肌肉生长抑制素在慢性阻塞性肺疾病合并肺动脉高压患者血浆中的表达及意义  

Plasma myostatin in patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease

作　　者：王同生[1] 苏秀丽[1] 孙瑜霞[1] 毛毅敏[1] 曲红培[1] Tong-sheng Wang;Xiu-li Su;Yu-xia Sun;Yi-min Mao;Hong-pei Qu(The First Affiliated Hospital(Clinical Medical College),Henan University of Science and Technology,Luoyang,Henan 471003,China)

机构地区：[1]河南科技大学第一附属医院(河南科技大学临床医学院),河南洛阳471003

出　　处：《中国现代医学杂志》2018年第10期78-83,共6页China Journal of Modern Medicine

基　　金：河南省医学科技攻关项目(No:201403146)

摘　　要：目的研究肌肉生长抑制素在慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者中的表达水平。分析肌肉生长抑制素与COPD合并PH的关系。方法 59例COPD合并PH患者和166例COPD无PH患者,检测肌肉生长抑制素和脑钠肽(BNP)水平。心脏彩超评估右心室功能和形态,心脏多普勒检测肺动脉压力(SPAP),SPAP≥40 mm Hg被确定为PH,三尖瓣瓣环收缩期偏移(TAPSE)≤16 mm为右心功能不全。检查肺功能、动脉血气、6 min步行距离。结果收录225例COPD患者,COPD合并PH患者占26.2%(59/225);COPD合并PH组肌肉生长抑制素和BNP水平高于COPD无PH组,两组肌肉生长抑制素水平分别是中位数16.4和12.8 ng/L,差异有统计学意义(P<0.05);BNP水平分别是(147.87±42.98)和(114.61±53.47)pg/ml,差异有统计学意义(P<0.05);相关分析:BNP和肌肉生长抑制素呈正相关;肌肉生长抑制素和SPAP呈正相关;肌肉生长抑制素与TAPSE和右室心肌性能指标相关(P<0.05);BNP只与SPAP呈正相关(P<0.05)。结论 COPD合并PH患者,血浆肌肉生长抑制素水平增加,与血浆BNP水平比较,在评估右心功能及肺动脉高压方面,肌肉生长抑制素水平有更强的相关性。肌肉生长抑制素可能优于BNP对COPD合并肺动脉高压的早期诊断。Objective To investigate the expressions of myostatin in patients with chronic obstructive pulmonary disease(COPD)combined with or without pulmonary hypentension(PH),and analyze the relationship of plasma myostatin level with PH in patients with COPD.Methods The levels of myostatin and BNP were investigated in 59 COPD patients with PH and 166 COPD patients without PH.Echocardiography was used to evaluate the function and morphology of the right ventricle(RV),and the value of tricuspid annular plane systolic excursion(TAPSE)less than 16 mm was considered as RV dysfunction.PH was defined as systolic pulmonary artery pressure(SPAP)≥40 mmHg assessed by Doppler echocardiography.Lung function,arterial blood gas,and 6-minute walking distance were checked.Results A total of 225 patients were recruited,26.2%(59/225)had PH.The plasma myostatin level was 16.4 ng/L(2.2-25.7 ng/L)in the patients with PH and 12.8 ng/L(3.2-20.3 ng/L)in the patients without PH,the plasma BNP level was(147.87±42.98)pg/ml in the patients with PH and(114.61±53.47)pg/ml in the patients without PH,the plasma myostatin and BNP levels were significantly higher in the patients with PH than in the patients without PH(z=-2.741 and-2.023,P<0.05).There was a positive correlation between plasma myostatin level and BNP level in the whole study groups(P<0.05).Plasma myostatin level was positively correlated with SPAP(P<0.05).Multivariate regression analysis suggested that myostatin level was significantly correlated with the values of TAPSE and RV myocardium performance indexes among the COPD patients(P<0.05),and that BNP level was only positively correlated with SPAP(P<0.05).Conclusions Plasma myostatin level is increased in COPD patients who have PH.Stronger correlations of plasma myostatin level with echocardiographic indexes of the right heart suggest that myostatin might be superior to BNP in the early diagnosis of PH in COPD patients.

关 键 词：慢性阻塞性肺疾病 肺动脉高压 肌肉生长抑制素 脑钠肽 

分 类 号：R563.9[医药卫生—呼吸系统]