溃疡性结肠炎患者血清及结肠组织α_1-抗胰蛋白酶水平与肺功能损害相关性研究  

Correlation between Pulmonary Function Impairment and Levels of α 1-antitrypsin in Serum and Colon of Ulcerative Colitis Patients: a Clinical Research

作　　者：王建云[1] 王新月[2] 孙慧怡[2] 刘大铭[2] 张雯[2] 金晨曦[3] 李莉[4] 朱陵群[5] 

机构地区：[1]北京中医药大学第三附属医院脾胃科,北京100029 [2]北京中医药大学东直门医院消化科,北京100700 [3]北京中医药大学东直门医院肺功能室,北京100700 [4]中国中医科学院望京医院药理实验室,北京100102 [5]北京中医药大学东直门医院中医内科学教育部重点实验室,北京100700

出　　处：《中国中西医结合杂志》2014年第1期20-26,共7页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：国家重点基础研究发展计划"973计划"(No.2009CB522705)

摘　　要：目的观察溃疡性结肠炎(ulcerative colitis,UC)患者血清及结肠组织α1-胰蛋白酶(α1-antitrypsin,A1AT)水平与肺损害的相关性,探讨UC肺损害的发生机制。方法将90例确诊为UC的患者,按病变范围、活动度、病情分期及病程进行分组,比较不同病变范围、活动度、病情分期及病程的UC患者血清A1AT水平;选择30名健康志愿者作为对照组,检测UC组及对照组血清肝、肾功能水平及肺功能,并比较两组间肝、肾功能,肺功能及血清A1AT水平的差异。分析UC患者各肺功能指标与血清A1AT的相关性。采用免疫组化法检测20例UC患者及10名健康志愿者结肠组织A1AT含量。结果 90例UC患者中,伴有肺功能异常者54例(60.0%),伴有其他UC肠外表现者24例(26.7%)。与对照组比较,UC组血清A1AT水平明显下降(P<0.05);病变范围为远端结肠及广泛结肠者血清A1AT水平较病变范围局限在直肠者明显下降(P<0.05);病程≥5年者血清A1AT水平较病程<5年者明显下降(P<0.05);病变范围为远端结肠及广泛结肠者肺功能通气指标中肺活量(vital capacity,VC);用力肺活量(forced vital capacity,FVC);一秒量(forced expiratory volume in one second,FEV1.0),肺容量指标中肺总量(total lung capacity,TLC)、功能残气量(function residual volume,FRV)及肺弥散指标中一氧化碳弥散量(diffusion capacity for carbon monoxide of lung,DLCO)较病变范围局限在直肠患者均明显下降(P<0.05);UC患者病程与用力肺活量FVC呈直线负相关(r=-0.23,P=0.018);UC患者血清A1AT水平与峰流速峰流速(peak expiratory flow,PEF)呈正相关(r=0.22,P=0.03)。UC患者结肠A1AT水平明显低于对照组(P<0.05)。重度UC患者结肠A1AT水平较轻中度患者下降(P<0.05)。UC患者结肠A1AT水平高于远端结肠炎及广泛结肠炎患者(P<0.05)。结论 UC患者肺功能异常的发病率高于UC其他肠外表现,肺功能检测有助于提前筛查UC肺损害。UC患者血清及结肠组织中A1AT水平均明显下Objective To explore the mechanism of pulmonary involvement in ulcerative colitis （UC） patients by observing the correlation between pulmonary functions and levels of （α1--antitrypsin （A1AT） in serum and colon tissue in UC patients. Methods Totally 90 patients with confirmed UC were as- signed to different groups according to the extent of disease, the disease activity, the staging of severity, and course of disease. The serum level of A1AT in UC patients with different extent of disease, the disease activity, the staging of severity, and course of disease were compared. And 30 healthy volunteers were re- cruited as the control group. The serum renal and hepatic functions, pulmonary functions, and serum lev- els of A1AT were detected in the UC group and the control group. The correlation between A1AT and each pulmonary function index in UC patients was analyzed. The A1AT content in the colon tissue was detected with immunohistochemical assay in 20 UC patients as well as in 10 healthy volunteers. Results Of the 90 UC patients, 54 patients were accompanied with pulmonary function abnormality （60.0%）, and 24 with extraintestinal manifestations （26.7%）. Compared with the control group, the serum level of A1 AT was signif- icantly lower in the UC group （P 〈0.05）. The serum level of A1AT was significantly higher in those with proctitis than in those with distal colonitis and pancolitis （P 〈0.05）. The serum level of A1AT was lower in patients with the course of disease 5 years and more than 5 years than in those with the course of disease less than 5 years （P 〈0.05）. Vital capacity （VC）, forced vital capacity （FVC）, forced expiratory volume in one second （FEVer）, total lung capacity （TLC）, function residual volume （FRV）, and the ratio of diffusion capacity for carbon monoxide of lung （DLCO） were much lower in those with proctitis than in those with distal colonitis and pancolitis （P 〈0.05）. The ratio of FVC was negatively linear correlated with the cours

关 键 词：溃疡性结肠炎 肺功能损害 α1-胰蛋白酶 

分 类 号：R574.62[医药卫生—消化系统]