标题：慢性阻塞性肺疾病急性加重期患者血清中miR-146a的表达及其临床意义

      作者：郭辉 1，程广坤 1，张晓雪 1，邓国平 2    上海健康医学院附属浦东新区人民医院检验科 1、呼吸内科 2，上海 201299

      卷次： 2019年30卷18期

      【摘要】 目的 探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者血清中微小RNA-146a (miR-146a)的表达及其临床意义。方法 选取 2017年 6月至 2018年 10月期间在浦东新区人民医院接受治疗的慢性阻塞性肺疾病(COPD)稳定期患者 60例作为稳定期组，选取同期收治的AECOPD患者 60例作为急性加重期组，另选取同期在本院体检的 60例健康志愿者作为对照组。比较三组受试者血清中miR-146a的相对表达量以及白细胞介素-1β(IL-1β)、白细胞介素-6 (IL-6)、肿瘤坏死因子-α (TNF-α)、干扰素-γ (INF-γ)水平，比较三组受试者1 s用力呼气量(FEV1)、FEV1/用力肺活量(FEV1/FVC)和最大呼气流量(PEF)，分析AECOPD患者血清中miR-146a相对表达量与炎症因子和肺功能指标的关系。结果 急性加重期组患者血清中的miR-146a相对表达量为0.54±0.18，明显低于稳定期组的 0.89±0.28和对照组的 0.92±0.31，差异均具有统计学意义(P<0.05)，而稳定期组和对照组血清中miR-146a相对表达量比较差异无统计学意义(P>0.05)；急性加重期组患者血清中 IL-1β、IL-6、TNF-α、INF-γ水平分别为(0.38±0.12) μg/L、(284.94±43.12) mg/L、(38.42±15.49) ng/mL、(0.86±0.21) μg/L，明显高于稳定期组的(0.29±0.08) μg/L、(211.52±36.28) mg/L、(28.51±12.06) ng/mL、(0.65±0.14) μg/L和对照组的 (0.24±0.04) μg/L、(116.27±30.12) mg/L、(17.68±10.25) ng/mL、(0.51±0.08) μg/L，而稳定期组血清中 IL-1β、IL-6、TNF-α、INF-γ水平又明显高于对照组，差异均具有统计学意义(P<0.05)；急性加重期组患者的 FEV1、FEV1/FVC、PEF分别为(54.68±13.53)%、(53.04±6.97)%、(65.37±10.91)%，明显低于稳定期组的(68.42±12.64)%、(64.58±12.35)%、(75.29±10.74)%和对照组的(93.16±6.57)%、(88.22±10.36)%、(92.57±5.68)%，而稳定期组的FEV1、FEV1/FVC、PEF又明显低于对照组，差异均具有统计学意义(P<0.05)；AECOPD患者血清中miR-146a相对表达量与 IL-1β、IL-6、TNF-α、INF-γ呈负相关(r=-0.426、-0.538、-0.397、-0.418，P<0.05)，与 FEV1、FEV1/FVC、PEF呈正相关 (r=0.342、0.407、0.305，P<0.05)。结论 AECOPD血清中miR-146a呈低表达，且其表达水平与炎症因子水平呈负相关，与肺功能指标呈正相关，miR-146a的相对表达量可能与AECOPD患者病情相关。
      【关键词】 微小RNA-146a；慢性阻塞性肺疾病；急性加重期；炎症反应；肺功能
      【中图分类号】 R563 【文献标识码】 A 【文章编号】 1003—6350（2019）18—2345—04

Expression of miR-146a in serum of patients with acute exacerbation of chronic obstructive pulmonary diseaseand its clinical significance.
GUO Hui 1, CHENG Guang-kun 1, ZHANG Xiao-xue 1, DENG Guo-ping 2. Department ofClinical Laboratory 1, Department of Respiratory Medicine 2, Pudong New Area People's Hospital Affiliated to Shanghai Uni-versity of Medicine and Health Sciences, Shanghai 201299, CHINA
【Abstract】 Objective To investigate the expression and clinical significance of microRNA-146a (miR-146a)in serum of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of60 patients with stable chronic obstructive pulmonary disease (COPD), who admitted to Pudong New District People'sHospital from June 2017 to October 2018, were selected as the stable period group. Sixty patients with AECOPD wereselected as the acute exacerbation group, and 60 healthy volunteers in the same period were selected as the controlgroup. The relative expression of miR-146a in the serum, the levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), tu-mor necrosis factor-α (TNF-α), and interferon γ (INF-γ) of the three groups were compared. The one second forced ex-piratory volume (FEV1), FEV1/forced vital capacity (FEV1/FVC), and the maximum expiratory flow (PEF) of the threegroups were compared. The relationship between the relative expression of miR-146a and inflammatory factors and pul-monary function in AECOPD patients was analyzed. Results The relative expression of miR-146a in serum of patientsin the acute exacerbation group was 0.54±0.18, which was significantly lower than 0.89±0.28 in the stable period groupand 0.92±0.31 in the control group (P<0.05). However, there was no significant difference in the relative expression ofmiR-146a between the stable period group and the control group (P>0.05). The levels of serum IL-1β, IL-6, TNF-α,and INF-γ in the acute exacerbation group were (0.38±0.12) μg/L, (284.94±43.12) mg/L, (38.42±15.49) ng/mL, (0.86±0.21) μg/L, respectively, which were significantly higher than corresponding (0.29±0.08) μg/L, (211.52±36.28) mg/L,