Study On Skin Temperature,sweat Rate, The Content Of Antimicrobial Peptides In Serum And The Relationship With Viscera Deficiency In COPD Patients

Objective: By collecting stable COPD patients and healthy control group,by measure the skin temperature,sweating rate and serum levels of antibacterial peptides in the different COPD group and different viscera deficiency group,to find the changing of skin temperature,sweating rate and the serum content of antibacterial peptide and possible influence factors,trying to reveal the changing rule of COPD patient's body temperature,sweat rate and the antibacterial peptide content in serum and the clinical significance for COPD disease progression.And through the determination of differentially expressed genes between COPD patients and healthy normal person,try to find the possible signal path of antibacterial peptide protein expression differences and antimicrobial peptides involved in the process of COPD,to interpretation the possible mechanisms of antibacterial peptides expression and the mechanism involved in the process of COPD.Methods: Collect outpatient and hospitalized patients diagnosed with COPD stabilization in May 2015 to May 2016 in the fourth hospital affiliated to xinjiang medical university,record the patient's general condition,TCM symptom scores,m MRC,CAT score and lung function and CEPT,use of DT-9875 infrared thermal imager to measure the acupoint of feishu,pishu,shenshu and governor meridian and determination of the average temperature of the back,Gauze sponge cushion method is used to collect sweat rate in the process of each movement in patients with cardiopulmonary determination.Collect patients' serum samples and determination of serum levels of antimicrobial peptides(HBD-2,HNP1-3,hepcidin,dermcidin,cathelicidin)content,the PCR-array method was developed for the determination of cell factors associated with COPD mRNA expression level,analysis the possible signal path of abnormal expression of serum antibacterial peptide in COPD patients and the possible mechanism of antibacterial peptides involved in COPD disease process.Results: 1)Compared with healthy control group,the average temperature of feishu,pishu,shenshu and governor meridian was significantly reduced.In the smoking group,the temperature of feishu was significantly lower than that in the non-smoking group,and the other acupoints were lower than those in the non-smoking group,but there was no significant difference.the temperature of feishu,pishu,shenshu in lung qi deficiency group,lung and spleen deficiency group,lung spleen and kidney deficiency group were significantly lower than that of normal healthy group,and each viscera deficient group found no significant differences.After adjustment for age and BMI partial correlation analysis found in COPD patients,patients with skin temperature of parts of the feishu and smoking index,number of exacerbations in last year,m MRC grade,CAT,TCM scores showed a negative correlation,and lung function of FEV1,FVC,FEV1 / FVC% was a positive correlation;The skin temperature in the pishu was negatively correlated with the patients' smoking index,m MRC score and TCM symptom score,which was positively correlated with FEV1%,FVC%,FEV1/FVC in lung function.The skin temperature of shenshu was negatively correlated with m MRC score and TCM symptom score,which was positively correlated with FEV1%,FVC%,FEV1/FVC in lung function.The average temperature of governor meridian have negatively correlation with smoking index,m MRC score and TCM symptom score,and was positively correlated with FEV1%,FVC%,FEV1/ FVC in pulmonary function.Compare sweating rate differences in different viscera deficient group in patients with COPD found lung qi deficiency group and lung lung spleen kidney deficiency group compared with healthy controls sweating rate increased significantly,lung and spleen deficiency group has no significant difference compared with healthy control group but have higher trend,sweating rate of lung spleen and kidney deficinecy group compared with lung and spleen deficiency group also increased significantly.The sweating rate of patients with COPD increases with the increase of the level of viscera deficiency.2)By comparing the differences between healthy normal groups and patients with COPD.The results showed that the average back temperature of COPD group was significantly lower than that of healthy normal group.Divide COPD patients according to limited airflow severity classification,after comparison found that the flow constrained GOLD1,GOLD2,GOLD3,GOLD4 back average temperature of a healthy normal group were lower,as can be seen from the result of temperature,the average temperature of the back has a trend of reducing by the increase of limited degree of airway.After grouping the patients in COPD with GOLD 2017 symptom/acute exacerbation,the average back temperature of group A,B,C and D was significantly lower than that in the healthy control group,and there was no significant difference between the groups.The correlation analysis found that in the COPD group,the average back temperature was negatively correlated with the patients' smoking index and m MRC score.Positive correlation with pulmonary function FEV1%,FVC%,FEV1/ FVC.COPD smoking group and non-smoking group average temperature was significantly lower than healthy controls,between COPD smoking and non-smoking group did not show significant differences in the average temperature of patient's back,but seen from the results,smoking has a tendency to reduce the average back temperature of patients with COPD.The local sweating rate of patients in COPD group was significantly higher than that in the healthy control group.According to the comparison of airflow limitation,the increase of sweat rate increased with the increase of airflow limitation.According to the 2017 GOLD symptom/acute exacerbation group,the sweating rate of group C and group D increased significantly compared with group A.Correlation analysis showed that sweating rate of patients with COPD has positive correlation with the number of exacerbations in the last year,m MRC score,and has significant negative correlation with FEV1%% FVC,FEV1 / FVC in lung function,has significant negative correlation with the most power and chase volume,maximum kilograms oxygen uptake in CEPT,and has positive correlation with the equivalent carbon dioxide ventilation and physiological invalid cavity.Of patients with COPD exacerbations risk factors associated with logistic regression analysis,build the regression equation,found that patients with COPD sweating rate had significant correlation with the incidence of acute exacerbation,in the number of exacerbations of COPD patients with multiple linear regression analysis found that CAT scores,sweating rate and the average temperature of the back with the years