Correlation Between Chronic Obstructive Pulmonary Disease With Pulmonary Hypertension And Endothelial Nitric Oxide Synthase 894G/T Gene Polymorphism

Objectives To observe the changes of inflammatory factors and endothelial function in patients with chronic obstructive pulmonary disease(COPD)combined with pulmonary hypertension,explore the relationship between eNOS gene 894G/T polymorphism and COPD with pulmonary hypertension,so as to provide a reliable basis for early and accurate prevention of pulmonary hypertension.Methods 1 research object:choose October 1,2016-April 1,2017 in north China university of science and technology affiliated hospital of respiratory department and accords with the standard set of a total of 120 patients,according to pulmonary hypertension diagnosis standard,divided into COPD group 60 cases(control group),COPD with pulmonary hypertension group of 60 cases(case group)according to chest HRCT and emphysema index(EI),the control group was divided into 35 cases with emphysema phenotype and 25 cases with bronchitis phenotype,the case group was divided into 37 cases with emphysema phenotype and 23 cases with bronchitis phenotype.2 Research methods: to collect the twogroups general clinical data: age,gender,smoking index,body mass index(BMI),length of course,home oxygen cure time,blood gas analysis and lung function,6minutes walk test(6MWT),pulmonary artery pressure(PASP),c-reactive protein(CRP),calcitonin(PCT)and serum amyloid A(SAA).Serum levels of interleukin-8(IL-8),tumor necrosis factor-?(TNF-?),endothelin-1(ET-1)and nitric oxide metabolites(NOX)were tested.genotypes and allele frequencies of eNOS gene 894 locus were determined on the PCR amplified products.SPSS17.0 software was used to complete the data analysis,the graph peak file could be opened with SeqMan software,and the sequence alignment could be used with SeqMan software.P<0.05 was considered statistically significant.Results 1 General clinical data of the two groups were compared: 1)comparison of gender,age,BMI and smoking index between the two groups showed no statistically significant difference(P>0.05).2)there was no statistically significant difference between the two groups in length of disease course and home oxygen cure time(P>0.05).3)there was no significant difference in lung function between the two groups(P>0.05).4)there was no significant difference in blood gas analysis between the two groups(P>0.05).5)there was no significant difference in the 6MWT distance between the two groups(P>0.05).6)inflammatory factors and endothelial function were compared between the two groups:(1)CRP,SAA and PCT of the case group were significantly increased with statistically significant differences(P<0.05).(2)IL-8 and TNF-?of the case group were significantly increased with statistically significant differences(P<0.05).(3)ET-1 and NOX of the case group were significantly increased wtih statistically significant differences(P<0.05).2 The correlation between eNOS gene 894G/T polymorphism and the pulmonary hyptertension in COPD patients: 1)according to the genetic test results,three genotypes were detected:TT genotype,GG genotype and G/T genotype,Hardy-Weinberg balance test was performed for the two groups(P>0.05).2)analysis of eNOS gene 894G/T genotype and allele in the two groups,G/T genotype,TT genotype and T allele OR value >1 in the case group.3)compared with pulmonary artery pressure of eNOS gene 894G/T in the case group,pulmonary artery pressure of G/T genotype and TT genotype was significantly increased than that of GG genotype,the difference was statistically significant(P<0.05).3Stratified analysis of the relationship between different genotypes and pulmonary arterial hypertension in COPD: 1)after stratified analysis of inflammatory factors,the OR valuesof G/T genotype and TT genotype of abnormal inflammatory factors were not significantly different from normal G/T genotype and TT genotype.2)after stratified analysis of endothelial function,the OR values of G/T genotype and TT genotype with abnormal endothelial function were significantly different from G/T genotype and TT genotype with normal endothelial function.3)after stratified analysis phenotypic,there was no significant difference of OR value between the G/T genotype of bronchitis phenotype and the G/T genotype of emphysema phenotype,there was significant difference of OR value between the TT genotype of the bronchitis phenotype and the TT genotype of the emphysema phenotypic.4Multifactor analysis,the group of COPD with pulmonary hypertension as the dependent variable,as smoking index,age,three genotypes,PaO2,PaCO2,FEV1%pred,FEV1/FVE,TNF-?IL-8,ET-1,NOX,CRP,SAA,PCT,bronchitis phenotype,emphysema phenotye,are adjusted for binary classification variables as covariate,logistic analysis found G/T genotype,TT genotype is associated with pulmonary hypertension,the difference was statistically significant(P<0.05).Conclusions 1 eNOS gene 894 G/T polymorphism is associated with pulmonary hypertension,G/T genotype,TT genotypes,and the T allele may increase the risk of pulmonary hypertension in patients with COPD.2 Abnormal endothelial function can strengthen the G/T genotype,TT genotype in pulmonary hypertension in patients with COPD,emphysema phenotype can strengthen the TT genotype in pulmonary hypertension in patients with COPD.Figure4;Table16;Reference 95.