patients. Moreover,myostatin levels were inversely correlated with BMI (r = - 0. 287, P = 0. 034) and forced expiratory volume in one second of the predicted value (r = - 0. 264, P = 0. 049) in COPD group I patients. Conclusions Malnutrition commonly and substantially exists in patients with COPD; serum myostatin concentration is significantly elevated and is correlated with the severity of malnutrition in the patients. The elevation of serum myostatin may contribute to malnutrition in COPD patients.     

肌抑制素与慢性阻塞性肺疾病患者的营养不良

Objective To investigate the prevalence and severity of malnutrition in patients with stable chronic obstructive pulmonary disease (COPD) , analyze serum levels of myostatin, tumor necrosis factor alpha (TNFα) and C reactive protein (CRP) , and investigate the relationship between serum myostatin and malnutrition in COPD. Methods Seventy-one patients with stable COPD and 60 age-matched healthy volunteers were recruited in this study. Pulmonary function was tested in all of the subjects and the severity of malnutrition was evaluated by a multiple-parameter malnutritional index (MNI). Based on the MNI scores, patients with COPD were divided into group Ⅰ (MNI≥5 score) and group Ⅱ (MNI ＜ 5 score) , the former represents the patients with severe or very severe malnutrition while the latter represents the patients with mild or without malnutrition. Serum concentration of myostatin, TNFα and CRP were measured by enzyme-linked immunosorbent assay. Results The MNI score was significantly elevated in patients with COPD [(7. 75 ±3. 86)score] compared with the controls [(1. 13 ±0. 96)score; P＜0.001],and 55 patients (77%) in COPD group Ⅰ showed MNI ≥ 5 (9. 30 ± 3. 01) score. Serum myostatin concentration was significantly elevated in COPD group Ⅰ [(12. 18 ±4. 76)μg/L] than in COPD group Ⅱ [(9. 73 ±2.85) μgL] and controls [(7.93 ±2.35) μg/L], with each P ＜ 0.001. Serum TNFα concentration was also significantly elevated in patients with COPD compared with the controls (P ＜ 0. 001).Pearson correlation analysis showed that serum myostatin levels were significantly correlated with MNI scores (r = 0. 438, P - 0. 000) and TNFa levels (r = 0. 234, P = 0. 041) in COPD group (combined group I and Ⅱ) while MNI scores were correlated inversely with BMI in COPD group (r = - 0. 530, P = 0. 000) . After stratified with subgroups, the correlation between myostatin levels and MNI scores was more significant and the correlation coefficient was higher (r =0.464, P =0.000) in COPD group I patients. Moreover,myostatin levels were inversely correlated with BMI (r = - 0. 287, P = 0. 034) and forced expiratory volume in one second of the predicted value (r = - 0. 264, P = 0. 049) in COPD group I patients. Conclusions Malnutrition commonly and substantially exists in patients with COPD; serum myostatin concentration is significantly elevated and is correlated with the severity of malnutrition in the patients. The elevation of serum myostatin may contribute to malnutrition in COPD patients.     

老年帕金森病患者血尿酸水平及其与认知功能的关系

目的 探讨老年帕金森病(PD)患者血尿酸水平与认知功能的关系,并对相关因素进行分析.方法 回顾性分析60例老年PD患者的病历资料,选择性别、年龄相匹配的60例健康体检者作为对照,记录性别、年龄、病程、Hoehn&Yahr分期(H-Y分期)、尿酸、简易智能量表(MMSE)评分,并进行比较和相关性分析.结果 老年PD组血浆尿酸水平[(262±53)μmol/L]明显低于对照组[(332±45)μmol/L],差异有统计学意义(t=-6.724,P＜0.001).PD组男性血浆尿酸水平[(271±48)μmol/L]均值略高于女性水平[(254±39)μmol/L],但差异无统计学意义(t=3.282,P=0.058).PD组男性血浆尿酸水平明显低于对照组男性尿酸水平[(353±62)μmol/L],差异有统计学意义(t=-5.625,P＜0.001).PD组女性血浆尿酸水平低于对照组女性尿酸水平[(294±59)/μmol/L],差异有统计学意义(t=-4.721,P=0.012).老年PD各亚组间血尿酸水平无显著差异,但与对照组比较差异均有统计学意义(F=22,039,P＜0,01).老年PD组血尿酸水平与病程长短无明显相关性(r=0.961,P＞0,05).老年PD患者存在认知功能障碍,其MMSE评分与H-Y分期(r=-0.577,P=0.019)、年龄(r=-0.333,P=0.034)呈负相关,与血尿酸水平呈正相关(r=0.789,P=0.000),与病程(r=-0.333,P=0.027)、体质指数(BMI)(t=-0.410,P=0.115)无相关性.结论 老年PD患者血尿酸水平降低,低尿酸水平可能与老年PD患者的认知功能障碍有关.

