作者：刘婷1 ，李洋 2 ，孙娇琳 2 ，石志红 2 ，杨岚 2

单位：

1.710061 陕西省西安市，西安交通大学第一附属医院涉外病房　；2.710061 陕西省西安市，西安交通大学第一附属医院呼吸与危重症医学科；通信作者：杨岚，E-mail：ylan8@medmail.com.cn

Units：

1.Foreign-related Ward，the First Affiliated Hospital of Xi'an Jiaotong University，Xi'an 710061，China；2.Department of Respiratory and Critical Care Medicine，the First Affiliated Hospital of Xi'an Jiaotong University，Xi'an710061，China；Corresponding author：YANG Lan，E-mail：ylan8@medmail.com.cn

关键词：

慢性阻塞性肺疾病；贫血；可溶性转铁蛋白受体；认知功能

Keywords：

Chronic obstructive pulmonary disease；Anemia；Soluble transferrin receptor；Cognitive function

CLC：

R 563.9

DOI：

DOI：10.3969/j.issn.1008-5971.2020.03.014

Funds：

摘要：

背景　目前，血清可溶性转铁蛋白受体（sTFR）水平与慢性阻塞性肺疾病（COPD）患者认知障碍的关系尚未完全明确。目的　探讨血清 sTFR 水平与 COPD 患者认知障碍程度的相关性。方法　选取 2017 年 2 月—2019 年 7 月在西安交通大学第一附属医院就诊的 COPD 患者 248 例作为观察组，另选取同期健康体检者 250 例作为对照组；另根据贫血程度将 COPD 患者分为轻度组 38 例、中度组 45 例、重度组 19 例及非贫血组 146 例。比较对照组、观察组及轻度组、中度组、重度组、非贫血组患者血清 sTFR、内皮素 1（ET-1）、铁调节素（hepcidin）、8- 羟基脱氧尿苷酸（8-OHdG）、低氧诱导因子 1α（HIF-1α）水平及蒙特利尔认知评估量表（MoCA）评分；血清 sTFR水平、MoCA 评分与 COPD 患者血清 ET-1、hepcidin、8-OHdG、HIF-1α 水平间的相关性分析及血清 sTFR 水平与COPD 患者 MoCA 评分的相关性分析均采用 Pearson 相关分析。结果　（1）观察组患者血清 sTFR、ET-1、hepcidin、8-OHdG、HIF-1α 水平高于对照组，MoCA 评分低于对照组（P<0.05）。（2）轻度、中度、重度组患者血清 sTFR、ET-1、hepcidin、8-OHdG、HIF-1α 水平高于非贫血组，MoCA 评分低于非贫血组（P<0.05）；中度、重度组患者血清 sTFR、ET-1、hepcidin、8-OHdG、HIF-1α 水平高于轻度组，MoCA 评分低于轻度组（P<0.05）；重度组患者血清 sTFR、ET-1、hepcidin、8-OHdG、HIF-1α 水平高于中度组，MoCA 评分低于中度组（P<0.05）。（3）Pearson 相关分析结果显示，血清 sTFR 水平与 COPD 患者血清 ET-1（r=0.482）、hepcidin（r=0.682）、8-OHdG（r=0.513）、HIF-1α（r=0.441）水平均呈正相关（P<0.05），MoCA评分与COPD患者血清ET-1（r=-0.461）、hepcidin（r=-0.515）、8-OHdG（r=-0.485）、HIF-1α（r=-0.437）水平均呈负相关（P<0.05）；血清 sTFR 水平与 COPD 患者 MoCA 评分呈负相关（r=-0.481，P<0.05）。结论　随着贫血程度加重，COPD 患者血清 sTFR 水平升高、认知障碍程度加重，且血清 sTFR 水平与 COPD 患者认知障碍程度有关。

Abstract：

Background　Relationship between serum soluble transferrin receptor（sTFR）level and cognitivedisorder in patients with COPD is not completely clear so far. Objective　To analyze the correlation between serum sTFRlevel and severity of cognitive disorder in patients with COPD. Methods　A total of 248 patients with COPD were selected asobservation group in the First Affiliated Hospital of Xi'an Jiaotong University from February 2017 to July 2019，meanwhile atotal of 250 healthy people admitted to this hospital for physical examination were selected as control group；all patients withCOPD were divided into mild group（n=38），moderate group（n=45），severe group（n=19）and non-anemia group（n=146）according to the incidence and severity of anemia. Serum levels of sTFR，ET-1，hepcidin，8-OHdG ，HIF-1αand MoCA score were compared between control group and observation group，among mild group，moderate group，severegroup and non-anemia group；Pearson correlation analysis was used to analyze the correlations of serum sTFR level and MoCAscore with serum levels of ET-1，hepcidin，8-OHdG，HIF-1α in patients with COPD，as well as between serum sTFR leveland MoCA score in patients with COPD. Results　（1）Serum levels of sTFR，ET-1，hepcidin，8-OHdG and HIF-1α inobservation group were statistically significantly higher than those in control group，while MoCA score in observation group wasstatistically significantly lower than that in control group（P<0.05）.（2）Serum levels of sTFR，ET-1，hepcidin，8-OHdGand HIF-1α in mild group，moderate group and severe group were statistically significantly higher than those in non-anemiagroup，while MoCA score in mild group，moderate group and severe group was statistically significantly lower than that in non-anemia group，respectively（P<0.05）；serum levels of sTFR，ET-1，hepcidin，8-OHdG and HIF-1α in moderate groupand severe group were statistically significantly higher than those in mild group，while MoCA score in moderate group and severegroup was statistically significantly lower than that in mild group，respectively（P<0.05）；serum levels of sTFR，ET-1，hepcidin，8-OHdG and HIF-1α in severe group were statistically significantly higher than those in moderate group，whileMoCA score in severe group was statistically significantly lower than that in moderate group（P<0.05）.（3）Pearson correlationanalysis results showed that，serum sTFR level was positively correlated with serum levels of ET-1 （r=0.482），hepcidin （r=0.682），8-OHdG（r=0.513）and HIF-1α（r=0.441）in patients with COPD，respectively（P<0.05），while MoCA score wasnegatively correlated with serum levels of ET-1（r=-0.461），hepcidin（r=-0.515），8-OHdG（r=-0.485）and HIF-1α（r=-0.437），respectively（P<0.05）；serum sTFR level was negatively correlated with MoCA score in patients with COPD（r=-0.481，P<0.05）. Conclusion　As severity of anemia aggravates，serum sTFR level increases and severity of cognitivedisorder aggravates in patients with COPD，and serum sTFR level is significantly correlated with the severity of cognitive disorderin patients with COPD.

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