【摘要】：目的:本研究旨在分析血清基質(zhì)金屬蛋白酶(matrix metalloprote inases,MMPs)-9在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)吸煙患者高分辨CT(high-resolution computed tomogra-phy,HRCT)不同表型中的水平變化及相關(guān)因素研究。方法:選取2016年1月-2017年1月于中國(guó)石油天然氣集團(tuán)中心醫(yī)院呼吸內(nèi)科入院COPD患者94例作為觀(guān)察組。其中男性56例,女性38例;年齡分布為48-87歲,平均年齡(71.19±0.894)歲。并選取同時(shí)期我院體檢中心體檢者29例作為對(duì)照組�；颊呷虢M標(biāo)準(zhǔn):(1)符合COPD診斷標(biāo)準(zhǔn)即符合中華醫(yī)學(xué)會(huì)呼吸病學(xué)分會(huì)慢性阻塞性肺疾病學(xué)組制定的《慢性阻塞性肺疾病診治指南(2013修訂版)》:吸入支氣管擴(kuò)張劑后FEV1/FVC0.7,視為持續(xù)性氣流受限,方可診斷為COPD;(2)年齡≥40歲;(3)患者及家屬知情同意并簽署知情同意書(shū)。對(duì)照組入組標(biāo)準(zhǔn):(1)年齡≥40歲;(2)無(wú)吸煙史;(3)進(jìn)行健康檢查且顯示肺功能正常、身體各機(jī)能指標(biāo)均正常的健康人;(4)受試者知情同意并簽署知情同意書(shū)。所有受試者排除標(biāo)準(zhǔn):(1)不符合上述納入標(biāo)準(zhǔn)者;(2)不愿參與本項(xiàng)研究者。所有入選者采集信息如下:性別、年齡、既往史、吸煙情況。觀(guān)察組常規(guī)檢查:血常規(guī)、血沉、PCT、CRP、肺功能、胸部HRCT等。將患者胸部HRCT進(jìn)行圖像處理與分析,根據(jù)患者肺氣腫和支氣管壁厚度嚴(yán)重程度,分為A、E、M三型;并根據(jù)患者吸煙情況將患者分為吸煙組和非吸煙組。使用北京冬歌生物科技有限公司提供MMP-9試劑盒,對(duì)所有受試者血清標(biāo)本嚴(yán)格按照說(shuō)明書(shū)進(jìn)行MMP-9測(cè)定。應(yīng)用SPSS 19.0軟件進(jìn)行數(shù)據(jù)分析。分析前對(duì)數(shù)據(jù)進(jìn)行正態(tài)性及方差齊性檢驗(yàn)。符合正態(tài)分布的計(jì)量資料采用x±s表示,非正態(tài)分布資料進(jìn)行對(duì)數(shù)轉(zhuǎn)換。組間正態(tài)分布的計(jì)量資料比較采用方差分析,多重比較采用LSD檢驗(yàn),組間非正態(tài)分布的計(jì)量資料采用秩和檢驗(yàn)(Kruskal-Wallis H檢驗(yàn))。單因素相關(guān)分析采用Spearman相關(guān)分析法并逐個(gè)繪制散點(diǎn)圖。計(jì)數(shù)資料比較采用Χ2檢驗(yàn),多因素相關(guān)性分析采用多元逐步線(xiàn)性回歸分析。p0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1觀(guān)察組與對(duì)照組mmp-9比較觀(guān)察組mmp-9表達(dá)水平為(128.56±9.074ng/ml)明顯高于健康對(duì)照組(27.23±10.213ng/ml)(p0.05),兩者差異有統(tǒng)計(jì)學(xué)意義。2觀(guān)察組中a、e、m三型mmp-9比較觀(guān)察組中a型患者56例,mmp-9表達(dá)水平為(128.11±10.23ng/ml);e型患者10例,mmp-9表達(dá)水平為(132.06±6.78ng/ml);m型患者28例,mmp-9表達(dá)水平為(128.56±9.07ng/ml),三組兩兩比較差異無(wú)統(tǒng)計(jì)學(xué)意義。3在copd吸煙和非吸煙患者及其a、e、m三型中mmp-9的比較3.1吸煙組與非吸煙組mmp-9比較吸煙組患者mmp-9表達(dá)水平為(130.49±9.01ng/ml),非吸煙組患者mmp-9表達(dá)水平為(123.23±6.96ng/ml),且兩組差異有統(tǒng)計(jì)學(xué)意義。3.2吸煙組a、e、m三型中mmp-9的比較吸煙組中m型患者mmp-9(128.31±7.77ng/ml)明顯低于e、a型(133.69±10.17ng/ml)、(135.62±9.94ng/ml),差異有統(tǒng)計(jì)學(xué)意義(t=2.05,2.65,p0.05)。吸煙患者中mmp-9各表型間相比差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。4吸煙對(duì)患者ct分型相關(guān)分析4.1吸煙組與非吸煙組laa評(píng)分比較吸煙患者laa評(píng)分(9.38±4.62分)與非吸煙患者(6.32±4.45分)相比差異有統(tǒng)計(jì)學(xué)意義(t=2.86,p0.01)。4.2吸煙組與非吸煙組a、e、m三型中l(wèi)aa評(píng)分的比較吸煙患者和非吸煙患者中m型、e型的laa評(píng)分與a型相比差異均有統(tǒng)計(jì)學(xué)意義(p0.01),但m型與e型在laa評(píng)分上差異均沒(méi)有統(tǒng)計(jì)學(xué)意義(p0.05)。4.3吸煙組與非吸煙組a、e、m三型中t/pa的比較吸煙組與非吸煙組t/pa相比差異無(wú)統(tǒng)計(jì)學(xué)意義(t=1.51,p0.05),但吸煙組和非吸煙組m型與a型t/pa相比差異有統(tǒng)計(jì)學(xué)意義(t=2.42,t=2.82,p0.05)。5炎性指標(biāo)及肺功能比較5.1吸煙組與非吸煙組中性粒細(xì)胞百分?jǐn)?shù)和淋巴細(xì)胞百分?jǐn)?shù)之間比較吸煙組的外周血中性粒細(xì)胞百分?jǐn)?shù)(76.78±10.80%)和淋巴細(xì)胞百分?jǐn)?shù)(15.73±9.18%)與非吸煙組中性粒細(xì)胞百分?jǐn)?shù)(67.41±12.65%)和淋巴細(xì)胞百分?jǐn)?shù)(22.51±12.08%)相比差異有統(tǒng)計(jì)學(xué)意義(t=3.55,t=2.90,P0.01)。5.2吸煙組與非吸煙組FEV1%比較非吸煙患者FEV1%好于吸煙組,差異有統(tǒng)計(jì)學(xué)意義(t=2.11,P0.05)。6吸煙與COPD患者合并癥數(shù)量對(duì)MMP-9的影響6.1合并癥數(shù)量的影響合并癥數(shù)量在3個(gè)以上的患者中,吸煙組和非吸煙組MMP-9差異有統(tǒng)計(jì)學(xué)意義(χ2=12.08,P0.01)。6.2合并癥種類(lèi)與MMP-9吸煙和非吸煙患者中合并心血管疾病MMP-9與沒(méi)有合并心血管疾病患者相比,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1觀(guān)察組COPD患者血清MMP-9表達(dá)水平明顯高于對(duì)照組,說(shuō)明MMP-9參與COPD的發(fā)病機(jī)制。2COPD患者A、E、M不同表型MMP-9表達(dá)水平無(wú)明顯差異,提示MMP-9并不是唯一參與氣道壁增厚和肺氣腫的金屬蛋白酶。吸煙患者M(jìn)MP-9表達(dá)水平更高,說(shuō)明吸煙是造成氣道炎癥和氣道結(jié)構(gòu)破壞、氣道重塑最重要的因素。吸煙組FEV1%下降更明顯,說(shuō)明吸煙導(dǎo)致更明顯的氣流受限。3吸煙患者外周血中性粒細(xì)胞百分比比非吸煙者更高,說(shuō)明吸煙導(dǎo)致患者炎癥反應(yīng)更明顯。4吸煙導(dǎo)致COPD患者中多種合并癥有關(guān),特別是心血管疾病。
[Abstract]:AIM: To analyze the changes of serum matrix metalloproteinase-9 (MMPs-9) levels in different phenotypes of high-resolution computed tomographic-phy (HRCT) in smokers with chronic obstructive pulmonary disease (COPD). From January to January 2017, 94 patients with COPD admitted to the Department of Respiratory Medicine, Central Hospital of China National Petroleum and Natural Gas Group were selected as the observation group, including 56 males and 38 females. The age distribution was 48-87 years with an average age of (71.19 (+ 0.894) years. Guidelines for the Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease (Revised Edition 2013): FEV1/FVC 0.7 after inhalation of bronchodilator, considered as persistent airflow limitation, can be diagnosed as COPD; (2) Age (> 40 years old); and (3) Informed consent and informed