支气管肺泡灌洗液组织蛋白酶S与慢性阻塞性肺疾病严重程度的关系  

Association between cathepsin S in bronchoalveolar lavage fluid and severity of chronic obstructive pulmonary disease

作　　者：吴凯悦 朱珍[1] 殷少军[1] 李耕谊 左晟[1] 孔志斌[1] 柳毅[1] 李虹[1] 宋爽[1] 刘华[1] WU Kai-Yue;ZHU Zhen;YIN Shao-Jun;LI Geng-Yi;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》2019年第3期189-194,共6页Chinese Journal of Multiple Organ Diseases in the Elderly

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(COPD)患者支气管肺泡灌洗液(BALF)中组织蛋白酶S在综合评估分组中的价值。方法入选2014年4月至2017年4月在上海市第六人民医院呼吸内科门诊随诊的COPD稳定期患者46例,根据COPD综合评估(CAT)结果分为4组:A组[CAT<10分、第1秒用力呼气容积(FEV1)占预计值百分比≥50%且近1年急性加重次数<2次]11例,B组(CAT≥10分、FEV1占预计值百分比≥50%且近1年急性加重次数<2次)7例,C组(CAT<10分、FEV1占预计值百分比<50%或近1年急性加重次数≥2次)13例,D组(CAT≥10分、FEV1占预计值百分比<50%或近1年急性加重次数≥2次)15例。同期纳入肺功能正常的健康自愿者29例作为对照组。酶联免疫吸附测定法(ELISA)测定BALF中组织蛋白酶S。高分辨率CT测量低衰减区域(LAA)占全肺体积的百分比(LAA%)。采用SPSS 16.0统计软件进行数据分析。结果 COPD组BALF中组织蛋白酶S水平显著高于对照组;组织蛋白酶S水平在不同病情严重程度中表现为:D组>C组>B组>A组(P<0.01);在不同肺气肿程度中表现为:LAA 3级>LAA 2级>LAA 1级>LAA 0级(P<0.01)。单因素分析提示,LAA分级可显著影响组织蛋白酶S水平(F=5.141,P<0.001)。相关分析结果提示,COPD患者BALF中蛋白酶S水平与前1年急性加重频率(r=0.142,P=0.003)、CAT评分(r=0.309,P=0.017)、LAA%(r=0.497,P<0.001)呈显著正相关。结论组织蛋白酶S水平能够反映COPD严重程度,可作为判断COPD病情严重度的标志物,具有一定的治疗指导作用。Objective To investigate the value of cathepsin S in bronchoalveolar lavage fluid(BALF)in comprehensive assessment of the patients with chronic obstructive pulmonary disease(COPD).Methods A total of 46 patients with stable COPD were included as the study(COPD)group,who paid follow-up visits at the Department of Respiratory Medicine of our Hospital from April 2014 to April 2017.They were divided,based on COPD assessment test(CAT)results,into group A(n=11),B(n=7),C(n=13),and D(n=15).Group A was assigned as CAT scored<10,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 as CAT scored≥10,the ratio≥50%,and the frequency less than twice.Group C as CAT scored<10,the ratio<50%,or the frequency more than twice.Group D as CAT scored≥10,the ratio<50%,or the frequency more than twice.As the control group,29 healthy volunteers were taken from the same frame with normal lung function.The levels of cathepsin S in BALF were determined with enzyme-linked immunosorbent assay(ELISA).High-resolution CT(HRCT)was used to measure the percentage ratio of low-attenuation area(LAA)to total lung area(LAA%).Results BALF cathepsin S levels in the COPD group were significantly higher than that of the control group.BALF cathepsin S levels related to the severity of the disease as group D>group C>group B>group A(P<0.01)and to the degree of emphysema as LAA grade 3>LAA grade 2>LAA grade 1>LAA grade 0(P<0.01).The results of univariate analysis showed that LAA classification significantly affected the level of cathepsin S(F=5.141,P<0.001).Correlation analysis indicated that BALF cathepsin S level in COPD patients correlated positively to the frequency of acute exacerbation in the previous year(r=0.142,P=0.003),CAT score(r=0.309,P=0.017)and LAA%(r=0.497,P<0.001).Conclusion The BALF cathepsin S level reflects the severity of COPD and can be used as a biomarker in the assessment and treatment of COPD.

关 键 词：慢性阻塞性肺疾病 组织蛋白酶S 支气管肺泡灌洗液 

分 类 号：R562.2[医药卫生—呼吸系统]