血清铜蓝蛋白、血红素结合蛋白和α2-巨球蛋白诊断哮喘与COPD的价值分析

doi:10.3877/cma.j.issn.1674-6902.2019.06.011

目的

探讨血清铜蓝蛋白(CP)、血红素结合蛋白(HPx)及α-巨球蛋白(AMG)在诊断哮喘与慢性阻塞性肺疾病(COPD)中的临床价值。

方法

选择2015年1月至2018年1月我院收治的44例COPD患者作为COPD组，选择同期收治的36例哮喘患者作为哮喘组，选取同期来医院体检的健康志愿者30例作为对照组，均留取各组患者空腹外周血，测定血清CP、Hpx、AMG、MPO水平，并留取痰标本，测定各组受检者痰液嗜酸性粒细胞阳离子蛋白(ECP)、白介素-8(IL-8)水平的差异。

结果

哮喘组、COPD组血清CP分别为(484.22±42.33)μg/ml、(550.45±51.75)μg/ml，MPO水平分别为(62.45±5.71)ng/ml、(81.02±4.33)ng/ml均高于对照组(322.65±52.63)μg/ml、(7.62±2.74)ng/ml(P<0.05)，COPD组血清CP、MPO又高于哮喘组(P<0.05)；哮喘组、COPD组血清Hpx分别为(89.25±10.14)%、(82.31±9.54)%，AMG分别为(136.41±30.78)μg/ml、(98.45±25.54)μg/ml低于对照组(102.32±19.56)%、(355.31±150.65)μg/ml，COPD组Hpx、AMG又低于哮喘组(P<0.05)；哮喘组、COPD组痰液ECP分别为(184.25±62.52)μg/L、(41.33±10.65)μg/L、IL-8分别为(405.31±228.41)ng/ml、(740.26±168.57)ng/ml高于对照组(17.05±9.77)μg/L、(19.23±10.66)ng/ml，哮喘组ECP高于COPD组，IL-8低于COPD组(P<0.05)。

结论

COPD系以中性粒细胞浸润为主的气道炎症，而哮喘以嗜酸性粒细胞浸润为主，前者CP、MPO、IL-8均高于后者，Hpx、AMG及ECP均低于后者，可作为两者鉴别依据。

关键词: 肺疾病, 慢性阻塞性, 支气管哮喘, 铜蓝蛋白, 血红素结合蛋白, α-巨球蛋白, 诊断

Objective

To analyze the clinical value of serum ceruloplasmin (CP), hemopexin (HPx) and α2-macroglobulin (AMG) in the diagnosis of asthma and chronic obstructive pulmonary disease (COPD).

Methods

A total of 44 patients with COPD admitted to our hospital from January 2015 to January 2018 were enrolled as the COPD group, 36 patients with asthma in the same period were selected as the asthma group, and 30 healthy volunteers who underwent physical examination during the same period were selected as the control group. The fasting peripheral blood of each group was collected. The levels of serum CP, Hpx and AMG were measured. The sputum samples were collected. The differences in the levels of eosinophil cationic protein (ECP) and interleukin-8 (IL-8) in each group were measured.

Results

The serum levels of CP were (484.22±42.33) μg /ml and (550.45±51.75) μg /ml, respectively, and the serum levels of MPO were (62.45±5.71) ng/ml and (81.02±4.33) ng/ml, respectively, in the asthma group and the COPD group, which were higher than those of the control group [ (322.65±52.63) μg /ml and (7.62±2.74) ng/ml, respectively, P<0.05]. And the serum levels of CP and MPO in the COPD group were also higher than those of the asthma group (P<0.05). The serum levels of Hpx were (89.25±10.14)% and (82.31±9.54)%, respectively, and the serum levels of AMG were (136.41±30.78) μg /ml and (98.45±25.54) μg /ml, respectively, in the asthma group and the COPD group, which were lower than those of the control group [(102.32±19.56) % and (355.31±150.65) μg /ml, respectively, P<0.05]. The ECP levels of the sputum were (184.25±62.52) μg /L and (41.33±10.65) μg /L, respectively, and the IL-8 levels were (405.31±228.41) ng/ml, (740.26±168.57) ng/ml and (19.23±10.66) ng/ml, respectively, in the asthma group and the COPD group, which were significantly higher than those of the control group [(17.05±9.77) μg/L and (19.23±10.66) ng/ml, respectively, P<0.05]. And the ECP levels in the asthma group were higher than those of the COPD group (P<0.05), however, the IL-8 levels in the asthma group were lower than those of the COPD group (P<0.05).