consent of patients and their families. The criteria for inclusion in the control group were: (1) age (> 40 years); (2) no history of smoking; (3) healthy persons with normal lung function and normal physical function; (4) informed consent and informed consent were signed by the subjects. (1) those who did not meet the inclusion criteria; (2) those who did not wish to participate in the study. The data were collected as follows: sex, age, past history, smoking status. Routine examination in observation group: blood routine, ESR, PCT, CRP, lung function, chest HRCT, etc. Group B and non-smoking group.MMP-9 kit provided by Beijing Dongge Biotechnology Co.Ltd was used to determine the serum MMP-9 in strict accordance with the specifications of all subjects.Data were analyzed by SPSS 19.0 software.The data were tested for normality and homogeneity of variance before analysis.The measurement data which accorded with normal distribution were expressed by x+s,but not by SPSS 19.0 software. Normal distribution data were logarithmically transformed. Variance analysis was used to compare the measurement data of normal distribution among groups, LSD test was used for multiple comparisons, Kruskal-Wallis H test was used for non-normal distribution among groups. Spearman correlation analysis was used for single factor correlation analysis and scatter plots were drawn one by one. _2 test, multivariate stepwise linear regression analysis was used for multivariate correlation analysis. The expression of MMP-9 was 128.11 (+ 10.23 ng / ml) in 56 patients with type a, 132.06 (+ 6.78 ng / ml) in 10 patients with type e, and 128.56 (+ 9.07 ng / ml) in 28 patients with type M. There was no significant difference between the three groups. Comparison 3.1 MMP-9 expression level in smoking group and non-smoking group was (130.49 [9.01 ng / ml], and that in non-smoking group was (123.23 [6.96 ng / ml], and there was significant difference between the two groups. 133.69 [10.17ng / ml], (135.62 [9.94ng / ml], the difference was statistically significant (t = 2.05, 2.65, p0.05). There was no significant difference between the MMP-9 phenotypes in smoking patients (p0.05). 4 Correlation analysis of CT typing between smoking and non-smoking patients The difference was statistically significant (t = 2.86, p0.01). 4.2 The LAA scores of smoking group and non-smoking group a, e, m were significantly different from those of smoking group and non-smoking group (p0.01), but there was no significant difference in the LAA scores of M and e between smoking group and non-smoking group (p0.05). There was no significant difference in t / PA between smoking group and non-smoking group (t = 1.51, p0.05), but there was significant difference in t / PA between smoking group and non-smoking group (t = 2.42, t = 2.82, p0.05). The percentage of peripheral blood neutrophils (76.78+10.80%) and the percentage of lymphocytes (15.73+9.18%) in the smoking group were significantly higher than those in the non-smoking group (67.41+12.65%) and the percentage of lymphocytes (22.51+12.08%) (t = 3.55, t = 2.90, P 0.01). Compared with non-smoking group, FEV1% was better than smoking group, the difference was statistically significant (t = 2.11, P 0.05). 6. The number of complications in smoking and COPD patients affected the number of MMP-9. The number of complications in more than three patients, smoking group and non-smoking group MMP-9 was significantly different (2 = 12.08, P 0.01). 6.2 complications and MMP-9 smoking type Conclusion: The expression level of MMP-9 in serum of COPD patients in observation group was significantly higher than that in control group, indicating that MMP-9 participated in the pathogenesis of COPD. MMP-9 is not the only metalloproteinase involved in airway wall thickening and emphysema. Smoking patients have higher levels of MMP-9 expression, suggesting that smoking is the most important factor causing airway inflammation, airway structural damage and airway remodeling. The percentage of granulocytes is higher than that of non-smokers, suggesting that smoking causes more pronounced inflammation. 4 Smoking causes a variety of complications in patients with COPD, especially cardiovascular disease.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R563.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前9條

