COPD急性加重期血浆Ang-2的变化及临床意义

Changes of plasma Ang-2 and its clinical significance during acute exacerbations of chronic obstructive pulmonary disease

目的探讨血浆血管生成素-2(Ang-2)在慢性阻塞性肺疾病急性加重期(AECOPD)治疗前后的变化及其临床意义。方法选择44例AECOPD患者,入院后予以吸氧、抗感染、止咳化痰及平喘等常规治疗。比较治疗前后Ang-2、超敏C反应蛋白(hs-CRP)水平以及动脉血氧分压(Pa O2)的变化,并探讨治疗前血浆Ang-2与hs-CRP及Pa O2相关性,治疗后血浆Ang-2与肺功能指标FEV1/FVC以及FEV1占预计值百分比的相关性。按照吸烟史将研究对象分为非吸烟组、已戒烟组及持续吸烟组,比较三组患者血浆Ang-2水平。结果 AECOPD患者治疗前血浆Ang-2浓度为(2 937.2±938.1)pg/ml,血清hs-CRP浓度为(6.5±3.9)mg/dl,Pa O2为(66.9±9.5)mm Hg,经治疗临床缓解后血浆Ang-2浓度为(1 919.7±672.1)pg/ml,hs-CRP浓度为(2.6±1.9)mg/dl,Pa O2为(79.4±9.6)mm Hg,各指标与治疗前相比,差异有统计学意义(P<0.01)。相关性分析显示,治疗前血浆Ang-2与血清hs-CRP呈正相关(r=0.404,P<0.01),与Pa O2呈负相关(r=-0.327,P=0.03),治疗后血浆Ang-2与肺功能指标FEV1/FVC以及FEV1占预计值百分比无显著相关性(P>0.05)。非吸烟组、已戒烟组及持续吸烟组患者血浆Ang-2水平无显著差异(P>0.05)。结论血浆Ang-2可作为AECOPD的候选炎性生物学标志物。

Objective To investigate the change of plasma levels of angiopoietin-2 in patients with acute exacerbations of chronic obstructive pulmonary disease（ AECOPD） before and after the effective treatment,and its clinical significance was also analyzed. Methods 44 patients with acute exacerbations of COPD were enrolled in the study. All patients were given continuous low flow oxygen,antibiotics,antitussive,expectorant,antiasthma and other conventional treatment. Plasma levels of Ang-2,serum hs-CRP and Pa O2 were measured in patients with AECOPD within 24 h of hospitalization and pre-discharge（ convalescence）. The relationship between Ang-2 and hs-CRP,Pa O2 during the acute exacerbation were analyzed. After clinical recovery from the acute exacerbation the relationship between Ang-2 and FEV1/ FVC,FEV1% pred were analyzed. Patients were divided into three groups according to the smoking status： never smokers,ex-smokers and current smokers. The levels of plasma Ang-2 were compared among different groups. Results The levels of Ang-2,hs-CRP and Pa O2 during the acute exacerbation were（ 2 937. 2 ± 938. 1） pg / ml,（ 6. 5 ± 3. 9） mg / dl and（ 66. 9 ± 9. 5） mm Hg,respectively. After clinical recovery from the acute exacerbation the levels of Ang-2,hs-CRP and Pa O2were（ 1 919. 7 ± 672. 1） pg / ml,（ 2. 6 ± 1. 9） mg / dl and（ 79. 4 ± 9. 6） mm Hg,respectively.The levels of plasma Ang-2 and serum hs-CRP decreased significantly after clinical recovery from the acute exacerbation（P〈0. 01）. Analysis results indicated that during an acute exacerbation plasma Ang-2 was significantly positively correlated with serum hs-CRP（ r = 0. 404,P 0. 01）,but inversely correlated with Pa O2（ r =- 0. 327,P = 0. 03）. However,there was no significant correlation between plasma Ang-2 levels and FEV1/ FVC or FEV1% pred（P〉0. 05）. No significant difference was found in the level of Ang-2 among never smokers,ex-smokers and current smokers（P〉0. 05）. Conclusions Plasma Ang-2 may serve as a biomarker for inflammation during COPD exacerbations.