中国全科医学
中國全科醫學
중국전과의학
Chinese General Practice
2015年
34期
4210-4215
,共6页
肺疾病,慢性阻塞性%脂代谢%促血管生成素2%病情严重程度
肺疾病,慢性阻塞性%脂代謝%促血管生成素2%病情嚴重程度
폐질병,만성조새성%지대사%촉혈관생성소2%병정엄중정도
Pulmonary disease,chronic obstructive%Lipid metabolism%Angiogenin 2%Severity of illness
目的：探讨慢性阻塞性肺疾病（COPD）患者脂代谢和血清促血管生成素2（ANG2）水平与病情严重程度的关系。方法采用随机数字表法选取2012年11月—2014年1月河北省人民医院收治的COPD患者185例作为COPD组，另选取同期本院体检健康者30例作为对照组。COPD组患者给予沙美特罗替卡松联合噻托溴铵粉吸入剂吸入治疗。分别于对照组入选次日和观察组治疗前（T0）和治疗1周（T1）、2周（T2）、1个月（T3）和3个月（T4）采集空腹静脉血5 ml，检测血清ANG2水平和血浆总胆固醇（ TC）、三酰甘油（ TG）、高密度脂蛋白胆固醇（ HDL-C）和低密度脂蛋白胆固醇（ LDL-C）水平，并评估BODE指数（ B为体质指数，O为气流阻塞程度，D为呼吸困难，E为运动能力）。比较不同BODE指数分级COPD患者治疗前后的血脂水平和血清ANG2水平并分析COPD患者脂代谢紊乱、血清ANG2水平与其BODE指数的关系。结果 COPD组和对照组HDL-C、LDL-C水平比较，差异均无统计学意义（P﹥0.05）；COPD组和对照组TC、TG、ANG2水平和BODE指数比较，差异均有统计学意义（P﹤0.05）；其中与COPD组T0比较，COPD组T2、T3、T4 TC、TG水平均升高，ANG2水平和BODE指数均降低，差异有统计学意义（P﹤0.05）；对照组TC、TG水平均高于COPD组T0、T1、T2、T3、T4时，ANG2水平和BODE指数均低于COPD组T0、T1、T2、T3、T4时，差异有统计学意义（P﹤0.05）。T0和T4时，COPD组BODE指数分级分布比较，差异有统计学意义（U＝9.25，P﹤0.01）。T0、T4时，不同BODE指数分级患者HDL-C、LDL-C水平比较，差异均无统计学意义（P﹥0.05）；不同BODE指数分级患者TC、TG、ANG2水平比较，差异均有统计学意义（P﹤0.05）；其分级越高， TC、TG水平越低，ANG2水平越高，差异均有统计学意义（ P﹤0.05）。Pearson相关分析结果显示，COPD患者TC、TG水平与 BODE 指数呈负相关（r ＝-0.941、-0.940，P ﹤0.05），血清 ANG2水平与 BODE 指数呈正相关（r＝0.921，P﹤0.05）。COPD患者治疗期间不良反应症状均较轻微且均可在不加干预的情况下于3 d内消失。结论COPD患者存在脂代谢紊乱和血清ANG2水平升高，且其血脂水平和血清ANG2水平均与其病情严重程度相关，这可能与ANG2与Tie受体结合引发内皮细胞凋亡和血管退化及COPD患者营养不良导致血脂水平降低有关，COPD患者脂代谢和血清ANG2可作为其病情严重程度评价的参考指标。
目的：探討慢性阻塞性肺疾病（COPD）患者脂代謝和血清促血管生成素2（ANG2）水平與病情嚴重程度的關繫。方法採用隨機數字錶法選取2012年11月—2014年1月河北省人民醫院收治的COPD患者185例作為COPD組，另選取同期本院體檢健康者30例作為對照組。COPD組患者給予沙美特囉替卡鬆聯閤噻託溴銨粉吸入劑吸入治療。分彆于對照組入選次日和觀察組治療前（T0）和治療1週（T1）、2週（T2）、1箇月（T3）和3箇月（T4）採集空腹靜脈血5 ml，檢測血清ANG2水平和血漿總膽固醇（ TC）、三酰甘油（ TG）、高密度脂蛋白膽固醇（ HDL-C）和低密度脂蛋白膽固醇（ LDL-C）水平，併評估BODE指數（ B為體質指數，O為氣流阻塞程度，D為呼吸睏難，E為運動能力）。比較不同BODE指數分級COPD患者治療前後的血脂水平和血清ANG2水平併分析COPD患者脂代謝紊亂、血清ANG2水平與其BODE指數的關繫。結果 COPD組和對照組HDL-C、LDL-C水平比較，差異均無統計學意義（P﹥0.05）；COPD組和對照組TC、TG、ANG2水平和BODE指數比較，差異均有統計學意義（P﹤0.05）；其中與COPD組T0比較，COPD組T2、T3、T4 TC、TG水平均升高，ANG2水平和BODE指數均降低，差異有統計學意義（P﹤0.05）；對照組TC、TG水平均高于COPD組T0、T1、T2、T3、T4時，ANG2水平和BODE指數均低于COPD組T0、T1、T2、T3、T4時，差異有統計學意義（P﹤0.05）。T0和T4時，COPD組BODE指數分級分佈比較，差異有統計學意義（U＝9.25，P﹤0.01）。T0、T4時，不同BODE指數分級患者HDL-C、LDL-C水平比較，差異均無統計學意義（P﹥0.05）；不同BODE指數分級患者TC、TG、ANG2水平比較，差異均有統計學意義（P﹤0.05）；其分級越高， TC、TG水平越低，ANG2水平越高，差異均有統計學意義（ P﹤0.05）。Pearson相關分析結果顯示，COPD患者TC、TG水平與 BODE 指數呈負相關（r ＝-0.941、-0.940，P ﹤0.05），血清 ANG2水平與 BODE 指數呈正相關（r＝0.921，P﹤0.05）。COPD患者治療期間不良反應癥狀均較輕微且均可在不加榦預的情況下于3 d內消失。結論COPD患者存在脂代謝紊亂和血清ANG2水平升高，且其血脂水平和血清ANG2水平均與其病情嚴重程度相關，這可能與ANG2與Tie受體結閤引髮內皮細胞凋亡和血管退化及COPD患者營養不良導緻血脂水平降低有關，COPD患者脂代謝和血清ANG2可作為其病情嚴重程度評價的參攷指標。