Abstract：

Objective To explore the relationship between uric acid (UA) level and cognitive function in elderly patients with Parkinson,s disease (PD) and analyze the cognition related factors.Methods The clinical data of 60 elderly PD cases in our hospital from 2001 to 2009 were retrospectively analyzed. The 60 healthy people receiving medical examination in our hospital and matched by gender and age, were as control group. The information including gender, age, illness duration, Hoehn & Yahr stage (H-Y stage), serum UA level and Mini-Mental State Examination (MMSE) scale were recorded. Results The serum UA level was significantly lower in PD group than in control group [(262±53) μmol/L vs. (332±45) μmol/L, t=-6.724, P＜0.001]. In PD group, the serum UA level was slightly higher in males than in females [(271 ±48) μmol/L vs.(254±39) μmol/L, t=3. 282, P=0. 058]. The serum UA level was significantly lower in male PD patients than in male controls [(353± 62) μmol/L, t=- 5. 625, P＜0. 001], and was lower in female PD patients than in female controls [( 294 ± 59) μmol/L, t = - 4. 721, P = 0. 012]. There were no significant differences in serum UA level among different H-Y stage subgroups (P＞0. 05), but the serum UA level was lower in different H-Y stage subgroups than in control group (F=22. 039, P＜0. 01 ). There was no correlation between the UA level and the illness duration (r=0. 961, P＞0.05).The MMSE score had significant difference between elderly PD group and control group (t= -3. 168,P＜0. 001). In PD patients, the MMSE score was positively correlated with serum UA level (r=0. 789, P= 0. 000), and was negatively correlated with H-Y stage (r= - 0. 577, P = 0. 019 ), age (r= -0. 333, P=0. 034), but was not correlated with illness duration (r= -0. 333, P=0. 207) and BMI (t=- 0. 410, P= 0. 115). Conclusions The level of serum UA is lower in elderly patients with PD than in normal controls. There is correlation between the serum UA level and cognitive impairment. Lower serum UA level predicts worse cognitive scores.     

慢性阻塞性肺疾病患者对氧磷酶和氧化应激与全身炎性反应的研究

Objective To analyze the activity of paraoxonase (PON1) and explore the relationship of PON1 and oxidative stress with systemic inflammation response in the acute exacerbation phase and stationary phase in patients with chronic obstructive pulmonary disease (COPD). Methods Serum PON1 activity was measured by phenylacetate in 38 patients with COPD and 30 healthy people. The activity of glutathione peroxidase (GSH-Px) was detected by improved Hafeman method. Total antioxidant capacity (TAC) was measured by eolorimetry and malondialdehyde (MDA) level was measured by thiobarbituric acid colouration method. The interleukin-6 (IL-6) and interleukin-8 (IL-8) levels were detected by radioimmunoassay. The level of C-reactive protein (CRP) was measured by immune turbidimetry. Results In the acute exacerbation phase, the activity of serum PON1 was significantly lower in COPD group than in control group [(98.03±42.40)×103U/L vs. (136.00±60. 50)×103U/L, t=4.962, P<0.01], and it was negatively related to the IL-8 level (r= - 0. 589, P<0.01) and positively related to FEV1% (r= 0. 434, P<0. 05). The activity of GSH-Px was negatively related to the IL-6 level (r=-0. 362, P< 0. 05). In the stationary phase of COPD group, the activity of serum PON1 had no statistical difference compared with control group[(131.50±53.65))×103U/L vs. (136. 00±60.50)×103U/ L, t=2. 457, P>0. 053, and it was negatively related to the IL-8 level (r=-0. 563, P<0.05). Conclusions Serum PON1 activity is significantly decreased in acute exacerbation phase of COPD group compared with control group and it is positively related to FEV1%. The oxidative stress is closely related to systemic inflammation response in patients with acute exacerbation of COPD.     

