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目的观察溃疡性结肠炎(ulcerative colitis,UC)患者血清及结肠组织α1-胰蛋白酶(α1-antitrypsin,A1AT)水平与肺损害的相关性,探讨UC肺损害的发生机制。方法将90例确诊为UC的患者,按病变范围、活动度、病情分期及病程进行分组,比较不同病变范围、活动度、病情分期及病程的UC患者血清A1AT水平;选择30名健康志愿者作为对照组,检测UC组及对照组血清肝、肾功能水平及肺功能,并比较两组间肝、肾功能,肺功能及血清A1AT水平的差异。分析UC患者各肺功能指标与血清A1AT的相关性。采用免疫组化法检测20例UC患者及10名健康志愿者结肠组织A1AT含量。结果 90例UC患者中,伴有肺功能异常者54例(60.0%),伴有其他UC肠外表现者24例(26.7%)。与对照组比较,UC组血清A1AT水平明显下降(P<0.05);病变范围为远端结肠及广泛结肠者血清A1AT水平较病变范围局限在直肠者明显下降(P<0.05);病程≥5年者血清A1AT水平较病程<5年者明显下降(P<0.05);病变范围为远端结肠及广泛结肠者肺功能通气指标中肺活量(vital capacity,VC);用力肺活量(forced vital capacity,FVC);一秒量(forced expiratory volume in one second,FEV1.0),肺容量指标中肺总量(total lung capacity,TLC)、功能残气量(function residual volume,FRV)及肺弥散指标中一氧化碳弥散量(diffusion capacity for carbon monoxide of lung,DLCO)较病变范围局限在直肠患者均明显下降(P<0.05);UC患者病程与用力肺活量FVC呈直线负相关(r=-0.23,P=0.018);UC患者血清A1AT水平与峰流速峰流速(peak expiratory flow,PEF)呈正相关(r=0.22,P=0.03)。UC患者结肠A1AT水平明显低于对照组(P<0.05)。重度UC患者结肠A1AT水平较轻中度患者下降(P<0.05)。UC患者结肠A1AT水平高于远端结肠炎及广泛结肠炎患者(P<0.05)。结论 UC患者肺功能异常的发病率高于UC其他肠外表现,肺功能检测有助于提前筛查UC肺损害。UC患者血清及结肠组织中A1AT水平均明显下降,提示UC患者的肺功能损害主要表现为与A1AT水平下降相关的慢性气道炎症、气道重塑及阻塞性改变。
Objective To observe the correlation between α1-antitrypsin (A1AT) level and lung injury in patients with ulcerative colitis (UC) and to explore the mechanism of lung injury in patients with UC. Methods 90 patients diagnosed as UC were divided into groups according to the extent of disease, activity, stage of disease and course of disease. The serum A1AT levels of patients with different extent of disease, activity, stage of disease and course of disease were compared. 30 healthy volunteers The control group was used to detect the level of serum liver and renal function and pulmonary function in UC and control groups. The differences of liver and renal function, pulmonary function and serum A1AT level were compared between the two groups. The correlation between each lung function index and serum A1AT in patients with UC was analyzed. The immunohistochemical method was used to detect the A1AT content in the colon of 20 UC patients and 10 healthy volunteers. Results Of the 90 patients with UC, 54 (60.0%) had pulmonary dysfunction, and 24 (26.7%) had other UC with parenteral manifestations. Compared with the control group, the level of serum A1AT in UC group was significantly decreased (P <0.05). The level of serum A1AT in distal colon and extensive colon was significantly lower than that in the rectum (P <0.05) The level of serum A1AT was significantly lower than that of <5 years (P <0.05). The range of disease was vital capacity (VC), forced vital capacity (FVC) in far-end colon and extensive colon, ; Forced expiratory volume in one second (FEV1.0), total lung capacity (TLC), functional residual volume (FRV), and diffuse volume of carbon monoxide in lung diffuse index (P <0.05). The duration of UC patients was negatively correlated with forced vital capacity (FVC) (r = -0.23, P = 0.018). UC patients had a significantly lower level of diffusion capacity for carbon monoxide of lung The level of A1AT in serum was positively correlated with peak expiratory flow (PEF) (r = 0.22, P = 0.03). The level of A1AT in UC patients was significantly lower than that in control group (P <0.05). Patients with severe UC had lower level of A1AT in the colon (P <0.05). The level of A1AT in UC patients was higher than that in patients with distal colitis and colitis (P <0.05). Conclusions The incidence of pulmonary dysfunction in patients with UC is higher than that of other parenteral UC. Pulmonary function tests may be helpful for the early screening of UC lung injury. A1AT levels in serum and colon of patients with UC were significantly decreased, suggesting that pulmonary function impairment in UC patients mainly associated with decreased A1AT levels of chronic airway inflammation, airway remodeling and obstructive changes.