支气管哮喘患者外周血蛋白磷酸酶1A水平与气道重塑的关系

Relationship between peripheral blood protein phosphatase magnesium-dependent 1A level and airway remodeling in patients with bronchial asthma

目的探讨支气管哮喘患者外周血蛋白磷酸酶1A(PPM1A)水平与气道重塑的关系。方法选择2017年8月至2020年1月广东省中山市博爱医院(以下简称“我院”)收治的114例支气管哮喘患者,参考全球哮喘倡议中哮喘分级标准将患者分为重度组(51例)和轻中度组(63例),另选择我院同期50名健康志愿者为对照组。检测血清PPM1A、白细胞介素(IL)-4、IL-17A、IL-13水平,肺功能和气道重塑指标。分析血清PPM1A水平与气道重塑、肺功能、IL-4、IL-17A、IL-13相关性。结果重度组和轻中度组血清PPM1A水平、第1秒用力呼气容积(FEV1)、FEV1与用力肺活量的比值(FEV1/FVC)、FEV1占预计值百分数(FEV1%pred)低于对照组,重度组血清PPM1A水平、FEV1、FEV1/FVC、FEV1%pred低于轻中度组,差异有统计学意义(P<0.05)。重度组和轻中度组IL-17A、IL-13、IL-4水平,气道壁厚度/气道外径百分比、气道壁面积占气道总面积百分比高于对照组,重度组IL-17A、IL-13、IL-4水平,气道壁厚度/气道外径百分比、气道壁面积占气道总面积百分比高于轻中度组,差异有统计学意义(P<0.05)。线性回归方程为PPM1A=2.035+0.492 IL-4-0.671 IL-17A-0.503 IL-13+0.586 FEV1+0.416 FEV1/FVC+0.356 FEV1%pred-0.725气道壁厚度/气道外径百分比-0.783气道壁面积占气道总面积百分比(R2=0.786,调整后R2=0.753,F=39.265,P<0.001),支气管哮喘患者PPM1A水平与FEV1、FEV1/FVC、FEV1%pred呈正相关(P<0.05),与气道壁厚度/气道外径百分比、气道壁面积占气道总面积百分比、IL-4、IL-17A、IL-13呈负相关(P<0.05)。结论支气管哮喘患者外周血PPM1A水平明显下降,PPM1A缺失可能参与了支气管哮喘气道重塑过程。

Objective To investigate the relationship between peripheral blood protein phosphatase magnesium-dependent 1A(PPM1A)level and airway remodeling in patients with bronchial asthma.Methods A total of 114 patients with bronchial asthma admitted to Boai Hospital of Zhongshan,Guangdong Province(hereinafter referred to as“our hospital”)from August 2017 to January 2020 were selected.The patients were divided into severe group(51 cases)and mild to moderate group(63 cases)according to the asthma grading standards in the Global Asthma Initiative.Another 50 healthy volunteers from our hospital during the same period were selected as the control group.Serum levels of PPM1A,interleukin(IL)-4,IL-17A,IL-13,lung function and airway remodeling were measured.The correlation between serum PPM1A level and airway remodeling,lung function,IL-4,IL-17A,and IL-13 was analyzed.Results Serum PPM1A level,forced expiratory volume in one second(FEV1),ratio of FEV1 to forced vital capacity(FEV1/FVC),and percentage of FEV1 to predicted value(FEV1%pred)in severe and mild to moderate groups were lower than those in the control group,the levels of serum PPM1A,FEV1,FEV1/FVC,and FEV1%pred in severe group were lower than those in mild to moderate group,with statistical significance(P<0.05).The levels of IL-17A,IL-13,and IL-4,the percentage of airway wall thickness/airway outer diameter and the percentage of airway wall area/total area of the airway in the severe and mild to moderate groups were higher than those in the control group.The levels of IL-17A,IL-13 and IL-4,the percentage of airway wall thickness/airway outer diameter to the percentage of airway wall area/total area of the airway in the severe group were higher than those in the mild to moderate group,and the differences were statistically significant(P<0.05).The linear regression equation was PPM1A=2.035+0.492 IL-4-0.671 IL-17A-0.503 IL-13+0.586 FEV1+0.416 FEV1/FVC+0.356 FEV1%pred-0.725 percentage of airway wall thickness/airway outer diameter-0.783 percentage of airway wall area/total area of the airway(R2=0.786,adjustment R2=0.753,F=39.265,P<0.001).The level of PPM1A in asthmatic patients was positively correlated with FEV1,FEV1/FVC and FEV1%pred(P<0.05),and negatively correlated with the percentage of airway wall thickness/airway outer diameter,the percentage of airway wall area/total area of the airway,IL-4,IL-17A,and IL-13(P<0.05).Conclusion The level of PPM1A in peripheral blood of patients with bronchial asthma decreased significantly,and the loss of PPM1A may be involved in the process of airway remodeling in bronchial asthma.