Conclusion

COPD is an airway inflammation mainly by neutrophil infiltration and asthma is mainly by eosinophil infiltration. The CP, MPO and IL-8 levels of the former are higher than those of the latter, while Hpx, AMG and ECP levels are lower than those of the latter, which can be used as a basis for their identification.

Key words: Chronic obstructive pulmonary disease, Asthma, Ceruloplasmin, Hemopexin, α-macroglobulin, Diagnosis

表1 各组血清CP、MPO水平比较(±s)

组　别	例数	CP(μg/ml)	MPO(ng/ml)
对照组	30	322.65±52.63	7.62±2.74
哮喘组	36	484.22±42.33	62.45±5.71
COPD组	44	550.45±51.75	81.02±4.33
F值		36.828	82.205
P值		0.000	0.000

表1 各组血清CP、MPO水平比较(±s)

组　别	例数	CP(μg/ml)	MPO(ng/ml)
对照组	30	322.65±52.63	7.62±2.74
哮喘组	36	484.22±42.33	62.45±5.71
COPD组	44	550.45±51.75	81.02±4.33
F值		36.828	82.205
P值		0.000	0.000

表2 各组痰液ECP、IL-8水平比较(±s)

组　别	例数	ECP(μg/L)	IL-8(ng/ml)
对照组	30	17.05±9.77	19.23±10.66
哮喘组	36	184.25±62.52	405.31±228.41
COPD组	44	41.33±10.65	740.26±168.57
F值		33.845	48.682
P值		0.000	0.000

表2 各组痰液ECP、IL-8水平比较(±s)

组　别	例数	ECP(μg/L)	IL-8(ng/ml)
对照组	30	17.05±9.77	19.23±10.66
哮喘组	36	184.25±62.52	405.31±228.41
COPD组	44	41.33±10.65	740.26±168.57
F值		33.845	48.682
P值		0.000	0.000

