COPD并肺动脉高压患者外周血单个核细胞PPAR.docVIP

COPD并肺动脉高压患者外周血单个核细胞PPARγ表达 　　作者：杨中卫,王成国　　作者单位：郧阳医学院附属东风医院呼吸内科，湖北 十堰 442008 　　【摘要】 目的：探讨COPD所致的肺动脉高压患者外周血单个核细胞中过氧化物酶体增殖物激活受体(PPAR)Γ表达水平与胰岛素抵抗的关系。方法：30例COPD并有肺动脉高压患者(PAH组)，33例无肺动脉高压的COPD患者(COPD组)，20例体检者(对照组)采用实时荧光定量RTPCR法测定PPARΓ mRNA表达水平，放射免疫法和葡萄糖氧化酶法测定空腹胰岛素(FIN)和空腹血糖(FPG)，计算胰岛素抵抗指数(IRI)。结果：COPD及PAH组FPG、FIN、IRI均较对照组升高，PPARΓ mRNA表达水平分别是对照组的0.213，0.003。PAH组PPARΓ表达下降及IRI升高比COPD组更明显。PPARΓ表达水平与IRI呈负相关。结论：COPD患者存在空腹血糖异常和胰岛素抵抗，外周血单个核细胞中PPARΓ表达下调，并发肺动脉高压时PPARΓ表达下调及胰岛素抵抗更为显著;PPARΓ表达下调可能与COPD所致肺动脉高压患者的糖代谢异常有关。 　　【关键词】 过氧化物酶体增殖物激活受体Γ,胰岛素抵抗,肺动脉高压;慢性阻塞性肺病 　　Abstract: Objective To investigate the relationship between expression of peroxisome proliferators activated receptorΓ in PBMCs and insulin resistance in chronic obstructive pulmonary disease(COPD) patients complicating pulmonary hypertension.Methods The expression of PPARΓ mRNA was determined with realtime fluorescence quantitative RTPCR assay in 30 COPD patients complicating pulmonary hypertension (PAH group),33 COPD patients (COPD group) and 20 cases of health control (control group),respectively.Radioimmunoassay and glucose oxidase methods were used to determinate the level of fasting plasma insulin (FIN) and fasting plasma glucose(FPG),then the insulin resistance index (IRI) was calculated.Results Compared with control group,FPG,FIN and IRI were all increased in COPD group and PAH group,the expression of PPARΓ mRNA was 0.213,0.003 times of control group,respectively.The decrease of PPARΓ mRNA expression and the increase of IRI in PAH group was more obvious than that in COPD group.The expression of PPARΓ was negatively correlated with IRI.Conclusion COPD patients have abnormal FPG,insulin resistance and the decrease of PPARΓ expression in PBMCs,the expression downregulation of PPARΓ and insulin resistance are more obvious in patients with PAH complication than that with COPD;The downregulation of PPARΓ may relate with the abnormal glycometabolism in COPD patient with PAH complication.