慢性阻塞性肺疾病患者对氧磷酶和氧化应激与全身炎性反应的研究

Objective To analyze the activity of paraoxonase (PON1) and explore the relationship of PON1 and oxidative stress with systemic inflammation response in the acute exacerbation phase and stationary phase in patients with chronic obstructive pulmonary disease (COPD). Methods Serum PON1 activity was measured by phenylacetate in 38 patients with COPD and 30 healthy people. The activity of glutathione peroxidase (GSH-Px) was detected by improved Hafeman method. Total antioxidant capacity (TAC) was measured by eolorimetry and malondialdehyde (MDA) level was measured by thiobarbituric acid colouration method. The interleukin-6 (IL-6) and interleukin-8 (IL-8) levels were detected by radioimmunoassay. The level of C-reactive protein (CRP) was measured by immune turbidimetry. Results In the acute exacerbation phase, the activity of serum PON1 was significantly lower in COPD group than in control group [(98.03±42.40)×103U/L vs. (136.00±60. 50)×103U/L, t=4.962, P<0.01], and it was negatively related to the IL-8 level (r= - 0. 589, P<0.01) and positively related to FEV1% (r= 0. 434, P<0. 05). The activity of GSH-Px was negatively related to the IL-6 level (r=-0. 362, P< 0. 05). In the stationary phase of COPD group, the activity of serum PON1 had no statistical difference compared with control group[(131.50±53.65))×103U/L vs. (136. 00±60.50)×103U/ L, t=2. 457, P>0. 053, and it was negatively related to the IL-8 level (r=-0. 563, P<0.05). Conclusions Serum PON1 activity is significantly decreased in acute exacerbation phase of COPD group compared with control group and it is positively related to FEV1%. The oxidative stress is closely related to systemic inflammation response in patients with acute exacerbation of COPD.     

慢性阻塞性肺疾病患者对氧磷酶和氧化应激与全身炎性反应的研究

Objective To analyze the activity of paraoxonase (PON1) and explore the relationship of PON1 and oxidative stress with systemic inflammation response in the acute exacerbation phase and stationary phase in patients with chronic obstructive pulmonary disease (COPD). Methods Serum PON1 activity was measured by phenylacetate in 38 patients with COPD and 30 healthy people. The activity of glutathione peroxidase (GSH-Px) was detected by improved Hafeman method. Total antioxidant capacity (TAC) was measured by eolorimetry and malondialdehyde (MDA) level was measured by thiobarbituric acid colouration method. The interleukin-6 (IL-6) and interleukin-8 (IL-8) levels were detected by radioimmunoassay. The level of C-reactive protein (CRP) was measured by immune turbidimetry. Results In the acute exacerbation phase, the activity of serum PON1 was significantly lower in COPD group than in control group [(98.03±42.40)×103U/L vs. (136.00±60. 50)×103U/L, t=4.962, P<0.01], and it was negatively related to the IL-8 level (r= - 0. 589, P<0.01) and positively related to FEV1% (r= 0. 434, P<0. 05). The activity of GSH-Px was negatively related to the IL-6 level (r=-0. 362, P< 0. 05). In the stationary phase of COPD group, the activity of serum PON1 had no statistical difference compared with control group[(131.50±53.65))×103U/L vs. (136. 00±60.50)×103U/ L, t=2. 457, P>0. 053, and it was negatively related to the IL-8 level (r=-0. 563, P<0.05). Conclusions Serum PON1 activity is significantly decreased in acute exacerbation phase of COPD group compared with control group and it is positively related to FEV1%. The oxidative stress is closely related to systemic inflammation response in patients with acute exacerbation of COPD.     

