慢性阻塞性肺疾病合并支气管扩张的相关临床研究_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

齐玉晶 , 宾雁飞 ^△ ,  何志义

广西医科大学第一附属医院呼吸与危重症医学科（广西南宁 530021）;

Corresponding author：

何志义, Email: zhiyi-river@163.com

Keywords：

慢性阻塞性肺疾病; 支气管扩张; BODE 指数; 中性粒细胞弹性蛋白酶; 基质金属蛋白酶-9

DOI：

10.7507/1671-6205.201901013

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目的探讨慢性阻塞性肺疾病（简称慢阻肺）合并支气管扩张患者的临床特点及痰和血清中中性粒细胞弹性蛋白酶（NE）、基质金属蛋白酶-9（MMP-9）的表达情况。方法收集呼吸科门诊定期检查的中重度稳定期慢阻肺患者 25 例，行胸部高分辨 CT 检查，按照支气管扩张评分将患者分为单纯慢阻肺组 14 例及慢阻肺合并支气管扩张组 11 例。患者给予体重指数（BMI）、肺功能、改良英国医学研究委员会问卷（mMRC）、6 分钟步行距离（6MWD）评分，通过 BMI、气流受限程度、呼吸困难、运动耐量评定 BODE 指数。留取患者外周静脉血和诱导痰，采用酶联免疫吸附试验分别测定血清和痰的 NE 和 MMP-9 水平；根据痰涂片计数白细胞总数和分类。结果与单纯慢阻肺组相比，慢阻肺合并支气管扩张组 BODE 指数显著增高（5.2±1.2 比 3.6±1.3，P<0.01）；mMRC 评分显著升高［（1.5±0.5）分比（0.8±0.6）分，P<0.01］。FEV₁%pred、BMI、6MWD 无明显差异。慢阻肺合并支气管扩张组痰中巨噬细胞显著增多［（0.62±0.07）×10⁶/ml 比（0.50±0.07）×10⁶/ml，P<0.05］，MMP-9 表达增高［（32.6±5.08）ng/ml 比（28.1±5.14）ng/ml，P<0.05］。慢阻肺合并支气管扩张组支气管扩张评分与 BODE 指数呈显著正相关（r=0.869，P<0.01），与痰 MMP-9 也呈显著正相关（r=0.625，P<0.05）。结论慢阻肺合并支气管扩张的患者较单纯慢阻肺对比其 MMP-9 在痰上清水平增高，mMRC 评分及 BODE 指数更高，生活质量更差。

Citation： 齐玉晶, 宾雁飞, 何志义. 慢性阻塞性肺疾病合并支气管扩张的相关临床研究. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(5): 484-487. doi: 10.7507/1671-6205.201901013 Copy

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1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med, 2006, 3(11): e442.
2. Hurst JR, Elborn JS, De Soyza A. COPD-bronchiectasis overlap syndrome. Eur Respir J, 2015, 45(2): 310-313.
3. Patel IS, Vlahos I, Wilkinson TM, et al. Bronchiectasis, exacerbation indices, and inflammation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2004, 170(4): 400-407.
4. Minov J, Stoleski S, Mijakoski D, et al. Exacerbations in COPD patients with bronchiectasis. Med Sci (Basel), 2017, 5(2): pii: E7.
5. Martinez-Garcia MA, de la Rosa Carrillo D, Soler-Cataluna JJ, et al. Prognostic value of bronchiectasis in patients with moderate-to-severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2013, 187(8): 823-831.
6. Pin I, Gibson PG, Kolendowicz R, et al. Use of induced sputum cell counts to investigate airway inflammation in asthma. Thorax, 1992, 47(1): 25-29.
7. Ooi GC, Khong PL, Chan-Yeung M, et al. High-resolution CT quantification of bronchiectasis: clinical and functional correlation. Radiology, 2002, 225(3): 663-672.
8. Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med, 2004, 350(10): 1005-1012.
9. Martinez-Garcia MA, Soler-Cataluna JJ, Perpina-Tordera M, et al. Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. Chest, 2007, 132(3): 1565-1572.
10. GOLD. Global Strategy for the Diagnosis Management, and Prevention of Chronic Obstructive Pulmonary Disease. Available at: https://goldcoped.org/, 2014.
11. Blasi F, Chalmers JD, Aliberti S. COPD and bronchiectasis: phenotype, endotype or co-morbidity?. COPD, 2014, 11(6): 603-604.
12. Smith IE, Jurriaans E, Diederich S, et al. Chronic sputum production: correlations between clinical features and findings on high resolution computed tomographic scanning of the chest. Thorax, 1996, 51(9): 914-918.
13. Demkow U, van Overveld FJ. Role of elastases in the pathogenesis of chronic obstructive pulmonary disease: implications for treatment. Eur J Med Res, 2010, 15(Suppl 2): 27-35.
14. Gramegna A, Amati F, Terranova L, et al. Neutrophil elastase in bronchiectasis. Respir Res, 2017, 18: 211.
15. Churg A, Zhou S, Wright JL. Series "matrix metalloproteinases in lung health and disease": matrix metalloproteinases in COPD. Eur Respir J, 2012, 39(1): 197-209.
16. Pifferi M, Bush A, Caramella D, et al. Matrix metalloproteinases and airway remodeling and function in primary ciliary dyskinesia. Respir Med, 2017, 124: 49-56.
17. Bchir S, Nasr HB, Bouchet S, et al. Concomitant elevations of MMP-9, NGAL, proMMP-9/NGAL and neutrophil elastase in serum of smokers with chronic obstructive pulmonary disease. J Cell Mol Med, 2017, 21(7): 1280-1291.

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