| Objective: Chronic obstructive pulmonary disease(COPD)describes a group of progressively debilitating lung disease that limit airflow and interfere with normal breathing.Irritants(e.g.cigarette smoke ? environmental pollutants and smoke from biomass fuels)are thought to modify the inflammatory response of the respiratory tract,inducing parenchymal tissue destruction(leading to emphysema)and defence mechanisms and the disruption of normal repair,resulting in progressive airflow limitation.It will reduce the quality of life,lead to frequent hospitalization,and increase the risk of death.Cigarette smoke is the most important etiological factor in the development and progression of COPD.Stimulating the innate and adaptive immune system cause a large influx of inflammatory cells.The inflammatory response of COPD is involved in a variety of inflammatory cells and cytokines secreted by the cells.Monocyte chemotaxis protein-1(MCP-1)is an important chemokine,which plays an important role in the recruitment and activation of macrophages.Chemokine receptors antagonist may become a new treatment direction of COPD,to reduce chronic inflammation and parenchymal damage in COPD.Significant heterogeneity of clinical presentation,imaging features,disease progression and treatment response exists within COPD.Understanding the phenotype of COPD will contribute to the diagnosis and treatment of the disease.COPD outpatient were enrolled in this study,through the detection of different phenotypes of COPD patients,serum MCP-1,high sensitive C reactive protein(Hs-CRP),calcitonin angiotensinogen(PCT)expression levels were studied to investigate the correlation between the clinical phenotype and cytokine,provide a new ideafor the treatment of COPD classification diagnosis and individualized treatment.Methods:1 Subjects: Selected 70 patients with COPD(aged 45 to 80 years),and 10 healthy volunteer matched for gender and age between January 2015 and January 2016.The diagnosis of COPD on the basis of the COPD treatment guidelines of 2013 revised by the 2013 Chronic obstructive pulmonary disease study group of Chinese Medical Association.The total number of COPD patients is 70(41 male,29 female,average age 65.11±9.54 years).There was no significant difference in the age,sex and weight of the subjects(P > 0.05).According to whether smoking or not,the subjects of study were divided into1)Healthy smokers,2 male,0female,average age 66.5±2.12 years,2)Healthy non smokers,2 male,6female,average age 69.5±3.55 years,3)COPD smokers,45 male,6female,average age 65.06±10.04 years,4)COPD non smokers,3male,16 female,average age 65.26±8.29 years.On the basis of acute exacerbation and remission criteria of COPD which was raised by Anthorisen,the patients were divided into 1)COPD exacerbations: 27 male,15 female,average age 67.36±9.62 years,2)Stable COPD patients,19 male,9 female,average age 61.75±8.50 years.According to the treatment guidelines of COPD developed in 2013,the patients were divided into1)group A: low risk,less symptom,11 male,4female,average age 63.53±6.44 years;2)group B: low risk,more symptoms,8 male,6 female,average age 65.14±8.88 years;3)group C: high risk,less symptoms,8 male,6 female,average age 56.64±7.92 years;4)Group D:high risk,more symptoms,9 male,18 female,average age 70.37±8.92 years.According whether the bronchial wall thickening or emphysema visual high-resolution computed tomography(HRCT)which was raised by Fujimoto,patients were divided into:1)bronchitis type: 14 male,12 female,average age65.85±11.94years;2)emphysema type:18 male,4 female,average age64.91±8.31 years;3)mixed type: 16 male,6 female,average age64.45±7.69 years.On the day of admission,the patients accepted a chest tomography HRCT scan and Hs-CRP examination,preserved blood samples and accepted pulmonary function tests.2 Specimen collection: Blood was collected from cubital vein on fasting,then was injected into dry vacuum non-anticoagulant tube,4 ?3000r/min centrifugated 15 min,supernatant was collected into EP tube,and saved in the-80 °C refrigerator,and waiting for detection for the levels of MCP-1 and PCT.Blood was collected from cubital vein on fasting,then was injecteded into EDTA anticoagulant tube,examined the levels of Hs-CRP by immunochromatographic method immediately.3 Quantification of MCP-1,PCT and Hs-CRP :MCP-1 levels in serum and PCT levels in serum were quantified by ELISA according to the manufacturer's