C反应蛋白与老年慢性阻塞性肺疾病患者胰岛素抵抗的相关性分析

Correlation between C-reactive protein and insulin resistance in senile patients with chronic obstructive pulmonary disease

目的研究老年慢性阻塞性肺疾病(COPD)患者体内C反应蛋白(CRP)水平变化及其与胰岛素抵抗的相关性。方法上海交通大学医学院附属新华医院崇明分院收治86例老年COPD患者,按疾病状态分为COPD急性加重期(AECOPD)组和COPD稳定期组,同时选取同期该院健康体检人员48例作为对照组。采集患者基本资料,同时留取静脉血,检测各组患者CRP、空腹血糖(FPG)、餐后2h血糖(2hPBG)、空腹胰岛素(FINS)、总胆固醇(TC)、甘油三酯(TG)等生化指标,计算胰岛素抵抗指数(HOMA-IR)来评价患者胰岛素抵抗水平,统计并分析CRP与患者胰岛素抵抗相关性。结果 AECOPD组CRP、2hPBG及FINS明显高于COPD稳定组和对照组,差异均具有统计学意义(P<0.05);FPG显著高于对照组(P<0.05)。AECOPD组HOMA-IR为3.98±1.21,明显高于COPD稳定组的2.41±1.65和对照组为1.68±0.46,差异也具有统计学意义(P<0.05)。COPD稳定组CRP、FINS、HOMA-IR与对照组相比显著升高(P<0.05)。AECOPD患者CRP与2hPBG、FINS、HOMA-IR成正相关(r分别为0.642、0.698、0.602,P<0.05),而COPD稳定期患者CRP与FPG、2hPBG、FINS、HOMA-IR均无相关性。结论老年COPD患者血浆CRP水平升高并伴有一定的胰岛素抵抗。AECOPD组CRP水平与胰岛素抵抗存在一定的相关性。

Objective To investigate C-reactive protein（CRP） level in senile patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD） and patients with stable COPD and evaluate its relationship with insulin resistance. Methods Eighty-six patients with COPD were recruited from Chongming Branch of Xinhua Hospital and divide into AECOPD group and stable COPD group according to the course of disease and 48 healthy volunteers were enrolled as controls at the same time. Baseline materials of patients were collected and CRP, fasting blood glucose （FPG）, 2 hour postprandial blood glucose （2 hPBG）, fasting insulin（FINS）, blood lipids were detected. Insulin Resistance Index（HOMA-IR） was calculated and used to assess the level of insulin resistance. The relationship between CRP and parameters above were analyzed. Results The levels of CRP, 2 hPBG,and FINS were significantly higher in AECOPD group than those in stable COPD group and control group,and FPG was also higher than control group（ P 〈 0.05）. The HOMA-IR of AECOPD group was 3.98 ±1.21, which was much higher than that of stable COPD group and control group 2.41± 1.65 and 1.68±0.46, respectively（ P 〈0.05）. Meanwhile, there were significant increase in the levels of CRP, FINS, HOMA-IR in stable COPD group compared with those of control group （P 〈0.05）. According to the correlation analysis, there were positive correlation of CRP,2 hPBG, FINS, HOMA-IR in AECOPD group（ r = 0. 642,0. 698,0. 602, all P 〈 0.05） . However, no correlation were detected of CRP and FPG, 2 hPBG, FINS,HOMA-IR in stable COPD group. Conclusion CRP and insulin resistance increased in senile COPD patients. CRP level was related to insulin resistance only in AECOPD patients.