The Correlation Research To TGF-β1, FGF-1, Pulmonary Function And High Resolution Computed Tomography Score Of COPD With Pulmonary Fibrosis

Objective: Chronic obstruction pulmonary disease (COPD) is a common respiratory disease, which detected remodeling of air-way and pulmonary fibrosis and the pulmonary function and prognosis harmed severely with its progress. The clinical characters of COPD with pulmonary fibrosis were detected by high-resolution computed tomography (HRCT), pulmonary function test (PFT) and so on.Methods: 89 cases of in hospital patients with COPD in the Second Hospital of Hebei Medical University from October 2007 to January 2009 were selected, 60 cases were combined with pulmonary fibrosis as the study group and according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, 16 patients were stageⅠ; 22, stageⅡ;11, stageⅢ; 11, stageⅣ; and 29 cases of COPD patients were the control group. All of the patients were excluded the other types of pulmonary fibrosis, such as (1) idiopathic pulmonary fibrosis/ cryptogenic fibrosing alveolitis, (2) collagen vascular disease, (3) drug toxicity, (4) chronic hypersensitivity pneumonitis, (5) asbestosis, (6) familial idiopathic pulmonary fibrosis, and (7) Hermansky-Pudlak syndrome and so on. When the patients were in clinical stable condition,the clinical characters between the two group, such as smoking index, arterial blood gas(ABG), PFT, composite physiologic index (CPI), HRCT, TGF-β1, and FGF-1, were analyzed, the same as the correction between HRCT pulmonary fibrosis visual score and pulmonary function,CPI,TGF-β1,FGF-1.Results:1 Clinical presentation of COPD with pulmonary fibrosis In the COPD group, there were 22 males and 7 females aged (68.79±7.18) years, range 52~80 years. the history is (22.85±8.97) years, range 4~40 years, smoking index is (30.77±8.08) pack-years. In the COPD with pulmonary fibrosis group, there were 49 males and 11 females aged (72.47±8.88) years, range 49~92 years, the history is (24.93±11.19) years, range 3~42 years, smoking index is (40.02±14.43) pack-years. Both of the groups were aging patients, showed a longer history and higher smoking index, however the difference had not statistical significance.2 Arterial blood gas of COPD with pulmonary fibrosis Both of the group showed hypoxemia with or without hypercapnia. The COPD group PO2 (67.26±10.52) mmHg, PCO2(61.34±11.32) mmHg,and the COPD with pulmonary fibrosis group PO2 (55.20±9.32) mmHg, PCO2 (55.20±9.32) mmHg, so the latter showed notability hypoxemia, but the hypercapnia was not obvious, and all of the difference had statistical significance (p<0.05). 3 Pulmonary function ests of COPD with pulmonary fibrosis29 patients showed obstructive ventilation dysfunction in the COPD group. 52 patients showed mixed respiratory dysfun- ction in the COPD with pulmonary fibrosis group and 8 patients showed obstructive ventilation dysfunction, both of which restrictive ventilatory dysfunction was not found. However both groups showed diffusion dysfunction. The COPD group showed FVC%pre,FEV1%pre,FEV1/FVC,were decreased (70.90±20.52,63.37±21.94, 53.84±10.64), TLC%pre, RV/TLC normal or increased (90.36±8.12,45.30±7.48) , DLCO%pre was decreased (65.39±7.43).The COPD with pulmonary fibrosis group showed FVC%pre,FEV1%pre,FEV1/FVC were decreased (59.87±17.58,59.77±19.99,61.58±5.87),TLC%pre showed normal or decreased(78.03±9.01),RV/TLC showed normal or increased (39.34±8.37), DLCO%pre was decreased (58.48±12.25). Com- posite physiological index of the COPD with pulmonary group: (59.77±19.99). The group showed FVC%pre, FEV1%pre, FEV1/ FVC and DLCO%pre more lower, TLC%pre showed normal or decreased, RV/TLC showed normal or increased, the difference of FEV1%pre had not statistical significance, however the diff- erence of the other pulmonary function index had statistical significance (p<0.05).4 The character of HRCT and the correlation with pulmonary function of COPD with pulmonary fibrosisHRCT showed centrilobular emphysema, panlobular emp- hysema and paraseptal emphysema, emphysema can be a diffuse process, or can be locally selective. The two groups in the distri- bution of the scope and extent of lesions was no significant difference. The COPD group HRCT emphysema visual score were (1.11±2.16), the HRCT emphysema visual score correlated well with FVC%pre,FEV1%pre, FEV1/FVC, TLC%pre,RV/TLC and DLCO%pre(r= -0.37,-0.36,-0.21,0.13,0.38,-0.44, P<0.05 ). The COPD with pulmonary fibrosis group HRCT emphysema visual score (2.90±3.05), the score is higher than COPD group, but the