Role And Significance Of Serum Levels Of TGF-β、VEGF And IGF-I In Patients With Combined Pulmonary Fibrosis And Emphysema And The Correlation Research To Smoking

Objective：Along with the CT and high resolution CT technologypromotion and application, many of the patients are clinical pulmonaryfibrosis lesions,meanwhile, they exist emphysema disease,too. Then theresearchers named Combined Pulmonary fibrosis and emphysema (CPFE),and after the study, they have found that a significant correlation with smoking,and independent diagnostic criteria:(1) the clinical characteristics withemphysema, in part with pulmonary fibrosis characteristics, such asprogressive dyspnea, inhale the burst at the end of the sound, oak, point to(foot), etc.(2) although with pulmonary fibrosis clinical diagnosis standardsbut lung volume without narrowing.(3) findings: X-ray chest radiograph andhigh resolution lung CT: at the same time a emphysema and lung fibrosischange.(4) the lung function: not fully comply with jam type or limit typeventilation function obstacle, but mixed type ventilation function obstacle.Atpresent, the pathogenesis of Combined Pulmonary fibrosis and emphysema(CPFE) is still not clear enough, and needs to be studied further. The paperaimed to detect the level of transformation growth factor-β1(TGF-β1),vascular endothelial growth factor (VEGF), insulin growth factor-I (IGF-I) inthe serum of Combined Pulmonary fibrosis and emphysema (CPFE),idiopathic pulmonary fibrosis (IPF),and emphysema (emphysema) patients, inorder to exploreing cell factors in Combined Pulmonary fibrosis andemphysema (CPFE)role, and at the same time through testing various cells inthe similarities and differences of different factors disease to study thecorrelation with smoking, so as to provide the support of theory forclinical looking for early preventive measures and new treatment.Method：20cases of in hospital patients with Combined Pulmonary fibrosis and emphysema (CPFE) in the Second Hospital of Hebei MedicalUniversity from December2010to December2011were selected as a researchteam（Ⅰ）. All of the patients must meet the following diagnostic criteria suchas (1) the clinical characteristics with emphysema, in part with pulmonaryfibrosis characteristics, such as progressive dyspnea, inhale the burst at the endof the sound, oak, point to (foot), etc.(2) although with pulmonary fibrosisclinical diagnosis standards but lung volume without narrowing.(3) findings:X-ray chest radiograph and high resolution lung CT: at the same time aemphysema and lung fibrosis change.(4) the lung function: not fully complywith jam type or limit type ventilation function obstacle, but mixed typeventilation function obstacle.40cases of in hospital patients with idiopathicpulmonary fibrosis (IPF) were selected as the Control group （Ⅱ）. All of thepatients must meet the following diagnostic criteria such as the main criteriaincluding (1) the known reason except interstitial lung disease, such ascollagen vascular disease caused by a pulmonary fibrosis caused by drugs,fibrosis, and chronic hypersensitivity pneumonitis, professional orenvironmental factors (such as the asbestos) of pulmonary fibrosis lung,familial idiopathic pulmonary fibrosis, Hermansky-Pudlak syndrome causedby such as the pulmonary fibrosis.(2) Lung function: restrictive ventilationfunction obstacle and (or) gas exchange diffusion block.(3) a high resolutionCT shows double lung grid shape change, appear honeycomb-like change latemay be associated with change of ground-glass opacity.(4) after fiber opticsbronchoscopy lung biopsy or bronchoaleolar laage art not support otherdisease diagnosis. The secondary standard including (1)> age50(2) nosignificant incentives or hidden progressive dyspnea (3) come on time is3months or more (4) At the end of the sound, double lung can smell the Velcro.40cases of in hospital patients with emphysema (emphysema) were selectedas the Control group （Ⅲ）.All of the patients must meet the definition ofemphysema such as the terminal peribronchiolar distal happen lasting,abnormal gas cavity expansion, the alveolar walls damage and no obviousfibrosis. The definitions of emphysema was formulated in1985the United States with the national heart, chest, and blood institute (NIH).3ml ofperipheral