The Stduy Of Relationship Between IL-18、TNF-αand Nutritional Status, Prognosis In Patients With Stable COPD

ObjectiveThe purpose of the study is to explore the relationship between serum IL-18, TFN-a and nutritional status, prognosis in patients with stable COPD in moderate or severe stage by comparing the level of IL-18, TFN-a and nutritional index, prognostic index in COPD patients with controls.Materials and MethodsTwenty three dystrophic patients with stable COPD,18normotrophic patients with stable COPD and15healthy volunteers were recruited for the study. Patients were recruited from outpatients’clinics of the second xiangya hospital of Central South University during the period from September2010to September2011. The diagnosis of COPD was according to the criteria recommended by the GLOD guideline2010. The serum IL-18, TNF-a level were detecting in all of the subjects by ELISA. Parameters of nutritional status and prognostic indicators also were collected. Statistical analysis was performed using SPSS19.0statistical package for windows. Single factor linear correlation analysis and multiple stepwise regression analysis were used for univariate testing between the COPD patients and the controls. Results1. The times of acute exacerbation, FEV1%, FEV1/FVC, six minutes walking distance were used as prognostic criteria. And NRS2002、BMI、 ASF、ALB were used as criteria of nutritional status. Although there was no significant difference between dystrophic COPD group and normotrophic COPD group in prognostic criteria, there was significant difference between COPD and normal subjects (P<0.01). Moreover, there was a significant positive correlation between the NRS2002and acute exacerbation, negative correlation between the NRS2002and FEV1%, FEV1/FVC, six minutes walking distance.2. The serum IL-18was (78.03±9.53) ng/L and the serum TFN-a was (504.49±67.08) ng/L in dystrophic COPD group, while it was (100.54±13.95) ng/L and (317.90±40.14) ng/L respectively in normotrophic COPD group, there was significant difference between the two groups (P<0.01). The serum IL-18was (38.93±3.27) ng/L and the serum TFN-a was (178.82±33.63) ng/L in normal subjects, with P<0.01, showing that significant difference between COPD group with normal subjects.3. There was a significant positive correlation between the serum IL-18, TNF-α and NRS2002,(P<0.01) and negative correlation between the NRS2002and BMI, ASF, ALB (P<0.01respectively). There was a significant correlation between the serum TNF-α and nutritional status (NRS2002、BMI、ASF、ALB), using multivariate stepwise regression analysis (b’=1.139、-1.090、-1.175、-1.096, respectively)(P<0.01).4. There was a significant positive correlation between the serum IL-18, TNF-α and acute exacerbation,(P<0.01) and negative correlation between the FEV1%, FEV1/FVC (P<0.01respectively). There was a significant correlation between the serum IL-18and prognostic criteria (the times of acute exacerbation, FEV1%, FEV1/FVC), using multivariate stepwise regression analysis (b’=0.682,-0.618,-0.565, respectively)(P<0.01).Conclusions1. The malnutrition with COPD may affect the prognosis of patients. It is not that all patients with COPD complicated by malnutrition because of the different susceptibility to malnutrition in COPD subjects.2. The linear relationship exists between the serum level of IL-18, TNF-awith malnutrition in COPD patients. Furthermore, the correlation of TNF-α with malnutrition indicators is better than IL-18. So TNF-α may be involved in the regulation of malnutrition in patients with COPD directly.3. The linear relationship exists between the serum level of IL-18, TNF-α with prognosis in COPD patients. Furthermore, the correlation of IL-18with prognosis indicators is better than TNF-α. So IL-18may be involved in the regulation of prognosis in patients with COPD directly.