목적：탐토만성조새성폐질병（COPD）환자지대사화혈청촉혈관생성소2（ANG2）수평여병정엄중정도적관계。방법채용수궤수자표법선취2012년11월—2014년1월하북성인민의원수치적COPD환자185례작위COPD조，령선취동기본원체검건강자30례작위대조조。COPD조환자급여사미특라체잡송연합새탁추안분흡입제흡입치료。분별우대조조입선차일화관찰조치료전（T0）화치료1주（T1）、2주（T2）、1개월（T3）화3개월（T4）채집공복정맥혈5 ml，검측혈청ANG2수평화혈장총담고순（ TC）、삼선감유（ TG）、고밀도지단백담고순（ HDL-C）화저밀도지단백담고순（ LDL-C）수평，병평고BODE지수（ B위체질지수，O위기류조새정도，D위호흡곤난，E위운동능력）。비교불동BODE지수분급COPD환자치료전후적혈지수평화혈청ANG2수평병분석COPD환자지대사문란、혈청ANG2수평여기BODE지수적관계。결과 COPD조화대조조HDL-C、LDL-C수평비교，차이균무통계학의의（P﹥0.05）；COPD조화대조조TC、TG、ANG2수평화BODE지수비교，차이균유통계학의의（P﹤0.05）；기중여COPD조T0비교，COPD조T2、T3、T4 TC、TG수평균승고，ANG2수평화BODE지수균강저，차이유통계학의의（P﹤0.05）；대조조TC、TG수평균고우COPD조T0、T1、T2、T3、T4시，ANG2수평화BODE지수균저우COPD조T0、T1、T2、T3、T4시，차이유통계학의의（P﹤0.05）。T0화T4시，COPD조BODE지수분급분포비교，차이유통계학의의（U＝9.25，P﹤0.01）。T0、T4시，불동BODE지수분급환자HDL-C、LDL-C수평비교，차이균무통계학의의（P﹥0.05）；불동BODE지수분급환자TC、TG、ANG2수평비교，차이균유통계학의의（P﹤0.05）；기분급월고， TC、TG수평월저，ANG2수평월고，차이균유통계학의의（ P﹤0.05）。Pearson상관분석결과현시，COPD환자TC、TG수평여 BODE 지수정부상관（r ＝-0.941、-0.940，P ﹤0.05），혈청 ANG2수평여 BODE 지수정정상관（r＝0.921，P﹤0.05）。COPD환자치료기간불량반응증상균교경미차균가재불가간예적정황하우3 d내소실。결론COPD환자존재지대사문란화혈청ANG2수평승고，차기혈지수평화혈청ANG2수평균여기병정엄중정도상관，저가능여ANG2여Tie수체결합인발내피세포조망화혈관퇴화급COPD환자영양불량도치혈지수평강저유관，COPD환자지대사화혈청ANG2가작위기병정엄중정도평개적삼고지표。
Objective To investigate lipid metabolism and serum angiogenin 2(ANG2)level in patients with chronic obstructive pulmonary disease( COPD) and their relationship with illness severity. Methods Using convenience number table method,we enrolled 185 COPD patients who were admitted into Hebei General Hospital from November 2012 to January 2014. We also enrolled 30 healthy people who received physical examination in the same period in the hospital as control group. COPD group was administrated with inhalation powder of salmeterol and fluticasone propionate combined with tiotropium bromide. Fasting venous blood was taken on the next day after the inclusion from control group and was taken before treatment(T0),after 1-week treatment(T1),2-week treatment(T2),1 -month treatment(T3)and 3 -month treatment(T4)from COPD group. Then