本文選題：MMP-9　切入點(diǎn)：TIMP-1　出處：《廣州醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的通過研究感染后閉塞性細(xì)支氣管炎患兒肺泡灌洗液及血液中基質(zhì)金屬蛋白酶-9(MMP-9)及基質(zhì)金屬蛋白酶抑制物-1(TIMP-1)的表達(dá)水平，探討MMP-9、TIMP-1和MMP-9/TIMP-1在兒童感染后閉塞性支氣管炎的臨床意義。 方法采用酶聯(lián)免疫分析法（ELISA）分別測定13例感染后閉塞性細(xì)支氣管炎與10例支氣管異物對照組灌洗液中和13例感染后閉塞性細(xì)支氣管炎及13例正常對照組血液中的MMP-9、TIMP-1表達(dá)水平。 結(jié)果與支氣管異物對照組(131.33±43.93)相比,閉塞性細(xì)支氣管炎(2732.81±599.57)肺泡灌洗液中MMP-9的表達(dá)水平明顯增高（P0.01）；與正常組（1160.34±273.75）相比，閉塞性細(xì)支氣管炎組（2872.15±737.04）血中MMP-9表達(dá)水平明顯增高(P0.05)；與支氣管異物對照組相比（211.56±41.04)相比,閉塞性細(xì)支氣管炎組(144.55±24.84)肺泡灌洗液中TIMP-1的表達(dá)水平無明顯差異（P0.05）；與正常組（257.60±12.45）相比，閉塞性細(xì)支氣管炎組（268.79±15.307）血中TIMP-1表達(dá)水平無明顯差異(P0.05)；與對照組相比（0.50±0.13；4.90±1.29）,閉塞性細(xì)支氣管炎灌洗液及血液中MMP-9/TIMP-1（14.71±2.53；11.14±2.78）的比率明顯升高（P0.01；P0.05）。 結(jié)論在兒童感染后閉塞性細(xì)支氣管炎，MMP-9在灌洗液及血液中表達(dá)明顯增高;MMP-9/TIMP-1比率明顯升高.提示MMP-9可能參與兒童感染后閉塞性細(xì)支氣管炎的致病機(jī)制，MMP-9/TIMP-1比率失衡可能在兒童感染后閉塞性細(xì)支氣管氣道纖維化及重塑起重要作用。 目的通過分析兒童閉塞性細(xì)支氣管炎支氣管鏡活檢(TBLB)組織學(xué)特點(diǎn)，，結(jié)合臨床和影像表現(xiàn)，提高對本病的認(rèn)識、診斷及鑒別診斷。 方法回顧性分析13例經(jīng)臨床診斷證實(shí)BO患兒的臨床表現(xiàn)和支氣管鏡活檢(TBLB)表現(xiàn)及高分辨CT資料，男10例,女3例，年齡從9月-38個(gè)月，平均年齡25.3個(gè)月，平均病程8個(gè)月,所有患兒均為肺部感染或肺損傷后反復(fù)或持續(xù)喘息、氣促、咳嗽或者喘鳴且癥狀均持續(xù)時(shí)間＞6周。13例均肺部高分辨率CT（HRCT）檢查，并行支氣管鏡活檢術(shù)(TBLB)。13例進(jìn)行誘導(dǎo)痰細(xì)胞學(xué)檢查。因BO患兒年齡較小，均未行肺功能檢查。 結(jié)果患者均有較典型的臨床表現(xiàn)，HRCT表現(xiàn)：馬賽克征13例（100㳠）；斑點(diǎn)或斑片狀模糊影9例（76㳠）；支氣管壁增厚3例（23㳠）；含氣不全或肺實(shí)變不張3例（23㳠）；支氣管擴(kuò)張癥2例（15㳠）；鈣化灶1例（7㳠）。3例行支纖鏡檢查顯示氣管、支氣管內(nèi)膜炎癥。TBLB取得肺組織學(xué)或細(xì)支氣管病理改變?yōu)椋杭?xì)支氣管周圍炎癥13例（100㳠）；細(xì)支氣管管壁纖維化11例（85㳠）；上皮細(xì)胞壞死脫落7例（53㳠）,鄰近肺泡炎癥或萎縮6例（18㳠）；9例中性粒細(xì)胞增高，其中7例明顯增高（≥60％）,余4例因細(xì)胞總數(shù)不達(dá)標(biāo)未能檢出。. 結(jié)論細(xì)支氣管粘膜炎癥及增厚同時(shí)伴有細(xì)支管壁纖維化、官腔內(nèi)上皮細(xì)胞的脫落是兒童BO TBLB組織活檢較特征的表現(xiàn)，同時(shí)結(jié)合患兒臨床表現(xiàn)和胸部HRCT、支氣管鏡檢查可以明顯提高BO與其他疾病診斷和鑒別診斷，并可在治療隨訪后最終確診。
[Abstract]:Objective to study the expression of matrix metalloproteinase-9 (MMP-9) and matrix metalloproteinase-1 inhibitor (TIMP-1) in alveolar lavage fluid and blood of children with bronchiolitis obliterans after infection. To investigate the clinical significance of MMP-9 TIMP-1 and MMP-9/TIMP-1 in children with obstructive bronchitis. Methods the expression of MMP-9 TIMP-1 in 13 cases of bronchiolitis obliterans after infection and 10 cases of bronchiolitis obliterans, 13 cases of bronchiolitis obliterans after infection and 13 cases of normal controls were detected by enzyme linked immunosorbent assay (Elisa). Results compared with bronchial foreign body control group (131.33 鹵43.93), the expression of MMP-9 in bronchiolitis obliterans (2732.81 鹵599.57) was significantly higher than that in