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Article Type

Original Study

Abstract

Objective The objective of this study was to evaluate the role of serum surfactant protein D (SP-D) in chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2DM). Background SP-D plays a critical role in innate host defense of the lung. SP-D binds bacterial, fungal, and viral pathogens, enhancing their opsonization and their killing by alveolar macrophages. COPD may be considered as a novel risk factor for T2DM via multiple pathophysiological alterations such as inflammation, oxidative stress, administration of glucocorticoids, insulin resistance, and weight gain. On the other hand, diabetes may act as an independent factor, negatively affecting pulmonary structure and function. Diabetes is associated with an increased risk of pulmonary infections, disease exacerbations, and worsened COPD outcomes. Patients and methods This study was carried out on 87 patients classified into the following groups: group I, which included 35 patients with COPD without diabetes mellitus; group II, which included 18 patients with COPD and T2DM; group III, which included 19 patients with T2DM without COPD; and group IV, which included 15 age-matched and sex-matched healthy individuals. All individuals were subjected to full history taking, clinical examination, estimation of BMI, forced expiratory volume in 1 s% (FEV1%) predicted, forced vital capacity% (FVC%) predicted, and FEV1/FVC and laboratory investigations including estimation of fasting blood glucose (FBG), glycated hemoglobin (HbA1c), and serum SP-D, which was carried out using the enzyme-linked immunosorbent assay technique. Results There was a significant statistical difference regarding serum SP-D between studied groups. The highest level of it was in group I than in group II, more lower in group IV, and the lowest level was in group III. There was a significant positive correlation between SP-D and each of age and smoking index, whereas there was a significant negative correlation between SP-D and each of BMI, FBG, HbA1c, FEV1% predicted, FVC% predicted, and FEV1/FVC in studied participants. Age, BMI, and FEV1% predicted are good predictors of SP-D in studied patient groups. Age and smoking index are risk factors for COPD in group I and for COPD and diabetes mellitus in group II, and they are not risk factors for T2DM (group III). Conclusion SP-D was significantly higher in COPD either alone or with T2DM, and it was significantly lower in isolated T2DM. Although SPD did not increase significantly with increasing COPD severity in COPD groups I and II, it correlated negatively with spirometric parameters in all studied participants. There was a positive correlation between SP-D and each of age and smoking index, whereas there was a negative correlation between SP-D and each of BMI, FBG, HbA1c, FEV1% predicted, FVC% predicted, and FEV1/FVC. Factors that predicted serum level of SP-D were age, BMI, and FEV1%. Age and smoking index were risk factors for COPD and they were not risk factors for T2DM.

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