the number of exacerbations of COPD patients.3)The serum antimicrobial peptide hbd-2 in patients in COPD decreased significantly compared with the healthy control group,and hnp1-3,Hepcidin,Dermcidin and Cathelicidin were significantly higher than those in the healthy control group.According to group limited airflow classification found HBD-2 in GOLD3 significantly reduced than GOLD1 and GOLD2 group,HNP1-3 in GOLD3 group also significantly lower than GOLD1,GOLD2 group,of Hepcidin,Dermcidin is no significant difference in three groups.Cathelicidin in GOLD3 increased significantly than GOLD1 group,and Cathelicidin have a rising trend with the limited degree of airflow.Divide COPD patients according to GOLD2017 symptoms/degree of acute exacerbation group found that Dermcidin and Hepcidin in group A decreased significantly compared with B,C,D group,Dermcidin has a rising trend increased with the level of gread,the rest of the antimicrobial peptide in A,B,C,D group were no significant differences between groups.Divide COPD patients according to different degree of viscera deficiency and found that different internal damage of COPD patients compared with healthy controls,each HBD-2 were significantly lower,HNP1-3,Hepcidin,Dermcidin were significantly increased,Cathelicidin in lung qi deficiency group significantly increased compared with healthy controls,while the remaining two groups no significant difference,found no significant difference between groups.The COPD patient's age,BMI as control factors in partial correlation analysis found that serum levels of antimicrobial peptides in COPD patients no correlation with the average temperature of the back,sweating rate and HBD-2,HNP1-3 content was positively correlated,other antimicrobial peptides and found no significant association between the sweating rate.The serum antibacterial peptide HBD-2 was negatively correlated with the m MRC score of the patients and was positively correlated with FEV1%,FEV1/ FVC.HNP1-3 has negative correlation with m MRC,and was positively correlated with FEV1%,FVC%,FEV1/ FVC,and negatively correlated with the respiratory reserve of cardiopulmonary function.Hepcidin was positively correlated with the annual incidence of acute exacerbation and the number of hospital visits and CAT scores,and was positively correlated with the aerobic ventilation equivalent in the cardiopulmonary exercise.Dermcidin was positively correlated with the annual incidence of acute exacerbation,annual hospitalization,m MRC score and CAT score,and was positively correlated with aerobic ventilation equivalent in cardiopulmonary function.Cathelicidin was negatively correlated with FEV1/ FVC,and was negatively correlated with the maximum gas and anaerobic area in the cardiopulmonary function index.Add the serum levels of antimicrobial peptides into acute exacerbation risk Logistc regression analysis,found that sweating rate and serum level of Dermcidin associated with the occurrence of COPD exacerbations,and the equation to predict the total accuracy was 86.0%.Will be included in the serum levels of antimicrobial peptides in patients with COPD exacerbations the multiple linear regression analysis,found and sweat rate,serum levels of Dermcidin and CAT scores,the average temperature of back have correlation with the number of exacerbations.The gene expression in patients with COPD(DUSP6,AR,SNCA,ADRB2,HMGCL)was found to be lower in patients with COPD compared with the normal group.Gene expression increased(KLHL3,MAOA,MAPK8,MMP13,MT1 X,SERPINA3,etc.).Path analysis found that IL-17 f/NF-?? pathway may be impact the expression of HBD-2;The HNPs may be mediated through the downstream MAPK signaling pathway to participate in the expression of the epithelial cells of the airway epithelium proliferation and human airway epithelial cells.Hepcidin expression may be due to activation of the jak-stat signal transduction pathway;Cathelicidin may play a role in the pathogenesis of COPD and the progression of the disease progression through MAPK pathway.Conclusion: 1)This study found that when the state of viscera deficiency in COPD patients occurs,patients' surface temperature drop,sweating rate increased,and expression of antibacterial peptide quantity has abnormal changes,thereby again confirmed that the "lung main fur" and "gas" theory.That COPD patients at the same time easy to sweat out,cool feeling symptom such as is objective existence,and preliminary findings lead to the material basis of recurrent COPD may objectively illustrates the COPD patients with pulmonary qi deficiency,Wei Yang not solid theoretical basis.It provides an objective basis for the treatment of COPD of Chinese traditional Chinese medicine(moxibustion,TDP,etc.)and traditional Chinese medicine(arrest sweating).2)In this study,we found that patients with COPD had lower temperature and increased sweating rate.Explained from the perspective of objective patients with COPD is like the warm environment,add the characteristics of the clothing,its mechanism may be related to autonomic nerve dysfunction in patients with COPD,basal metabolic rate rise,merge the metabolic syndrome and related peripheral nerve injury.The pathogenesis of COPD is diverse and complex,and it is not a single inflammatory mechanism.It may also be associated with abnormal changes in neural,metabolic and immunological pathways.3)The study found that serum levels of antimicrobial peptides in COPD patients changes compared with healthy normal group,and has correlation with the degree of difficulty in breathing,lung function and CEPT,serum levels of antimicrobial peptides can reflect the degree of disease progression in COPD patients,maybe a prognostic of progress and the risk of acute indicators of COPD.Antibacterial peptides expression was also found that patients with COPD by intervening in certain signaling pathways involved in the disease process of COPD,further research can be through the intervention of antimicrobial peptide related signaling pathways involved in the pathogenesis of COPD have the treatment and prevention of the progression and exacerbations of COPD.4)This study on patients with COPD exacerbations of logistic regression analysis and multiple linear regression analysis was carried out on the annual number of exacerbations,found that the serum level of Dermcidin and sweating rate may be to predict the risk of COPD exacerbations index,and the serum level of Dermcidin,sweating rate and the average temperature in back have correlation with the number of exacerbations.The surface temperature,sweat rate of the patients with COPD,and serum levels of antimicrobial peptides can be used as acute exacerbation risk predictors,and could by intervening these factors preventing exacerbations,relieve the disease process,puts forward new ideas in the prevention and treatment of COPD exacerbations.