摘要目的 研究探讨血清Ⅰ型胶原氨基端前肽(PINP)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)在慢性阻塞性肺疾病急性加重期(AECOPD)并肺源性心脏病患者的水平变化及临床意义.方法 研究时间为2016年1月至2018年1月,研究对象选择60例就诊于广东省人民医院南海医院的AECOPD合并肺源性心脏病患者、60例就诊于广东省人民医院南海医院的慢性阻塞性肺疾病(COPD)缓解期合并肺源性心脏病患者与60例在广东省人民医院南海医院行健康体检且年龄性别相匹配的健康体检者,分别设置为急性加重期组、缓解期组、对照组,采用免疫电化学发光法对其血清PINP、β-CTX表达水平进行检测,比较3组的血清PINP、β-CTX表达水平,并分析血清PINP、β-CTX表达水平与AECOPD合并肺源性心脏病的相关性.根据其心肺功能情况将急性加重期组患者分为肺功能轻度受损合并心功能Ⅱ级组、肺功能中重度受损合并心功能Ⅲ级组,比较不同程度心肺功能受损患者的血清PINP、β-CTX表达水平,并分析血清PINP、β-CTX表达水平与AECOPD合并肺源性心脏病患者心肺功能的相关性.结果 (1)急性加重期组的血清PINP、β-CTX表达水平明显低于缓解期组、对照组(F=167.707,77.260,P值均＜0.01),而缓解期组的血清PINP、β-CTX表达水平低于对照组(F=167.707,77.260,P值均＜0.01).经相关性分析,血清PINP、β-CTX表达水平与AECOPD合并肺源性心脏病的发生呈负相关.(2)肺功能中重度受损合并心功能Ⅲ级组的血清PINP、β-CTX表达水平明显低于肺功能轻度受损合并心功能Ⅱ级组(t =4.556,4.217,P值均＜0.01).经相关性分析发现,血清PINP、β-CTX表达水平与AECOPD合并肺源性心脏病患者的心肺功能呈正相关.结论 血清PINP、β-CTX在AECOPD合并肺源性心脏病患者中的表达水平普遍下降,其表达水平随着AECOPD合并肺源性心脏病患者的心肺功能下降而降低,可作为AECOPD合并肺源性心脏病患者病情评估的辅助指标,还可对AECOPD合并肺源性心脏病患者的骨质疏松症风险给予预测.

abstractsObjective To study the serum type Ⅰ procollagen amino terminal peptide (PINP),procollagen type Ⅰ carboxy terminal peptide beta special sequence (β-CTX) in the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and level change and clinical significance in patients with pulmonary heart disease.Methods The study time is from January 2016 to January 2018,the research object to choose 60 patients with AECOPD complicated with pulmonary heart disease in Guangdong Provincial People's Hospital Nanhai Hospital,60 patients with pulmonary heart disease during remission of COPD in Guangdong Provincial People's Hospital Nanhai Hospital,with 60 cases in Guangdong Provincial People's Hospital Nanhai Hospital physical examination of sex and age matched healthy check-up,respectively is set to the acute aggravating period group,the remission group and the control group,by using the method of electrochemical luminescence immune serum PINP,β-CTX expression level testing,comparing three groups of serum PINP,β-CTX expression level,and analyze serum PINP,β-CTX expression level and the correlation of AECOPD complicated with pulmonary heart disease.According to their cardiopulmonary function in patients with acute aggravating period group can be divided into mild impairment of pulmonary function combined with cardiac function Ⅱ group,severe pulmonary function impairment and cardiac function Ⅲ group,compare different degree of cardiopulmonary function damage in patients with serum PINP,β-CTX expression level,and analyze serum PINP,β-CTX expression level and the correlation of cardiopulmonary function in patients with AECOPD complicated with pulmonary heart disease.Results (1)The acute aggravating period of serum PINP,β-CTX expression level significantly lower than that of the remission group and the control group (F =167.707,77.260,both P ＜0.01),whereas remission group serum PINP,β-CTX expression level is lower than that of the control group (F =167.707,77.260,both P ＜0.01).Through correlation analysis,serum PINP,β-CTX expression level and negatively correlated with the occurrence of AECOPD complicated with pulmonary heart disease.(2)The levels of serum PINP and β-CTX in patients with severe pulmonary function impairment and cardiac function Ⅲ were significantly lower than those of with mild pulmonary function impairment and cardiac function Ⅱ group (t =4.556,4.217,both P ＜0.01).Through correlation analysis,found that serum PINP,β-CTX expression levels and cardiopulmonary function in patients with AECOPD complicated with pulmonary heart disease were positively correlated.Conclusions Serum PINP,β-CTX expression level in patients with AECOPD complicated with pulmonary heart disease generally decline,with its expression level decreases with the decrease of cardiopulmonary function in patients with AECOPD complicated with pulmonary heart disease,can be used as an auxiliary indicator for the assessment of patients with AECOPD complicated with pulmonary heart disease,and can also predict the risk of osteoporosis in patients with AECOPD complicated with pulmonary heart disease.