| Objective:Chronic obstructive pulmonary disease(COPD)is a group of chronic inflammatory airway diseases characterised by persistent airflow limitation.The pathogenesis involves airway inflammation,oxidation-antioxidation imbalance and elastase-anti-elastase imbalance,with the inflammatory response running throughout the disease,Many inflammatory cells including neutrophils,macrophages,T lymphocytes and multiple inflammatory mediators are involved in chronic non-specific inflammatory diseases.COPD is combined with a variety of chronic diseases,of which diabetes is more common,and affects COPD prognosis.Insulin resistance(IR)is a condition in which the target organs on which insulin acts become less sensitive to the action of insulin.It is thought that IR is mostly the initiating factor in the development of type 2 diabetes.The mechanism of IR is still unclear,and it is currently thought that it may be related to damage from inflammatory factors and lipotoxicity.Growth differentiation factor 15(GDF-15),secreted by macrophages in the presence of injury,inflammation and oxidative stress,may be involved in the development of COPD and COPD combined with IR.In this study,by measuring serum GDF-15 levels in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and AECOPD combined with IR.The aim is to explore the role of serum GDF-15 in reflecting severity of disease in AECOPD and in the combination of IR in AECOPD,to provide a new approach to the prevention and treatment of COPD,and to propose new diagnostic and treatment ideas for nutritional support,blood glucose adjustment and reduction of cardiovascular and cerebrovascular complications in COPD.Methods:Ninety-six patients with AECOPD who were hospitalized in the Department of Respiratory Medicine of the Affiliated Hospital of Chuanbei Medical College from December 2020 to July 2021 were selected,including 81 males and 15 females,with an average age of(71.57±8.43)years;they were divided into three groups according to the severity of their disease by comprehensive assessment,including 26 cases in the mild AECOPD group(21 males and 5 females,with an average age of((71.88 ±8.45)years),37 cases in the moderate AECOPD group(33 males,4 females,mean age(70.00±8.14)years),and 33 cases in the severe AECOPD group(27 males,6 females,mean age(73.09±8.49)years).A pre and post-treatment paired study was conducted in 36 of 96 patients with AECOPD(26 males and 10 females,mean age(72.22±10.04)years)after 1-2 weeks of symptomatic treatment with anti-infection,oxygen,cough and expectoration,antispasmodic and asthma relief.45 healthy controls(37 males and 8 females,mean age(71.02±3.74)years)in the same period.Homeostatic model assessment of insulin resistance index(HOMA-IR)=fasting blood glucose(FPG)x fasting insulin(FINS)/22.5,following HOMA-IR≥2.69 as the IR as the cut-off point,and 96 AECOPD patients were divided into two subgroups,AECOPD with IR and AECOPD without IR,according to the presence or absence of IR as the cut-off point of HOMA-IR≥2.69.There were 25 cases in the AECOPD with IR group(21 males and 4 females,mean age(70.73±10.03)years)and 71 cases in the AECOPD without IR group(60 males and 11 females,mean age(71.81±7.71)years).ELISA was used to determine the levels of FINS and GDF-15 in the peripheral serum of each group.Results:(1)96 patients in the AECOPD group(81 males,15 females,mean age 71.57± 8.43 years);45 patients in the healthy control group(37 males,8 females,mean age 71.02± 3.74 years)during the same period,the difference in age between the two groups was not statistically significant(P>0.05),the body mass index and smoking index in the AECOPD group were higher than those in the healthy control group.The differences were statistically significant(P<0.05).(2)The serum GDF-15 level of patients in the AECOPD group was(482.39±223.40)ng/ml before treatment and(240.11±94.64)ng/ml after treatment in the AECOPD group;the serum GDF-15 level of patients in the healthy control group was(122.05±50.46)ng/ml.The serum GDF-15 in the AECOPD group was higher than that in the healthy control group before and after treatment,and the difference was statistically significant(P<0.05),and the serum GDF-15 in the AECOPD group before treatment was higher than that in the AECOPD group after treatment,and the difference was statistically significant(P<0.05).(3)The serum GDF-15 level in the mild AECOPD group was(301.88±143.06)ng/ml;the serum GDF-15 level in the moderate AECOPD group was(425.25±78.93)ng/ml;the serum GDF-15 level in the severe AECOPD group was(653.69±243.71)ng/ml.The serum GDF-15 level in the AECOPD severe group was higher than that in the AECOPD moderate group and mild group,and the difference was statistically significant(P<0.05),Serum GDF-15 levels were higher in the moderate group than in the mild group,with all differences being statistically significant(P<0.05).(4)GDF-15,FPG,FINS and HOMA-IR levels in the AECOPD with IR group were(689.34±226.80)ng/ml,(9.31±1.74)mmol/1,(16.30±4.05)mU/L and 4.06±1.87,respectively.GDF-15,FPG,FINS and HOMA-IR levels in the AECOPD without IR group were(393.26±156.11)ng/ml,(5.97±1.30)mmol/1,(11.14±3.23)mU/L and 1.74±0.60,respectively.GDF-15,FPG,FINS and HOMA-IR levels in healthy controls were(122.05±50.46)ng/ml,(4.92±0.82)mmol/1,(6.53±1.28)mU/L and 1.47±0.36,respectively.The levels of GDF-15,FPG,FINS and HOMA-IR were higher in the AECOPD with IR group than in the AECOPD without IR group and the healthy control group,and the differences were statistically significant(P<0.05),while the differences in HOMA-IR in the AECOPD without IR group and the healthy control group were not statistically significant(P>0.05).In contrast,serum GDF-15,FPG and FINS levels were higher in the AECOPD without IR group than in the healthy control group,and the differences were statistically significant(P<0.05).(5)Peripheral blood GDF-15 levels in the AECOPD group were positively correlated with FPG,FINS and HOMA-IR(r=0.205,P<0.001:r=0.562,P<0.001;r=0.500,P<0.001;)and the correlations were statistically significant(all P<0.05).There was no significant correlation between peripheral blood GDF-15 levels and age,smoking index and body mass index(all P>0.05)Conclusion:(1)GDF-15 was significantly higher in patients with AECOPD before and after treatment compared to healthy controls,suggesting that GDF-15 is involved in the development of COPD.(2)GDF-15 levels in AECOPD patients gradually increase as the severity of the disease increases,suggesting that GDF-15 reflects the severity of AECOPD disease.(3)All glucose metabolism parameters and GDF-15 were significantly higher in the AECOPD with IR group than in the AECOPD without IR group and the healthy control group,and GDF-15 levels were positively correlated with FPG,FINS and HOMA-IR in the AECOPD group,it is suggested that GDF-15 may be involved in the development of insulin resistance in COPD,that inflammation may be a key link affecting insulin resistance in COPD,and that GDF-15 may act as an early warning factor to help identify people at risk of developing diabetes in COPD patients at an early stage. |
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