摘要目的 探讨因肺部肿瘤行手术治疗的患者中肺功能正常吸烟者和慢阻肺患者的小气道上皮间质转化(EMT)现象.方法 选择2018年1月至2019年1月宁夏医科大学总医院胸外科收治的因肺部肿瘤行手术治疗的患者52例,分为A组(肺功能正常不吸烟组,15例),B组(肺功能正常吸烟组,21例),C组(吸烟慢阻肺稳定期组,16例).HE染色观察3组患者肺组织和小气道的病理变化;免疫组化检测3组患者小气道上皮细胞标志物E-钙黏蛋白、α-平滑肌肌动蛋白(α-SMA)和波形蛋白的定位及表达,并用Western印迹法检测上述蛋白表达水平的变化.结果 (1)3组患者年龄、性别和疾病构成比比较,差异均无统计学意义(均P＞0.05),但C组第一秒用力呼气容积(FEV1)与用力肺活量(FVC)的比值(FEV1/FVC)和FEV1占预计值的百分比(FEV1％预计值)均显著低于A、B组(均P＜0.01),但A组和B组差异无统计学意义(P＞0.05);(2)B、C组小气道管壁厚度均显著大于A组[(32.4±2.4)、(54.6±4.9)比(22.4±2.2)μm],且C组显著大于B组(P=0.003);(3)B、C组小气道E-钙黏蛋白相对表达量均显著低于A组(0.021±0.008、0.018±0.007比0.062±0.010)(均P＜0.05),而B、C组α-SMA和波形蛋白的相对表达量均显著高于A组,且C组显著高于B组(0.641±0.113、0.780±0.133比0.404±0.123和0.064±0.033、0.083±0.022比0.030±0.021)(P=0.002和P=0.003).结论 在肺部肿瘤行手术治疗患者中,合并慢阻肺患者的小气道中存在EMT现象,且在肺功能正常吸烟者小气道中已经发生了EMT.

abstractsObjective To investigate the phenomenon of small airway epithelial-mesenchymal transition (EMT) in patients with normal pulmonary function and chronic obstructive pulmonary disease (COPD) who received surgical treatment for lung tumors.Methods In this study,52 patients undergoing surgical treatment for lung tumors admitted to the General Hospital of Ningxia Medical University were included from January 2018 to January 2019.According to the preoperative pulmonary function and smoking history,patients were divided into group A (non-smoking with normal pulmonary function group,15 patients),group B (smoking with normal pulmonary function group,21 patients),group C (COPD stable phase group,16 patients).HE staining was performed to observe the pathological changes in small airway and lung tissue.Immunohistochemistry was used to detect the localization and expression of E-cadherin,α-smooth muscle actin (α-SMA) and Vimentin in small airway.Western blot was used to detect the levels of E-cadhefin,α-SMA and Vimentin.Results (1) There were no significant differences in age,gender,and the ratio of disease composition among the three groups (P＞0.05),but forced expiratory volume in one second (FEV1) as percentage of predicted value (FEV1％pred) and FEV1/forced vital capacity (FEV1/FVC) in group C were lower than those in groups A and B (all P＜0.01),while there was no significant difference between group A and group B (P＞0.05);(2) the bronchial wall thickness in group B and group C were higher than that of group A [(32.4±2.4) and (54.6±4.9) vs (22.4±2.2) μm],and group C was significantly higher than group B (P=0.003);(3) the expression levels of E-cadherin in the epithelial cells of small airway in group B and group C were lower than those in group A (0.021±0.008 and 0.018±0.007 vs 0.062±0.010) (all P＜0.05),while the levels of mesenchymal cell markers such as α-SMA and Vimentin in group B and group C were higher than group A,and group C was higher than group B (α-SMA:0.641 ±0.113,0.780±0.133 vs 0.404±0.123;Vimentin:0.064±0.033,0.083±0.022 vs 0.030±0.021) (P=0.002 and P=0.003).Conclusion In patients undergoing surgical treatment of lung tumors,there is EMT in the small airways of patients with COPD,and EMT has occurred in the small airways of smokers with normal pulmonary function.