本文關鍵詞：煤工塵肺患者外周血T細胞表達水平及其與肺功能的相關性研究　出處：《河北醫(yī)科大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 煤工塵肺 T細胞 肺功能 相關性

【摘要】：目的:煤工塵肺(coal workers’pneumoconiosis,CWP)目前存在病情呈進行性進展、臨床缺乏早期診斷手段、缺乏有效的治療措施等問題,本研究在對CWP患者年齡、觸塵時間、肺功能等指標分析的基礎上,通過檢測患者外周血CD3~+、CD3~+CD4~+、CD3~+CD8~+、CD4~+CD25highCD127low細胞表達水平,并對各指標之間的相關性進行研究,旨在為CWP疾病的發(fā)病機制和診治預防提供新的思路和理論參考。方法:根據(jù)GBZ 70-2009《塵肺病診斷標準》,本研究共收集111例CWP患者,根據(jù)病情嚴重程度分為CWP I期組(30例)、CWP II期組(60例)及CWP III期組(21例),CWP期別由塵肺鑒定小組進行獨立判定,同時以30例健康體檢者作為對照組。排除冠心病、腦血管疾病、高血壓、糖尿病,近期肺部感染、嚴重肝腎功能不全、近期使用過免疫抑制劑者等。本研究已通過醫(yī)院倫理審查委員會的審查和批準,并取得所有入組者的知情同意,并簽署知情同意書。本研究對所有患者進行肺功能、外周血CD3~+、CD3~+CD4~+、CD3~+CD8~+及CD4~+CD25highCD127low細胞表達水平檢測,并分析各指標之間的相關性。本研究所涉及的所有數(shù)據(jù)均采用SPSS 19.0統(tǒng)計軟件進行統(tǒng)計分析,t檢驗進行兩均數(shù)比較,相關性采用Pearson檢驗并計算相關系數(shù)。所有假設檢驗均采用雙側檢驗,以P0.05為差異有統(tǒng)計學意義。結果:1 CWP患者的肺活量(VC)、一秒用力呼氣容積與預計值的比值(FEV1/Pre)、一秒用力呼氣容積與用力肺活量的比值(FEV1/FVC)、肺比彌散量(TLCO/VA)均明顯低于健康對照組,隨著CWP期別的上升,肺功能指標VC、FEV1/Pre、FEV1/FVC、TLCO/VA均逐漸降低(P0.05)。2與對照組比較,CWP各組CD3~+細胞、CD3~+CD8~+細胞水平均較低(P0.05);CWP各組CD3~+CD4~+細胞、CD3~+CD4~+/CD3~+CD8~+比值、CD4~+CD25highCD127low細胞顯著增高(P0.05);隨著CWP期別的上升,患者外周血CD3~+、CD3~+CD8~+細胞水平呈下降趨勢,經(jīng)兩組間配對t檢驗,差異均具有統(tǒng)計學意義(P0.05);CD3~+CD4~+細胞、CD3~+CD4~+/CD3~+CD8~+比值、CD4~+CD25highCD127low細胞水平均呈上升趨勢(P0.05)。3相關性分析結果顯示,CD3~+CD4~+細胞、CD3~+CD4~+/CD3~+CD8~+比值、CD4~+CD25highCD127low細胞水平與VC、FEV1/Pre、FEV1/FVC呈顯著負相關(P0.05);CD3~+CD8~+細胞水平與VC、FEV1/Pre、FEV1/FVC、TLCO/VA呈顯著正相關(P0.05);CD3~+CD4~+/CD3~+CD8~+比值與TLCO/VA呈顯著負相關(P0.05);CD3~+細胞水平與TLCO/VA呈顯著正相關(P0.05);CD3~+CD4~+細胞、CD4~+CD25highCD127low細胞水平與TLCO/VA之間無明顯相關性(P0.05);CD3~+細胞水平與VC、FEV1/Pre、FEV1/FVC之間亦無明顯相關性(P0.05)。結論:1隨著年齡、觸塵時間的增加,CWP患者的疾病期別隨之上升,病情嚴重亦隨之增加;2隨著CWP病情的進展,患者肺功能呈現(xiàn)出進行性損傷,主要表現(xiàn)為限制性和混合性通氣功能障礙,肺彌散功能亦明顯降低,肺功能的早期改變可以敏感的反映CWP病情的進展,監(jiān)測肺功能的變化可為CWP的診斷提供早期預警;3隨著CWP患者T細胞免疫調(diào)節(jié)活性的增加,免疫抑制能力增強,CWP患者的機體內(nèi)環(huán)境紊亂情況加劇,病情嚴重程度隨之進展,提示CWP患者體內(nèi)免疫T細胞紊亂可能是CWP的重要發(fā)病機制;4外周血T細胞水平與肺功能指標具有顯著的相關關系,外周血T細胞的表達水平可在一定程度上反映肺功能的損傷程度及評估患者病情的發(fā)展變化。
[Abstract]:Objective: pneumoconiosis (coal workers pneumoconiosis, CWP) has showed a progressive clinical progress, the lack of early diagnosis, the lack of effective treatment measures, on the age of patients with CWP, touch time, analyzing the pulmonary function, through the detection of peripheral blood of patients with CD3~+. CD3~+CD4~+, CD3~+CD8~+, the expression level in CD4~+CD25highCD127low cells, and to study the correlation between the index of CWP, aimed at the pathogenesis of the disease and the diagnosis and treatment to provide new ideas and theoretical reference for prevention of GBZ 70-2009<. Methods: according to the diagnostic criteria of pneumoconiosis ", this study collected 111 cases of CWP patients according to the severity of the disease is divided into CWP I group (30 cases), CWP II group (60 cases) and CWP III group (21 cases), CWP stage independently determined by pneumoconiosis identification group, and 30 healthy cases as control group without coronary heart disease, Cerebrovascular disease, hypertension, diabetes, recent pulmonary infection, severe liver and kidney dysfunction, recently used immunosuppressive agents. This study has been adopted and approved by the hospital ethics review committee review, and obtain informed consent from all participants, and signed the informed consent form. The study on pulmonary