慢性阻塞性肺疾病患者血清瘦素水平的变化及其与 IL-6的关系

目的通过测定慢性阻塞性肺疾病（COPD）急性加重期患者治疗前、后血清中瘦素水平的变化，及其与炎性因子白细胞介素-6（IL-6）的相关性分析，了解瘦素在COPD病情发展过程中的意义。同时通过分析COPD急性加重期患者血清瘦素与乏氧、二氧化碳潴留、气道阻力的相关性，了解瘦素与COPD加重期患者病情严重程度的关系。方法选择2011年8月至2012年2月因COPD急性加重，于哈尔滨医科大学第一附属医院呼吸内科住院的男性患者60例，年龄（68.4±7.8）岁，并排除肿瘤、结缔组织病、肝肾功能障碍、糖尿病等消耗性疾病，且经过呼吸内科10～15 d治疗后均进入稳定期。采集患者治疗前、后的晨起空腹静脉血，离心后取血清，通过放射免疫法测定瘦素及IL-6的水平，分析瘦素和IL-6在治疗前、后的差异性及二者的相关性。并在患者急性加重期时做动脉血气分析和肺通气功能试验，分别做瘦素与PaCO2、PaO2、SaO2、FEV1、FEV1/FVC的相关性分析。计量资料用均数±标准差的方式表示，差异的比较用独立样本t检验，分析两个变量之间的相关性用线性相关分析法（Pearson法）。结果（1）COPD急性加重期患者治疗前血清瘦素水平（4.41±1.18）ng/ml]高于治疗后（2.53±0.70）ng/ml]，差异具有显著性（P＜0.001）；（2）COPD急性加重期患者治疗前血清IL-6水平（516.49±81.47）pg/ml]高于治疗后（317.79±37.47）pg/ml]，差异具有显著性（P＜0.001）；（3）COPD患者急性加重期时血清瘦素与IL-6呈显著正相关（r＝0.598，P＜0.001），而经治疗进入稳定期后二者无相关性（r＝-0.120，P＞0.05）；（4）COPD患者急性加重期时血清瘦素与血气分析结果的相关性分析：与二氧化碳分压呈显著正相关（r＝0.490，P＜0.001），与血氧分压呈显著负相关（r＝-0.702，P＜0.001），与血氧饱和度呈显著负相关（r＝-0.656，P＜0.001）；（5）COPD患者急性加重期时血清瘦素与肺通气功能结果的相关性分析：与FEV1呈显著负相关（r＝-0.620，P＜0.001），与FEV1/FVC无相关性（r＝-0.210，P＞0.05）。结论 COPD患者急性加重期时血清瘦素和IL-6水平较稳定期时均显著升高，且二者有显著相关性，因此瘦素可能成为COPD加重期时的炎性标记物；瘦素与COPD患者急性加重期时的二氧化碳潴留、乏氧、气道阻力均有密切关系，因此瘦素可能在评估病情严重程度方面有一定意义。

The relationship between leptin and IL-6 in patients with chronic obstructive pulmonary disease

Objective To investigate the change of serum leptin , interleukin （ IL ）-6 in various period of chronic obstructive pulmonary disease （ COPD ） , and observe the correlation between leptin and IL-6 in acute exacerbation of COPD patients .At the same time we observe the correlation between serum leptin and PaCO 2 ,PaO2 , SaO2 ,FEV1,FEV1/FVC in acute exacerbation of COPD patients to know the relationship between serum leptin and severity of COPD .Methods Blood samples were obtained from total 60 male patients with acute exacerbation of COPD,whose average age was （ 68.4 ±7.8 ） years.They were all treated in Respiratory Department of the First Clinical Medical College of Harbin Medical University during August 2011 to February 2012 .After breathing medical therapy,they were all into clinical recovery .The leptin and IL-6 were detected by the radioinmmunity method .We compare the difference of serum leptin ,IL-6 level between patients pre-treatment and after-treatment.At the same time we do the correlation analysis between serum leptin and IL-6 level in acute exacerbation of COPD .We do the correlation analysis between serum leptin level and article blood gas index and lung ventilation function index of＆amp;nbsp;patients with acute exacerbation of COPD .The arterial blood gas was analyzed with type blood gas analyzer .The pulmonary function was detected by the pulmonary function meter .The difference of measurement data was compared with the independent t-test.The linear correlation was used to analyze the correlation among the data .Results The concentrations of leptin （ 4.41 ±1.18 ） ng/ml in patients with COPD during acute exacerbation were significantly higher than it in stable stage（2.53 ±0.70）ng/ml（P〈0.001）.The concentrations of IL-6（516.49 ±81.47）pg/ml in patients with COPD during acute exacerbation were significantly higher than it in stable stage （ 317.79 ±37.47 ） pg/ml（ P〈0.001 ） .The level of leptin with COPD during acute exacerbation correlated positively with IL -6 （ P〈0.01 ） .The level of leptin with COPD correlated positively with PaCO 2 （ P〈0.001 ） , and negative correlated with PaO2,SaO2,FEV1（P〈0.001）.Conclusion The concentrations of leptin and IL-6 in patients of COPD during acute exacerbation were significantly increased ,and the level of leptin was correlated positively with IL-6.So leptin may be taken as the inflammation marker in the acute exacerbation phase of COPD .The concentrations of leptin in patients of COPD during acute exacerbation have a good correlation with the lack of oxygen ,carbon dioxide retention and the spring of airway .It can be used to evaluate the severity of COPD .