慢性阻塞性肺疾病急性加重期患者血浆选择素相关蛋白水平的观察

目的 探讨整合素相关蛋白CD_(47)和P-选择素在COPD发病中的作用.方法 病例来自2008年10月至2009年3月在遵义医学院附属医院呼吸一科住院的COPD患者35例,其中男26例,女9例;年龄55～84岁,平均(65±7)岁.未经任何治疗时为急性加重期(AECOPD)组,经过抗感染、解痉平喘、祛痰、吸氧和支持等治疗,达到临床缓解时为稳定期组.同期体检的健康志愿者加名为对照组,其中男14名,女6名;年龄45～80岁,平均(59±7)岁.采用流式细胞术检测所有研究对象外周血浆中CD_(47)和P-选择素水平,并检测血小板计数.采用SNK-q检验和Pearson回归分析进行相关性分析.结果 AECOPD组CD_(47)阳性率为(93±4)%,明显高于稳定期组的(72±11)%和对照组的(67±10)%,差异均有统计学意义(q值分别为11.26和13.32,均P＜0.01),稳定期组与对照组的差异无统计学意义(q=1.73,P＞0.05);AECOPD组P-选择素阳性率为(35±11)%],明显高于稳定期组(12±8)%]和对照组(10±4)%],差异均有统计学意义(q值分别为9.93和12.19,均P＜.0.05),稳定期组也明显高于对照组,差异有统计学意义(q=1.90,P＜0.05);AECOPD组血小板计数为(188±56)×10~9/L,与稳定期组的(213±57)×10~9/L和对照组的(204±51)×10~9/L比较,差异无统计学意义(F=1.74,P＞0.05);AECOPD组CD_(47)与P-选择素呈正相关(r=0.77,P＜0.01),稳定期及对照组CD_(47)与P-选择素均无相关性(r值分别为-0.04和-0.15,均P＞0.05).结论 CD_(47)和P-选择素作为血小板活化标志物,在AECOPD时明显增高,表明AECOPD存在血小板活化,提示血小板作为一种炎性细胞参与AECOPD发病,可能以其活化形式发挥重要作用.CD_(47)和P-选择素可作为判断AECOPD严重程度及血小板活化程度的指标.

Integrin-associated proteins in blood plasma of patients with acute exacerbation of chronic obstructive pulmonary disease

Objective To explore the role of CD_(47) and P-selectin in patients with COPD.Methods The blood plasma levels of CD_(47) and P-selectin in 20 healthy volunteers (control group) and 35 patients with COPD in acute exacerbation and at stable stage were measured by flow cytometry.Platelet count was measured by hematology analyzer.SNK-q test and Pearson correlation analysis of the regression equation were used for statistics.Results The level of CD_(47) in the COPD acute exacerbation group(93±4)%]was significantly higher than that of the COPD stable group(72±11) %]and that of the control group (67±10)%],q = 11.26,13.32,all P ＜ 0.01,but the difference in CD_(47) between the stable group and the control group was not significant (q = 1.73,P ＞ 0.05).The level of P-selectin in the acute exacerbation group(35±11)%]was significantly higher than those of the stable group(12± 8)%]and the control group(10±4) %](q = 9.93,12.19,all P ＜ 0.05),and the level of stable group was also higher than that of the control group (q = 1.90,P ＜ 0.05).The difference in platelet counts among the acute exacerbation group(188±56) ×10~9/L],the stable group(213±57)×10~9/L]and the control group(204±51)×10~9/L]was not significant (F = 1.74,P ＞ 0.05).A significant positive correlation between CD_(47) and P-selectin was observed in the acute exacerbation group(r =0.77,P ＜0.01),but not in the stable group and the control group (r =-0.04,-0.15,all P ＞ 0.05).Conclusions The levels of CD_(47) and P-selectin as markers of platelet activation increase significantly during AECOPD,which suggests that platelet activation exists in AECOPD and platelets as a type of inflammatory cells participate in the disease.