目的 观察吸烟慢性阻塞性肺疾病(COPD)患者肺组织基质金属蛋白酶-9(MMP-9)在肺内的分布和表达,分析其与气流受限、呼吸衰竭、生活质量、呼吸困难程度的关系,探讨COPD的可能发病机制,为临床提供防治新思路.方法 收集2010年10月至2011年10月天津医科大学总医院胸、肺外科手术肺肿瘤患者边缘肺组织(距肿瘤组织＞5 cm)标本63例.根据吸烟史、临床症状、体征、肺功能等将标本来源患者分为5组,不吸烟非COPD(A组)组、吸烟非COPD(B组)组、吸烟轻度COPD(C组)组、吸烟中度COPD(D组)组、吸烟重度COPD(E组)组,检测肺功能、血气分析、生活质量、呼吸困难程度,采用HE染色法观察各组肺组织形态学改变,采用免疫组织化学法,检测MMP-9在肺组织的分布与表达,并进行相关性分析.结果 ①(a)FEV1(L):D、E组与A、B、C各组比较差异有统计学意义(P＜0.05),且D、E组比较差异有统计学意义(P＜0.05).FEV1/FVC(％):除A、B组(P＞0.05)外,五组间比较差异有统计学意义(P＜0.05).(b)PaO2:D、E组与A、B、C各组比较差异有统计学意义(P＜0.05),且D、E组比较差异有统计学意义(P＜0.05).(c)CAT评分(分)及MMRC分级(级):除A组与B组,B组与C组(P＞0.05)外,五组间比较差异有统计学意义(P＜0.05).②中、重度COPD组有明显肺泡结构破坏,支气管壁、肺泡腔可见更多炎性细胞浸润,细胞外基质降解明显.③与非COPD、轻度COPD组比较,中、重度COPD组肺组织中可见大量MMP 9蛋白阳性细胞.五组间比较MMP-9的阳性系数值差异有统计学意义(P＜0.05).④相关分析:MMP-9的阳性系数与FEV1、FEV1％pred、FEV1/FVC、MEF50％ pred、MEF25％ pred呈直线负相关(r=-0.504,P=0.009;r=0.512,P=0.009;r=-0.534,P=0.008；r=-0.463,P=0.01;r=-0.461,P=0.015),与PaO2呈直线负相关(r=-0.450,P=0.021),与CAT评分及MMRC分级呈直线正相关(r=0.455,P=0.016；r=0.452,P=0.018).结论 ①吸烟可促进肺组织MMP-9表达.②随着COPD患者病情加重,MMP-9表达逐渐增强.③MMP 9与COPD患者肺功能下降,生活质量恶化,病情进展有关.
目的 觀察吸煙慢性阻塞性肺疾病(COPD)患者肺組織基質金屬蛋白酶-9(MMP-9)在肺內的分佈和錶達,分析其與氣流受限、呼吸衰竭、生活質量、呼吸睏難程度的關繫,探討COPD的可能髮病機製,為臨床提供防治新思路.方法 收集2010年10月至2011年10月天津醫科大學總醫院胸、肺外科手術肺腫瘤患者邊緣肺組織(距腫瘤組織＞5 cm)標本63例.根據吸煙史、臨床癥狀、體徵、肺功能等將標本來源患者分為5組,不吸煙非COPD(A組)組、吸煙非COPD(B組)組、吸煙輕度COPD(C組)組、吸煙中度COPD(D組)組、吸煙重度COPD(E組)組,檢測肺功能、血氣分析、生活質量、呼吸睏難程度,採用HE染色法觀察各組肺組織形態學改變,採用免疫組織化學法,檢測MMP-9在肺組織的分佈與錶達,併進行相關性分析.結果 ①(a)FEV1(L):D、E組與A、B、C各組比較差異有統計學意義(P＜0.05),且D、E組比較差異有統計學意義(P＜0.05).FEV1/FVC(％):除A、B組(P＞0.05)外,五組間比較差異有統計學意義(P＜0.05).(b)PaO2:D、E組與A、B、C各組比較差異有統計學意義(P＜0.05),且D、E組比較差異有統計學意義(P＜0.05).(c)CAT評分(分)及MMRC分級(級):除A組與B組,B組與C組(P＞0.05)外,五組間比較差異有統計學意義(P＜0.05).②中、重度COPD組有明顯肺泡結構破壞,支氣管壁、肺泡腔可見更多炎性細胞浸潤,細胞外基質降解明顯.③與非COPD、輕度COPD組比較,中、重度COPD組肺組織中可見大量MMP 9蛋白暘性細胞.五組間比較MMP-9的暘性繫數值差異有統計學意義(P＜0.05).④相關分析:MMP-9的暘性繫數與FEV1、FEV1％pred、FEV1/FVC、MEF50％ pred、MEF25％ pred呈直線負相關(r=-0.504,P=0.009;r=0.512,P=0.009;r=-0.534,P=0.008；r=-0.463,P=0.01;r=-0.461,P=0.015),與PaO2呈直線負相關(r=-0.450,P=0.021),與CAT評分及MMRC分級呈直線正相關(r=0.455,P=0.016；r=0.452,P=0.018).結論 ①吸煙可促進肺組織MMP-9錶達.②隨著COPD患者病情加重,MMP-9錶達逐漸增彊.③MMP 9與COPD患者肺功能下降,生活質量噁化,病情進展有關.
