leptin和HIF-1α对慢性阻塞性肺疾病患者预后影响的研究  

Value of serum leptin and HIF-1αlevels in prognosis of patients with chronic obstructive pulmonary disease

作　　者：叶飒[1] 王飞燕[1] 周宏斌[1] YE Sa;WANG Feiyan;ZHOU Hongbin(Department of Respiratory Medicine,Zhejiang Provincial People’s Hospital(People’s Hospital of Hangzhou Medical College),Hangzhou 310014,China)

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)呼吸内科,杭州310014

出　　处：《浙江医学》2020年第17期1809-1813,1819,共6页Zhejiang Medical Journal

基　　金：国家自然科学基金资助项目(81900029)。

摘　　要：目的探讨血清瘦素(leptin)和缺氧诱导因子1α(HIF-1α)对慢性阻塞性肺疾病(COPD)患者预后的影响。方法选取2013年8月至2016年8月在浙江省人民医院诊治的稳定期COPD患者83例(COPD组),同期本院体检中心的健康体检者45例作为正常对照组。COPD患者检测肺功能,进行改良版英国医学研究委员会(mMRC)呼吸困难问卷评分及统计上一年急性加重次数。采用ELISA法检测两组受试者的血清leptin和HIF-1α水平并进行比较,将COPD组患者血清leptin/BMI和HIF-1α水平与其GOLD分级、mMRC呼吸困难问卷评分及上一年急性加重次数进行统计分析,对30个月随访期内的患者进行生存分析及预后多因素Cox比例风险回归模型分析。结果COPD组患者leptin/BMI和HIF-1α水平均明显高于正常对照组,差异均有统计学意义(均P<0.01)。COPD组患者中GOLD分级高、mMRC呼吸困难问卷评分高、上一年急性加重次数≥2次、病情严重程度重的患者leptin/BMI和HIF-1α水平较高,血清leptin/BMI水平和HIF-1α水平呈正相关(r=0.64,P<0.01)。COPD组患者血清leptin/BMI、HIF-1α水平和第一秒用力呼气容积(FEV1)%均呈负相关(r=-0.59和-0.45,均P<0.01),与mMRC呼吸困难问卷评分均呈正相关(r=0.40和0.22,均P<0.05),与上一年急性加重次数均呈正相关(r=0.75和0.53,均P<0.01)。COPD组患者血清leptin/BMI、HIF-1α水平与病情严重程度均呈正相关(r=0.48和0.73,均P<0.01)。Cox比例风险回归模型显示,血清leptin/BMI及FEV1%是影响COPD组患者预后的因素(均P<0.05)。结论血清leptin/BMI和HIF-1α的水平与COPD的病情发展有关,leptin/BMI水平高的COPD患者预后较差。Objective To explore the value of serum leptin and hypoxia-inducible factor 1 alpha(HIF-1α)levels in the prognosis of patients of chronic obstructive pulmonary disease(COPD).Methods The levels of serum leptin and HIF-1αwere measured with enzyme-linked immunosorbent assay(ELISA)in 83 COPD patients and 45 normal controls.The relationship of leptin/BMI and HIF-1αlevels with the clinical features of the COPD patients were analyzed.Patients were followed up for 30 months,the factors related to the prognosis of patients was analyzed with Cox proportional hazards regression model.Results Serum levels of leptin/BMI and HIF-1αwere significantly higher in the COPD patients than those in the control group(both P<0.01),and the levels of serum leptin/BMI was positively correlated with HIF-1α(r=0.64,P<0.01).Serum levels of leptin/BMI and HIF-1αin the COPD patients were negatively correlated with forced expiratory volume in one second(FEV1)%(r=-0.59 and-0.45,both P<0.01).Serum levels of leptin/BMI and HIF-1αwere positively correlated with the modified British Medical Research Council(mMRC)score(r=0.40 and 0.22,both P<0.05)and episode of acute exacerbations in the previous year(r=0.75 and 0.53,both P<0.01).Serum levels of leptin/BMI and HIF-1αwere positively correlated with the comprehensive assessment group by disease severity(mMRC grade,classification of pulmonary function and episode of acute exacerbations in the previous year)(r=0.48 and 0.73,both P<0.01).Cox proportional hazards regression model showed that serum leptin/BMI and FEV1%were independent prognostic factors(both P<0.05).Conclusion The levels of serum leptin/BMI and HIF-1αare related to the development of COPD,and the serum leptin/BMI level may be used as an index for the prognosis of COPD.

关 键 词：瘦素 缺氧诱导因子1Α 慢性阻塞性肺疾病 肺功能 预后 

分 类 号：R563.9[医药卫生—呼吸系统]