老年慢性阻塞性肺疾病病人中炎症因子、25-羟维生素D3水平变化及急性发作的相关危险因素

Analysis of levels of inflammatory factors,25-hydroxyvitamin D3 and related risk factors for acute exacerbation in the elderly patients with chronic obstructive pulmonary disease

目的探究老年COPD病人急性发作期及缓解期炎症因子、25-羟维生素D3[25(OH)2 D3]的变化,并探究老年COPD病人急性发作的相关危险因素。方法收集2017年10月至2018年12月于我院就诊的COPD病人110例,其中急性发作期病人42例为COPD急性加重(AECOPD)组,缓解期病人68例为COPD组;另选取本院同期健康体检者60例作为对照组。测定各组病人TNF-α、转化生长因子-β(TGF-β)、IL-10、血内皮生长因子(VEGF)、25(OH)2D3水平及肺功能,并分析COPD病人急性发作的相关危险因素。结果AECOPD组和COPD组的VEGF、TNF-α、TGF-β水平均高于对照组,IL-10、25(OH)2 D3水平明显低于对照组(P<0.05),且上述指标AE-COPD组和COPD组组间比较,差异亦有统计学意义(P<0.05)。AECOPD组和COPD组FEV1、FVC、FEV1/FVC均显著低于对照组,且AECOPD组较COPD组更低,差异均有统计学意义(P<0.05)。重度肺功能障碍和正在吸烟是AECOPD的危险因素(P<0.05),长期家庭氧疗和药物吸入是AECOPD的保护因素(P<0.05)。结论老年COPD病人炎症反应严重,且在急性发作期会加重,戒烟、长期家庭氧疗和药物吸入有助于病情控制。

Objective To explore the change of the levels of inflammatory factors and 25-hydroxyvitamin D3[25(OH)2D3]in the elderly patients with chronic obstructive pulmonary disease(COPD)at acute stage or remission stage,and to analyze the related risk factors of acute attack in the elderly patients with COPD.Methods A total of 110 patients with COPD admitted to our hospital from October 2017 to December 2018 were enrolled.Forty-two cases with acute exacerbation of COPD(AECOPD)were divided into AECOPD group,68 cases at remission stage were divided into COPD group,and 60 cases receiving physical examination during the same period in our hospital were selected as the control group.The levels of inflammatory cytokines,vascular endothelial growth factor(VEGF),25(OH)2D3 and lung function were detected in each group,and the related risk factors of acute attack in COPD patients were analyzed.Results The levels of VEGF,tumor necrosis factor-α(TNF-α),transforming growth factor-β(TGF-β)were significantly higher and the levels of 25(OH)2 D3 and IL-10 were significantly lower in AECOPD group and COPD group than those in control group(P<0.05),and there were statistical differences in above indexes between AECOPD group and COPD group(P<0.05).The lung function index such as forced expiratory volume in one second(FEV1),forced vital capacity(FVC),FEV1/FVC in AECOPD group and COPD group were significantly lower than those in control group(P<0.05),and were much lower in AECOPD group compared with COPD group(P<0.05).Severe pulmonary dysfunction,ongoing smoking were associated risk factors,and long-term home oxygen therapy,and long-term drug inhalation were protection factors for AECOPD.Conclusions Inflammatory reactions is serious in the elderly patients with COPD,and it will aggravate in the acute phase.Long-term family oxygen therapy and long-term drug inhalation maybe helpful.