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目的:观察肾不纳气型慢性阻塞性肺疾病(COPD)患者在急性加重期外周血白细胞中糖皮质激素受体(GR)的表达水平,并探讨其可能的影响因素。方法:根据入组标准,选择30例肾不纳气型COPD患者作为实验组(简称肾不纳气组),30例脾虚湿盛型COPD患者作为证型对照组(简称脾虚湿盛组),另外选择30例非COPD患者作为疾病对照组(简称非COPD组)。采用逆转录-多聚酶链式反应(RT-PCR)检测外周血白细胞中糖皮质激素受体GR的含量,并分析GR与病程、肺功能、血清皮质醇之间的相关性。结果:肾不纳气组GR的含量显著低于脾虚湿盛组与正常组(P<0.05),而脾虚湿盛组与正常组之间无显著差异(P>0.05)。GR与病程呈负相关(P<0.05);与肺功能第一秒用力呼气量与用力呼气量比值(FEV1/FVC,1秒率)、第1秒用力呼气容积与预计值之比(FEV1%)呈正相关(P<0.05),与血清皮质醇呈正相关(P<0.05)。结论:肾不纳气型COPD患者急性加重期外周血白细胞中GR含量显著降低,且与血清皮质醇的含量呈同步下降趋势,可能与患者病情反复加重,长期应用糖皮质激素抑制肾上腺皮质功能,并下调GR的水平有关。GR含量的下降降低了糖皮质激素的抗炎疗效,进而导致患者气道炎症控制不佳。
OBJECTIVE: To investigate the expression of glucocorticoid receptor (GR) in peripheral blood leukocytes in patients with chronic obstructive pulmonary disease (COPD) and to explore the possible influencing factors. Methods: According to the inclusion criteria, 30 patients with renal insufficiency-type COPD were selected as the experimental group (Renal-naive group) and 30 patients with spleen-deficiency and wetness-type COPD as the syndrome control group In addition, 30 non-COPD patients were selected as disease control group (non-COPD group). The levels of glucocorticoid receptor GR in peripheral leukocytes were determined by reverse transcription polymerase chain reaction (RT-PCR), and the correlation between GR and duration of disease, lung function and serum cortisol were analyzed. Results: The content of GR in renal dysfunction group was significantly lower than those in normal control group and those in normal control group (P <0.05). However, no significant difference was found between the two groups (P> 0.05). GR was negatively correlated with the course of the disease (P <0.05). The ratio of the first second forced expiratory volume to forced expiratory volume (FEV1 / FVC, 1 second rate) (FEV1%) was positively correlated (P <0.05), and positively correlated with serum cortisol (P <0.05). CONCLUSIONS: The levels of GR in peripheral blood leucocytes in patients with renal insufficiency-type COPD are significantly decreased in the acute stage of exacerbation, and the serum levels of cortisol decrease synchronously with the serum levels of cortisol, which may be aggravated with the patient’s condition. Long-term use of glucocorticoids inhibits adrenocortical function, And reduce the level of GR related. Decreased GR levels reduce the anti-inflammatory effects of glucocorticoids, leading to poor patient control of airway inflammation.