慢性阻塞性肺疾病患者诱导痰中α-防御素1—3含量与病情程度的相关性研究

目的探讨慢性阻塞性肺疾病急性加重期（AECOPD）患者治疗前后诱导痰中α-防御素1-3（HNP1—3）含量、中性粒细胞比例（N％）与肺功能及血气分析结果的相关性，以探讨HNP1—3在COPD发病机制中的可能作用。方法收集AECOPD患者42例（根据肺功能检测结果分为轻度组11例、中度组13例、重度组18例）治疗前后及20例急性支气管炎痊愈者（对照组）的诱导痰，分别进行痰中性粒细胞计数并计算其百分比，用ELISA方法检测诱导痰中HNP1—3的含量；测定各观察对象治疗前后的血气分析及肺功能，分析HNP1—3含量与N％、肺功能和血气分析的相关性。结果COPD患者诱导痰中HNP1-3水平、N％、PaCO2随病情严重程度的增加而增高（P〈0．01），并明显高于对照组（P〈0．01），FEV，％pred、FEV，／FVC、PaO2随病情严重程度的增加而降低（P〈0．01），明显低于对照组（P〈0．01）。三组患者诱导痰中HNP1—3含量分别与N％呈显著正相关（r=0．887～0．973，P值均〈0．01），与FEV，Yoopred、FEV，／FVC、Pa02分别呈显著负相关（r=0．721～0．973，P值均〈0．01）。经治疗一周后，轻度、中度、重度患者FEV，Voopred、FEV1／FVC、PaO2明显增高，诱导痰中HNP1—3含量、N％明显降低。结论HNPl—3参与了COPD炎症的过程，此过程与中性粒细胞有关。痰中HNPl3含量可作为COPD患者病情严重程度的指标，并有助于判断预后。

Study of relationship between human alpha defensinl-3 level in induced sputum of patients with chronic obstructive pulmonary disease and the illness severity

Objective To study the correlation among the levels of alpha defensinl-3 （HNP1 3）, percentage of neutrophil （N%） in induced sputum and lung function as well as blood gas analysis in COPP patients with acute exacerbation at pre-and post-treatment, and to explore possible roles of HNP1- 3 in COPD. Methods Forty-two patients COPD with acute exacerbation were recruited and randomly divided into three groups according to their lung function, twenty acute bronchitis recovery subjects also were selected. The variation of lung function,blood gas analysis,N% and concentrations of H NP1- 3 （by enzyme-linked immunosorhent assay） in induced sputum at pre and post-treatment and control group were measured, the correlations among HNP1-3, N% and lung function, blood gas analysis were analyzed. Results HNP1 3, N% in induced sputum and PaCO2 in exacerbation of COPI） were higher following higher severity of COPD（ P 〈0.01）, and remarkable higher compared to control group（ P 〈0.01 ）, while FEVI %pred, FEVI/FVC and PaO2 in exacerbation of COPD were lower following higher severity of COPD（P〈0.01）,and notable lower compared to control group （P 〈0.01）. The HNP1 3 level in sputum was closely positively correlated with N% （ r 0. 887 to 0. 973, respectively P 〈 0.05） and closely negatively correlated with FEV1% pred, FEV1/FVC and PaO2 （r = -0.721 to -0.973, respectively P 〈0.05）. There was remarkable improvement in FEV1% pred, FEV1/FVC and PaO2accompanied with notable decrease of N% and concentration of HNP1-3 in induced sputum at mild/ moderate/severe patients following treatment one week later. Conclusions HNP1-3 may be involved in the pathogenesis of airway inflammation in COPD. Sputum HNP1-3 may be a marker of severity of COPD,to some degree, be useful to predict prognosis.