慢阻肺患者内源性NO合酶表达、膈肌组织改变对膈肌功能变化的影响

Effect of endogenous NO synthase expression and diaphragmatic tissue changes on the functional changes of diaphragm in patients with COPD

目的研究分析轻中度慢性阻塞性肺疾病(慢阻肺)患者膈肌组织学结构变化的特点及内源性一氧化氮合酶(NOS)表达情况,探讨一氧化氮(NO)在慢阻肺患者膈肌功能变化中发挥的作用。方法选取实施开胸手术的22例患者作为研究对象,其中12例为轻中度慢阻肺患者(慢阻肺组),10例为肺功能正常的患者(对照组),采用免疫组化及HE染色观察膈肌组织学改变,采用Westernblot检测两组患者的NOS表达变化,并分析两组患者的肺功能差异。结果慢阻肺组患者的FEV_1、FEV1%、FEV_1/FVC检测值均显著低于对照组且差异均具有统计学意义(P<0.05)。慢阻肺组患者的膈肌肌球蛋白重链(MHC)亚型阳性(MHCslow、MHCfast)细胞所占比例与对照组比较差异均不具有统计学意义(P>0.05)。慢阻肺组患者的胶原沉着面积(22.84±1.86)%、毛细血管数量(12.87±3.82)个/视野、NOS(0.321±0.126)OD值均显著高于对照组(P<0.05),两组膈肌纤维横截面积差异不具有统计学意义(P>0.05)。结论慢阻肺患者的膈肌纤维超微结构较非慢阻肺患者发生显著的改变,同时NOS表达率升高,这对慢阻肺患者的膈肌收缩力、耐力均有不利的影响。

Objective To research and analyze the diaphragmatic muscle tissue structure change and the characteristics of the endogenous nitric oxide synthase（ NOS） expression and the role of nitric oxide（ NO） in COPD patients at moderate to stable stage,and to explore the value of NO in diaphragmatic muscle tissue structure change.Methods 22 patients with thoracic surgery were selected as the research objects,including 12 cases of mild to moderate COPD and 10 healthy controls. It used immunohistochemistry and HE staining to observe the histological changes of diaphragmatic muscle. Western blot was used to detect the expression of NOS. The differences in pulmonary function were compared between the two groups. Results The value of FEV1%,FEV1/ FVC and FEV1 were significantly lower in the COPD group than in the control group（ P〈0. 05）. The proportion of MHC positive cells（ MHCslow,MHCfast） in diaphragm showed no significant difference between the two groups（ P〉0. 05）. The collagen of the COPD group was calm area of（ 22. 84 ± 1. 86） %. The number of capillaries was（ 12. 87 ± 3. 82） / field. NOS（ 0. 321 ± 0. 126） OD was significantly higher than that in the control group（ P〈0. 05）. The diaphragm muscle fiber cross-sectional area showed no statistical significance（ P〉0. 05）. Conclusion The ultrastructure of diaphragmatic fiber in COPD patients changes significantly,and the expression of NOS increase,which has a negative effect on the contractility and endurance of the diaphragmatic muscle in patients with COPD.