blood is extracted from the empty stomach of patients in themorning, with3000RPM, centrifugal10minutes, extraction serum, buy-80℃save. Seurm levels of TGF-β1、VEGF、IGF-I were measured by doubleantibody sandwich ABC-ELISA method.Results:1general condition: Combined Pulmonary fibrosis and emphysemagroups: blood white blood cells>10x109/L person in15patients,75.00%,neutrophils>0.75in13patients (65.00%). Average blood oxygen partialpressure (PaO2) for (58.15±13.52)mmHg (1mmHg=0.133kPa), averageblood carbon dioxide points pressure (PaCO2) for (45.51±17.09) mmHg.Idiopathic pulmonary fibrosis groups: blood white blood cells>10x109/Lof33patients (82.50%), neutrophils>0.75to the27cases, accounting for67.50%. PaO2for an average of (50.29±14.53)mmHg, PaCO2for anaverage of (37.81±13.68) mmHg. Emphysema groups: blood white bloodcells>10x109/L person in15patients,37.50%, neutrophils>0.75for19cases, accounting for47.50%. PaO2for an average of (50.17±14.53) mmHg,PaCO2for an average of (58.81±12.68)mmHg.23groups comparison of Seurm levels of TGF-β1、VEGF、IGF-ICombined Pulmonary fibrosis and emphysema group and idiopathicpulmonary fibrosis serum levels of TGF-β1, IGF-I were significantly higherthan that of emphysema group, and there are significant differences, so there isstatistical significance. Idiopathic pulmonary fibrosis group was significantlyhigher than serum level of VEGF of emphysema group, a significantdifference and have statistical significance, however, Combined Pulmonaryfibrosis and emphysema group serum level of VEGF higher than emphysemagroup,but (P>0.05), therefore, statistical significanceand is not obvious.3smoking group and no smoking group comparison of Seurm levels ofTGF-β1、VEGF、IGF-I in Combined Pulmonary fibrosis and emphysemapatientsCombined Pulmonary fibrosis and emphysema smoking group was significantly lower than the level of serum VEGF no smoking group (P <0.05), with a statistical significance. Smoking group TGF-β1serum levelhigher than the no smoking group (P﹥0.05), statistical significance is notbig, smoking set higher levels of serum IGF-I than no smoking group (P﹥0.05),but statistical significance is not big.4Serum level of TGF-β1, VEGF, IGF-I and correlation analysis ofvarious factorscombined Pulmonary fibrosis and emphysema group and emphysemagroup serum levels of TGF-β1and IGF-I is positively associated (r值分别为0.885�'�0.918, P<0.01);combined Pulmonary fibrosis and emphysema groupand emphysema of two groups of smoking and daily with serum VEGFexpensive negative correlation (r值为-0.5431， P<0.05); Pulmonary fibrosisare expensive and serum daily group TGF-β1was positively related（r值为0.641，P<0.05）; Three groups serum levels of TGF-β1、IGF-I, VEGF donot exist the linear correlation with oxygen partial pressure，carbon dioxidepoints pressure, oxygen saturation and routine blood each index.Conclusions:1The experiments show that serum level of vascular endothelial growthfactor (VEGF) increased significantly in the early inflammatory reactionperiod of idiopathic pulmonary fibrosis, presumably, there is a closerelationship between serum levels of vascular endothelial growth factor(VEGF) and early inflammatory response of pulmonary fibrosis.2serum level of vascular endothelial growth factor (VEGF) is reduced inthe smoking group, and serum level of vascular endothelial growth factor(VEGF) decrease, and that can lead to the occurrence of emphysema, atthe same time,we can speculate that smoking is a factors in the main riskfactors of emphysema. Meanwhile, serum level of growth factor-β1transformation (TGF-β1) is Significant rise in the smoking group, and TGF-β1is a powerful factor that can cause Pulmonary fibrosis. smoking may causePulmonary fibrosis by changing the serum level of transformation growthfactor-β1(TGF-β1). Therefore, smoking is a common risk factor for lung fibrosis and emphysema.3The experiments show that serum level of insulin-like growth factor(IGF-I) significantly increase in the idiopathic pulmonary fibrosis group, andwe can speculate insulin-like growth factor-I (IGF-I) is a factor of fibrosis. Atthe same time, not only transformation growth factor-β1(TGF-β1) andinsulin-like growth factor-I (IGF-I) exist linear regression relation, but alsomay play a synergetic role in the process of the fibrosis.