instructions.Hs-CRP levels in whole blood were quantified by immunochromatographic method according to the manufacturer's instructions.Results:1 There was no difference in serum MCP-1,Hs-CRP,PCT between healthy smokers and healthy non smokers.There was no difference in serum MCP-1,Hs-CRP,PCT between COPD smokers and COPD non smokers.Serum levels of MCP-1,Hs-CRP,PCT in COPD smokers were higher than that in healthy smokers and healthy non smokers(P <0.05).Serum levels of Hs-CRP,PCT in COPD non smokers were higher than that in healthy smokers and healthy non smokers(P <0.05).There was no difference in serum MCP-1between COPD non smokers,healthy smokers and healthy non smokers.2 Serum levels of MCP-1,Hs-CRP in stable group were significantly higher than that in control group(P <0.05).Serum levels of MCP-1,Hs-CRP,PCT in AECOPD were significantly higher than that in control group and stable patients(P <0.05).3 Serum levels of MCP-1,Hs-CRP,PCT in AECOPD patients withdifferent type of HRCT were significantly higher than those in control group(P<0.05).Serum levels of MCP-1 in mixed group was significantly higher than those of emphysema and bronchitis types(P <0.05).There was no significant difference between emphysema type and bronchitis type.Serum levels of Hs-CRP in mixed group was significantly higher than those of emphysema and bronchitis types(P <0.05).Serum levels of Hs-CRP in bronchitis type group was significantly higher than those of emphysema type(P <0.05).4 Serum level of MCP-1,Hs-CRP,PCT in stable patients with different type of HRCT were significantly higher than those in control group(P <0.05).Serum level of MCP-1 in mixed group was significantly higher than those of emphysema and bronchitis types(P <0.05).There was no significant difference between emphysema type and bronchitis type.Serum levels of Hs-CRP in mixed group was significantly higher than those of emphysema and bronchitis types(P <0.05).Serum levels of Hs-CRP in bronchitis type group was significantly higher than those of emphysema type(P <0.05).5 Serum levels of MCP-1,Hs-CRP,PCT in different groups of comprehensive assessment AECOPD patients were significantly higher than control group(P <0.05).Serum MCP-1 of group D were significantly higher than group A,B,C(P <0.05);Serum MCP-1of group C was higher than that of group A and group B(P <0.05),there was no significant difference between group A and group B.Serum Hs-CRP of group D were significantly higher than group A,B,C(P <0.05);there was no significant difference between the rest of the groups.6 Serum levels of MCP-1 of group D and serum levels of Hs-CRP of group C in stable COPD were significantly higher than control group(P<0.05).Serum levels of MCP-1 of group D were significantly higher than group A,B,C(P <0.05);Serum levels of MCP-1of group C was higher than group A group B(P <0.05),there was no significant difference between group A group B.Serum levels of Hs-CRP in group C was higher than that of group A,group B and group D(P <0.05).There was no significant differencebetween the rest of the groups.7 MCP-1 and Hs-CRP had positive correlation(r=0.522,P <0.05).MCP-1 and FEV1/FVC,FEV1/% predicted had negative correlation(r=-0.498?-0.547,P <0.05),Hs-CRP and FEV1/FVC,FEV1/% predicted had negative correlation(r=-0.343?0.368,P<0.05)?Conclusions:Serum levels of MCP-1,Hs-CRP,PCT in COPD(smokers or non smokers)were higher than the healthy control group(smokers or non smokers),it illustrated that the increase of inflammatory factors significantly affected by the disease and little affected by smoking.There was no difference in serum MCP-1,Hs-CRP,PCT between COPD smokers and COPD non smokers.There was no difference in serum MCP-1,Hs-CRP,PCT between healthy smokers and healthy non smokers.Smoking has little effect on serum levels of MCP-1,Hs-CRP,PCT in healthy and COPD patients.MCP-1 and Hs-CRP in patients with stable COPD were higher than that of healthy control people.The lung function decreased and airflow limitation became severe with the increase of MCP-1 and Hs-CRP.MCP-1,Hs-CRP is involved in the occurrence and development of COPD;inflammatory cytokines were involved in the injury and remodeling of lung tissue.There is a negative correlation between MCP-1,Hs-CRP and FEV1% predicted,FEV1/FVC.They are expected to be additive serological indicator for the diagnosis and evaluation of airflow limitation. |
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