脂联素等与慢性阻塞性肺病相关肺动脉高压的相关性研究

目的观察慢性阻塞性肺病（COPD）合并肺动脉高压（PH）和COPD非PH患者血浆脂联素（APN）、血清肿瘤坏死因子α（TNF-α）和C反应蛋白（CRP）的水平,探讨炎症反应在COPD相关PH发病机制中的意义。方法将60例COPD急性加重期患者,根据超声心动图拟诊PH的标准为肺动脉收缩压（PASP）≥40 mmHg,分为COPD合并PH组和COPD非PH组各30例,2组均给予吸氧、抗感染、止咳化痰、平喘等常规对症治疗平均住院日（13.10±3.20）d,（13.27±4.36）d]。选择同期健康体检者22例。应用酶联免疫吸附法（ELISA）测定血浆APN和血清TNF-α水平,免疫比浊法测定血清CRP,比较3组间血浆APN、血清TNF-α和CRP水平,且观察COPD非PH组和COPD合并PH组治疗前后上述指标的变化,并将血APN、TNF-α和CRP水平与PASP进行相关性分析。结果 COPD非PH组和COPD合并PH组血浆APN、血清TNF-α和CRP水平均较对照组明显升高,差异有统计学意义（P〈0.05）;且COPD合并PH组明显高于COPD非PH组（P〈0.05）。与治疗前比较,COPD非PH组与PH组治疗后的PASP、血浆APN、血清TNF-α和CRP水平均明显降低（P〈0.05）。PH组治疗后血浆APN、血清TNF-α和CRP水平明显高于COPD非PH组,差异有统计学意义（P〈0.05）。COPD合并PH组治疗前后血浆APN、血清TNF-α和CRP水平分别与PASP呈正相关（r分别为0.744、0.614、0.482、0.627、0.538、0.493,P〈0.05）。结论血浆APN、血清TNF-α和CRP水平的升高与COPD相关PH患者的PASP的升高相关,说明APN、TNF-α和CRP可能参与COPD相关PH的形成过程。

Relationship during adiponectin,other inflammatory mediators and COPD related pulmonary hypertension

Objective To investigate the plasma adiponectin（ APN）,serum tumor necrosis factor α（ TNF- α） and C- reactive protein（ CRP） in patients with chronic obstructive pulmonary disease（ COPD） with and without pulmonary hypertension（ PH）, and to explore the significance of the inflammatory response in COPD- related PH. Methods60 patients with COPD at acute exacerbation were divided into COPD with PH group and COPD without PH group according to the pulmonary artery systolic pressure（ PASP） ≥40 mmHg. And 22 healthy persons were selected as control group. All patients got treatment as oxygen,anti-infection,drugs for relieving cough,sputum and asthma,and other symptomatic and supportive treatment（ average length of stay： 13. 10 ± 3. 20 days and 13. 27 ± 4. 36 days）. Enzyme linked immunosorbent assay（ ELISA） was employed to measure the levels of plasma APN and serum TNF- α. Serum CRP was detected by turbidimetric immunoassay. The plasma APN,serum TNF- α and CRP levels were compared in three groups, the levels of blood APN,TNF- α and CRP were observed before and after treatment,and then the correlation was analyzed in the blood APN,TNF- α and CRP levels and PASP. Results The plasma APN,serum TNF- α and CRP in COPD with PH group and COPD without PH group were significantly higher than those in the control group（ P 0. 05）; the levels of APN,TNF- α and CRP in the PH group was significantly higher than those in COPD without PH group（ P 0. 05）. After treatment,compared to that before treatment, the pulmonary artery systolic pressure（ PASP）,plasma APN,serum TNF- α and CRP levels decreased significantly between COPD with PH group and COPD without PH group（ P 0. 05）. The levels of plasma APN,serum TNF- α and CRP in the PH group were significantly higher than those in COPD without PH group,the difference was statistically significant（ P 0. 05）. The plasma APN,serum TNF- α and CRP of COPD with PH group before and after treatment were positively correlated with PASP（ r = 0. 744,r = 0. 614,r = 0. 482; r = 0. 627,r = 0. 538,r = 0. 493,P 0. 05）. Conclusion The levels of plasma APN,serum TNF- α and CRP are related to PASP in COPD patients with PH and they may play an very important role during the formation of the COPD- related PH.