The Serum Levels And Significance Of Visfatin In Stable And Acute Exacerbation Phases Of Chronic Obstructive Pulmonary Disease

Objective: To investigate the concentration change of serumvisfatin level in patients with stable and acute exacerbation phases ofchronic obstructive pulmonary disease(COPD), and preliminarily explorethe possible pathogenesis and the relationship among visfatin levels,systemic inflammation, chronic hypoxia and nutritional metabolism withCOPD. Method: This study had a control group comprising of twentyage-matched healthy people (woman9, man11)and observation groupcomprising of eighty patients (woman37, man43). These patients werediagnosed with COPD according to criteria from The Chinese MedicalAssociation Respiratory Association. They were selected as stable COPDgroup in clinically stable for at least8week after treatment. There wereno significant difference in age and gender between groups (P>0.05).Samples of every group were collected by venipuncture afterovernight fasting. All blood samples were performed in duplicate. Onewas used to measure blood glucose、blood lipid and blood routineexamination immediately(TC、TG、TP、ALB、GLB、HDL-C、LDL-C、APO-A、APO-B、GLU、WBC、NEU%), the other was centrifuged at4000rpm for10minute and then serum was collected and stored at-70°C. They were used to measure visfatin, Interleukin-8（IL-8）, Hypoxiainducible factor-1α（HIF-1α）and Tumor necrosis factor-α（TNF-α）byEnzyme Linked Immunosorbent Assay method (ELLSA). The bloodsamples from the radial arteries of the patients were used to measure theparameters of PaCO2, PaO2and oxygen saturation. Additionally,pulmonary function test, height, weight and body mass index (BMI) weremeasured and calculated by same people. The numerical values werepresented as mean±standard deviation. All the data were analyzed withSPSS16.0. A P value <0.05was accepted as statistically significant.Results:(1).The levels of serum visfatin were significantly higher in theAECOPD group compared with the stable COPD group and the healthycontrol group（81.67±23.27pg/ml versus72.78±19.25pg/ml,62.05±24.88pg/ml）, Significant differences among these three groups (P<0.05) hadstatistically significance.(2).The patients were divided into differentgroups according to BMI, the severity of pulmonary function impairingand the severity of hypoxia. In AECOPD, the significant differences ofvisfatin levels among BMI1-BMI4groups, COPDⅠ-COPDⅣ groups,different hypoxia groups and normal control group existed statisticallysignificance because all p value <0.01(F=3.991,P=0.005;F=3.718,P=0.008; F=7.996,P=0.000,). In stable COPD, thedifferences of visfatin levels among BMI1-BMI4groups, COPDⅠ-COPDⅣ groups and normal control group had no statistically significance because All p value>0.05(F=2.183,P=0.077; F=1.79,P=0.138). There was statistically significance among normal controlgroup, the mild hypoxia group, the middle hypoxia group and severehypoxia group(F=3.429,P=0.021,P<0.05).(3).According to the occuringof complication of chronic pulmonary heart disease, we devided theAECOPD patients into the COPD group and the COPD complicated withchronic pulmonary heart disease group. The levels of serum visfatin weresignificantly higher in the COPD complicated with chronic pulmonaryheart disease group compared with the COPD group and the controlgroup. The significant differences among groups had statisticallysignificance in AECOPD and stable COPD (F=9.324, F=8.858，P<0.001).(4). According to the occuring of smoking, we devided the AECOPDpatients into smoking group and non-smoking group. there was nostatistically significance between the smoking group and non-smokinggroup (t=0.131,P=0.896,P>0.05).(5). According to the correlationanalysis, it was observed that visfatin and the indexes of nutrition、hypoxia、inflammation(BMI、TC、TG、TP、ALB、GLB、HDL-C、LDL-C、APO-A、APO-B、GLU、HIF-1α、FEV1/FVC、FEV1%、PaCO2、SO2%、PaO2、TNF-α、IL-8、NEU%) existed a significant correlationin AECOPD (except WBC P>0.05). But in stable COPD, HIF-1α、FEV1/FVC、TNF-α、IL-8and visfatin had significant correlation(P<0.01).(6). In AECOPD, the indexes of nutrition、 hypoxia、 inflammation as independent variable were analyzed with multivariatestepwise regression analysis. TC、 TG、LDL-C、GLU、HIF-1α、FEV1/FVC、 TNF-α、 IL-8、 NEU%were the important factors ofinfluencing visfatin level. Furthermore, HIF-1α、FEV1/FVC、TNF-α、NEU%were the important influencing factors in stable COPD.Conclusion:(1).The serum levels of visfatin existed significant change inpatients with AECOPD and stable COPD, and this adipocytokine had asignificant correlation with inflammation factors、hypoxia induciblefactor-1a and nutritive indexes.(2).Visfatin likely participated in theprocess of continuous systemic inflammation, chronic hypoxia andnutritional metabolism. In addition, visfatin might play an important roleof accelerating evolution of COPD and increasing the risk ofcomplications such as diabetes、 cardiovascular and cerebrovasculardiseases,etc.