本文選題：五色流式細胞術(shù) + 煤工塵肺��； 參考：《華北理工大學》2017年碩士論文

【摘要】：目的煤工塵肺(Coal worker’s pneumoconiosis,CWP)為煤礦工人長期吸入煤塵和/或矽塵引起的肺組織彌漫性纖維化疾病。粉塵顆粒進入機體導致巨噬細胞活化或損傷,釋放細胞毒性氧化劑、蛋白酶、細胞因子,促使炎癥細胞到達肺泡上皮細胞表面引起肺泡炎癥和損傷,而炎癥細胞所釋放的毒性氧衍生物和蛋白水解酶可進一步引起細胞DNA損傷、細胞凋亡和相關(guān)的細胞外基質(zhì)沉積,導致肺纖維化的發(fā)生。本研究通過檢測壹期CWP患者外周血粒細胞、CD16+和CD16-單核細胞、B淋巴細胞、細胞毒性T+NK、非細胞毒性T細胞等16種白細胞亞群,探討各細胞水平變化在CWP發(fā)生發(fā)展中的作用,為CWP的機制探究、臨床診斷及治療提供新思路。方法1選取2015-2016年在開灤職業(yè)病防治院住院的部分壹期CWP患者66例(CWP組),依照《塵肺診斷標準》(GBZ-2009)進行確診,選取與CWP組相同接塵條件的井下接塵礦工47例(接塵組)和開灤集團非接塵的井上健康查體人員40例(正常組)。3組間性別、年齡、接塵年限均匹配;所有查體人員均于清晨空腹采集靜脈血2 ml于EDTA-K2抗凝管中,其中住院患者均在治療前采集;采用五色流式細胞術(shù)檢測外周血粒細胞、CD16+和CD16-單核細胞、B淋巴細胞、細胞毒性T+NK、非細胞毒性T細胞等16種白細胞亞群。2運用SPSS 17.0統(tǒng)計軟件分析。對符合正態(tài)分布的計量資料,以均數(shù)±標準差(x±s)表示,三組間均數(shù)比較采用單因素方差分析;對符合偏態(tài)分布的計量資料,用中位數(shù)(M)和四分位數(shù)間距(P25-P75)表示,Kruskal-Wallis H檢驗用于多組間比較,Nemenyi檢驗用于多組間兩兩比較,兩組間比較采用Mann-Whitney U檢驗,以P0.05為差異有統(tǒng)計學意義。結(jié)果1 CWP組、接塵組及正常組外周血白細胞亞群水平變化:與正常組相比,CWP組外周血B淋巴細胞、CD16-單核細胞、總單核細胞、嗜酸性粒細胞、嗜堿性粒細胞水平顯著增高,差異有統(tǒng)計學意義(P0.05);與接塵組相比,CWP組外周血B淋巴細胞、嗜酸性粒細胞水平顯著增高,細胞毒性T+NK顯著降低,差異有統(tǒng)計學意義(P0.05);接塵組外周血細胞毒性T+NK、CD16-單核細胞、CD16+單核細胞水平顯著高于正常組,差異有統(tǒng)計學意義(P0.05);中性粒細胞在CWP中呈下降趨勢;其他指標間比較,差異無統(tǒng)計學意義(P0.05)。2 CWP并發(fā)COPD組與單純CWP組外周血白細胞亞群變化:CWP并發(fā)COPD組和單純CWP組結(jié)果比較,外周血白細胞亞群水平無明顯改變,差異無統(tǒng)計學意義(P0.05)。3不同接塵年限與不同接塵類別壹期CWP患者外周血白細胞亞群水平變化:接塵年限小于30年和大于30年2組結(jié)果比較,外周血白細胞亞群水平無明顯改變;接觸煤塵和矽塵2組結(jié)果比較,外周血白細胞亞群水平也無明顯改變,差異均無統(tǒng)計學意義(P0.05)。4不同肺功能壹期CWP患者外周血白細胞亞群水平變化:肺功能正常、輕度障礙和中-重度障礙3組結(jié)果比較,外周血白細胞亞群水平無明顯改變,差異無統(tǒng)計學意義(P0.05)。5吸煙與非吸煙的壹期CWP患者外周血白細胞亞群水平變化:與非吸煙組相比,吸煙組外周血總淋巴細胞、B淋巴細胞顯著增高,成熟的中性粒細胞顯著降低,差異有統(tǒng)計學意義(P0.05);其他指標間比較,差異無統(tǒng)計學意義(P0.05)。結(jié)論1 B淋巴細胞、細胞毒性T+NK、CD16+和CD16-單核細胞、中性粒細胞、嗜酸性粒細胞、嗜堿性粒細胞均參與CWP的發(fā)生發(fā)展。2 CD16+、CD16-單核細胞水平升高可能與粉塵刺激有關(guān),嗜酸性粒細胞、B淋巴細胞水平升高可能與肺損傷纖維化有關(guān),細胞毒性T+NK水平變化可能貫穿于CWP發(fā)生發(fā)展過程。CWP患者外周血白細胞亞群水平變化可能受吸煙影響。
[Abstract]:Objective coal workers' pneumoconiosis (Coal worker 's pneumoconiosis, CWP) is a diffuse fibrosis disease of lung tissue caused by coal dust and / or silica dust inhalation of coal workers for a long time. Dust particles enter the body to cause activation or damage of macrophages, release cytotoxic oxidants, protease, and cell factors to induce inflammatory cells to reach the alveolar epithelial cell surface. The toxic oxygen derivatives and protein hydrolase released by inflammatory cells can further cause DNA damage, apoptosis and related extracellular matrix deposition, leading to pulmonary fibrosis. This study was conducted by detecting peripheral blood granulocytes, CD16+ and CD16- mononuclear cells, and B lymphocytes in one stage CWP patients. Cytotoxic T+NK, non cytotoxic T cells and other 16 leukocyte subgroups, to explore the role of cell level changes in the development of CWP, to explore the mechanism of CWP, to provide new ideas for clinical diagnosis and treatment. Method 1 select 66 cases of CWP patients (group CWP) for 2015-2016 years in the hospital of Kailuan occupational disease prevention and treatment hospital (group CWP), according to the diagnosis of pneumoconiosis 47 cases of dusty miners (dust receiving group) and Kailuan Group, 40 cases of undusty well health checkup in Kailuan Group (normal group) were selected for diagnosis, and the sex, age and age of.3 were all matched in 40 cases (normal group) of the 47 cases (the dust group) and the Kailuan group. All the lookup personnel collected 2 ml in the EDTA-K2 anticoagulant tube on the morning of the morning of the Qing Dynasty. The patients were collected before treatment; the peripheral blood