血浆锁链素水平与慢性阻塞性肺疾病急性加重风险的关系

Desmosine plasma levels and exacerbation risk assessment of chronic obstructive pulmonary disease

目的 探讨血浆锁链素水平与慢性阻塞性肺疾病（慢阻肺）急性加重风险的关系.方法 研究对象为2013年3月至2014年3月于北京医院就诊的慢阻肺患者（慢阻肺组）和同期健康体检者（健康对照组）.根据慢阻肺全球策略的评估标准,将慢阻肺组分为慢阻肺低风险组和慢阻肺高风险组.应用酶联免疫吸附（ELISA）法检测全部受试者的血浆锁链素水平,比较各组受试者锁链素水平的差异.结果 共入选健康对照组50名（其中健康非吸烟组24名,健康吸烟组26名）和慢阻肺组63例（其中慢阻肺低风险组30例,慢阻肺高风险组33例）.健康非吸烟组、健康吸烟组、慢阻肺低风险组、慢阻肺高风险组受试者的血浆锁链素水平分别为（200±159）、（191±105）、（197±118）、（131±47） ng/L.慢阻肺高风险组血浆锁链素水平显著低于健康非吸烟组（平均差值-70,95％ CI：-128～-11,P=0.021）、健康吸烟组（平均差值-60,95％CI：-118 ～-3,P=0.039）和慢阻肺低风险组（平均差值-67,95％CI：-122 ～-12,P=0.018）.慢阻肺组血浆锁链素水平与1年内急性加重的频率（r=-0.409,P=0.002）、mMRC评分（r=-0.447,P=0.010）、肺气肿视觉评分（r=-0.386,P =0.047）之间均呈负相关,与第1秒用力呼气量（FEV1）占预计值的百分比（FEV1％预计值）无显著相关（r =0.225,P=0.084）.结论 未来发生急性加重风险较高的慢阻肺患者血浆锁链素水平较低,血浆锁链素水平与急性加重频率之间呈负相关.

Objective To explore the relationship between desmosine plasma levels and exacerbation risk in patients with chronic obstructive pulmonary disease （COPD）.Methods COPD patients and normal subjects were recruited from Beijing Hospital during March 2013 to March 2014.COPD patients were divided into COPD low risk and COPD high risk groups according to the criteria of Global Initiative for Chronic Obstructive Lung Disease （GOLD） strategy.The plasma concentrations of desmosine were measured by enzyme-linked immunosorbent assay （ELISA） for exploring the inter-group difference in desmosine levels.Results Sixty-three COPD patients （COPD low risk group,n =30; COPD high risk group,n =33） and 50 normal subjects （24 healthy non-smokers,26 healthy smokers） were recruited.The plasma desmosine concentrations in healthy non-smokers,healthy smokers,low risk and high risk COPD patients were （200 ± 159）,（191± 105）,（197± 118） and （131 ±47） ng/L respectively.The plasma concentration of desmosine was significantly lower in COPD high risk group than healthy non-smokers （mean difference-70,95% CI：-128--11,P =0.021）,healthy smokers （mean difference-60,95% CI：-118--3,P =0.039） and COPD low risk group （mean difference-67,95% CI：-122--12,P =0.018）.The plasma concentration of desmosine was negatively correlated with exacerbation frequency （r =-0.409,P =0.002）,mMRC scores （r =-0.447,P =0.010） and emphysema severity （r =-0.386,P =0.047） in COPD patients.No significant correlation existed between desmosine plasma levels and forced expiratory volume in one second （FEV1% pred） in COPD patients （r =0.225,P =0.084）.Conclusions The plasma levels of desmosine are lower in high risk COPD patients than those in normal subjects or low risk COPD patients.And it is negatively correlated with exacerbation frequency in COPD patients.