组织蛋白酶S水平与慢性阻塞性肺疾病严重程度及CT表型的关系  

Roles of Cathepsin S in evaluating the severity and the CT phenotype of chronic obstructive pulmonary disease

作　　者：李耕谊 殷少军[1] 柳毅[1] 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 Sheng(Department of Respiratory Medicine,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呼吸内科,201306

出　　处：《中华肺部疾病杂志（电子版）》2018年第3期284-288,共5页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：上海健康医学院种子基金重点项目(HMSF-17-022)

摘　　要：目的探讨血浆组织蛋白酶S(cathepsin S)对评估慢性阻塞性肺疾病(COPD)严重程度及CT表型的价值。方法入选2015年6月至2017年5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361例,根据慢阻肺综合评估分组方法将患者分为4组:A组84例,B组92例,C组107例,D组78例,同期纳入肺功能正常的健康体检者196例作为对照组。行肺功能检查,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)测定血浆组织蛋白酶S水平。结果 COPD组血浆组织蛋白酶S水平显著高于对照组;血浆组织蛋白酶S水平在COPD各综合评估分组中表现为:D组>C组>B组>A组;组织蛋白酶S水平在不同GOLD分级中表现为:GOLDⅣ级≥GOLDⅢ级≥GOLDⅡ级≥GOLDⅠ级;组织蛋白酶S水平在不同LAA分级中表现为:LAA 3级≥LAA 2级≥LAA1级≥LAA 0级;相关性分析提示,血清组织蛋白酶S水平与COPD患者FEV_1/FVC、FEV_1占预计值%呈显著负相关,与LAA%、2T/D和WA呈显著正相关;Logistic回归分析提示,组织蛋白酶S为严重气流受限(FEV_1占预计值%<50%)和重度肺气肿改变(LAA%≥15%)的独立危险因子(P=0.0493,OR=3.06;P=0.0147,OR=8.41)。结论血浆组织蛋白酶S水平可作为反映COPD不同严重程度及CT表型的标志物。Objective To investigate the value of Cathepsin S in evaluating the severity and CT phenotype of COPD. Methods We recruited 361 patients with stable chronic obstructive pulmonary disease （COPD） attending respiratory outpatient clinic at Shanghai Sixth People′s Hospital from June 2015 to May 2017 and divided them into 4 groups based on COPD assessment tools. Group A contained 84 patients, Group B contained 92 patients, Group C contained 107 patients, and Group D contained 78 patients. One hundred ninety-six healthy subjects with normal pulmonary function were enrolled to the control group. Pulmonary function test was performed. The percentage ratio of low attenuation area to total lung area （LAA%）, two times the ratio of airway wall thickness to outer diameter（2T/D）, and the ratio of wall area to total airway area （WA） were measured by HRCT. Plasma cathepsin S levels were measured by enzyme-linked immunosorbent assay （ELISA）. Results Plasma cathepsin S levels in the COPD group was significantly higher than the control group. Plasma cathepsin S levels from highest to lowest according to COPD grouping were as follows Group D〉Group C〉Group B〉Group A. Plasma cathepsin S levels from highest to lowest according to GOLD staging were as follows： GOLD Ⅳ≥GOLD Ⅲ≥GOLD Ⅳ≥GOLD Ⅰ. Plasma cathepsin S levels from highfest to lowest according to LAA score were as follows： score 3≥score 2≥score 1≥score 0. Correlation analysis showed that plasma cathepsin S of COPD patients was significantly negatively correlated with FEV 1/FVC and FEV 1/pred% and was positively correlated with LAA%, 2T/D, and WA%. Multivariate logistic regression analysis showed that cathepsin S is a risk factor for severe airflow limitation and severe emphysema. Conclusions This suggests the new insight that cathepsin S may be used as a marker to reflect different degrees of COPD severity and CT phenotype.

关 键 词：肺疾病 慢性阻塞性 组织蛋白酶S 肺气肿 气道重塑 高分辨率CT 

分 类 号：R563[医药卫生—呼吸系统]