摘要
目的探讨高血糖对慢性阻塞性肺疾病急性加重期患者炎性与血凝状态及肺功能影响。方法选择2014年12月至2016年12月于石家庄市第二医院诊断慢性阻塞性肺疾病急性加重期患者150例,依据患者入院24h内FPG水平分为正常血糖组80例,血糖升高组70例。比较两组第1秒用力呼气容积(FEV1)、第1秒用力呼气容积占用力肺活量的百分比(FEV1/FVC)、FEV1占预计值的百分比与6min步行距离。入院后24h内晨空腹抽取肘静脉,ELISA检测血清中白介素6(IL-6),单核细胞趋化蛋白1(MCP-1),中性粒细胞明胶酶蛋白(NGAL),免疫比浊法检测血清C-RP水平。酶联荧光分析法检测血浆D-二聚体(D-D)、纤维蛋白原(FIB),计算中性粒细胞与淋巴细胞比值(NLR)。结果与正常血糖组比较,血糖升高组FEV1[(1.55±0.28)vs(1.27±0.36)L,t=2.962]、FEV1/FVC[(58.51±11.62)%vs(43.90±10.58)%,t=2.781],FEV1占预计值的百分比[(48.18±12.54)%vs(34.87±11.96)%,t=2.961],6min步行距离[(412.59±61.69)vs(354.78±54.51)m,t=2.903]水平下降(P<0.05)。血清IL-6[(11.85±4.01)vs(22.70±3.52)ng/L,t=2.905]、MCP-1[(6.15±0.81)vs(9.83±0.76)pg/ml,t=2.991],NGAL[(1.03±0.25)vs(3.91±0.37)μg/L,t=2.740]、NLR[(1.79±0.54)vs(2.43±0.67),t=2.802],D-D[(1.18±0.45)vs(2.76±0.51)ng/ml,t=2.903]、FIB[(3.01±0.37)vs(4.78±0.25)g/L,t=2.691]升高(P<0.05)。相关分析显示,FPG与IL-6、MCP-1、NGAL、NLR、FIB、D-D水平有相关性。Logistic回归分析显示,IL-6、MCP-1、NGAL、NLR是影响血糖进一步升高主要危险因素。结论慢性阻塞性肺疾病急性加重期患者伴有高血糖状态时,其血清炎性反应程度明显升高,凝血功能紊乱加剧,肺功能损伤程度进一步加重。
Objective To investigate the effect and its mechanism of hyperglycemia on inflammatory and coagulation function and pulmonary function in patients with acute exacerbation of chronic obstructive pulmonary disease（COPD）. Methods A total of 150 patients with acute exacerbation of COPD were enrolled in this study from December 2014 to December 2016,and divided into two groups according to the fasting blood glucose level within 24 hours after admission：patients with normal blood glucose（n=80）and patients with elevated blood glucose（n=70）.The percentage of forced expiratory volume in the first second（FEV1）,the forced expiratory volume in the first second（FEV1/FVC）,the percentage of FEV1 in the predicted value and the walking distances of 6 mins were measured and compared between the two groups.Serum interleukin-6（IL-6）,monocyte chemoattractant protein-1（MCP-1）,and neutrophil gelatinase protein（NGAL）were tested by ELISA.Serum C-reactive protein（C-RP）was measured by serum turbidimetric assay.The levels of plasma D-dimer（D-D）and fibrinogen（FIB）were measured by enzyme-linked immunosorbent assay.The ratio of neutrophile granulocype and lymphocype（NLR）were calculated. Results The percentage of FEV1（1.27±0.36）vs（1.55±0.28）L,t=2.962）,FEV1/FVC[（43.90±10.58）% vs（58.51±11.62）%,t=2.781],the percentage of FEV1 in the predicted value[（34.87±11.96）% vs（48.18±12.54）%,t=2.961],and 6-min walking distance[（354.78±54.51）vs（412.59±61.69）m,t=2.903]were significantly lower in patients with elevated blood glucose than in patients with normal glucose group（P〈0.05）.Serum IL-6[（22.70±3.52）vs（11.85±4.01）ng/L,t=2.905],MCP-1[（9.83±0.76）vs（6.15±0.81）pg/ml,t=2.401],NGAL[（3.91±0.37）vs（1.03±0.25）μg/L,t=2.740],NLR[（2.43±0.67）vs（1.79±0.54）,t=2.802],plasma D-D[（2.76±0.51）vs（1.18±0.45）ng/ml,t=2.903）and FIB [（4.78±0.25）vs（3.01±0.37）g/L,t=2.691]were significantly higher in patients with elevated blood glucose than in patients with normal glucose group（P〈0.05）.Correlation analysis showed that FPG was associated with IL-6,MCP-1,NGAL,NLR,FIB and D-D.Logistic regression analysis showed that IL-6,MCP-1,NGAL and NLR were main risk factors for hyperglycemia. Conclusion Hyperglycemia can increase the degree of inflammatory reaction,promote coagulation dysfunction and aggravate the degree of lung function injury in patients with acute exacerbation of chronic obstructive pulmonary disease.
作者
吕侯强
崔淑芬
谢轩
范素芳
杨丛丽
LV Houqiang,CUI Shufen,XIE Xuan, et al.(Department of Respiratory Medicine, Second Hospital of Shijiazhuang, Shijiazhuang 050051, China)
出处
《中国糖尿病杂志》
CAS
CSCD
北大核心
2018年第8期657-661,共5页
Chinese Journal of Diabetes
基金
河北省医学科学研究重点课题计划(No.20181037)
关键词
慢性阻塞性肺疾病
高血糖
D-二聚体
炎性反应
肺功能
Chronic obstructive pulmonary disease
Hyperglycemia
D-dimer
Inflammatory response
Pulmonary function