慢性阻塞性肺疾病患者对氧磷酶和氧化应激与全身炎性反应的研究

Objective To analyze the activity of paraoxonase (PON1) and explore the relationship of PON1 and oxidative stress with systemic inflammation response in the acute exacerbation phase and stationary phase in patients with chronic obstructive pulmonary disease (COPD). Methods Serum PON1 activity was measured by phenylacetate in 38 patients with COPD and 30 healthy people. The activity of glutathione peroxidase (GSH-Px) was detected by improved Hafeman method. Total antioxidant capacity (TAC) was measured by eolorimetry and malondialdehyde (MDA) level was measured by thiobarbituric acid colouration method. The interleukin-6 (IL-6) and interleukin-8 (IL-8) levels were detected by radioimmunoassay. The level of C-reactive protein (CRP) was measured by immune turbidimetry. Results In the acute exacerbation phase, the activity of serum PON1 was significantly lower in COPD group than in control group [(98.03±42.40)×103U/L vs. (136.00±60. 50)×103U/L, t=4.962, P<0.01], and it was negatively related to the IL-8 level (r= - 0. 589, P<0.01) and positively related to FEV1% (r= 0. 434, P<0. 05). The activity of GSH-Px was negatively related to the IL-6 level (r=-0. 362, P< 0. 05). In the stationary phase of COPD group, the activity of serum PON1 had no statistical difference compared with control group[(131.50±53.65))×103U/L vs. (136. 00±60.50)×103U/ L, t=2. 457, P>0. 053, and it was negatively related to the IL-8 level (r=-0. 563, P<0.05). Conclusions Serum PON1 activity is significantly decreased in acute exacerbation phase of COPD group compared with control group and it is positively related to FEV1%. The oxidative stress is closely related to systemic inflammation response in patients with acute exacerbation of COPD.     

慢性阻塞性肺疾病患者对氧磷酶和氧化应激与全身炎性反应的研究

Objective To analyze the activity of paraoxonase (PON1) and explore the relationship of PON1 and oxidative stress with systemic inflammation response in the acute exacerbation phase and stationary phase in patients with chronic obstructive pulmonary disease (COPD). Methods Serum PON1 activity was measured by phenylacetate in 38 patients with COPD and 30 healthy people. The activity of glutathione peroxidase (GSH-Px) was detected by improved Hafeman method. Total antioxidant capacity (TAC) was measured by eolorimetry and malondialdehyde (MDA) level was measured by thiobarbituric acid colouration method. The interleukin-6 (IL-6) and interleukin-8 (IL-8) levels were detected by radioimmunoassay. The level of C-reactive protein (CRP) was measured by immune turbidimetry. Results In the acute exacerbation phase, the activity of serum PON1 was significantly lower in COPD group than in control group [(98.03±42.40)×103U/L vs. (136.00±60. 50)×103U/L, t=4.962, P<0.01], and it was negatively related to the IL-8 level (r= - 0. 589, P<0.01) and positively related to FEV1% (r= 0. 434, P<0. 05). The activity of GSH-Px was negatively related to the IL-6 level (r=-0. 362, P< 0. 05). In the stationary phase of COPD group, the activity of serum PON1 had no statistical difference compared with control group[(131.50±53.65))×103U/L vs. (136. 00±60.50)×103U/ L, t=2. 457, P>0. 053, and it was negatively related to the IL-8 level (r=-0. 563, P<0.05). Conclusions Serum PON1 activity is significantly decreased in acute exacerbation phase of COPD group compared with control group and it is positively related to FEV1%. The oxidative stress is closely related to systemic inflammation response in patients with acute exacerbation of COPD.     