function in all patients the peripheral blood, CD3~+, CD3~+CD4~+, CD3~+CD8~+ and CD4~+CD25highCD127low cells to detect the expression level, and analyze the correlation between the index. All the data involved in this study were performed by SPSS 19 statistical software for statistical analysis, t test were two were compared using Pearson test, correlation and calculation of correlation coefficient. All hypothesis tests are used to P0.05 for the two-sided test, the difference was statistically significant. Results: 1 patients with CWP (VC), vital capacity ratio of forced expiratory volume in one second and the expected value (FEV1/Pre), a second force The ratio of expiratory volume and forced vital capacity (FEV1/FVC), ratio of lung diffusing capacity (TLCO/VA) were significantly lower than the healthy control group, along with other CWP increased, lung function index VC, FEV1/Pre, FEV1/FVC, TLCO/VA (P0.05).2 decreased compared with the control group, CWP group and CD3~ + cells, CD3~+CD8~+ cells were more low (P0.05); CWP group of CD3~+CD4~+ cell, CD3~+CD4~+/CD3~+CD8~+ ratio, CD4~+CD25highCD127low cells increased significantly (P0.05); CWP with other increase in peripheral blood of patients with CD3~+, CD3~+CD8~+ cells decreased, the two groups paired t test, the difference was statistically significant (P0.05); CD3~+CD4~+ cells, CD3~+CD4~+/CD3~+CD8~+ ratio, CD4~+CD25highCD127low the cell level increased (P0.05).3 correlation analysis showed that CD3~+CD4~+ cells, CD3~+CD4~+/CD3~+ cells and CD8~+ ratio, CD4~+CD25highCD127low level VC, FEV1/Pr E was negatively related to FEV1/FVC (P0.05); CD3~+CD8~+ cells with the level of VC, FEV1/Pre, FEV1/FVC, TLCO/VA showed a significant positive correlation (P0.05); CD3~+CD4~+/CD3~+CD8~+ was negatively correlated with the ratio of TLCO/VA (P0.05); CD3~+ cell level was positively correlated with TLCO/VA (P0.05); CD3~+CD4~+ cells, there was no correlation between CD4~+CD25highCD127low cell with the level of TLCO/VA (P0.05); CD3~+ cells with the level of VC, FEV1/Pre, FEV1/FVC have no significant correlation (P0.05). Conclusion: 1 with the increase of age, touch time, patients with CWP disease don't rise, serious illness also increases; 2 with progression of CWP disease and pulmonary function in patients showing progressive damage, mainly for limiting and mixed ventilatory dysfunction, pulmonary function also significantly reduced, progress can reflect the sensitivity of the CWP disease early changes in lung function, lung function monitoring can change Provide an early warning for the diagnosis of CWP; 3 with the increase of T cells in patients with CWP immune activity, enhancing immune suppression ability of CWP patients, the imbalance of internal environment intensified and the severity of the disease will progress, suggesting that CWP in patients with T cell immune disorders may be the pathogenesis of heavy CWP; 4 T cells in peripheral blood the level and lung function index has significant correlation, the development and change of the expression level of T cells in peripheral blood can reflect disease severity and evaluate the pulmonary function of patients in a certain extent.

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R135.2

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本文編號：1412000