COPD稳定期合并骨骼肌萎缩患者血清激活素A、肌肉生长抑制素水平研究

Serum activin A and myostatin levels in stable COPD patients complicated with skeletal muscle atrophy

目的通过观察慢性阻塞性肺疾病(COPD)稳定期合并骨骼肌萎缩患者血清激活素A(ACTA)、肌肉生长抑制素(MSTN)水平的变化,探讨两者与炎症因子、肺功能及身体组成指标的相关性。方法选择2019年2月至2020年10月新疆维吾尔自治区人民医院收治的COPD稳定期患者126例和健康体检者126例(对照组),患者中合并骨骼肌萎缩67例(萎缩组),未合并骨骼肌萎缩59例(无萎缩组)。检测3组对象血清ACTA、MSTN、炎症因子(CRP、TNF-α、IL-8)水平以及肺功能指标[第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、FEV_(1)与FVC比值(FEV_(1)/FVC)、最大自主通气量(MVV)]和身体组成指标[BMI、脂肪质量指数(FMI)和非脂肪组织质量指数(FFMI)]。分析ACTA、MSTN之间相关性以及ACTA、MSTN与炎症因子、肺功能和身体组成指标之间的相关性。结果萎缩组血清ACTA、MSTN、CRP、TNF-α、IL-8水平均高于非萎缩组和对照组,且非萎缩组高于对照组(均P<0.05);萎缩组FEV_(1)、FVC、FEV_(1)/FVC、MVV、BMI、FMI、FFMI均低于非萎缩组和对照组,非萎缩组FEV_(1)、FVC、FEV_(1)/FVC、MVV均低于对照组(均P<0.05)。相关性分析结果显示,ACTA、MSTN与CRP、TNF-α、IL-8水平均呈正相关(均P<0.05),与FEV_(1)、FVC、FEV_(1)/FVC、MVV、BMI、FMI、FFMI均呈负相关(均P<0.05);ACTA与MSTN呈正相关(P<0.05)。结论COPD稳定期合并骨骼肌萎缩患者血清ACTA、MSTN水平均异常升高,且高水平的ACTA、MSTN与机体炎症反应、肺功能低下和骨骼肌质量下降有关。

Objective To investigate serum activin A and myostatin levels in stable chronic obstructive pulmonary disease(COPD)patients complicated with skeletal muscle atrophy.Methods One hundred and twenty six patients with stable COPD admitted in People's Hospital of Xinjiang Uygur Autonomous Region from February 2019 to October 2020,and 126 healthy subjects(control group)were enrolled in the study.There were 67 COPD patients with skeletal muscular atrophy(atrophy group),and 59 patients without muscular atrophy(non-atrophy group).Serum activin A,myostatin,inflammatory factors[C-reactive protein(CRP),TNF-α,IL-8]levels were detected,pulmonary function[forced expiratory volume in the first second(FEV_(1)),forced vital capacity(FVC),ratio of FEV_(1)to FVC(FEV_(1)/FVC),maximum voluntary ventilation(MVV)]and body composition indexes[body mass index(BMI),fat mass index(FMI)and fat-free index(FFMI)]were measured in the three groups.The correlation between activin A and myostatin levels,and the correlation of activin A and myostatin levels with inflammatory factors,pulmonary function and body composition indexes were analyzed.Results The serum activin A,myostatin,CRP,TNF-αand IL-8 levels in atrophy group were higher than those in non-atrophy group and control group,the levels of the above indexes in the non-atrophy group were higher than those in the control group(P<0.05).The FEV_(1),FVC,FEV_(1)/FVC,MVV,BMI,FMI and FFMI in atrophy group were lower than those in non-atrophy group and control group,and FEV_(1),FVC,FEV_(1)/FVC and MVV in non-atrophy group were lower than those in control group(P<0.05).Pearson correlation analysis showed that activin A and myostatin levels were positively correlated with CRP and TNF-α,IL-8 levels(P<0.05),and were negatively correlated with FEV_(1),FVC,FEV_(1)/FVC,MVV,BMI,FMI,FFMI(P<0.05).Activin A was positively correlated with myostatin levels(P<0.05).Conclusion Serum activin A and myostatin levels in stable COPD patients complicated with skeletal muscle atrophy are elevated,and the high activin A and myostatin levels are related to inflammatory reaction,decline of skeletal muscle mass and low pulmonary function.