difference had not statistical significance. The HRCT emphysema visual score is correlated well with FVC%pre,FEV1%pre,RV/TLC and DLCO%pre (r= -0.41,-0.30,0.10,-0.38,P<0.05),but there was no significant correlation with FEV1/FVC and TLC(r= -0.03,-0.05,P>0.05). The COPD with pulmonary fibrosis group was divided into four stages according to GOLD. The HRCT emphysema visual score of stageⅠ~ stageⅣ(2.28±0.70,1.87±0.60,3.09±0.84, 5.67±0.84). Emphyse- ma visual score were not increased obviously with the increase of stages and the difference had not statistical signifycance. There was no obvious pulmonary fibrosis of the COPD group. In the COPD with pulmonary fibrosis group, the pulmonary fibrosis changes were mainly distributed in middle and lower zones. In the surrounding of bronchus as the center of the diffusion, reticular nodules, honeycombing, ground-glass attenuation can be seen. The COPD with pulmonary fibrosis group HRCT pulmonary fibrosis visual score were (4.70±2.65), pulmonary fibrosis score correlated well with FVC%pre, FEV1%pre and DLCO%pre(r= -0.45, -0.32, -0.47, P<0.05), FEV1/FVC, TLC% pre and RV/TLC with the pulmonary fibrosis score had not significant correlation (r= -0.03,-0.12,-0.21,P>0.05).The group were divided into four stages according to GOLD, the HRCT pulmonary fibrosis visual score of StageⅠ~ stageⅣ(2.31±0.45, 4.18±0.38,5.18±0.54,8.09±0.54). The score of HRCT pulmonary fibrosis were increased obviously with the increase of stages and the difference had statistical significance (p<0.05).5 Serum TGF-β1, FGF-1 and the correlation with HRCT visual score of COPD with pulmonary fibrosisSerum TGF-β1, FGF-1 were (495.83±122.24, 5.25±3.13) pg/ml of the COPD group, and the COPD with pulmonary fibrosis group (479.54±149.67, 3.10±1.51) pg/ml. TGF-β1showed lower in the COPD with pulmonary fibrosis group, but the difference had not statistical significance. There were positive correlation between TGF-β1 and pulmonary fibrosis score(r=0.39, p<0.05). However, there were not significant correlation between TGF-β1 and the HRCT emphysema visual score (p>0.05). There were negative correlation between FGF-1 and HRCT pulmonary fibrosis visual score (r= -0.37, p<0.05). However, there were not significant correlation between FGF-1 and HRCT emphysema visual score (p>0.05). The COPD with pulmonary fibrosis group was divided into four stages according to GOLD. The serum TGF-β1of stageⅠ~ stageⅣ(370.07±31.85, 461.08±27.17, 584.46±38.42, 570.79±38.42) pg/ml. TGF-β1 was increased with the increase of stages. StageⅢand stageⅣhad not statistical significance, however there were statistical significance between other groups (p<0.05).The serum FGF-1 of StageⅠ~ stageⅣ(4.12±0.34,3.07±0.29,2.27±0.42 , 2.53±0.42) pg/ml. The serum FGF-1 levels decreased grad- ually with the increase of the stages. There were statistical significance among stageⅠa nd other stages (p<0.05). However, there was not significant statistical signify- cance between the other stages.Conclusion:1 The patients with COPD may combined with pulmonary fibrosis with the progress of disease.2 Arterial blood gas of COPD with pulmonary fibrosis group mainly showed hypoxemia, with or without carbon dioxide retention. Most of the patients showed mixed respiratory dysfun- ction in the COPD with pulmonary fibrosis group and some showed obstructive ventilation dysfunction, both of which restri- ctive ventilation dysfunction was not found. All accompanied by diffusion dysfunction.3 HRCT show emphysema combined with pulmonary fibrosis at the same lung, HRCT show centrilobular emphysema, panlobul- ar emphysema and paraseptal emphysema, emphysema can be a diffuse process, or can be locally selective. Pulmonary fibrosis changes are mainly distributed in middle and lower lung field. In the surrounding of bronchus as the center of the diffusion, reticular nodules, honeycomb, ground-glass attenuation can be seen. With the progress of the disease, pulmonary fibrosis grad- ually became Severity. HRCT emphysema visual score has neg- atively correlation with FVC%pre, FEV1%pre and DLCO% pre; and has positively correlation with RV/TLC.HRCT pulmonary fibrosis visual score has negatively correlation with FVC%pre, FEV1%pre and DLCO%pre. HRCT pulmonary fibrosis visual score has positively correlation with CPI, and the correlation is better than any pulmonary function index.4 TGF-β1 has positively correlation with pulmonary fibrosis score, and FGF-1 has negatively correlation with pulmonary fibrosis score, both of them play an important role in the develo- pment of pulmonary fibrosis.