哮喘-慢性阻塞性肺疾病重叠综合征患者血清YKL-40、HIF-1α、ICAM-1变化及其意义  

Changes and significance of serum YKL-40,HIF-1α,ICAM-1 in patients with asthma chronic obstructive pulmonary disease overlap syndrome

作　　者：陈丽萍[1] 陈艳红 冯平[1] 张长洪[1] 林卫佳 项保利[1] CHEN Liping;CHEN Yanhong;FENG Ping;ZHANG Changhong;LIN Weijia;XIANG Baoli(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,Hebei,China)

机构地区：[1]河北北方学院附属第一医院呼吸与危重症医学科,张家口075000

出　　处：《医学研究与战创伤救治》2025年第2期174-179,共6页Journal of Medical Research & Combat Trauma Care

基　　金：张家口市2021年市级科技计划自筹经费项目(2121162D)。

摘　　要：目的探讨哮喘-慢性阻塞性肺疾病重叠综合征(ACOS)患者血清几丁质酶-3样蛋白1(YKL-40)、缺氧诱导因子1α(HIF-1α)、细胞间黏附分子-1(ICAM-1)、气道重塑、免疫功能的变化及其临床意义。方法采取回顾性研究方法,将河北北方学院附属第一医院2020年1月至2022年12月确诊的120例ACOS患者纳入研究作为ACOS组,选取同期确诊的单纯哮喘患者90例作为哮喘组、单纯慢性阻塞性肺疾病(COPD)患者90例作为COPD组,对比3组患者的血清YKL-40、HIF-1α、ICAM-1、气道重塑[气道管壁厚度(WT)、气道壁厚度/外径比值(TDR)、气道面积/总横截面积比值(WA)]、免疫功能指标[辅助T细胞1(Th1)、Th2、调节性T细胞(Treg)],并按照病情程度对ACOS组进行分层对比分析。结果ACOS组患者YKL-40[(58.93±11.20)μg/L]、HIF-1α[(98.54±17.04)]μg/L、ICAM-1[(246.8±19.3)μg/L]均高于哮喘组[(32.66±5.94)μg/L、(64.11±10.30)μg/L、(221.0±16.8)μg/L]和COPD组[(45.76±8.14)μg/L、(67.48±9.85)μg/L、(196.3±17.4)μg/L](P<0.05);ACOS组患者WT[(1.10±0.29)mm]、TDR[(27.81±2.82)%]、WA[(46.73±5.11)%]均高于哮喘组[(0.63±0.18)mm、(21.70±2.55)%、(38.49±4.52)%]和COPD组[(0.94±0.22)mm、(24.35±2.63)%、(42.08±5.54)%],Th1[(10.11±2.34)%]、Th2[(2.24±0.56)%]、Th1/Th2[(4.51±0.96)]、Treg[(1.94±0.54)%]均低于哮喘组[(17.82±4.61)%、(2.41±0.58)%、(7.39±1.38)、(3.36±0.72)%]和COPD组[(22.03±4.83)%、(2.91±0.53)%、(7.57±1.43)、(2.61±0.66)%](P<0.05)。重度ACOS患者YKL-40[(72.25±9.81)μg/L]、HIF-1α[(116.63±15.50)μg/L]、ICAM-1[(269.6±18.7)μg/L]、WT[(1.40±0.26)mm]、TDR[(31.02±2.29)%]、WA[(50.56±3.81)%]、Th1/Th2[(7.57±0.77)]显著高于中度和轻度患者(P<0.05),Th1[(6.80±1.56)%]、Th2[(1.82±0.39)%]、Treg[(1.44±0.32)%]低于中度和轻度患者(P<0.05)。YKL-40、HIF-1α、ICAM-1诊断COPD发生哮喘的ROC曲线下面积分别为0.728、0.826、0.770(P均<0.05)。结论ACOS患者血清YKL-40、HIF-1α、ICAM-1水平升高显著,气道重�Objective To explore the changes and clinical significance of serum chitinase like protein 1(YKL-40),hypoxia inducible factor 1 alpha(HIF-1α),intercellular adhesion molecule 1(ICAM-1),airway remodeling,and immune function in patients with asthma chronic obstructive pulmonary disease overlap syndrome(ACOS).Methods A retrospective research method was adopted to include 120 patients diagnosed with ACOS in the First Affiliated Hospital of Hebei North University from January 2020 to December 2022 into the study as the ACOS group,and 90 patients with asthma alone diagnosed during the same period were selected as the asthma group,while 90 patients with chronic obstructive pulmonary disease(COPD)alone were selected as the COPD group.The serum lev-els of YKL-40,HIF-1α,ICAM-1,airway remodeling[airway wall thickness(WT),airway wall thickness/outer diameter ratio(TDR),airway area/total cross-sectional area ratio(WA)],and immune function indicators[helper T cells 1(Th1),Th2,and reg-ulatory T cells(Treg)]were compared among the three groups,and a stratified comparative analysis was performed on the ACOS group according to the severity of the disease.Results YKL-40(58.93±11.20)μg/L,HIF-1α(98.54±17.04)μg/L,ICAM-1(246.8±19.3)μg/L in ACOS group were higher than those in asthma group(32.66±5.94)μg/L,(64.11±10.30)μg/L,(64.11±10.30)μg/L,(221.0±16.8)μg/L and COPD group(45.76±8.14)μg/L,(67.48±9.85)μg/L,(196.3±17.4)μg/L(P<0.05);WT(1.10±0.29)mm,TDR(27.81±2.82)%,WA(46.73±5.11)%in ACOS group were higher than those in asthma group(0.63±0.18)mm,(21.70±2.55)%,(38.49±4.52)%and COPD group(0.94±0.22)mm,(24.35±2.63)%,(42.08±5.54)%,Th1(10.11±2.34)%,Th2(2.24±0.56)%,Th1/Th2(4.51±0.96)and Treg(1.94±0.54)%were lower than those of asthma group(17.82±4.61)%,(2.41±0.58)%,(7.39±1.38)and(3.36±0.72)%and COPD group(22.03±4.83)%,(2.91±0.53)%,(7.57±1.43),(2.61±0.66)%(P<0.05);Patients with severe ACOS had YKL-40(72.25±9.81)μg/L,HIF-1α(116.63±15.50)μg/L,ICAM-1(269.6±18.7)μg/L,WT(1.40±0.26)mm,TDR(31.02±2.29)%,W

关 键 词：哮喘 慢性阻塞性肺疾病 重叠综合征 炎症 气道重塑 免疫功能 

分 类 号：R563[医药卫生—呼吸系统]