李尚茹,罗璐玲,刘礼银,胡系伟,佘国
LI Shangru,LUO Luling,LIU liyin,HU Xiwei,SHE Guo

• 1:贵州医科大学附属医院全科医学科
• 2:贵州医科大学
• 3:贵州医科大学附属医院呼吸与危重症医学科
• 4:贵州医科大学附属医院临床检验中心

摘要(Abstract)：

目的探讨慢性阻塞性肺疾病(COPD)患者急性加重期治疗前后血清8-羟基-2'-脱氧鸟苷(8-OHd G)、C-反应蛋白(CRP)及降钙素原(PCT)水平的变化和意义。方法选取COPD急性加重期且治疗后进入稳定期的患者60例作为试验组,根据第一秒用力呼气容积(FEV1)%预测值分为轻+中度组(n=31,FEV_1%预测值≥50%)和重+极重度组(n=29,FEV1%预测值<50%)、收集2组患者的一般临床特征资料,同时选取年龄、性别与试验组相匹配的健康体检人群30例作为对照组;分别取试验组患者治疗前和出院前1天(治疗后)、健康对照组受检者体检日清晨空腹静脉血5 mL,采用酶联吸附法测定2组患者血清8-OHdG水平;抽取COPD 2组患者治疗前、后清晨空腹静脉血5 mL,分别采用超敏免疫比浊法和免疫荧光双抗体夹心法检测血清CRP、PCT水平,同时采用COPD测试(CAT)问卷对2组患者治疗前、后COPD常见症状进行测评,并采用肺功能测试仪对2组患者治疗后肺功能[FEV_1、FEV_1/用力肺活量(FVC)及FEV_1%预测值]进行检测,采用Spearman秩相关分析试验组患者治疗前后血清8-OHdG、CRP、PCT水平与CAT评分的相关性。结果试验组患者治疗前、后血清8-OHd G水平均高于对照组(P <0.05),试验组患者治疗后血清8-OHdG、CRP、PCT水平及CAT评分均较治疗前下降(P <0.05);轻+中度组患者呼吸衰竭发生率低于重+极重度组(P <0.05);轻+中度组患者和重+极重度组患者治疗后血清8-OHdG、CRP、PCT水平及CAT评分均较治疗前下降(P <0.05),重+极重度组患者治疗前、后血清8-OHdG、CRP及CAT评分均高于轻+中度组(P <0.05),重+极重度组患者治疗前血清PCT水平高于轻+中度组(P <0.05);试验组患者治疗前血清8-OHdG、CRP、PCT水平与CAT评分均呈正相关(P <0.05),治疗后仅血清8-OHdG水平与CAT评分呈正相关(P <0.05)。结论 COPD急性加重期患者治疗后血清8-OHdG、CRP及PCT水平较治疗前得到改善,其中血清8-OHdG水平可以用于评估COPD的严重程度。
Objective To investigate the changes and significance of serum levels of 8-OHdG,CRP and PCT in patients with AECOPD before and after treatment. Methods Sixty patients with COPD were selected as the experimental group who entered the stable period after treatment. According to the forced expiratory volume in one second percent(FEV_1%) predicted value,they were divided into mild+ moderate group(n = 31,FEV_1% pred≥50%) and severe-extremely severe group(n = 29,FEV_1%pred < 50%),and 30 healthy subjects were selected as the control group who matched with the experimental group in age and gender at the same time. Five mL of fasting venous blood in the morning was taken from the experimental group before treatment and 1 day before discharge(after treatment),the healthy control group's physical examination day,and the supernatant was centrifuged,the serum 8-OHdG level of the two groups was determined by enzymatic linked adsorption method. The general clinical characteristics of the mild + moderate group and the severe + extremely severe group were collected. Five mL of fasting venous blood in the morning was taken from the patients in the mild +moderate group and the severe + extremely severe group before and after treatment,the serum levels of CRP and PCT were detected by hypersensitive immunoturbidimetry and immunofluorescence double antibody sandwich method. Chronic obstructive pulmonary disease assessment test(CAT)questionnaire was used to evaluate the common symptoms of COPD before and after treatment in the mild + moderate group and the severe + extremely severe group. After treatment,lung function indicators(FEV1,FEV1/forced vital capacity(FVC) and FEV1% pred) of experimental group were detected by lung function tester,Spearman rank correlation analysis was used to analyze the correlation between serum levels of 8-OHdG,CRP,PCT,and CAT scores in experimental group before and after treatment. Results The serum 8-OHdG levels in experimental groups were higher than those in healthy control group before and after treatment(P < 0. 05),and the serum levels of 8-OHdG,CRP,PCT,and CAT scores in experimental groups after treatment were decreased compared with before treatment(P < 0. 05). The incidence of respiratory failure in the mild + moderate group was lower than that in the severe + extremely severe group(P < 0. 05). After treatment,the serum levels of 8-OHdG,CRP,PCT and CAT scores in mild + moderate group and severe + extremely severe group were significantly decreased compared with those before treatment(P < 0. 05). The serum levels of 8-OHdG,CRP,and CAT scores in the severe + extremely severe group were higher than those in mild+ moderate group before and after treatment(P < 0. 05),and the serum level of PCT in severe +extremely severe group was higher than that in mild + moderate group before treatment(P < 0. 05).Before treatment,the serum levels of 8-OHdG,CRP,and PCT were positively correlated with CAT score(P < 0. 05),however,the serum level of 8-OHdG was only positively correlated with CAT score after treatment(P < 0. 05). Conclusions The serum levels of 8-OHdG,CRP,and PCT in AECOPD patients are improved after treatment,and the serum 8-OHdG levels can assist in assessing the severity of COPD.

关键词(KeyWords)： 肺疾病,慢性阻塞性;C反应蛋白质;氧化应激;炎症反应;8-羟基脱氧鸟苷;降钙素原;CAT评分
pulmonary disease,chronic obstructive;C-reactive protein(CRP);oxidative stress;inflammatory response;8-hydroxy-2'-deoxyguanosine(8-OHdG);procalcitonin(PCT);CAT scores

Abstract:

Keywords:

基金项目(Foundation): 贵州医科大学国家自然科学基金培育项目(19NSP058)

作者(Author): 李尚茹,罗璐玲,刘礼银,胡系伟,佘国
LI Shangru,LUO Luling,LIU liyin,HU Xiwei,SHE Guo

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