慢性阻塞性肺疾病患者对氧磷酶和氧化应激与全身炎性反应的研究

Objective To analyze the activity of paraoxonase (PON1) and explore the relationship of PON1 and oxidative stress with systemic inflammation response in the acute exacerbation phase and stationary phase in patients with chronic obstructive pulmonary disease (COPD). Methods Serum PON1 activity was measured by phenylacetate in 38 patients with COPD and 30 healthy people. The activity of glutathione peroxidase (GSH-Px) was detected by improved Hafeman method. Total antioxidant capacity (TAC) was measured by eolorimetry and malondialdehyde (MDA) level was measured by thiobarbituric acid colouration method. The interleukin-6 (IL-6) and interleukin-8 (IL-8) levels were detected by radioimmunoassay. The level of C-reactive protein (CRP) was measured by immune turbidimetry. Results In the acute exacerbation phase, the activity of serum PON1 was significantly lower in COPD group than in control group [(98.03±42.40)×103U/L vs. (136.00±60. 50)×103U/L, t=4.962, P<0.01], and it was negatively related to the IL-8 level (r= - 0. 589, P<0.01) and positively related to FEV1% (r= 0. 434, P<0. 05). The activity of GSH-Px was negatively related to the IL-6 level (r=-0. 362, P< 0. 05). In the stationary phase of COPD group, the activity of serum PON1 had no statistical difference compared with control group[(131.50±53.65))×103U/L vs. (136. 00±60.50)×103U/ L, t=2. 457, P>0. 053, and it was negatively related to the IL-8 level (r=-0. 563, P<0.05). Conclusions Serum PON1 activity is significantly decreased in acute exacerbation phase of COPD group compared with control group and it is positively related to FEV1%. The oxidative stress is closely related to systemic inflammation response in patients with acute exacerbation of COPD.     

慢性阻塞性肺疾病患者纤毛摆动时间的研究

目的 探讨慢性阻塞性肺疾病(COPD)患者纤毛摆动时间和肺功能的关系,及黏液纤毛清除功能(MCC)在COPD发病中的作用.方法 手术切除的支气管组织30例,分为COPD组、吸烟组及对照组,每组10例,光镜下观察活性纤毛细胞的百分率及纤毛摆动时间,并计数各个时间点的摆动纤毛细胞的百分率,收集临床资料包括吸烟指数、体质量指...     

细胞色素C氧化酶在慢性阻塞性肺疾病中的表达及其与肺血管内皮细胞凋亡的关系

目的 观察COPD患者肺组织中细胞色素C氧化酶(COX)和血管内皮细胞凋亡的变化,探讨COPD的发病机制.方法 2007年9月至2008年5月在中南大学湘雅二医院行肺切除术的周围型肺癌患者20例,参照COPD的诊断标准和患者的吸烟状况分为对照组(7例)、吸烟非COPD组(7例)和吸烟并COPD组(6例),取远离病变的肺组织.采用脱氧核糖核苷酸末端转移酶介导的缺口末端标记法检测肺血管内皮细胞凋亡,采用分光光度法、半定量逆转录PCR法和Western blot法分别检测肺组织中COX活性、COXⅡ亚基(COXⅡ)mRNA和蛋白表达,免疫组织化学法检测肺血管内皮细胞COXⅡ蛋白的分布和表达.多组间比较采用单因素方差分析,用LSD-t检验进行两两比较.结果 吸烟并COPD组肺血管内皮细胞凋亡指数为(13.8±1.9)%,明显高于吸烟非COPD组[(9.6±0.8)%]和对照组[(5.9±1.0)%];吸烟并COPD组肺组织中COX活性为(4.4±0.7)×105U/kg,COXⅡmRNA相对表达量为0.76±0.17,肺血管内皮细胞中COXⅡ蛋白相对表达量为14.5±1.6,明显低于吸烟非COPD组[(6.0±0.6)×105 U/kg、0.81±0.15和18.6±2.1]和对照组[(7.6±0.4)× 105U/kg、0.86±0.20和23.8±3.4],差异均有统计学意义(t值为-13.66～13.27,均P＜0.05);COX活性与FEV1占预计值%和FEV1/FVC呈显著正相关(r值分别为0.84和0.91,均P＜0.01),与吸烟指数呈显著负相关(r=-0.78,P＜0.01);肺血管内皮细胞凋亡与COXⅡ蛋白表达呈显著负相关(r=-0.75,P＜0.01).结论 COPD患者的肺血管内皮细胞凋亡增加,COX表达和活性下降,且均与吸烟有相关性.COX可能参与介导COPD肺血管内皮细胞凋亡过程.     

