IGF-Ⅰ、IGFBP-4和IGFBP-5在特发性肺纤维化患者支气管肺泡灌洗液和血清中的表达及意义

The Expressions and Roles of IGF-Ⅰ,IGFBP-4 and IGFBP-5 in BALF and Serum of Patients with Idiopathic Pulmonary Fibrosis

目的检测特发性肺纤维化(IPF)患者支气管肺泡灌洗液(BALF)和血清中胰岛素样生长因子1(IGF-Ⅰ)、胰岛素样生长因子结合蛋白4(IGFBP-4)、胰岛素样生长因子结合蛋白5(IGFBP-5)的表达水平,探讨其在IPF患者的诊治及病情评估方面的临床意义。方法选择2012年2月至2013年3月就诊于中国医科大学附属第一医院的IPF患者22例作为IPF组,另选择Ⅰ期肺结节病患者16例作为对照非纤维化组,检测并比较2组BALF和血清中IGF-Ⅰ、IGFBP-4、IGFBP-5表达水平的差异,分析三者的浓度与细胞学计数、肺功能、血气分析、肺HRCT评分的相关性。结果 IPF组患者BALF中IGF-Ⅰ、IGFBP-4水平高于对照组,血清中IGFBP-5水平高于对照组。IPF组BALF和血清中的IGFBP-5水平均与巨噬细胞百分比呈正相关。IPF组血清中IGF-Ⅰ水平与用力肺活量(FVC%)、一氧化碳弥散量(DLCO%)呈正相关,BALF中IGFBP-4水平与第一秒用力呼气容积(FEV1%)、FVC%呈负相关,血清中IGFBP-4水平与FEV1%呈正相关。IPF组BALF和血清中IGF-Ⅰ、IGFBP-4、IGFBP-5水平与氧分压(Pa O2)无相关性。IPF组BALF中IGF-Ⅰ、IGFBP-4水平与肺高分辨率CT(HRCT)评分呈正相关。结论 IPF患者体内IGF-Ⅰ、IGFBP-4、IGFBP-5表达水平升高,这3项指标可作为IPF患者病情监测、疗效判断乃至靶向治疗的客观指标。

Objective To detect the change and significance of the level of insulin-like growth factor（IGF-I）, insulin-like growth factor-binding protein-4 （IGFBP-4） and insulin-like growth factor-binding protein- 5 （IGFBP-4） in bronchoalveolar lavage fluid （BALF） and serum of patients with IPF, and to study their roles in the diagnosis, treatment and clinical significance of patients with IPF. Methods Twenty two patients with IPF and 16 patients with pulmonary sarcoidosis as control group were enrolled from Department of Respiratory Disease in the First Hospital of China Medical University. The level of IGF-I, IGFBP-4 and IGFBP-5 in BALF and serum were detected and compared between these groups. Correlation analysis were made between the concentration of IGFBP-4 and IGFBP-5 and the data of cytology count, blood gas analysis and pulmonary HRCT score in IPF group. Results The level of IGF-I, IGFBP-4 in BALF increased in IPF group compared with control group and the level of IGFBP-5 in serum also increased in IPF group. The level of IGFBP-5 in BALF and sertml was positively correlated with M% in IPF group. In IPF group, the level of IGF-I in serum was positively correlated with FVC% and DLCO% level. The level of IGFBP-4 in BALF were negatively correlated with FEVI%, FVC% and IGFBP-4 level in serum was positively correlated with FEVI%. The level of IGF-I, IGFBP-4 and IGFBP-5 in BALF and serum of IPF group were not correlated with PaO2. The levels of IGF-I and IGFBP-4 in BALF of IPF group were positively correlated with pulmonary HRCT score. Conclusion The expression of IGF- I , IGFBP-4 and IGFBP-5 is devated in the patients with IPF and may become objective indicators to deter- mine the efficacy even targeted therapy.