伴肺动脉高压的慢性阻塞性肺疾病患者的血清炎性因子水平变化及意义

Changes and significance of serum inflammatory factors in patients with chronic obstructive pulmonary disease with pulmonary hypertension

目的探讨伴肺动脉高压的慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者的血清炎性因子水平变化及意义。方法选取榆林市星元医院2016年1月-2019年1月收治的112例伴肺动脉高压的COPD患者,根据COPD患者是否合并肺动脉高压分为COPD组(n=64)和COPD合并肺动脉高压组(n=48)。另选取同期健康体检者40例作为健康对照组。肺动脉压力采用超声心电图测定,肺功能采用第1秒用力呼气容积(forced expiratory volume 1 second,FEV1)/预计值(FEV1%)和FEV1/用力肺活量(forced lung capacity,FVC)百分比(FEV1/FVC%)进行评价。采用酶联免疫吸附试验对健康对照组、COPD组与COPD合并肺动脉高压组血清胖癌坏死因子(tumor necrosis&ctor,TNF-α)、白细胞介素-6(interleukin-6,IL-6)和高迁移率族蛋白B1(High mobility group protein B1,HMGB1)水平进行检测,同时采用Pearson直线相关性分析牌动脉压力、肺功能与TNF-α、IL-6、HMGgl水平的关系。结果健康对照组TNF-α、IL-6、HMGBl水平明显低于COPD组和COPD合并肺动脉高压组(P<0.05)。COPD组TNF-α、IL-6、HMGBl水平明显低于COPD合并肺动脉高压组(P<0.05)。健康对照组和COPD组肺动脉压比较差异无统计学意义(P>0.05);COPD合并肺动脉高压组肺动脉压明显高于健康对照组和COPD组(P<0.05)。健康对照组FEV1%、FEV1/FVC%水平明显高于COPD组和COPD合并肺动脉高压组(P<0.05)。COPD合并肺动脉高压组明显低于COPD组(P<0.05)。TNF-α、IL-6、HMGB1炎症因子水平与肺动脉高压严重程度成正比(P<0.05)。经Pear son相关性分析可知,肺动脉压力与TNF-α、IL-6、HMGB1水平呈正相关(P<0.05),与FEV1%、FEV1/FVC%呈负相关(P<00.5)。TNF-α、IL-6与HMGB1水平呈正相关(P<0.05)。结论TNF-α、IL-6与HMGB1为伴肺动脉高压COPD患者重要的炎症介质,伴肺动脉高压COPD患者发生发展与血清TNF-α、IL-6与HMGB1炎症因子水平密切相关。

Objective To investigate the changes in serum inflammatory factors in patients with chronic obstructive pul monary disease(COPD)with pulmonary artery hypertension and its significance.Methods 112 cases of COPD patients with pulmonary hypertension admitted to our hospital from January 2016 to January 2019 were selected and divided into COPD group(n=64)and COPD group(n=48)according to whether patients with pulmonary hypertension were combined with pulmonary hypertension.Another 40 cases were selected as healthy control group.Pulmonary artery pressure was measured by ultrasonic electrocardiogram,and lung function was evaluated by the Forced expiratory volume 1 second(FEV1)/expected value(fev1%)and FEV1/FVC percentage(FEV1/FVC%).Serum Tumor necrosis factor(tnf-alpha),in terleukin-6(il-6)and High mobility group protein B1(HMGB1)levels in the healthy control group,COPD group and COPD group combined with pulmonary hypertension were detected by elisa.Meanwhile,Pearson linear correlation was used to analyze the relationship between pulmonary artery pressure and pulmonary function and the levels of TNF-a,IL-6 and HMGB1.Results The levels of TNF-a,IL-6 and HMGB1 in healthy control group were significantly lower than those in COPD group and COPD group with pulmonary hypertension(P<0.05).The levels of TNF-a,IL-6 and HMGB1 in COPD group were significantly lower than those in COPD group with pulmonary hypertension(P<0.05).There was no significant difference in pulmonary artery pressure between the healthy control group and the COPD group(￡>0.05).Pulmonary hypertension was significantly higher in COPD group than in control group and COPD group(P<0.05).The levels of fevl%and FEV1/FVC%in healthy control group were significantly higher than those in COPD group and COPD group with pulmonary hypertension(P<0.05).COPD group with pulmonary hypertension was signifi cantly lower than COPD group(P<0.05).The levels of TNF-a,IL-6 and HMGB1 were positively correlated with the se verity of pulmonary hypertension(P<0.05).Pearson correlation analysis showed that pulmonary artery pressure was posi tively correlated with tnf-alpha,il-6 and HMGB1 levels(P<00.5),and negatively correlated with fevl%and FEV1/FVC%(P<00.5).TNF-a and IL-6 were positively correlated with HMGB1 levels(P<00.5).Conclusion Tnf-a,il-6 and HMGB1 are important mediators of inflammation in patients with pulmonary hypertension COPD,and the occur rence and development of patients with pulmonary hypertension COPD is closely related to the levels of serum tnf-a,il-6 and HMGB1 inflammatory factors.