血清基质金属蛋白酶⁃12、纤维蛋白原、Clara细胞分泌蛋白⁃16联合临床特征预测慢性阻塞性肺疾病急性加重期患者预后的风险

目的研究血清标志物及临床特征预测慢性阻塞性肺疾病(COPD)急性加重期患者预后的价值。方法比较急性加重期COPD不同预后患者临床资料,利用ROC分析基质金属蛋白酶⁃12(MMP⁃12)、纤维蛋白原(FIB)、Clara细胞分泌蛋白⁃16(CC⁃16)预测其预后不良的价值,并进行多因素该分析。结果预后不良患者中年龄≥60岁、肺功能Ⅲ-Ⅳ级、吸烟、合并冠心病、合并糖尿病、合并消化道出血出现比例及MMP⁃12、FIB、CC⁃16水平高于预后良好患者,差异有统计学意义(P<0.05)。不同血清标志物预测患者预后不良的下曲线面积为0.719、0.824、0.683。经logistic回归性分析证实MMP⁃12≥20.930 pg/mL,FIB≥3.465 g/L,CC⁃16≥0.405 pg/mL、年龄≥60岁、肺功能Ⅲ-Ⅳ级、吸烟、合并症是患者预后不良的危险因素。结论年龄、肺功能分级、合并症等临床特征及血清MMP⁃12、FIB、CC⁃16水平对急性加重期COPD患者预后有重要的预测作用。

All-trans retinoic acid regulates the expression of MMP-2 and TGF-β2 via RDH5 in retinal pigment epithelium cells

·AIM: To investigate the effect of all-trans retinoic acid(ATRA) on retinol dehydrogenase 5(RDH5), matrix metalloproteinase-2(MMP-2) and transforming growth factor-β2(TGF-β2) transcription levels, and the effect of RDH5 on MMP-2 and TGF-β2 in retinal pigment epithelium(RPE) cells.·METHODS: After adult RPE cell line-19(ARPE-19 cells) intervened with gradient concentrations of ATRA(0-20 μmol/L) for 24h, flow cytometry was used to detect the proliferation and apoptosis of cells in each group, and quantitative realtime polymerase chain reaction(q RT-PCR) was used to detect RDH5, MMP-2 and TGF-β2 m RNA expression. Then, after ARPE-19 cells transfected with three different si RNA targets for 48h, the RDH5 knockdown efficiency of each group and expression of MMP-2 and TGF-β2 m RNA within them was detected by q RT-PCR. ·RESULTS: Flow cytometry results showed that ATRA could inhibit the proliferation of RPE cells and promote the apoptosis of RPE cells, and the difference of apoptosis was statistically significant when the ATRA concentration exceeded 5 μmol/L and compared with the normal control group(P=0.027 and P=0.031, respectively). q RT-PCR results showed that ATRA could significantly inhibit the expression level of RDH5 m RNA(P<0.001) and promote the expression of MMP-2 and TGF-β2 m RNA(P=0.03 and P<0.001, respectively) in a dose-dependent manner, especially when treated with 5 μmol/L ATRA. The knockdown efficiency of RDH5 si RNA varies with different targets, among which RDH5 si RNA-435 had the highest knockdown efficiency, i.e., more than 50% lower than that of the negative control group(P=0.02). When RDH5 was knocked down for 48h, the results of q RT-PCR showed that the expressions of MMP-2 and TGF-β2 m RNA were significantly up-regulated(P<0.001).·CONCLUSION: ATRA inhibits the expression of RDH5 and promotes MMP-2 and TGF-β2, and further RDH5 knockdown significantly upregulates MMP-2 and TGF-β2. These findings suggest that RDH5 may be involved in an epithelial-mesenchymal transition of RPE cells mediated by ATRA.