锁链素对慢性阻塞性肺疾病治疗反应性的预测作用

Role of desmosine in prediction of treatment response in chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病(COPD)血清、诱导痰锁链素与治疗反应性的相关性。方法检测65例初诊COPD患者及26例对照组血清、诱导痰锁链素的表达,分析其与肺功能、功能性呼吸困难评分(MRC)、圣乔治呼吸问卷评分(SGRQ)的相关性,并探讨其与COPD治疗反应性的相关性。结果COPD组诱导痰锁链素[(1 061.2±933.9)ng/mL]高于对照组[(443.5±501.7)ng/mL;t=2.277,P=0.027],与FEV_1、FVC呈负相关(r值分别为-0.357,-0.479,P值分别为0.02,0.001)。丙酸氟替卡松/沙美特罗治疗3个月后,血清及诱导痰锁链素浓度较治疗前无统计学差异(均P>0.05),而诱导痰锁链素低表达者FVC、MRC及SGRQ总分、活动评分改善较高表达者明显(均P<0.05)。结论稳定期COPD诱导痰锁链素与肺功能呈负相关,低表达者治疗后症状改善更为显著。

Objective To explore the association of serum and sputum desmosine with treatment response in patients with chronic obstructive pulmonary disease(COPD).Methods Serum and induced sputum desmosine were measured with enzyme linked immunosorbent assay in 65 patients with newly diagnosed COPD and 26 healthy people.The associations of desmosine with pulmonary function,modified Medical Research Council dyspnea scale(m MRC),and St.George′s Respiratory Questionnaire score(SGRQ)were analyzed before and after treatment with inhaled corticosteroid/long acting β2-agonist.The relationship between desmosine and treatment response in COPD were explored.Results Level of sputum desmosine was higher in patients with COPD than in healthy controls(1 061.2±933.9 ng/m L vs.443.5±501.7 ng/m L;t=2.277,P=0.027).Sputum desmosine level was negatively related with forced expiratory volume in 1 second(FEV1)(r=-0.357,P=0.001)and forced vital capacity(FVC)(r=-0.479,P=0.02).Serum desmosine level was correlated with pulmonary function,MRC,and SGRQ(P>0.05 for all comparisons).3 months after treatment,neither serum nor sputum desmosine declined significantly(P>0.05).FVC,MRC,and the total scores and activity scores on the SGRQ improved more markedly in patients with lower expression of sputum desmosine than in those with higher expression(P<0.05 for all comparisons).Conclusions Level of sputum desmosine is inversely correlated with pulmonary function in stable COPD.Patients with lower expression of sputum desmosine have more significant improvement in symptoms.