慢性阻塞性肺疾病患者肋间外肌线粒体相关功能的临床研究  

Clinical studies on the functions of mitochondrial function of intercostal muscles in patients with chronic obstruction pulmonary disease

作　　者：叶斌[1,2] 李福祥 Ye Bin;Li Fuxiang(Department of respiratory,Chengdu First People′Hospital,Chengdu 610041,China;Department of respiratory,the Affiliated Hospital of Southwest MedicalUniversity,Luzhou 646000,China;Department of critical care medicine,Chengdu Military General Hospital,Chengdu 610083,China)

机构地区：[1]成都市第一人民医院呼吸内科,四川610041 [2]西南医科大学附属医院呼吸内科,泸州646000 [3]成都军区总医院重症医学科,四川610083

出　　处：《中华肺部疾病杂志（电子版）》2018年第5期544-550,共7页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：国家自然科学基金面上项目(81171869);四川省卫生厅科研课题(130316)

摘　　要：目的探讨不同营养状况慢性阻塞性肺疾病(COPD)患者肋间外肌线粒体功能。方法收集20例COPD患者和10例非COPD患者,将COPD患者分为低BMI COPD组(BMI<18.5)和正常BMI COPD组(18.5<BMI<24.99),非COPD患者作为对照组。对三组患者进行肺功能检查、血气分析检测,评估三组患者病情严重程度;测定肋间外肌组织中IL-6、IL-8和TNF-α的浓度,光镜观察肋间外肌肌细胞形态,评估三组患者的肋间外肌基本情况;测定肋间外肌线粒体蛋白浓度、呼吸链复合酶Ⅰ-Ⅳ和超氧化物歧化酶(SOD)活性、线粒体膜通透性开放孔(MPTP)动力学,电镜观察线粒体形态,评估三组患者肋间外肌线粒体功能。采用Pearson进行FEV1与炎性指标和线粒体指标相关性分析。结果与非COPD对照组相比,COPD患者的肺功能指标FVC(%)、VC(%)、FEV1(%)、FEV1/预测值、FEV1/FVC和DLco)均显著降低,低BMI COPD组的FEV1/预测值、FEV1/FVC值和DLco显著低于正常BMI COPD组。血气分析检查显示,正常BMI COPD组患者血液p H值和PaCO2值与非COPD对照组无显著性差异;低BMI COPD组血液p H值低于正常BMI COPD组和非COPD对照组,PaCO2值高于正常BMI COPD组; COPD患者血液PaCO2值显著低于非COPD对照组,低BMI COPD组低于正常BMI COPD组。COPD患者的肋间外肌组织中IL-6、IL-8和TNF-α浓度显著高于非COPD对照组,且低BMI COPD组显著高于正常BMI COPD组。光镜观察显示,COPD患者肋间外肌肌纤维间距增大和肌细胞变形随着健康状况不良而增大明显,低BMI COPD患者的肋间外肌形态结构变化更加明显。线粒体功能测定显示,与非COPD对照组相比,COPD患者的肋间外肌线粒体蛋白含量显著下降,呼吸链复合酶Ⅰ-Ⅳ和超氧化物歧化酶SOD活性显著降低,MPTP的吸光度值下降显著,且低BMI COPD组的上述指标与正常BMI COPD组相比,差异有统计学意义;电镜观察线粒体形态学发现,随着COPD患者营养状况恶化,肋间外肌线粒体基质密度�Objective To study the mitochondrial function of COPD patients with different nutritionstatus. Methods Twenty patients with COPD and 10 health subjects were enrolled in this study, and theCOPD patients were divided into low BMI groups （BMI〈18.5） and normal BMI groups （18.5〈BMI〈24.99）. The health subjects were used as normal control groups. The severity of the three groups was evaluated throughthe measurements of pulmonary ventilation function, blood gas analysis. The basic situation of intercostalmuscles of the three groups were evaluated via the measurements of the levels of IL-6, IL-8, TNF-α. Themitochondrial functions of the intercostal muscles were evaluated via the measurements of mitochondrial proteinconcentration, the activities of respiratory chain complexase Ⅰ-Ⅳ and SOD, the kinetics of mitochondrialpermeability transition pore （MPTP） and the observation of mitochondrial morphology with electron microscopy.Analysis the correlation relationship of FEV1 with the indexes of inflammation and mitochondrialfunction withPearson. Results Compared with those of the normal groups, the indexes of pulmonary function, such as FVC（%）, VC （%）, FEV1 （%）, FEV1 / predictive value, FEV1 / FVC and DLco were significant decreased inCOPD patients. And the values of FEV1 / predictive, FEV1 / FVC and DLco of the low BMI groups weresignificantly lower compared with those of the normal BMI groups. The results of blood gas analysis showed thatthe values of pH and PaCO2 of the normal BMI groups showed no significant differences compared with those ofthe health groups. The pH values of the low BMI groups were significantly lower than those of the health groupsand the normal BMI groups, and the values of PaCO2 were significantly higher than those of the normal BMIgroups. The values of PaCO2 of the COPD patients were significantly lower than those of the health groups andthere were significant differences between the low BMI groups and the normal BMI groups. The indexes inintercostal muscle showed th

关 键 词：肺疾病 慢性阻塞性 肋间外肌 线粒体功能异常 

分 类 号：R563[医药卫生—呼吸系统]