COPD稳定期患者血清CC16蛋白表达与肺功能、肺气肿表型的关系分析  

Relationship between serum CC16 protein expression,lung function and emphysema phenotype in stable COPD patients

作　　者：沈琪乐 赵勤华[1] 宫素岗[1] 刘锦铭[1] 王岚[1] 邱宏玲 Shen Qile;Zhao Qinhua;Gong Sugang;Liu Jinming;Wang Lan;Qiu Hongling(Pulmonary Circulation Department,Tongji University Affiliated Shanghai Pulmonary Hospital,Shanghai 200433,China)

机构地区：[1]同济大学附属上海市肺科医院肺循环科,上海200433

出　　处：《中华肺部疾病杂志（电子版）》2024年第5期690-695,共6页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：上海市中西医结核综合专项建设项目(ZHYY-ZXYJHZX-2-25)。

摘　　要：目的分析慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)稳定期患者血清克拉拉细胞分泌蛋白(Clara cell secretory protein 16,CC16)表达与肺功能和肺气肿表型的关系。方法收集100例COPD稳定期的患者为对象,根据一氧化碳的单次呼吸弥散量(TLCO)的Z评分将患者分为47例非肺气肿COPD(non-emphysematous COPD,NE-COPD)和53例肺气肿COPD(emphysematous COPD,E-COPD)。通过酶联免疫吸附法(enzyme linked immunosorbent assay,ELISA)测量血清CC16浓度。Spearman相关性和线性回归被用来检测CC16水平与COPD肺功能之间的关系。结果E-COPD患者肺气肿指数(emphysema index,EI)[1.40%(0.95%,1.86%)vs.5.00%(3.13%,8.64%)]较NE-COPD患者增加(P<0.05),而第1秒用力呼气容/用力肺活量的Z评分(FEV_(1)/FVC_(z-score))[-2.51(-3.06,-1.97)vs.-2.96(-3.85,-2.25)]、TLCO_(z-score)[-0.89(-1.32,-0.05)vs.-2.79(-4.02,-2.18)]、肺泡容积(alveolar volume,VA)z-score[0.01(-0.92,0.84)vs.-1.03(-1.69,-0.36)]、一氧化碳转移系数(K_(CO))_(z-score)[-0.78(-1.30,0.06)vs.-2.33(-3.14,-1.41)]以及血清CC16[14.63(8.87,26.74)ng/ml vs.8.90(2.90,14.89)ng/ml]降低(P<0.001)。经Sperman相关性分析,血清CC16水平与EI呈负相关(Rho=-0.344);而与TLCOz-score(Rho=0.384)、K_(COz-score)(Rho=0.266)、VAz-score(Rho=0.214)、FEV_(1)/FVC_(z-score)(Rho=0.383)呈正相关性,P<0.05。在E-COPD(Rho=0.408)、NE-COPD(Rho=0.379)亚组中血清CC16水平与FEV_(1)/FVC_(z-score)呈正相关(P<0.001)。校正人口统计学、心肺运动试验参数、用药等临床因素后,COPD患者、ECOPD、NE-COPD中血清CC16水平与FEV_(1)/FVC_(z-score)仍然显著相关(P<0.05)。结论血清CC16水平与COPD患者肺功能和肺气肿表型有关的重要因子,低血清CC16寓意着COPD患者病情可能较严重,可能合并复杂的病理表型,同时伴有肺功能不佳。Objective To investigate the relationship between serum Clara cell secretory protein(CC16)expression and lung function and emphysema phenotype in patients with chronic obstructive pulmonary disease(COPD)in the stable stage.Methods A cross-sectional study was conducted in 100 patients with stable COPD in which serum CC16 concentrations were measured by enzyme-linked immunosorbent assay(ELISA).Spearman′s correlation and linear regression were used to test the relationship between CC16 levels and lung function in COPD.Results Patients were categorized into 47 cases of non-emphysematous COPD(NE-COPD)and 53 cases of emphysematous COPD(E-COPD)using the Z-score of single breath diffusion of carbon monoxide(TLCO).Compared with NE-COPD,the emphysema index(EI)[1.40%(0.95%,1.86%)vs.5.00%(3.13%,8.64%)]was significantly increased in patients with E-COPD(P<0.05),whereas,z-score of forceful expiratory volume in the first second(FEV_(1))/forceful lung capacity(FEV_(1)/FVC_(z-score))[-2.51(-3.06,-1.97)vs.-2.96(-3.85,-2.25)],TLCOz-score[-0.89(-1.32,-0.05)vs.-2.79(-4.02,-2.18)],alveolar volume(VA)z-score[0.01(-0.92,0.84)vs.-1.03(-1.69,-0.36)],diffusion constant for carbon monoxide(K_(CO))_(z-score)[-0.78(-1.30,0.06)vs.-2.33(-3.14,-1.41)],and serum CC16[14.63(8.87,26.74)ng/ml vs.8.90(2.90,14.89)ng/ml]were significantly reduced(P<0.05).After Sperman correlation analysis,serum CC16 level was negatively correlated with EI(Rho=-0.344);while it was negatively correlated with TL_(COz-score)(Rho=0.384),K_(COz-score)(Rho=0.266),VAz-score(Rho=0.214),FEV_(1)/FVC_(z-score)(Rho=0.383)were positively correlated;all P<0.05.In the subgroups of E-COPD(Rho=0.408),NE-COPD(Rho=0.379),the levels of serum CC16 were positively correlated with FEV_(1)/FVC_(z-score) were all positively correlated(P<0.001).After correcting for demographics,cardiopulmonary exercise test parameters,medication,and other clinical factors,serum CC16 levels remained significantly correlated with FEV_(1)/FVC_(z-score) in all COPD patients,E-COPD,and NE-COPD subgroups(P<0.05).Con

关 键 词：肺疾病 慢性阻塞性 肺功能 肺气肿表型 克拉拉细胞分泌蛋白 

分 类 号：R563[医药卫生—呼吸系统]