1	张　希，崔　珺，马咏梅，等. 诱导痰中血管内皮生长因子、细胞因子对慢性阻塞性肺疾病合并哮喘诊断的临床意义[J]. 临床肺科杂志，2017, 22(6): 1043-1046.
2	Hasegawa K, Gibo K, Tsugawa Y, et al. Age-related differences in the rate, timing，and diagnosis of 30-day readmissions in hospitalized adults with asthma exacerbation[J]. Chest, 2016, 149(4): 1021-1029.
3	蔡明文，谭　琳．VEGF、IL -13、IL -17对慢性阻塞性肺疾病合并支气管哮喘的鉴别诊断意义[J]. 临床和实验医学杂志，2015, 14(23): 1941-1944.
4	黄华萍，李　羲，王　杰，等. 振动反应成像技术在支气管哮喘和慢性阻塞性肺疾病诊断中的应用[J]. 第三军医大学学报，2015, 37(14): 1486-1490.
5	王宏伟，卢明毅. 肺功能检查在老年性哮喘与慢性阻塞性肺疾病鉴别诊断中的临床应用价值[J]. 中国医药导刊，2014, 16(7): 1125-1126.
6	Maltby S, Gibson PG, Powell H, et al. Omalizumab Treatment Response in a Population With Severe Allergic Asthma and？Overlapping COPD[J]. Chest, 2017, 151(1): 730-730.
7	杨万勇，陈　波，阮福旺，等. COPD和哮喘患者血清与支气管灌洗液中IL-8, SLPI, sCD14和sICAM-1含量比较[J]. 湖南师范大学学报(医学版), 2016, 13(3): 116-119，120.
8	Mogensen I, Alving K, Bjerg A, et al. Simultaneously elevated exhaled nitric oxide and serum-eosinophil cationic protein relate to recent asthma events in asthmatics in a cross-sectional population-based study.[J]. Clin Exp Allergy, 2016, 46(12): 1540-1548.
9	中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013年修订版)(一)[J]. 中华结核和呼吸杂志，2013, 36(4): 255-264.
10	潘建丽，黄　伦，欧　灵，等. 外周血白介素-17检测在气道慢性炎症性疾病诊断中的临床价值[J/CD]. 中华肺部疾病杂志(电子版), 2016, 9(5): 479-483.
11	Alpár Horváth, gnes Jókay, rpád Farkas, et al. The characteristics of diagnosis, patient care and education of asthma and COPD patients from the perspective of the actors in the Hungarian healthcare system[J]. Journal of Public Health, 2015, 24(1): 1-9.
12	Hoshino M, Ohtawa J, Akitsu K. Association of airway wall thickness with serum periostin in steroid-naive asthma[J]. Allergy Asthma Proc, 2016, 37(3): 225-230.
13	蒋　媛，张　倩，吴雨丹，等. 基质金属蛋白酶活性在3种肺疾病中的比较[J]. 常州大学学报(自然科学版), 2017, 29(2): 47-51.
14	Casaburi R, Duvall K. Improving Early-Stage Diagnosis and Management of COPD in Primary Care[J]. Postgraduate Medicine, 2014, 126(4): 141-154.
15	Rahman MA, Ahmed S, Islam MT, et al. Total Serum IgE Level Estimation in Asthma Patient and Healthy Volunteers in a Tertiary Care Hospital, Bangladesh[J]. Mymensingh Med J, 2016, 25(1): 126-131.
16	张夏男，李跃纲，贾效伟，等. 铜蓝蛋白在石英诱导的PI3K/PTEN信号通路中的作用[J]. 中华劳动卫生职业病杂志，2014, 32(4): 241-245.
17	Chen MH, Kan HT, Liu CY, et al. Serum decoy receptor 3 is a biomarker for disease severity in nonatopic asthma patients[J]. J Formos Med Assoc, 2017, 116(1): 49-56.
18	刘建博. 痰液细胞原血红素联合肿瘤标志物检测对非小细胞肺癌的诊断意义[J]. 中国实验诊断学，2017, 21(3): 396-398.
19	Konishcheva A, Gervazieva V, Ospelnikova T. Autoreactivity in patients with combined COPD and asthma phenotype[J]. Allergy, 2014, 69(3): 222-223.
20	Caswell-Smith R, Hosking A, Cripps T, et al. Reference ranges for serum periostin in a population without asthma or copd[J]. Clin Exp Allergy, 2016, 46(10): 1303-1314.
21	Bommart S, Marin G, Molinari N, et al. CCSP Serum Level is A Surrogate Marker of Small Airway Involvment in Asthma[J]. J Allergy Clin Immunol, 2017, 140(2): 581-584.
22	牛占丛，段国辰，刘军肖，等. 血红素加氧酶-1对脓毒症小鼠肺损伤炎症反应的调节作用[J]. 中国中西医结合急救杂志，2016, 23(4): 373-377.
23	Del Giacco SR, Garcia-Larsen V. Aerobic exercise training reduces bronchial hyper-responsiveness and serum pro-inflammatory cytokines in patients with asthma[J]. Evid Based Med, 2016, 21(2): 70-70.
24	刘　刚，宋冬梅，江　宇，等. 血红素氧合酶-1在急性百草枯中毒小鼠肺组织中的表达及意义[J]. 中华危重病急救医学，2015, 27(4): 280-284.
25	吕若君，杨　颖，白晓雪，等. α2巨球蛋白在老年肺结核患者外周血中的表达及临床意义[J]. 中国老年学杂志，2014, 34(15): 4183-4184.
26	Lisspers K, Johansson G, Jansson C, et al. Improvement in COPD management by access to asthma/COPD clinics in primary care: data from the observational PATHOS study.[J]. Respiratory Medicine, 2014, 108(9): 1345-1354.
27	钟　荣，肖　军，于志辉，等. 小窝蛋白-1/血红素加氧酶-1信号链轴对机械通气所致肺损伤调控效应的研究[J]. 中华危重病急救医学，2015, 27(7): 568-573.
28	李文斌，邢　静，王艳飞，等. 血α1、α2、β、γ球蛋白及κ、λ轻链在儿童支原体肺炎的意义[J]. 临床肺科杂志，2018, 23(5): 781-784.
29	Asano T, Kanemitsu Y, Takemura M, et al. Serum Periostin as a Biomarker for Comorbid Chronic Rhinosinusitis in Patients with Asthma[J]. Ann Am Thorac Soc, 2017, 14(5): 667-675.
30	詹先林，闫　伟. α2-巨球蛋白及其糖基化在恶性肿瘤中的研究进展[J]. 检验医学，2017, 32(10): 922-927.
31	任成山，王关嵩，钱桂生. 慢性阻塞性肺疾病的成因及其治疗的困惑与希望[J/CD]. 中华肺部疾病杂志(电子版), 2019, 12(2): 127-141.
32	王长征. 改善支气管哮喘控制现状，需要重视患者的长期管理[J/CD]. 中华肺部疾病杂志(电子版), 2013, 6(4): 296-298.

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Values of serum ceruloplasmin, hemopexin and α2-macroglobulin in diagnosis of asthma and chronic obstructive pulmonary disease

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Values of serum ceruloplasmin, hemopexin and α2-macroglobulin in diagnosis of asthma and chronic obstructive pulmonary disease