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目的探讨肺泡巨噬细胞合成肾上腺髓质素(ADM)在慢性阻塞性肺疾病(COPD)中的作用与机制。方法选择2003年10月至2004年3月,北京大学深圳医院呼吸科15例COPD住院患者(COPD组)和同期14名健康体检者(对照组),收集其肺泡灌洗液,用放免法测定血浆、支气管肺泡灌洗液(BALF)和肺泡巨噬细胞(AM)培养上清液ADM的浓度。结果(1)COPD组BALF的细胞总数、中性粒细胞(PMN)及AM较对照组显著增高(P<0.01)。(2)COPD组血浆、BALF和AM培养上清液ADM浓度均较对照组增高(P<0.01)。(3)COPD组血浆及BALF的ADM浓度分别与BALF中AM数呈正相关(r分别为0.467和0.448,P均<0.05),血浆与BALFADM浓度亦分别与AM培养液中ADM浓度呈正相关(r分别为0.791和0.874,P均<0.01)。结论COPD患者气道内AM增加,合成ADM增多,是BALF中ADM的重要来源,从而在COPD气道炎症、肺通气及肺动脉高压中发挥广泛调节作用。
Objective To investigate the role of alveolar macrophages in the synthesis of adrenomedullin (ADM) in chronic obstructive pulmonary disease (COPD). Methods From October 2003 to March 2004, 15 COPD patients (COPD group) and 14 healthy subjects (control group) of Respiratory Department of Peking University Shenzhen Hospital were collected and their bronchoalveolar lavage fluid was collected and determined by radioimmunoassay Plasma, bronchoalveolar lavage fluid (BALF) and alveolar macrophage (AM) culture supernatant ADM concentration. Results (1) The total number of BALF cells, neutrophils (PMN) and AM in COPD group were significantly higher than those in control group (P <0.01). (2) ADM concentrations in plasma, BALF and AM culture supernatant in COPD group were significantly higher than those in control group (P <0.01). (3) The concentration of ADM in plasma and BALF of COPD group was positively correlated with the number of AM in BALF (r = 0.467 and 0.448, respectively, P <0.05), and the concentration of plasma and BALFADM was positively correlated with the concentration of ADM in AM (r Respectively, 0.791 and 0.874, P <0.01). Conclusions AM in the airway of COPD patients increases and the synthesis of ADM increases. It is an important source of ADM in BALF and plays a broad regulatory role in COPD airway inflammation, pulmonary ventilation and pulmonary hypertension.