AECOPD和急性稳定期COPD患者呼出气一氧化氮水平与炎症及肺功能相关性研究

Correlation between the exhaled nitric oxide levels and inflammation as well as pulmonary function in patients with AECOPD and acute stable COPD

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)与急性稳定期慢性阻塞性肺疾病(ASCOPD)患者呼出气一氧化氮(FeNO)水平变化状态与炎症及肺功能相关性。方法选取2018至2020年本院呼吸内科收治的经病理学诊断确诊的123例不同程度的COPD患者作为研究对象,并将其分为AECOPD组(n=62)和ASCOPD组(n=61),比较2组患者治疗前后的第1秒用力呼气容积(FEV1)占预计值百分比(FEV1%)、FeNO及相关指标进行检测与分析,同时选取同时期健康志愿者65名作对照,并在此基础上比较炎症、肺功能指标与FeNO水平变化的相关性。结果治疗前AECOPD组的Eos、N、FeNO表达水平均显著高于ASCOPD及对照组,ASCOPD组高于对照组(P<0.05);治疗前AECOPD组的FEV1%、FEV1/FVC高于对照组。AECOPD组中的GOLD亚组(1~2级)Eos表达显著高于3~4级组,N、FeNO表达显著地低于3~4级组(P<0.05)。AECOPD组治疗后1周的Eos、N、FeNO、FEV1%表达水平显著低于治疗前,同时也显著高于对照组(P<0.05)。治疗后AECOPD组CRP、TNF-ɑ、IL-6、PCT表达水平均显著降低(P<0.05)。经Pearson相关性分析发现,AECOPD、ASCOPD患者的CRP、TNF-α、IL-6、PCT等炎性因子与FEV1、FEV1/FVC、FEV1%等肺功能指标呈负相关(P<0.05),CRP、TNF-α、IL-6、PCT等炎性因子与FeNO呈正相关(P<0.05)。结论AECOPD、ASCOPD患者的肺功能指标、FeNO水平与血清炎性因子呈异常升高密切相关,但相对而言,ASCOPD患者的血清炎性因子呈异常升高较AECOPD患者不显著,可将FeNO作为AECOPD患者的病情监测参考指标之一。

Objective To investigate the correlation between the exhaled nitric oxide levels and inflammation as well as pulmonary function in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and acute stable COPD(ASCOPD).Methods A total of 123 patients with COPD at different stages who were treated in our hospital from January 2018 to December 2020 were enrolled in the study,who were divided into two groups:AECOPD group(n=62)and ASCOPD group,moreover,the other 65 healthy sebjects were enrolled as control group.The levels of FEV1%,FeNO and related indexes were detected and compared among the three group.In addition the correlation between inflammation,lung function indexes and FeNO levels was analyzed.Results Before treatment,the expressin levels of Eos,N,FeNO in AECOPD group were significantly higher than those in ASCOPD group and control group,which in ASCOPD group were significantly higher than those in control group(P<0.05).Before treatment the levels of FEV1%,FEV1/FVC in AECOPD group were significantly higher than those in control group(P<0.05).After 1-week treatment,the levels of Eos,N,FeNO,FEV1%in AECOPD group were significantly increased,moreover,which were significantly higher than those in control group(P<0.05).After treatment,the levels of CRP,TNF-α,IL-6,PCT in AECOPD group were significantly decreased(P<0.05).Pearson correlation analysis showed that CRP,TNF-α,IL-6,PCT and other inflammatory factors were negatively correlated with FEV1,FEV1/FVC,FEV1%and FeNO in patients with AECOPD and ASCOPD(P<0.05),however,which were positively correlated with FeNO(P<0.05).Conclusion The pulmonary function indexes and FeNO levels in patients with AECOPD or ASCOPD are closely related to the abnormal increase of serum inflammatory factors,and the abnormal increase in patients with AECOPD is more significant than that in patients with ASCOPD,therefor,FeNO can be regarded as one of the reference indicators for monitoring the disease condition of patients with AECOPD.