1 邱卓明;康閃閃;黎振興;朱恬華;區(qū)雪婷;魏立平;;N末端腦鈉肽前體對(duì)慢性阻塞性肺疾病急性加重期合并左心衰的診斷價(jià)值[J];實(shí)用醫(yī)學(xué)雜志;2015年19期

2 ;慢性阻塞性肺疾病診治指南(2013年修訂版)[J];中國(guó)醫(yī)學(xué)前沿雜志(電子版);2014年02期

3 支顏霄;顧玉海;;不同時(shí)期慢性阻塞性肺疾病患者與慢性阻塞性肺疾病合并肺間質(zhì)纖維化患者血清MMP-9水平[J];青海醫(yī)學(xué)院學(xué)報(bào);2013年03期

4 邱川;李明才;武燕;李敏;;慢性阻塞性肺疾病氣道炎癥的研究進(jìn)展[J];中國(guó)呼吸與危重監(jiān)護(hù)雜志;2011年02期

5 景霞;許建英;;吸煙對(duì)大鼠氣道上皮細(xì)胞基質(zhì)金屬蛋白酶9表達(dá)的影響[J];中國(guó)呼吸與危重監(jiān)護(hù)雜志;2009年03期

6 李少文;王文莉;陳潮欽;石永英;洪文郁;鄭忠生;肖玲;吳潔文;;基質(zhì)金屬蛋白酶-9與吸煙等危險(xiǎn)因素對(duì)慢性阻塞性肺部疾病的潛在影響[J];中國(guó)醫(yī)藥;2006年05期

7 趙強(qiáng),陳國(guó)偉;不穩(wěn)定型心絞痛患者血清基質(zhì)金屬蛋白酶水平的臨床意義——附45例檢測(cè)報(bào)告[J];新醫(yī)學(xué);2004年08期

8 徐茂盛,謝晟,王仁貴,肖江喜,王儀生,蔣學(xué)祥;慢性阻塞性肺疾病的肺高分辨率CT呼氣相研究[J];實(shí)用放射學(xué)雜志;2004年06期

9 張偉宏,蔡柏薔,王京嵐,林耀廣,朱元玨,劉玉清,馬毅,朱杰敏,牟文斌,孫革利,劉維,王l，

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