脂联素水平与慢性阻塞性肺疾病严重程度及CT特征的关系  

Correlation of plasma adiponectin level with severity and CT features of chronic obstructive pulmonary disease

作　　者：朱珍[1] 殷少军[1] 魏丽[1] 左晟[1] 孔志斌[1] 柳毅[1] 李虹[1] 宋爽[1] 刘华[1] ZHU Zhen YIN Shao-Jun WEI Li ZUO Sheng KONG Zhi-Bin LIU Yi LI Hong SONG Shuang LIU Hua(Department of Respiratory Diseases, the Sixth People＇ s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 201306, China)

机构地区：[1]上海市交通大学附属第六人民医院东院呼吸内科,上海201306

出　　处：《中华老年多器官疾病杂志》2017年第6期401-405,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：上海市浦东新区卫生系统重点学科群建设基金(Pwzxq2014-07);上海健康医学院种子基金重点项目(HMSF-17-21-022)~~

摘　　要：目的探讨脂联素对评估慢性阻塞性肺疾病(COPD)严重程度及CT特征的价值。方法入选2015年1月至2016年12月在上海市第六人民医院东院呼吸内科门诊随诊的COPD稳定期患者430例,根据疾病严重程度分为4组。(1)A组(n=116):改良版英国医学研究委员会呼吸问卷(mMRC)0~1分、第1秒用力呼气容积(FEV1)/预计值≥50%,且前1年急性加重<2次。(2)B组(n=83):mMRC≥2分、FEV1/预计值≥50%,且前1年急性加重<2次。(3)C组(n=92):mMRC0~1分、FEV1/预计值<50%,或前1年急性加重≥2次。(4)D组(n=139):mMRC≥2分、FEV1/预计值<50%,或前1年急性加重≥2次。同期纳入肺功能正常的健康体检者206名作为对照组。行肺功能检查,主要检测高分辨率CT测量低衰减区域(LAA)占全肺体积的百分比(LAA%)、2倍气道壁厚度与气道直径比(2T/D)、管壁面积占总横截面积比(WA);利用酶联免疫吸附试验(ELISA)测定血浆脂联素水平。结果各组研究对象的空腹血糖、糖化血红蛋白(HbA1c)、脂联素水平、FEV1/用力肺活量(FVC)、FEV1/预计值、肺一氧化碳弥散量(DLCO)、残气容积/肺总量(RV/TLC)、LAA%、2T/D和WA间差异均具有统计学意义(P<0.05)。单因素分析结果表明,性别、体质量指数(BMI)、前1年急性加重次数、肺功能和LAA分级可显著影响脂联素水平(P<0.05)。相关分析结果表明,COPD患者的脂联素水平与吸烟指数(r=0.356)、前1年急性加重频率(r=0.749)、COPD患者自我评估测试问卷(CAT)评分(r=0.497)、RV/TLC(r=0.002)、LAA%(r=0.010)、2T/D(r=0.006)和WA(r=0.011)呈显著正相关(P<0.05),与BMI(r=-0.440)、FEV1/FVC(r=-0.247)、FEV1/预计值(r=-0.037)和DLCO(r=-0.528)呈显著负相关(P<0.05)。结论脂联素可作为反映COPD不同病理程度的表型标志物。Objective To investigate the value of adiponectin in evaluation of the severity and CT features of chronic obstructive pulmonary disease （COPD）.Methods A total of 430 patients with stable COPD who were follow-up outpatients of our department from January 2015 to December 2016 were recruited in this study.According to the severity, they were divided into 4 groups.Group A （n=116） was scored from 0 to 1 by a modified version of British Medical Research Council （mMRC） respiratory questionnaire, with the ratio of forced expiratory volume in the first second （FEV1） to the expected value ≥50%, and the frequency of acute exacerbations during last year less than twice.Group B （n=83） was defined with mMRC score ≥2, the ratio ≥50%, and the frequency less than twice.Group C （n=92） had the mMRC score from 0 to 1, the ratio 〈50%, or the frequency more than twice.Group D （n=139） was assigned as mMRC score ≥2, the ratio 〈50%, or the frequency more than twice.Another 206 healthy subjects with normal pulmonary function were enrolled as control group.All underwent pulmonary function test, and high-resolution computed tomography （HRCT） for the percentage of lung voxels with low-attenuation areas （LAA%）, the ratio of 2-fold airway wall thickness to outer diameter （2T/D） and the ratio of wall area to total airway area （WA） were mainly tested.Plasma adiponectin level was measured by enzyme-linked immunosorbent assay （ELISA）.Results There were significant differences in fasting blood glucose （FBG）, hemoglobin A1c （HbA1c）, adiponectin, FEV1/FVC, LAA%, 2T/D, WA%, FEV1/Expected value （%）, diffusing capacity of the lungs forcarbon monoxide （DLCO）, and ratio of residual volume （RV） to total lung capacity （RV/TLC） among the 4 groups （P〈0.05）.The results of univariate analysis showed that gender, body mass index （BMI）, the frequency of acute exacerbations in last year, lung function and LAA classification significantly affected the level of adiponecti

关 键 词：慢性阻塞性肺疾病 脂联素 肺气肿 气道重塑 高分辨率CT 

分 类 号：R562.21[医药卫生—呼吸系统]