Relationship Between Nrf2/HO-1 Pathway And Malnutrition In Patients With Chronic Obstructive Pulmonary Disease

Objective: To explore the functions of Nrf2,HO-1 in stable COPD patients with malnutrition and investigate the relationship between Nrf2,HO-1 and tumor necrosis factor-? in COPD patients with malnutrition by observing the changes of plasma levels of Nrf2,HO-1 in stable COPD patients with malnutrition,without malnutrition and the subjects of the controls.Methods: A total of 60 patients with moderate-severe COPD(GOLD II-III)were divided into two groups: group COPD I(patients with malnutrition during stable disease n=30);group COPD II(patients without malnutrition during stable disease n=30).At the same time,30 healthy people were selected as normal controls.In order to eliminate the interference of gender factors,the subjects were male.The levels of Nrf2,HO-1,TNF-? in plasma of all subjects were detected by ELISA.Body mass index(BMI),percentage of ideal body mass(IBW%),triceps skin-fold thickness(TSF),arm muscle circumference(MAC)and serum albumin(ALB)were measured in all subjects.The relationship between the levels of Nrf2,HO-1,TNF-? in plasma and the nutritional status indicators was analyzed by variance analysis and Pearson correlation analysis.Results:1.TSF,ALB,AMC,BMI and IBW% in group COPD I were significantly lower than those in group COPD II and normal control group(P <0.05).TSF,ALB and AMC in group COPD II were significantly lower than those in normal control group(P <0.05).BMI,IBW% in group COPD II were lower than the normal control group,but the difference was not statistically significant(P> 0.05).2.The levels of Nrf2 in group COPD I[(1.92�0.59)ng/ml] were lower than those in group COPD II[(2.75�0.53)ng/ml] and controls[(3.44�0.48)ng/ml],the differences were statistically significant(P<0.05).The levels of HO-1 in group COPD I[(113.51�33.02)nmol/L] were lower than those in group COPD II[(139.38�27.20)nmol/L] and controls [(176.39�30.63)nmol/L],the differences were statistically significant(P<0.05).The levels of TNF-? in group COPD I [(173.01�30.76)pg/ml]were significantly higher than those in group COPD II [(146.81�27.96)pg/ml]and controls [(109.93�34.30)pg/ml](P<0.05).The levels of Nrf2 in group COPD II[(2.75�0.53)ng/ml]was significantly lower than those in the normal control group[(3.44�0.48)ng/ml](P <0.05).The levels of TNF-? in group COPD II[(146.81�27.96)pg/ml] were lower than those in normal control group[(109.93�34.30)pg/ml],and the difference was statistically significant(P <0.05).3.The levels of Nrf2 was positively correlated with the levels of HO-1 in group COPD I(r=0.823,P=0.000)and group COPDII(r=0.513,P=0.042).There was no significant correlation between Nrf2,HO-1 and TNF-? in all groups,there was no significant correlation between Nrf2,HO-1,TNF-? and nutritional indicators.Conclusion: 1.Nutritional indexes of malnutrition COPD group and non-malnutrition COPD group were lower than those of healthy control group.Nutritional indexes of malnourished COPD group was lower than those of non-malnourished COPD group.2.The levels of Nrf2 and HO-1 in malnourished COPD group were lower than those in non-malnourished COPD group and normal control group,the differences were statistically significant.There was a positive correlation between Nrf2 and HO-1 in both groups of COPD patients,There was no significant correlation between the levels of plasma Nrf2,HO-1 and the levels of nutritional indexes in COPD patients and controls.3.The levels of TNF-? concentrations of malnourished COPD group was higher than that of non-malnourished COPD group,the difference was statistically significant.However,there was no significant correlation between serum levels of TNF-? and the levels of nutritional indexes in the three groups.