慢性阻塞性肺疾病患者血清VEGF水平、外周血CD34^(+)细胞数量与骨骼肌功能障碍的关系

The Relationship Between Serum VEGF Level,Number of CD34^(+)Cells in Peripheral Blood and Skeletal Muscle Dysfunction in Patients with Chronic Obstructive Pulmonary Disease

目的检测慢性阻塞性肺疾病(COPD)患者血清血管内皮生长因子(VEGF)水平、外周血CD34^(+)细胞数量,并分析二者与骨骼肌功能障碍的关系。方法选取北京市门头沟区医院2021年7月至2022年12月收治的96例COPD患者,依据COPD患者骨骼肌功能障碍诊断标准将患者分为骨骼肌功能障碍组52例和无骨骼肌功能障碍组44例;选择同期在医院体检的健康者96例为对照组。测定所有受试者肺功能指标[用力肺活量(FVC)、第一秒用力呼气容积占预计值的百分比(FEV1%)、第一秒用力呼气容积/用力肺活量(FEV1/FVC)],骨骼肌功能[握力、4m步速、5次起坐试验时间、6min步行距离(6MWD)],血清C-反应蛋白(CRP)、白细胞计数(WBC)水平;酶联免疫吸附法、流式细胞仪分别检测血清VEGF水平、CD34^(+)细胞数量;分析COPD患者血清VEGF、CD34^(+)细胞数量、骨骼肌功能的相关性,COPD患者发生骨骼肌功能障碍的影响因素,血清VEGF、CD34^(+)细胞数量预测COPD患者发生骨骼肌功能障碍的价值。结果与对照组相比,无骨骼肌功能障碍组FVC、FEV1%、FEV1/FVC、握力、4m步速、6MWD降低(P<0.05),5次起坐试验时间较长、CRP、WBC水平升高(P<0.05),骨骼肌功能障碍组BMI、FVC、FEV1%、FEV1/FVC、握力、4m步速、6MWD降低(P<0.05),5次起坐试验时间较长、CRP、WBC水平升高(P<0.05);与无骨骼肌功能障碍组相比,骨骼肌功能障碍组BMI、握力、4m步速、6MWD降低(P<0.05),5次起坐试验时间较长(P<0.05)。对照组、无骨骼肌功能障碍组、骨骼肌功能障碍组血清VEGF水平依次升高,CD34^(+)细胞数量依次降低(P<0.05)。COPD患者血清VEGF水平与CD34^(+)细胞数量呈负相关(P<0.05);血清VEGF水平与握力、4m步速、6MWD呈负相关(P<0.05),与5次起坐试验时间呈正相关(P<0.05);CD34^(+)细胞数量与握力、4m步速、6MWD呈正相关(P<0.05),与5次起坐试验时间呈负相关(P<0.05)。BMI低水平、VEGF高水平、CD34^(+)细胞数量低水平是COPD患者发生骨骼肌功能障碍的危险因素(P<0.05)。血清VEGF、CD34^(+)细胞数量、两者联合预测COPD患者发生骨骼肌功能障碍的曲线下面积分别为0.900、0.835、0.935。结论COPD患者血清VEGF水平明显增加,外周血CD34^(+)细胞数量明显下降,二者水平变化与骨骼肌功能障碍的发生具有相关性。

Objective To detect the level of serum vascular endothelial growth factor(VEGF)and the number of CD34^(+)cells in peripheral blood of patients with chronic obstructive pulmonary disease(COPD),and to analyze the relationship between these markers and skeletal muscle dysfunction.Methods A total of 96 patients with COPD admitted to the Beijing Mentougou District Hospital from July,2021 to December,2022 were selected for the study.According to the diagnostic criteria of skeletal muscle dysfunction in COPD patients,these patients were divided into the skeletal muscle dysfunction group(52 cases)and non-skeletal muscle dysfunction group(44 cases);96 healthy people who had physical examination at the same time were selected as the control group.Pulmonary function indicators[forced vital capacity(FVC),forced expiratory volume in the first second as a percentage of the expected value(FEV1%),forced expiratory volume in the first second/forced vital capacity(FEV1/FVC)],skeletal muscle function[grip strength,4 m walking speed,5 times of sitting test time,6 min walking distance(6MWD)],serum C-reactive protein(CRP),white blood cell count(WBC)levels were determined in all subjects;Serum VEGF level and CD34^(+)cell number were detected by enzyme linked immunosorbent assay and flow cytometry;The correlation between the number of serum VEGF and CD34^(+)cells and skeletal muscle function in patients with COPD,also the influencing factors of skeletal muscle dysfunction in patients with COPD,and the value of serum VEGF and CD34^(+)cell number in predicting skeletal muscle dysfunction in patients with COPD were analyzed.Results Compared with the control group,FVC,FEV1%,FEV1/FVC,grip strength,4 m walking speed and 6MWD were decreased in the non-skeletal muscle dysfunction group(P<0.05),and the Five-Times-Sit-To-Up test duration was longer,also CRP and WBC levels were increased(P<0.05).BMI,FVC,FEV1%,FEV1/FVC,grip strength,4m walking speed and 6MWD of the skeletal muscle dysfunction group were decreased(P<0.05),and the Five-Times-Sit-To-Up test duration was longer.CRP and WBC levels were increased(P<0.05);Compared with non-skeletal muscle dysfunction group,BMI,grip strength,4m walking speed and 6MWD in skeletal muscle dysfunction group were decreased(P<0.05),and the Five-Times-Sit-To-Up test duration was longer(P<0.05).The level of serum VEGF in the control group,non-skeletal muscle dysfunction group and skeletal muscle dysfunction group was increased successively,and the number of CD34^(+)cells was decreased successively(P<0.05).Serum VEGF level in COPD patients was negatively correlated with the number of CD34^(+)cells(P<0.05);Serum VEGF level was negatively correlated with grip strength,4m walking speed and 6MWD(P<0.05),and positively correlated with the Five-Times-Sit-To-Up test duration(P<0.05);The number of CD34^(+)cells was positively correlated with grip strength,4m walking speed and 6MWD(P<0.05),while negatively correlated with the Five-Times-Sit-To-Up test duration(P<0.05).Low BMI level,high VEGF level and low CD34^(+)cell count were risk factors for skeletal muscle dysfunction in COPD patients(P<0.05).The number of serum VEGF,CD34^(+)cells and their combined prediction area under curve of skeletal muscle dysfunction in COPD patients were 0.900,0.835 and 0.935,respectively.Conclusion The level of VEGF in serum of COPD patients increases significantly,while the number of CD34^(+)cells in peripheral blood decreases significantly.The changes of VEGF and CD34^(+)cells are correlated with the occurrence of skeletal muscle dysfunction.