类风湿关节炎对慢性阻塞性肺疾病累积效应

Cumulative effect of rheumatoid arthritis on chronic obstructive pulmonary disease

目的 分析慢性阻塞性肺疾病 （COPD）患者与类风湿关节炎 （RA）合并COPD患者临床表现及血清标志物表达差异,揭示RA对COPD自然病程的累积效应并初步探讨作用的分子机制。方法 收集COPD患者41例,RA合并COPD患者43例,对其临床指标及实验室指标进行详细记录,采用两样本t检验、Wilcoxon秩和检验及Pearson相关性分析进行统计学分析。结果 2组患者间肺功能指标：深吸气量 （IC）、第1秒用力呼气容积 （FEV1）、用力肺活量 （FVC）、FEV1/FVC、第1秒用力呼气容积占预计值百分比 （FEV1%pred）、残气容积占预计值百分比 （RV%pred）、肺总量占预计值百分比 （TLC%pred）、残气容积/肺总量百分比 （RV/TLC%）、肺活量占预计值百分比和一氧化碳弥散量占预计值百分比差异无统计学意义 （P 〉0.05）。RA合并COPD患者抗环瓜氨酸多肽及类风湿因子较COPD组明显升高且2组之间的差异有统计学意义 （t=16 259、23 598,P 值均〈0. 01）;2组比较COPD患者6分钟步行距离 （6MWD）较高,2组之间差异有统计学意义 （t=2 041,P 〈0.05）;改良版英国医学研究会呼吸困难评分、慢性阻塞性肺疾病评估测试评分差异无统计学意义 （P 〉0.05）;2组患者比较RA合并COPD患者血清IL-17、红细胞沉降率、C反应蛋白（CRP）及白介素6 （IL-6）表达明显升高,差异有统计学意义 （P 〈0 .01）;肿瘤坏死因子α、转化生长因子β及IL-1β差异无统计学意义 （P 〉0.05）;IL-17与6MWD呈负相关 （r=-0 535,P 〈0 .01）;IL-6与6MWD呈负相关 （r=-0. 516,P 〈0 .01）;CRP与6MWD呈负相关 （r=-0 233 P 〈0.05）。结论 RA促进COPD的自然病程进展,对COPD的发病过程具有累积效应。

Objective To analyze the difference of clinical manifestations and serum levels of biomarkers between chronic obstructive pulmonary disease （COPD） patients and rheumatoid arthritis （RA） patients combined with COPD, and to reveal the cumulative effect and molecular mechanism of RA on the natural course of COPD. Methods In the study, a total of 41 patients with COPD and 43 RA patients with COPD were collected. The clinical indexes and laboratory indexes were recorded carefully in the enrolled patients. Furthermore, two-sample t-test, Wilcoxon rank sum test and Pearson correlation analysis were used for statistical analysis. Results There was no significant difference of lung function indexes [-inspiratory capacity （IC）, forced expiratory volume in one second （FEV1）, forced vital capacity （FVC）, FEV1/FVC, FEV1% pred, residual volume （RV） M pred, total lung capacity （TLC） % pred, RV/ TLC%, vital capacity%pred and carbon monoxide diffusing capaeity%0pred] between the two groups （ P〉0.05）. The levels of anti-cyclic citruilinated peptide and rheumatoid factor in RA patients combined with COPD were significantly higher than those in COPD group, and the difference was statistically significant （ t = 16. 259, 23. 598, both P 〈 0.01 ）. Besides, there was statistical difference that the 6-minute walk distance （6MWD） of patients with COPD was higher than that of RA patients combinedwith COPD （ t =2. 041, P 〈0.05）. No obvious difference was found regarding modified British medical research council score and COPD assessment test score between groups （ P〉 0.05）. Compared with COPD patients, the serum levels of interleukin-17 （IL-17）, erythrocyte sedimentation rate, C-reactive protein （CRP） and IL-6 were significantly increased in rheumatoid arthritis patients combined with COPD, indicating statistical difference （P 〈 0.01）. In addition, there was no significant difference in tumor necrosis factor-s, transforming growth factor-β and IL-1β between groups （ P 〈0.05）. ILl7 was negatively correlated with 6MWD （ r =-0. 535, P 〈0.01）. IL 6 was negatively correlated with 6MWD （r =-0.516, P 〈0.01）.CRP was negatively correlated with 6MWD （r =-0.233, P〈0.05）. Conclusions RA promotes the natural progression of COPD and has a cumulative effect on the pathogenesis of COPD.