溃疡性结肠炎患者肺损害与血清ET-1水平相关性探讨

Study on the Correlation between the Pulmonary Injury and the ET-1 Serum Level in Ulcerative Colitis Patients

目的观察溃疡性结肠炎(ulcerative colitis,UC)患者血清内皮素-1(endothelin-1,ET-1)水平与肺损害的相关性,探讨UC肺损害的机制。方法选择90例2009年11月-2011年3月就诊于北京中医药大学东直门医院消化科门诊UC患者,观察并比较不同病程、病变范围、活动度的UC患者血清ET-1水平,探讨UC患者血清ET-1水平与肺功能各指标的相关性,包括肺活量(vital capacity,VC),用力肺活量(forcedvital capacity,FVC),一秒钟用力呼气容积(forced expiratory volume in one second,FEV1),一秒率(FEV1/FVC),峰流速(peak expiratory flow,PEF),最大中期呼气流速(maximal mid expiratory flow,MMEF),25%、50%、75%肺活量时的最大呼气流速(maximal expiratory flow in25%,50%,75%vital capacity,FEF25%,50%,75%),肺一氧化碳弥散量(diffusion capacity of the lungs for carbon monoxide,DLCO),肺泡通气量(alve-olar ventilation,VA),弥散常数(diffusion constant,KCO),肺总量(total lung capacity,TLC),残气量(residualvolume,RV),功能残气量(function residual volume,FRV),残气量/肺总量(RV/TLC)。另选择30名健康志愿者作为对照组,比较UC组与对照组肺部症状、胸部X线摄片、肺功能、血清ET-1水平及肝肾功能[丙氨酸转氨酶(alanine aminotransferase,ALT),天冬氨酸转氨酶(aspartate aminotransferase,AST),血尿素氮(blood u-rea nitrogen,BUN),血肌酐(serum creatinine,SCr)]。结果 UC组伴有咳嗽、胸闷等肺部症状10例(11.1%),胸部X线摄片异常25例(27.8%),肺功能异常54例(60.0%);UC组ALT升高2例(2.2%),AST升高2例,对照组ALT、AST均正常。UC组与对照组BUN及SCr均正常。与对照组比较,UC组血清ET-1水平升高,差异有统计学意义(P<0.05);各病变范围及活动度组患者血清ET-1水平比较,差异均无统计学意义(P>0.05);病程≥5年UC患者血清ET-1水平较病程<5年者升高,差异有统计学意义(P<0.05)。UC患者血清ET-1水平与FEF25%及KCO呈负相关,差异均有统计学意义(P<0.05)。结论血清ET-1水平可以更早地反映UC患者肺损害情况,血清ET-1可能是反应UC肺损害的敏感指标。UC患者肺损害可能与肺小气道阻塞,肺弹性功能减退以及弥散膜受损有关。

Objective To study the correlation between the pulmonary injury and the ET-1 serum level in ulcerative colitis（UC） patients,and to study the mechanism for UC induced pulmonary injury.Methods Recruited were 90 UC outpatients from the clinics of Gastroenterology Department,Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine from Nov.2009 to Mar.2011.The course of disease,disease range,serum ET-1 level of UC patients were observed and compared.The correlation between the serum ET-1 level and each pulmonary function index were studied [including vital capacity（VC）,forced vital capacity（FVC）,forced expiratory volume in one second（FEV1）,FEV1/FVC,peak expiratory flow（PEF）,maximal mid expiratory flow（MMEF）,maximal expiratory flow in 25%,50%,75%vital capacity（FEF25%,50%,75%）,diffusion capacity for carbon monoxide of lung（DLCO）,diffusion constant（KCO）,total lung capacity（TLC）,alveolar ventilation（VA）,residual volume（RV）,function residual volume（FRV）,and RV/TLC].Besides,another 30 healthy volunteers were enrolled as the control group.The pulmonary symptoms,chest X-ray,the lung function,the serum ET-1 level,and liver and kidney functions [including alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,blood urea nitrogen（BUN）,serum creatinine（SCr） were compared between the UC group and the control group.Results Ten UC patients were accompanied with cough and chest distress（accounting for 11.1%）,25 with abnormal chest films（accounting for 27.8%）,and 54 with pulmonary function abnormality（accounting for 60.0%）.In the UC group ALT increased in 2 cases（2.2%） and AST increased in 2.They were normal in the control group.The BUN and SCr were normal in the two groups.Compared with the control group,the serum ET-1 level in the UC group was significantly higher than that in the control group（P0.05）.There was no statistical difference in the serum ET-1 level（P0.05）.There was statistical difference in the serum ET-1 level in the UC group between those with the disease course≥5 years and those with the disease course5 years,showing statistical difference（P0.05）.There was negative correlation between the serum ET-1 level and FEF25% and between the serum ET-1 level and KCO（P0.05）.Conclusions Serum ET-1 level could reflect the pulmonary injury of UC patients earlier.Serum ET-1 level might be a sensitive indicator reflecting the pulmonary injury of UC.The pulmonary injury of UC patients might be correlated with small airway obstruction,reduced lung elasticity,and injured lung diffusion.