慢性阻塞性肺疾病急性加重患者病程中BMI及肥胖抑制素和胃促生长素的监测

Monitoring of BMI, plasma obestatin and ghrelin levels in patients with acute exacerbation of chronic obstructive pulmonary disease

目的:监测慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者病程中BMI及肥胖抑制素和胃促生长素的变化,探讨不同体重C,D级COPD患者血浆肥胖抑制素,胃促生长素浓度变化与COPD急性加重的关系。方法:选取C,D级AECOPD患者120例,根据BMI分组,低体重(BMI≤18.5 kg/m^2)为A组(40例),正常体重(BMI>18.5 kg/m^2且≤24.9 kg/m^2)为B组(40例),超重(BMI>24.9 kg/m^2)为C组(40例)。对患者行肺功能等常规检查,并测定血浆肥胖抑制素和胃促生长素浓度及血常规、血超敏CRP(hs-CRP)、血浆IL-6及IL-8的浓度,记录3组入院时、出院时、出院后6个月和12个月的临床资料及12个月内患者急性加重次数及死亡患者人数。结果:A组和C组患者1年内急性加重次数明显多于B组,且A组患者1年内病死率(18.42%)明显高于B组(2.70%)和C组(7.69%),差异有统计学意义(P<0.05)。3组患者入组时血浆肥胖抑制素和胃促生长素浓度,BMI,血hs-CRP,血浆IL-6,IL-8浓度差异均有统计学意义(P<0.05),而血WBC,FEV1差异均无统计学意义(P>0.05)。随访1年后,3组患者除BMI,血浆肥胖抑制素和胃促生长素浓度差异有统计学意义外(P<0.05),其他指标差异均无统计学意义(均P>0.05)。A,B,C组入院时血浆肥胖抑制素和胃促生长素浓度,血WBC,血hs-CRP,血浆IL-6和IL-8浓度高于出院时和随访1年后,差异有统计学意义(均P<0.05),而FEV1低于出院时,差异有统计学意义(P<0.05)。血浆肥胖抑制素浓度与BMI呈负相关,而血浆胃促生长素浓度与BMI呈正相关。血浆肥胖抑制素和胃促生长素浓度与血浆炎症因子IL-6,IL-8,血hs-CRP呈正相关(均P<0.05)。结论:COPD患者的BMI与肥胖抑制素和胃促生长素水平有关,并且BMI,血浆肥胖抑制素和胃促生长素浓度可能与慢性阻塞性肺疾病急性加重有关。

Objective： To Monitor BMI, plasma obestatin and ghrelin levels in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）, and investigate the relationship between plasma obestatin as well as ghrelin levels and AECOPD patients with different weights in GOLD group C and D. Methods： One hundred and twenty patients with AECOPD in GOLD group C and D were enrolled. According to BMI, all participants were stratified into an underweight group A（n=40） with BMI ≤18.5 kg/m^2, a normal weight group B（n=40） with BMI 18.5 kg/m^2 and ≤24.9 kg/m^2, and an overweight group C（n=40） with BMI 24.9 kg/m^2. Pulmonary function testing（PFT）, plasma obestatin, plasma ghrelin, routine blood test, C-reactive protein（hs-CRP）, plasma IL-6, plasma IL-8, acute exacerbation frequency and mortality were recorded in each group at admission, discharge, 6 months after discharge, and 1 year after discharge. Results： The acute exacerbation frequency and mortality of group A（18.42%） was significantly higher than those in group B（2.70%） and group C（7.69%, P〈0.05）. At admission, there were significant differences on plasma obestatin and ghrelin levels, BMI, hs-CRP, plasma IL-6 and IL-8 levels among the 3 groups（P〈0.05）; however, the differences in blood white cells and FEV1 had no statistically significance（P〉0.05）. After 1 year follow-up, there was no statistically difference among the three groups except for BMI and plasma obestatin and ghrelin levels. But in the three groups, plasma obestatin and ghrelin levels, blood white cells, hs-CRP, plasma IL-6 and plasma IL-8 at admission were higher than those at discharge as well as those at the end of follow-up, and FEV1 was lower than that at discharge and 1 year followup（P〈0.05）. Moreover, plasma obestatin was negatively correlated with BMI, while plasma ghrelin was positively correlated with BMI. Plasma obestatin and ghrelin were positively correlated with plasma inflammatory hallmarks IL-6, IL-8 and hs-CRP（P〈0.05）. Conclusion： In patients with AECOPD, BMI has correlation with plasma obestatin and ghrelin levels; BMI, plasma obestatin and ghrelin levels are correlated to acute exacerbation of chronic obstructive pulmonary disease.