血清人软骨糖蛋白-39、HRCT在支气管哮喘所致气道重塑中所起的作用

The role of serum cartilage glycoprotein-39, HRCT in the airway remodeling caused by the bronchial asthma

目的探讨血清人软骨糖蛋白-39、高分辨率CT（HRCT）和肺功能检查在评价支气管哮喘（简称哮喘）所致气道重塑方面的作用。方法收集包头市中心医院住院及门诊哮喘患者51例和24例健康人（来自健康体检中心）作为研究对象，根据应用口z受体激动剂（沙丁胺醇400掀）后，是否出现气流可逆，分为可逆性气流阻塞组（27例）、不可逆气流阻塞组（24例），以及健康对照组（24例）。将研究对象分别抽取空腹静脉血，采用酶联免疫吸附法测血清人软骨糖蛋白39浓度；在HRCT下，分别从主动脉弓、气管分叉处、气管分叉下1cm、右肺下静脉和横隔顶上2cm5个部位测量气道壁厚度，计算2T／D、WA％；并收集肺功能值（FEVl／FVC、FEVl％pred、FEF25％-75％、MEF50％、MEF25％）。结果①不可逆气流阻塞组血清人软骨糖蛋白-39、2T／D、WA％的水平均高于可逆性气流阻塞组，高于健康对照组（73．79±29．94，41．77±13．53，22．02±2．74；54．74±3．65，46．06±2．86，28．83±3．23；79．20±3．50，70．79±3．16，49．034-4．78），差异有统计学意义（P〈0．05）；肺功能FEV1％pred、FEVl／FVC、FEF25％-75％、MEF50％、MEF25％3组问比较差异有统计学意义，健康对照组最高，可逆性次之，不可逆气流阻塞组最低。②Spearman相关分析结果显示，血清人软骨糖蛋白-39的浓度与2T／D、WA％呈正相关（r=0．748，P〈0．05；r=0．739，P〈0．05）；血清人软骨糖蛋白-39与肺功能FEV1％pred、FEV1／FVC、FEF25％-75％、MEF50％、MEF25％均呈负相关（r=-0．665，P〈0．05；r=-0．750，P〈0．05；r=-0．772，Pd0．05；r=-0．759，P〈0．05；r=-0．697，P〈0．05）。结论血清人软骨糖蛋白-39可以作为气道重塑的生物标记物；HRCT可以作为无创手段评估哮喘患者气道重塑的情况；血清人软骨糖蛋白-39、HRCT能较早的发现气道重靼，其有可能指导临床早期治疗哮喘并监测治疗效果。

Objective To investigate the role of serum human cartilage glycoprotein-39, highresolution CT （HRCT） and pulmonary function test in airway remodeling induced by bronchial asthma （asthma）. Methods Collect of Baotou Central Hospital inpatient and outpatient asthma patients 51 cases and 24 cases of healthy people （from the health examination center） as the object of study. According whether airflow obstruction was reversible or not being used 132-receptor agonists （salbutamol 400 lifts）, the patiens were divided into irreversible airflow obstruction group （24 cases） and reversible airflow obstruction group （27 cases）, and the healthy group （24 cases）. The subjects were extracted fasting venous blood,measured by enzyme-linked immunosorhent assay serum concentrations of human cartilage glycoprotein-39. Under the HRCT, measure the 5 parts of airway wall thickness from the aortic arch, tracheal bifurcation,tracheal bifurcation under 1 cm, under the right pulmonary vein and diaphragm top 2 cm, calculate 2T/D, WA% And collect lung function values （FEV1/FVC, FEV1%pred, FEF25 %-75%,MEF50%,MEF25%）. Results ① The irreversible airflow obstruction group serum human cartilage glycoprotein-39,2T/D,WA% level were higher than in reversible airflow obstruction group,higher than that of healthy controls （73.79±29.94,41.77±13.53,22.02±2.74;54.74±3.65,46.06±2.86, 28.83±3.23;79. 20±3.50,70.79±3.16,49.03±4.78） ,with statistical significance （ P 〈0.05）. Lung function FEV1%pred,FEV1/FVC,FEF25%-75% ,MEF50% ,MEF25 % are different compared between three groups, the highest healthy controls, reversible times, minimum irreversible airflow obstruction group. ②The spearman correlation analysis results show that the concentration of serum human cartilage glycoprotein-39 was positively correlated with 2T/D, WA% （ r = 0. 748, P 〈0.05± r = 0. 739, P 〈 0.05）. Serum human cartilage glycoprotein-39 and lung function FEV1 % pred, FEV1/FVC, FEF25%-75%, MEF50%,MEF25% were negatively correlated （r= 0.665, P〈0.05; r=-0.750, P〈0.05; r= -0.772, P〈0.05; r =-0.759, P〈0.05; r =-0.697, P 〈0.05）.Conclusions ①HRCT can assess airway remodeling in asthma cases as an non-invasive mean. ②The serum human cartilage glycoprotein-39 can he used as the airway remodeling biomarkers. ③The serum human cartilage glycoprotein-39 and HRCT can be earlier found airway remodeling,which may guide clinical early treatment of asthma and to monitor treatment.