慢性阻塞性肺疾病急性加重期患者血浆选择素相关蛋白水平的观察

目的 探讨整合素相关蛋白CD_(47)和P-选择素在COPD发病中的作用.方法 病例来自2008年10月至2009年3月在遵义医学院附属医院呼吸一科住院的COPD患者35例,其中男26例,女9例;年龄55～84岁,平均(65±7)岁.未经任何治疗时为急性加重期(AECOPD)组,经过抗感染、解痉平喘、祛痰、吸氧和支持等治疗,达到临床缓解时为稳定期组.同期体检的健康志愿者加名为对照组,其中男14名,女6名;年龄45～80岁,平均(59±7)岁.采用流式细胞术检测所有研究对象外周血浆中CD_(47)和P-选择素水平,并检测血小板计数.采用SNK-q检验和Pearson回归分析进行相关性分析.结果 AECOPD组CD_(47)阳性率为(93±4)%,明显高于稳定期组的(72±11)%和对照组的(67±10)%,差异均有统计学意义(q值分别为11.26和13.32,均P＜0.01),稳定期组与对照组的差异无统计学意义(q=1.73,P＞0.05);AECOPD组P-选择素阳性率为[(35±11)%],明显高于稳定期组[(12±8)%]和对照组[(10±4)%],差异均有统计学意义(q值分别为9.93和12.19,均P＜.0.05),稳定期组也明显高于对照组,差异有统计学意义(q=1.90,P＜0.05);AECOPD组血小板计数为(188±56)×10~9/L,与稳定期组的(213±57)×10~9/L和对照组的(204±51)×10~9/L比较,差异无统计学意义(F=1.74,P＞0.05);AECOPD组CD_(47)与P-选择素呈正相关(r=0.77,P＜0.01),稳定期及对照组CD_(47)与P-选择素均无相关性(r值分别为-0.04和-0.15,均P＞0.05).结论 CD_(47)和P-选择素作为血小板活化标志物,在AECOPD时明显增高,表明AECOPD存在血小板活化,提示血小板作为一种炎性细胞参与AECOPD发病,可能以其活化形式发挥重要作用.CD_(47)和P-选择素可作为判断AECOPD严重程度及血小板活化程度的指标.     

老年慢性阻塞性肺病患者窦性心率震荡及心率变异性的研究

目的 探讨慢性阻塞性肺病(COPD)患者窦性心率震荡(HRT)及心率变异性(HRV)变化及临床意义.方法 临床诊断为COPD老年患者59例,选择同期健康老年人30例为对照组.24 h动态心电图检测各组HRT参数:震荡初始(TO)和震荡斜率(TS)及HRV各项指标,肺功能检测,同时超声心动图测量左心室射血分数(LVEF)、右心房内径(RAD)、右心室内径(RVD)、右心室壁厚度(RVWT)等指标;组间比较且对HRT与HRV指标进行相关性分析.结果 与对照组比较,COPD患者TO值显著增高[(-0.2±1.1)%与(-3.8±2.8)%,t=6.830,P＜0.01],TS值显著下降[(7.0±3.6)与(11.7±6.1)ms/RR,t=3.866,P＜0.01];HRV指标正常R-R间期的标准差(SDNN)、正常R-R间期的标准差的平均值(SDNNI)、SDNNI的标准差(SDANN)、相邻R-R间期之差的均方根值(rMSSD)和正常R-R间期标准差≥50 ms的百分数(PNN50)增加,且随肺动脉压力的增高而恶化.TO与SDANN,rMSDD呈负相关(r=-0.369,P＜0.05;r=-0.472,P＜0.01),TS和SDNN,SDANN,PNN50呈正相关(P＜0.05),与rMSDD无相关性(P＞0.05).结论 COPD患者HRT现象减弱,HRT和HRV变化随患者肺动脉压力的增加而恶化,联合检测对评价COPD患者自主神经功能状态及预后有较高临床价值.

