肌肉生长抑制素在慢性阻塞性肺疾病合并肺动脉高压患者血浆中的表达及意义

Plasma myostatin in patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease

摘要:

目的 研究肌肉生长抑制素在慢性阻塞性肺疾病（COPD）合并肺动脉高压（PH）患者中的表 达水平。分析肌肉生长抑制素与COPD合并PH 的关系。方法 59 例COPD 合并PH 患者和166 例COPD 无PH 患者，检测肌肉生长抑制素和脑钠肽（BNP）水平。心脏彩超评估右心室功能和形态，心脏多普勒检 测肺动脉压力（SPAP），SPAP ≥ 40 mmHg 被确定为PH，三尖瓣瓣环收缩期偏移（TAPSE）≤ 16 mm 为右 心功能不全。检查肺功能、动脉血气、6 min 步行距离。结果 收录225 例COPD 患者，COPD 合并PH 患 者占26.2%（59/225）；COPD 合并PH 组肌肉生长抑制素和BNP 水平高于COPD 无PH 组，两组肌肉生长抑 制素水平分别是中位数16.4 和12.8 ng/L，差异有统计学意义（P <0.05）；BNP 水平分别是（147.87±42.98） 和（114.61±53.47）pg/ml，差异有统计学意义（P <0.05）；相关分析：BNP 和肌肉生长抑制素呈正相关；肌 肉生长抑制素和SPAP 呈正相关 ；肌肉生长抑制素与TAPSE 和右室心肌性能指标相关（P <0.05）；BNP 只与 SPAP 呈正相关（P <0.05）。结论 COPD 合并PH 患者，血浆肌肉生长抑制素水平增加，与血浆BNP 水平比较， 在评估右心功能及肺动脉高压方面，肌肉生长抑制素水平有更强的相关性。肌肉生长抑制素可能优于BNP 对 COPD 合并肺动脉高压的早期诊断。

Abstract:

Objective To investigate the expressions of myostatin in patients with chronic obstructive pulmonary disease (COPD) combined with or without pulmonary hypentension (PH), and analyze the relationship of plasma myostatin level with PH in patients with COPD. Methods The levels of myostatin and BNP were investigated in 59 COPD patients with PH and 166 COPD patients without PH. Echocardiography was used to evaluate the function and morphology of the right ventricle (RV), and the value of tricuspid annular plane systolic excursion (TAPSE) less than 16 mm was considered as RV dysfunction. PH was defined as systolic pulmonary artery pressure (SPAP) ≥ 40 mmHg assessed by Doppler echocardiography. Lung function, arterial blood gas, and 6-minute walking distance were checked. Results A total of 225 patients were recruited, 26.2% (59/225) had PH. The plasma myostatin level was 16.4 ng/L (2.2 - 25.7 ng/L) in the patients with PH and 12.8 ng/L (3.2 - 20.3 ng/L) in the patients without PH, the plasma BNP level was (147.87 ± 42.98) pg/ml in the patients with PH and (114.61 ± 53.47) pg/ml in the patients without PH, the plasma myostatin and BNP levels were significantly higher in the patients with PH than in the patients without PH (z = -2.741 and -2.023, P < 0.05). There was a positive correlation between plasma myostatin level and BNP level in the whole study groups (P < 0.05). Plasma myostatin level was positively correlated with SPAP (P < 0.05). Multivariate regression analysis suggested that myostatin level was significantly correlated with the values of TAPSE and RV myocardium performance indexes among the COPD patients (P < 0.05), and that BNP level was only positively correlated with SPAP (P < 0.05). Conclusions Plasma myostatin level is increased in COPD patients who have PH. Stronger correlations of plasma myostatin level with echocardiographic indexes of the right heart suggest that myostatin might be superior to BNP in the early diagnosis of PH in COPD patients.