马景景, 江天, 崔洁, 田盈, 徐秋敏, 王爽, 全尚琨, 陈紫莺, 候晓敏, 郝小惠, 郭灵丽, 刘和亮. 矽肺患者肺泡灌洗液中sRAGE表达的变化及其意义[J]. 环境与职业医学, 2019, 36(2): 170-174. DOI: 10.13213/j.cnki.jeom.2019.18451
引用本文: 马景景, 江天, 崔洁, 田盈, 徐秋敏, 王爽, 全尚琨, 陈紫莺, 候晓敏, 郝小惠, 郭灵丽, 刘和亮. 矽肺患者肺泡灌洗液中sRAGE表达的变化及其意义[J]. 环境与职业医学, 2019, 36(2): 170-174. DOI: 10.13213/j.cnki.jeom.2019.18451
MA Jing-jing, JIANG Tian, CUI Jie, TIAN Ying, XU Qiu-min, WANG Shuang, QUAN Shang-kun, CHEN Zi-ying, HOU Xiao-min, HAO Xiao-hui, GUO Ling-li, LIU He-liang. Changes and significance of sRAGE expression in bronchoalveolar lavage fluid of patients with silicosis[J]. Journal of Environmental and Occupational Medicine, 2019, 36(2): 170-174. DOI: 10.13213/j.cnki.jeom.2019.18451
Citation: MA Jing-jing, JIANG Tian, CUI Jie, TIAN Ying, XU Qiu-min, WANG Shuang, QUAN Shang-kun, CHEN Zi-ying, HOU Xiao-min, HAO Xiao-hui, GUO Ling-li, LIU He-liang. Changes and significance of sRAGE expression in bronchoalveolar lavage fluid of patients with silicosis[J]. Journal of Environmental and Occupational Medicine, 2019, 36(2): 170-174. DOI: 10.13213/j.cnki.jeom.2019.18451

矽肺患者肺泡灌洗液中sRAGE表达的变化及其意义

Changes and significance of sRAGE expression in bronchoalveolar lavage fluid of patients with silicosis

  • 摘要: 目的 检测不同期别矽肺患者肺泡灌洗液(BALF)中可溶性晚期糖基化终末产物受体(sRAGE)、致纤维化相关因子分泌水平以及肺功能的变化,分析sRAGE与后两者间的相互关系,探讨sRAGE在矽肺纤维化进展过程中可能起到的作用及意义。

    方法 选取61例于2016年5-10月在中国煤炭工人北戴河疗养院行支气管肺泡灌洗术的患者为研究对象,其中观察对象组(矽尘作业人员的X射线胸片有不能确定的尘肺样影像改变,但并未达到壹期矽肺者纳入观察对象组)7例,矽肺壹期18例,矽肺贰期15例和矽肺叁期21例。收集研究对象的年龄、工龄、血压、体重指数(BMI)、首次接尘年龄等基础资料。采用美国PB840肺功能测定仪测定研究对象用力肺活量(FVC)、第一秒用力呼气量(FEV1)、最大呼气峰流速(PEF)、用力呼气25%肺活量流速(PEF25)、用力呼气50%肺活量流速(PEF50)、第一秒用力呼气量/用力肺活量(FEV1/FVC)、深吸气量(IC)、最大肺活量(VCmax)等肺功能相关指标;应用酶联免疫吸附(ELISA)试剂盒检测BALF中sRAGE、肿瘤坏死因子α(TNF-α)及转化生长因子β1(TGF-β1)水平;采用Pearson积矩相关分析sRAGE与相关指标如年龄、工龄、首次接尘年龄、血压、BMI、肺功能指标值以及TNF-α、TGF-β1水平的相关性。