Abstract：

Objective To explore the clinical significance of sinus heart rate turbulence (HRT)and heart rate variability (HRV) in patients with chronic obstructive pulmonary disease(COPD).Methods The 59 moderate to severe COPD patients and 30 healthy subjects were enrolled in this study. The 24-hour holter monitor was used to screen the HRT onset (TO), turbulence slope (TS)and HRV. Pulmonary function tests and echocardiographic examination were performed for measuring left ventricular ejection fraction (LVEF), right atrial dimension (RAD), right ventricular dimension (RVD), right ventricular wall thickness (RVWT). Then all the parameters were compared between NC group and COPD group, and the relationship between HRT and HRV was investigated. Results Compared with control group, TO was significantly increased [(-0.2±1.1) % vs.(-3.8±2.8) %, t=6. 830,P＜0.01] and TS was decreased [(7.0±3.6) ms/RR vs. (11.7±6.1) ms/RR, t =3. 866, P＜0.01] in COPD group. In time domain HRV parameters, normal RR intervallerinin standart deviation(SDNN), standard deviation of normal-to-normal beats index (SDNNi), standard deviation of the averages of normal sinus to normal sinus (SDANN), mean squared differences of the successive RR intervals (rMSDD), fraction of consecutive normal sinus intervals that differ by more than 50 ms (PNN50) were significantly lower in COPD group than in control group(P＜0. 05). TO was negatively correlated with SDANN and rMSDD (r=-0. 369, P＜0. 05; r=-0.472, P＜0.01).TS was positively correlated with SDNN, SDANN and PNN50 (all P＜0.05), but had no correlation with rMSDD (P＞0. 05). Conclusions HRT and HRV are dramatically blunted in COPD patients.Combination of HRV and prognosis. and HRT may be simple and elegant ways for evaluating cardiac autonomic functions.     

血清脂肪细胞型脂肪酸结合蛋白及脂联素水平与冠心病的相关性

目的 探讨脂肪细胞型脂肪酸结合蛋白(A-FABP)、脂联素和A-FABP/脂联素比值与冠心病及冠状动脉病变程度的相关性.方法 经冠状动脉造影入选340例患者,分为冠心病组(211例)和非冠心病对照组(129例),用ELISA法测定血清AFABP及脂联素水平,冠状动脉病变程度用病变血管支数和Gensini积分表示.并从上述患者中选取年龄、性别、体质指数相匹配的冠心病及非冠心病者各10例,分离外周血单核细胞,佛波酯刺激为巨噬细胞后取培养上清,用ELISA法测定培养上清液A-FABP及脂联素浓度.结果 (1)冠心病组血清A-FABP水平[18.3(13.2,22.8)μg/L]较非冠心病组[16.4(13.5,20.4)μg/L]高,但差异未达到统计学意义(P=0.088);冠心病组血清脂联素水平低于非冠心病组[13.9(9.8,17.1)mg/L比19.7(14.5,27.6)mg/L,P＜0.05].(2)随着冠状动脉病变支数的增加,血清A-FABP水平呈升高、脂联素水平呈递减趋势;Gensini积分与血清A-FABP呈正相关(r=0.120,P=0.043),与脂联素呈负相关(r=-0.405,P=0.007).(3)冠心病组血清A-FABP/脂联素比值明显高于非冠心病组[(1.51±0.79)μg/mg比(0.89±0.30)μg/mg,P＜0.01];血清A-FABP/脂联素比值与Gensini积分的相关性更明显(r=0.531,P=0.000).(4)冠心病者单核源性巨噬细胞A-FABP/脂联素比值高于非冠心病者[(0.51±0.19)μg/mg比(0.36±0.11)μg/mg,P＜0.05].结论 高A-FABP和低脂联素水平可能是反映严重冠状动脉狭窄的新的血清标记物.A-FABP/脂联素比值较单独A-FABP或脂联素与冠状动脉病变的相关性更好.     

