肾不纳气型COPD患者外周血白细胞中糖皮质激素受体表达的临床研究

Expression of Glucocorticoid Receptor in Peripheral Blood Leucocytes in COPD Patients of Kidney Failing to Receive Qi Pattern

目的:观察肾不纳气型慢性阻塞性肺疾病(COPD)患者在急性加重期外周血白细胞中糖皮质激素受体(GR)的表达水平,并探讨其可能的影响因素。方法:根据入组标准,选择30例肾不纳气型COPD患者作为实验组(简称肾不纳气组),30例脾虚湿盛型COPD患者作为证型对照组(简称脾虚湿盛组),另外选择30例非COPD患者作为疾病对照组(简称非COPD组)。采用逆转录-多聚酶链式反应(RT-PCR)检测外周血白细胞中糖皮质激素受体GR的含量,并分析GR与病程、肺功能、血清皮质醇之间的相关性。结果:肾不纳气组GR的含量显著低于脾虚湿盛组与正常组(P<0.05),而脾虚湿盛组与正常组之间无显著差异(P>0.05)。GR与病程呈负相关(P<0.05);与肺功能第一秒用力呼气量与用力呼气量比值(FEV1/FVC,1秒率)、第1秒用力呼气容积与预计值之比(FEV1%)呈正相关(P<0.05),与血清皮质醇呈正相关(P<0.05)。结论:肾不纳气型COPD患者急性加重期外周血白细胞中GR含量显著降低,且与血清皮质醇的含量呈同步下降趋势,可能与患者病情反复加重,长期应用糖皮质激素抑制肾上腺皮质功能,并下调GR的水平有关。GR含量的下降降低了糖皮质激素的抗炎疗效,进而导致患者气道炎症控制不佳。

Objective： To investigate the expression of glucocorticoid receptor（ GR） in peripheral blood leucocytes in patients with acute exacerbating COPD（AECOPD） of kidney failing to receive qi pattern and the related influencing factors. Methods： A total of 30 COPD cases of kidney failing to receive qi pattern were enrolled as experiment group（ KFRQ）, 30 COPD cases of damp abundance due to spleen asthenia pattern were era＇oiled as pattern control group （ DASA）, and 30 non-COPD cases as disease con- trol group （NCOPD） . The level of GR in peripheral blood leucocytes was detected by reverse transcriptase polymerase chain reaction （RT-PCR） and the relationship between GR and disease course, lung function, serum cortisol were analyzed. Results： The level of GR in KFRQ group was significantly lower than that in DASA group and NCOPD group （ P 〈 0.05 ）, and there was no significant difference between DASA group and NCOPD group in the level of GR （ P 〉 0.05 ）. The expression of GR was negatively correlated with disease duration （P 〈 0.05 ）, positively correlated with FEV1/FVC and FEV1% （P 〈 0.05 ） and serum cortisol （P 〈 0.05 ）. Conclusion ： The level of GR in peripheral blood leucocytes in AECOPD of kidney failing to receive qi pattern decreased significantly accompanied by a downward trend of glucocorticoid, which may result from the inhibiting effect of long-teim adminisration of glucocorticoid on adrenal gland function and GR expression. The decline in GR level reduces the anti-inflammatory effect of glucocorticoid, thus it can not control the airway inflammation effectively.