granulocyte, CD16+ and CD16- mononuclear cells, B lymphocyte, cytotoxic T+NK, non cytotoxic T cells and other 16 leukocyte subgroups.2 were analyzed by SPSS 17 software, and three groups were expressed with mean number + standard deviation (x + s). A single factor analysis of variance was used for the comparison of the average numbers; the median (M) and four quantile spacing (P25-P75) were used for the measurement data conforming to the partial distribution. The Kruskal-Wallis H test was used in the multi group comparison, and the Nemenyi test was used for the 22 comparison among the multiple groups. The two groups were compared with the Mann-Whitney U test. The difference was statistically significant with P0.05. Results 1 CWP group, dust group and normal group peripheral blood leucocyte subgroup level changes: compared with the normal group, CWP group peripheral blood B lymphocyte, CD16- monocyte, total monocyte, eosinophil, basophil level significantly increased, the difference was statistically significant (P0.05); compared with the dust group, the CWP group peripheral blood B lymphocyte, eosinophil fine Cytotoxic T+NK was significantly decreased, and the difference was statistically significant (P0.05). The level of peripheral blood cell toxicity T+NK, CD16- monocyte and CD16+ monocyte were significantly higher than that of the normal group (P0.05), and neutrophils decreased in CWP, and there was no statistical difference between the other indexes. (P0.05).2 CWP concurrent COPD group and simple CWP group peripheral blood leukocyte Subgroup Changes: CWP complicated with COPD group and simple CWP group results, the peripheral blood leukocyte subgroup level has no significant change, the difference is not statistically significant (P0.05).3 different dust life and different dust category one stage CWP patients with the peripheral blood leukocyte subgroup level changes: the dust age Compared with the results of 2 groups of less than 30 years and more than 30 years, there was no obvious change in the level of leukocyte subgroup in peripheral blood; compared with the 2 groups of coal dust and silica dust, there was no significant change in the level of leukocyte subgroup in peripheral blood (P0.05) the level of peripheral blood leucocyte subgroup in CWP patients with different lung function.4: normal, light lung function Compared with the 3 groups, the level of leukocyte subsets in peripheral blood was not significantly changed in the 3 groups. There was no significant difference in the level of peripheral blood leucocyte subgroup in.5 smoking and non smoking CWP patients: compared with the non-smoking group, the total peripheral blood lymphocytic cells in the peripheral blood, the B lymphocyte significantly increased, and the mature neutrophils compared with the non-smoking group. The difference was statistically significant (P0.05), and there was no significant difference between other indexes (P0.05). Conclusion 1 B lymphocytes, cytotoxic T+NK, CD16+ and CD16- monocytes, neutrophils, eosinophils and basophils all participate in the development of.2 CD16+, and the level of CD16- mononuclear cells may be elevated. The increase of eosinophil and B lymphocyte may be related to pulmonary fibrosis. The change of cytotoxic T+NK level may run through the development of CWP, and the level of peripheral blood leucocyte subgroup in.CWP patients may be affected by smoking.

【學位授予單位】：華北理工大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R135.2;R446.1

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