serum ANG2 level,TC,TG,HDL-C and LDL-C were detected,and BODE indexes were evaluated. Blood lipid level and serum ANG2 level were compared among COPD patients with different BODE index grades before and after treatment,and relationship between dyslipidemia and serum ANG2 level of the patients and BODE index. Results COPD group and control group were not significantly different in the levels of HDL-C and LDL-C( P﹥0. 05 for all);COPD group and control group were significantly different in the levels of TC,TG and ANG2 and BODE indexes( P﹤0. 05 for all);in COPD group,the levels of TC and TG at T2,T3 and T4 were higher than those of T0(P﹤0. 05),and the ANG2 level and BODE index of T2,T3 and T4 were lower than those of T0(P﹤0. 05);control group was higher in the levels of TC and TG and were lower in ANG2 level and BODE index than COPD group at T0 ,T1 ,T2 ,T3 and T4 ( P﹤0. 05 for all). There were significant differences in the BODE index grading distribution between T0 and T4(U =9. 25,P ﹤0. 01). At T0 and T4,patients with different BODE index grades were not significantly different in the levels of HDL-C and LDL-C( P﹥0. 05 for all);patients with different BODE index grades were significantly different in the levels of TC,TG and ANG2( P ﹤0. 05 for all);higher BODE index grades were associated with lower levels of TC and TG and higher ANG2 level ( P ﹤0. 05 for all ). Pearson correlation analysis showed that the levels of TC and TG of COPD patients were negatively correlated with BODE index ( r= -0. 941,-0. 940,P﹤0. 05),and were positively correlated with serum ANG2 level and BODE index( r=0. 921,P﹤0. 05). The adverse responses during the treatment of COPD patients were all slight and disappeared within 3 days without intervention. Conclusion Patients with COPD has disorder of lipid metabolism and high serum ANG2 level,and the blood lipid level and the level of serum ANG2 are related to their illness severity. It may be related with endothelial cell apoptosis and vascular degeneration induced by ANG2 combining with Tie receptors and lower blood lipid level induced by malnutrition in patients with COPD,thus lipid metabolism and serum ANG2 of COPD patients can be used as reference indicators for their illness severity.
