慢性阻塞性肺疾病患者血清分泌型卷曲相关蛋白5与气道炎症和胰岛素抵抗的相关分析  

Correlation analysis of serum secreted frizzled-related protein 5 levels with airway inflammation and insulin resistance in chronic obstructive pulmonary disease patients

作　　者：李耕谊 殷少军[1] 柳毅 李虹[1] 宋爽[1] 孔志斌[1] 左晟[1] 刘华[1] 朱珍[1] Li Gengyi;Yin Shaojun;Liu Yi;Li Hong;Song Shuang;Kong Zhibin;Zuo Cheng;Liu Hua;Zhu Zhen(Department of Respiratory, Shanghai Jiaotong University Affiliated Sixth People＇s Hospital, Shanghai 201306, China)

机构地区：[1]上海交通大学附属第六人民医院呼吸内科,201306

出　　处：《中华结核和呼吸杂志》2017年第12期903-908,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：上海健康医学院种子基金重点项目（HMSF-17-21-022）

摘　　要：目的 探讨慢性阻塞性肺疾病（慢阻肺）患者血清分泌型卷曲相关蛋白5（sfrp5）水平与气道炎症和胰岛素抵抗的关系.方法 选取2015年2月至2017年1月门诊慢阻肺患者178例,其中男152例,女64例,同期健康体检者纳入为对照组99名,其中男87名,女41名.对比两组血清sfrp5水平,观察患者稳态模型评估的胰岛素抵抗指数（HOMA-IR）,分为胰岛素抵抗慢阻肺组（HOMA-IR≥2.29）、非胰岛素抵抗慢阻肺组、单纯性胰岛素抵抗组和正常对照组各亚组的血清sfrp5及诱导痰炎症因子水平.结果 慢阻肺组的sfrp5水平显著高于健康对照组（t=-14.29,P〈0.001）;胰岛素抵抗慢阻肺组sfrp5水平[（8±3）ng/ml]显著低于非胰岛素抵抗慢阻肺组[（10±5）ng/ml]、单纯性胰岛素抵抗组[（13±3）ng/ml]、正常对照组[（14±4）ng/ml,F=35.85,P〈0.01].胰岛素抵抗慢阻肺组的In（HOMA-IR）、诱导痰肿瘤坏死因子-α（TNF-α）、IL-6水平高于非胰岛素抵抗慢阻肺组、单纯胰岛素抵抗组和正常对照组（F值分别为64.968、41.40、64.15,均P〈0.01）;非胰岛素抵抗慢阻肺组的In（HOMA-IR）、诱导痰TNF-α、IL-6水平显著高于单纯胰岛素抵抗组、正常对照组;胰岛素抵抗慢阻肺组FEV1/FVC、FEV1占预计值显著低于非胰岛素抵抗慢阻肺组、单纯性胰岛素抵抗组、正常对照组（F值分别为2.481、8.37,均P〈0.05）;非胰岛素抵抗慢阻肺组的FEV1/FVC、FEV1占预计值%显著低于正常对照组和单纯性胰岛素抵抗组;血清sfrp5水平与FEV1/FVC、FEV1占预计值%呈正比（r值分别为0.466、0.412,均P〈0.01）,与In（HOMA-IR）、诱导痰TNF-α、IL-6呈反比（r值分别为-0.304、-0.459、-0.517,均P〈0.01）.体重指数、In（HOMA-IR）和诱导痰IL-6为血清sfrp5的独立相关因素（r2值分别为0.286、0.176、14.69,均P〈0.01）.结论 sfrp5可能同时与慢阻肺、胰岛素抵抗有关;胰岛素抵抗可能与气道炎症、气流受限有关;sfrp5Objective To investigate the relationship between serum secreted frizzled-related protein 5（sfrp5） levels, insulin resistance, and airway inflammation in patients with chronic obstructive pulmonary disease（COPD）.Method A total of 178 COPD patients visiting our respiratory outpatient clinic from February 2015 to January 2017 were enrolled , and 99 healthy control subjects from the same time period were selected .Serum sfrp5 levels were compared between the 2 groups.Serum sfrp5 and inflammatory cytokines in induced sputum were observed in the 4 subgroups：insulin resistant COPD group [ homeostasis model assessment of insulin resistance （HOMA-IR）≥2.29], non-insulin resistant COPD group, non-COPD insulin resistant group , and healthy control group . Results Serum sfrp5 levels were found to be significantly higher in the COPD group as compared to the healthy control group （ t=-14.29, P〈0.001）. Serum sfrp5 levels in the insulin resistant COPD group [（8 ±3）ng/ml] were significantly lower than that of the non-insulin resistant COPD group [（10 ±5）ng/ml], non-COPD insulin resistant group [（13 ±3）ng/ml], and normal control group [（14 ±4）ng/ml, F=35.85, P〈0.01].The insulin resistant COPD group had higher levels of In（Homa-IR）, as well as tumor necrosis factor-α（TNF-α） and interleukin-6 （IL-6） in induced sputum as compared to the non-insulin resistant COPD group , non-COPD insulin resistant group , and healthy control group （ F values were 64.968, 41.40, 64.15, respectively, P value 〈0.01 for all items）.The non-insulin resistant COPD group had higher levels of In （HOMA-IR） as well as TNF-αand IL-6 in induced sputum as compared to the non-COPD insulin resistant group and healthy control group .FEV1/FVC and FEV1%predicted were significantly lower in the insulin resistant COPD group as compared to those of non-insulin resistant COPD group and non-COPD insulin resistant group , and healthy control group （ F values were 2.481 and 8.37, respectively, P value 〈0

关 键 词：肺疾病 慢性阻塞性 分泌型卷曲相关蛋白5 炎症 胰岛素抵抗 

分 类 号：R563.9[医药卫生—呼吸系统]