慢性阻塞性肺疾病急性加重期患者肺动脉压与血清S100B蛋白和细胞因子及降钙素原的关系  

The relationships of pulmonary arterial pressure with serum S100B protein, cytokines and procalcitonin in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：王国平[1] 申立宁 王晚萍[3] 白淑丽 崔娜[1] 

机构地区：[1]山西医科大学附属医院/长治市人民医院重症医学科,山西长治046000 [2]山西医科大学附属医院/长治市人民医院感染疾病科,山西长治046000 [3]山西医科大学附属医院/长治市人民医院呼吸内科,山西长治046000

出　　处：《中国中西医结合急救杂志》2015年第1期51-54,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：吴阶平医学基金会临床科研专项基金（320675014255）;山西省长治市星火计划项目（200704009）

摘　　要：目的：探讨慢性阻塞性肺疾病急性加重期（AECOPD）患者肺动脉压（PAP）与血清S100B蛋白和细胞因子及血浆降钙素原（PCT）的关系。方法采用前瞻性对照研究方法，选择2012年1月至2013年8月山西医科大学附属医院/长治市人民医院重症医学科和呼吸科收治的AECOPD患者80例、COPD稳定期（SCOPD）患者80例，选择100例健康体检者作为健康对照。常规检查血常规、血浆PCT水平；心脏彩色超声检测PAP；采用放射免疫分析法测定血清S100B蛋白；采用酶联免疫吸附试验（ELISA）测定白细胞介素（IL-18、IL-1β）及肿瘤坏死因子-α（TNF-α）水平；并对各指标进行线性相关性分析。结果各组受试者性别、年龄匹配，与健康对照组比较，SCOPD组与AECOPD组白细胞计数（WBC）、中性粒细胞比例（PMN）、PAP、PCT、S100B蛋白、IL-18、IL-1β和TNF-α均明显增加〔WBC（×109/L）：0.84±0.22、1.94±0.64比0.73±0.12， PMN：0.70±0.09、0.85±0.08比0.54±0.05，PAP（mmHg，1 mmHg＝0.133 kPa）：39±5、47±8比24±5，PCT （μg/L）：0.41±0.08、6.35±2.14比0.11±0.01，S100B（μg/L）：0.081±0.017、0.101±0.028比0.041±0.011，IL-18（ng/L）：162±19、181±27比112±19，IL-1β（ng/L）：55±12、75±14比34±10，TNF-α（ng/L）：67±17、89±18比35±17，均P＜0.05〕，且AECOPD组较SCOPD组增加更为显著（均P＜0.01）。血清S100B蛋白与PCT、IL-18、PMN及PAP均呈显著正相关（r值分别为0.36、0.41、0.39、0.35，均P＜0.05）；血浆PCT与PMN及PAP也呈显著正相关（r值分别为0.41、0.37，均P＜0.05）。结论血清S100B蛋白水平可能与血浆PCT、细胞因子及PAP变化有明显的相关性。Objective To investigate the relationships of pulmonary arterial pressure （PAP） with serum protein S100B, cytokines and plasma procalcitonin （PCT） in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods A prospective controlled study was conducted, 160 subjects admitted in the Critical Care Medicine and Respiratory Disease Departments in the Affiliated Hospital of Shanxi Medical University/Changzhi Municipal People＆#39;s Hospital from January 2012 to August 2013 were enrolled in the study, including 80 patients with AECOPD （AECOPD group） and 80 COPD under stable condition （SCOPD group）. Meanwhile 100 healthy people having passed physical examinations were chosen as healthy control group. The levels of blood routine and plasma PCT were examined, PAP was evaluated by modified Simpson, sequation with echocardiography, serum S100B was measured by radioimmunoassay, and enzyme linked immunosorbent assay （ELISA） was used to measure interleukins （IL-18, IL-1β） and tumor necrosis factor-α（TNF-α）. The linear correlation analysis was carried out for the various indicators. Results The gender and age in different groups were matched. Compared with the healthy control group, the levels of white blood cell count （WBC）, ratio of neutrophil granulocyte （PMN）, PAP, PCT and S100B, IL-18, IL-1β, and TNF-αwere significantly higher in SCOPD and AECOPD groups [WBC （×109/L）：0.84±0.22, 1.94±0.64 vs. 0.73±0.12, PMN： 0.70±0.09, 0.85±0.08 vs. 0.54±0.05, PAP （mmHg, 1 mmHg = 0.133 kPa）： 39±5, 47±8 vs. 24±5, PCT （μg/L）： 0.41±0.08, 6.35±2.14 vs. 0.11±0.01, S100B （μg/L）： 0.081±0.017, 0.101±0.028 vs. 0.041±0.011, IL-18 （ng/L）： 162±19, 181±27 vs. 112±19, IL-1β（ng/L）： 55±12, 75±14 vs. 34±10, TNF-α（ng/L）：67±17, 89±18 vs. 35±17, all P〈0.05], and the increase in level of indexes was more significant in AECOPD group than that in the SCOPD group （all P 〈 0.01）. Serum S100B was significant

关 键 词：肺疾病 阻塞性 慢性 急性加重期 肺动脉压 S100B蛋白 降钙素原 细胞因子 

分 类 号：R651.15[医药卫生—外科学]