    结果 矽肺患者的年龄、工龄、血压、BMI与观察对象组之间差异均无统计学意义,矽肺叁期患者组的首次接尘年龄(29.19±7.64)岁高于观察对象组(26.86±7.01)岁(P < 0.05)。研究对象的肺功能随矽肺分期的增加而降低,矽肺叁期组的VCmax、IC、PEF、PEF25、PEF50、PEF75、FEV1、FEV1/FVC指标值均低于观察对象组(均P < 0.05)。矽肺叁期患者sRAGE水平(1 060.91±472.75)pg/mL低于矽肺贰期(1 490.36±688.56)pg/mL和观察对象组(1 450.37±530.98)pg/mL(均P < 0.05);矽肺叁期患者TNF-α的水平(2.42±0.94)pg/mL高于观察对象组、矽肺壹期组(1.16±1.03)pg/mL、(1.51±0.97)pg/mL(均P < 0.05);各组间TGF-β1水平变化无明显统计学差异。相关性分析结果显示,sRAGE的水平与FEV1、FVC和BMI呈正相关,与首次接尘年龄呈负相关,相关系数分别为0.295、0.265、0.404和-0.267(均P < 0.05)。

    结论 sRAGE的水平与FEV1、FVC、BMI以及首次接尘年龄相关,sRAGE分泌的降低可能在矽肺纤维化发展后期起到重要作用。

     

    Abstract: Objective To detect the changes of soluble receptor for advanced glycation end products (sRAGE), fibrosis-related factors in alveolar lavage fluid (BALF), and lung function of patients with silicosis in different stages, analyze the relationship of sRGAE with fibrosis-related factors and lung function, and discuss the possible role and significance of sRGAE in the progression of silicosis.

    Methods Sixty-one patients who underwent bronchoalveolar lavage in the Chinese Coal Worker Beidaihe Nursing Home from May to October 2016 were selected as study subjects, including 7 silicosis observation subjects, whose chest X-ray films showed uncertain silicosis-like changes, and 18 stage Ⅰ, 15 stage Ⅱ, and 21 stage Ⅲ silicosis patients. General data such as age, working age, blood pressure, body mass index (BMI), and age of first exposure to dust were collected. Pulmonary function related indicators such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), peak expiratory flow at 25% of vital capacity (PEF25), forced expiratory flow at 50% of vital capacity (PEF50), ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC), deep inspiratory capacity (IC), and maximum vital capacity (VCmax) were measured with PB840 pulmonary function tester. The levels of sRAGE, tumor necrosis factor α (TNF-α), and transforming growth factor β1 (TGF-β1) in BALF were detected with enzyme-linked immunosorbent assay (ELISA) kits. Correlations of sRAGE with indicators such as age, working age, age of first exposure to dust, blood pressure, BMI, lung function indicators, TNF-α, and TGF-β1 were assessed by Pearson product moment correlation.

    Results There were no differences in age, working age, blood pressure, and BMI between the observation group and the patients with silicosis, but the age of first exposure to dust in the patients with silicosis at stage Ⅲ(29.19±7.64) years was higher than that of the observation group(26.86±7.01) years (P < 0.05). The lung function of the silicosis subjects decreased with the increase of silicosis stages, and VCmax, IC, PEF, PEF25, PEF50, PEF75, FEV1, FEV1/FVC were all lower in the patients with silicosis at stage Ⅲ than in the observation group (Ps < 0.05). The level of sRAGE of the silicosis stage Ⅲ group(1 060.91±472.75) pg/mL was lower than those of the silicosis stage Ⅱ group(1 490.36±688.56) pg/mL and the observation group(1 450.37±530.98) pg/mL (Ps < 0.05). The expression of TNF-α of the silicosis stage Ⅲ group(2.42±0.94) pg/mL was higher than those of the observation group(1.16±1.03) pg/mL and the silicosis stage Ⅰ group(1.51±0.97) pg/mL (Ps < 0.05). No significant difference was found in TGF-β1 level among the groups. The level of sRAGE was positively correlated with FEV1, FVC, and BMI, while negatively with the age of first exposure to dust, with correlation coefficients of 0.295, 0.265, 0.404, and -0.267 respectively (Ps < 0.05).

    Conclusion The level of sRAGE is associated with FEV1, FVC, BMI, and the age of first exposure to dust. Reduced sRAGE may play an important role in the late progression of silicotic fibrosis.

     

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