吸烟对COPD患者尿锁链素及肺功能的影响

徐德华++++++陈晓东++++++刘华清++++++唐纪文++++++叶妙琴

[摘要]目的 探讨吸烟对COPD患者尿锁链素水平及肺功能的影响。方法 选择2016年1～6月我院60例处于稳定期的COPD患者作为研究对象，根据是否吸烟将其分为COPD吸烟组30例和COPD非吸烟组30例，选取同期来医院进行健康体检的30例健康人作为健康对照组。采用间接竞争性酶联免疫吸附法测定所有受试者的尿锁链素水平，同时检测受试者的肺功能。结果 COPD吸烟组及COPD非吸烟组尿锁链素水平均显著高于健康对照组（P<0.05），而第1秒用力呼气量占用力肺活量百分率（FEV1%）则显著低于健康对照组（P<0.05）；COPD吸烟组尿锁链素水平较COPD非吸烟组高（P<0.05）；COPD吸烟组FEV1%低于COPD非吸烟组（P<0.05）；COPD吸烟组受试者吸烟指数与尿锁链素水平呈正相关（r=0.435，P<0.05），而与FEV1%呈明显负相关（r=-0.516，P<0.05），尿锁链素水平与FEV1%呈负相关（r=-0.614，P<0.05）。结论 吸烟可引起COPD患者尿锁链素水平升高，FEV1%降低。尿锁链素的变化提示发生肺部损伤的可能性。戒烟是预防和干预COPD的重要措施。

[关键词]慢性阻塞性肺疾病；尿锁链素；肺功能

[中图分类号] R563 [文献标识码] A [文章编号] 1674-4721（2016）10（c）-0023-03

[Abstract]Objective To explore the effect of smoking on the lung function and urine desmosine with chronic obstructive pulmonary disease （COPD）.Methods 60 cases of COPD patients in stable phase admitted in our Hospital from January to June 2016 were divided into COPD smoking group（n=30） and COPD nonsmoking group（n=30），and another 30 healthy people underwent physical examination during the same period were selected as the control group.The levels of urine desmosine of all the cases were measured by indirect competitive enzyme-linked immunosorbent assay （IC-ELISA），at the same time their lung function was also tested.Results The levels of urine desmosine in COPD smoking group and COPD nonsmoking group was significantly higher than that of the control group respectively（P<0.05），while FEV1% of the two COPD groups was significantly lower than that of the control group respectively（P<0.05）；the level of urine desmosine of COPD smoking group was significantly higher than that of COPD nonsmoking group（P<0.05），and FEV1% of COPD smoking group was significantly lower than that of COPD nonsmoking group（P<0.05）.Smoking index was positively correlated with the levels of urine desmosine（r=0.435，P<0.05），and smoking index negatively correlated with FEV1% and the levels of urine desmosine （r1=-0.516，r2=-0.614，P<0.05）.Conclusion Smoking can lead to the rise of the levels of urine desmosine and the reduce of FEV1%.Changes in urine desmosine suggest the possibility of lung injury.Smoking cessation is an important measure to prevent and interfere with COPD.

[Key words]Chronic obstructive pulmonary disease；Urine desmosine；Lung function

长期吸烟是现在已知慢性阻塞性肺疾病（COPD）的最重要诱因。吸烟可以引起多种炎症细胞聚集在肺中，蛋白水解酶-抗蛋白水解酶体系失衡、氧化应激以及凋亡机制，导致慢性气道炎症[1]。有研究认为COPD病因可能与肺脏吸入烟草、烟雾等有毒、有害气体或颗粒产生的异常炎症反应有关。程显声等[2]研究证实，在我国导致COPD的最主要因素也是吸烟。近年研究发现，锁链素（desmosine，DES）是弹性蛋白的特征性产物和肺损伤的生物标志物[3]。相关研究结果表明，DES在尿中排泄量的多少能够准确反映COPD患者肺组织损伤的程度。本研究通过测定COPD患者在吸烟和非吸烟和健康人群中尿DES水平以及肺功能的变化，旨在探讨尿DES与吸烟相关COPD发病的关联性。

1资料与方法

1.1一般资料

选择2016年1～6月于惠州市中医医院呼吸科门诊就诊的处于稳定期的COPD患者60例。COPD纳入标准：符合2011年修订的《慢性阻塞性肺疾病诊治指南》诊断标准。……