吲哚美辛对慢性阻塞性肺疾病大鼠肿瘤坏死因子α和骨骼肌蛋白质分解代谢的影响

目的 观察吲哚美辛对慢性阻塞性肺疾病(COPD)大鼠TNFα和骨骼肌蛋白质分解代谢的影响.方法 大鼠分为COPD模型组和健康对照组.COPD模型组制作COPD大鼠模型.造模成功后,以低于健康对照组平均体重90%为标准将大鼠分为COPD营养不良组和COPD营养正常组.COPD营养不良组按随机区组分为:COPD营养不良非干预组(A组),COPD营养不良吲哚美辛低剂量干预组(B组),COPD营养不良吲哚美辛中剂量干预组(C组),COPD营养不良吲哚美辛高剂量干预组(D组).检测各组吲哚美辛干预前后体重、血清TNFα及膈肌、伸趾长肌匀浆中3-甲基组氨酸和酪氨酸含量.结果 (1)吲哚美辛干预前,COPD营养不良组大鼠血清TNFα水平均明显高于COPD营养正常组、健康对照组;吲哚美辛干预后,B组、C组、D组大鼠血清中TNFα含量比A组显著降低,尤以C组最明显.(2)吲哚美辛干预后,大鼠膈肌、伸趾长肌匀浆中3-甲基组氨酸和酪氨酸含量上升,体重回升,尤以C组最明显.(3)COPD模型组大鼠血清TNFα含量与体重、膈肌、伸趾长肌重量呈负相关(r分别为-0.846、-0.778、-0.772,P＜0.01).结论 TNFα参与了COPD营养不良、骨骼肌萎缩的发生,吲哚美辛可降低COPD营养不良大鼠血清中TNFα水平及骨骼肌蛋白分解代谢,从而部分改善COPD营养不良大鼠的骨骼肌萎缩.     

阻塞性睡眠呼吸暂停低通气综合征患者血清褪黑素的变化及其意义

目的 研究阻塞性睡眠暂停低通气患者血清褪黑素的变化及其临床意义.方法 选择在兰州大学第一医院就诊,经多导睡眠监测确诊的OSAHS患者30例和健康对照10名,并用Epworth嗜睡量表进行评估.用高效液相色谱法检测血清褪黑素浓度.分别在22:30时、02:00时和07:00时测OSAHS患者和健康对照者血清褪黑素浓度.结...     

老年2型糖尿病患者高密度脂蛋白亚类与氧化应激和颈动脉粥样硬化的相关性

目的 探讨老年2型糖尿病患者血清高密度脂蛋白(HDL)亚类的分布特点及其与氧化应激和颈动脉粥样硬化的相关性.方法 老年2型糖尿病患者56例,男40例、女16例;老年健康对照者41例,男31例、女10例.分别测定血清HDL亚类、血清8-异前列腺素F2α及颈动脉超声.结果 老年2型糖尿病组HDL3(0.51±0.21)mmol/L,较健康对照组(0.59±0.15)mmol/L降低(t=1.991,P＜0.05),HDL及HDL2亦较健康对照组降低,分别为(1.07±0.36)mmol/L对(1.18±0.32)mmol/L和(0.56±0.25)mmol/L对(0.64±0.33)mmol/L,但差异无统计学意义(t值分别为1.611和0.614,均为P＞0.05);HDL3与HbA1c负相关(r=-0.503,P=0.005);血清8-异前列腺素F2α吸光度A值较健康对照组降低,分别为0.017±0.004和0.021±0.008(t=2.245,P＜0.05);颈动脉平均内膜-中层厚度(IMT)较健康对照组升高,但差异无统计学意义;颈动脉斑块检出率63.3%,高于对照组的36.0%(x2=4.076,P＜0.05).结论 老年2型糖尿病患者HDL亚类水平存在异常,小颗粒的HDL3水平下降,氧化应激增加,可能是导致其动脉粥样硬化的原因之一.     

慢性阻塞性肺疾病患者振动反应成像与肺功能的相关性

目的 探讨振动反应成像技术(VRI)与慢性阻塞性肺疾病(COPD)患者肺功能的相关性.方法 对210例COPD患者行肺功能和VRI检查,分析VRI结果与肺功能的相关性.结果 COPD患者的VRI图像评分(10.81±3.61)分,振动值(1.56±0.47)分,右肺QLD值(49.63±12.03)%,啰音数(5.00...