목적 관찰흡연만성조새성폐질병(COPD)환자폐조직기질금속단백매-9(MMP-9)재폐내적분포화표체,분석기여기류수한、호흡쇠갈、생활질량、호흡곤난정도적관계,탐토COPD적가능발병궤제,위림상제공방치신사로.방법 수집2010년10월지2011년10월천진의과대학총의원흉、폐외과수술폐종류환자변연폐조직(거종류조직＞5 cm)표본63례.근거흡연사、림상증상、체정、폐공능등장표본래원환자분위5조,불흡연비COPD(A조)조、흡연비COPD(B조)조、흡연경도COPD(C조)조、흡연중도COPD(D조)조、흡연중도COPD(E조)조,검측폐공능、혈기분석、생활질량、호흡곤난정도,채용HE염색법관찰각조폐조직형태학개변,채용면역조직화학법,검측MMP-9재폐조직적분포여표체,병진행상관성분석.결과 ①(a)FEV1(L):D、E조여A、B、C각조비교차이유통계학의의(P＜0.05),차D、E조비교차이유통계학의의(P＜0.05).FEV1/FVC(％):제A、B조(P＞0.05)외,오조간비교차이유통계학의의(P＜0.05).(b)PaO2:D、E조여A、B、C각조비교차이유통계학의의(P＜0.05),차D、E조비교차이유통계학의의(P＜0.05).(c)CAT평분(분)급MMRC분급(급):제A조여B조,B조여C조(P＞0.05)외,오조간비교차이유통계학의의(P＜0.05).②중、중도COPD조유명현폐포결구파배,지기관벽、폐포강가견경다염성세포침윤,세포외기질강해명현.③여비COPD、경도COPD조비교,중、중도COPD조폐조직중가견대량MMP 9단백양성세포.오조간비교MMP-9적양성계수치차이유통계학의의(P＜0.05).④상관분석:MMP-9적양성계수여FEV1、FEV1％pred、FEV1/FVC、MEF50％ pred、MEF25％ pred정직선부상관(r=-0.504,P=0.009;r=0.512,P=0.009;r=-0.534,P=0.008；r=-0.463,P=0.01;r=-0.461,P=0.015),여PaO2정직선부상관(r=-0.450,P=0.021),여CAT평분급MMRC분급정직선정상관(r=0.455,P=0.016；r=0.452,P=0.018).결론 ①흡연가촉진폐조직MMP-9표체.②수착COPD환자병정가중,MMP-9표체축점증강.③MMP 9여COPD환자폐공능하강,생활질량악화,병정진전유관.
Objective To evaluate the distribution and expression of matrix metalloproteinase (MMP)-9 in the lung tissues of COPD patients and its correlation with the level of airflow obstruction,respiratory failure,quality of life and dyspnoea.The purpose is to provide the new idea about its prevention and the therapy of COPD for clinic.Methods Totally sixty-three edge lung tissue samples (the distance of tumor tissue ＞5 cm) were selected from the chest surgical excision of lung tumor patientes in Thoracic Surgery,Pneumosurgery at the General Hospital,Tianjin Medical University.These tissue samples were assigned into non-smokers without COPD(A group) group,COPD patients without smoking (B group) group,mild COPD patients with smoking (C group) group,moderate COPD patients with smoking (D group) group,and severe COPD patients with smoking (E group) group.FEV1,FEV1％pred,FEV1/FVC,MEF50％pred,MEF25 ％pred,PaO2,PaCO2 of those were also tested respectively by pulmonary function instrument and blood gas analyzer,quality of life and the level of dyspnoea of those were also evaluated respectively by grading the scale of CAT,MMRC.The lung tissue pathology was observed with HE staining.Immunohistochemical staining was used to investigate the distribution and expression of MMP-9 in the lung tissues,and the correlative analysis was conducted.Results ①(a)FEV1 (L):There was statistical significant differences between each two different D,E and each two different A,B,C group in FEV1 (P ＜0.05).There was statistical significant differences between D and E group (P ＜0.05).FEV1/FVC(％):There was statistical significant differences between each two different A,B,C,D and E group in FEV1/FVC percentage (P ＜0.05),except between A and B group (P ＞0.05).(b)PaO2:There was statistical significant differences between each two different A,B,C,D and E group inPaO2(P＜0.05),except between A,B group,and B,C group (P＞0.05).(c)The scale of CAT and MMRC:There was statistical significant differences between each two different A,B,C,D and E group in the scale of CAT and MMRC (P ＜0.05),except between A,B group,and B,C group (P ＞0.05).②The alveoli of moderate and severe COPD patients have been significantly destroyed,the airway have remodeled,inflammation appeared in airway,the bronchus wall and the pulmonary alveoli have been filled with inflammatory cell,extracellular matrix have been apparently degradated.③The number of MMP-9 positive cells of moderate and severe COPD patients was significantly higher than that of mild COPD patients and patients without COPD.There was statistical significant differences between each two different A,B,C,D and E group in the positive expression of MMP-9 (P ＜0.05).The positive expression of MMP-9 in COPD group has the trend to ascend.④The correlation analysis:the expressions of MMP-9 in the five group was negative correlation with the FEV1,FVC％pred,FEV1/FVC,MEF50％pred,MEF25％pred (r =-0.504,P =0.009; r =-0.512,P =0.009; r =-0.534,P =0.008; r =-0.463,P =0.01; r =-0.461,P =0.015),negative correlation with the level of PaO2 (r =-0.450,P =0.032) and positive correlation with the Scale of CAT,classification of MMRC (r =0.455,P =0.016; r =0.452,P =0.018).Conclusions ①It was suggested that smoking can promot the expression of MMP-9 conditon.②It was suggested that the expression of MMP-9 increased as the COPD got worse.③It was suggested that the expression of MMP-9 was correlation with declining lung function decline,quality of life,COPD patients' conditon.