control group (P 0.01) and in normal group (1160.34 鹵273.75). The expression of MMP-9 in bronchiolitis obliterans group (2872.15 鹵737.04) was significantly higher than that in bronchiolitis group (211.56 鹵41.04), and that in bronchiolitis obliterans group (144.55 鹵24.84) was not significantly different from that in bronchiolitis group (257.60 鹵12.45). There was no significant difference in the expression of TIMP-1 in the blood of the bronchiolitis obliterans group (268.79 鹵15.307), but the ratio of MMP-9/TIMP-1(14.71 鹵2.53 鹵11.14 鹵2.78 in the lavage fluid and blood of bronchiolitis obliterans was significantly higher than that in the control group (0.50 鹵0.13 鹵4.90 鹵1.29). Conclusion in children with bronchiolitis obliterans, the expression of MMP-9 is significantly increased in lavage fluid and blood. It is suggested that MMP-9 may be involved in the pathogenesis of bronchiolitis obliterans after infection and the imbalance of MMP-9 / TIMP-1 ratio. It may play an important role in bronchiolobronchial fibrosis and remodeling after infection in children. Objective to improve the understanding, diagnosis and differential diagnosis of bronchiolitis obliterans by analyzing the histological features of TBLB in children with bronchiolitis obliterans. Methods the clinical manifestations, TBLB findings and high resolution CT findings of 13 children with BO confirmed by clinical diagnosis were retrospectively analyzed. There were 10 males and 3 females, aged from September to 38 months, with an average age of 25.3 months and an average course of disease of 8 months. All the children had repeated or continuous wheezing after pulmonary infection or lung injury, shortness of breath, cough or wheezing, and the symptoms lasted more than 6 weeks. 13 cases of TBLBU were examined by inductive sputum cytology because of their younger age and no pulmonary function examination was performed. Results all the patients had typical clinical manifestations: mosaic sign (13 cases) and HRCT (100 cases). Mottled or patchy blur in 9 cases? Bronchial wall thickening: 3 cases: 23? Qi-containing incompleteness or pulmonary atelectasis: 3 cases: 23? Bronchiectasis: a report of 2 cases. Calcification: 1 case: 7? Bronchofiberscope examination showed that bronchial endobronchial inflammation. TBLB obtained lung histology or bronchiole pathological changes: bronchiolitis in 13 cases or 100? Bronchiole wall fibrosis: report of 11 cases. 7 cases of epithelial cell necrotic exfoliation? Adjacent alveolar inflammation or atrophy in 6 cases. Neutrophils were increased in 9 cases, of which 7 cases were significantly increased (鈮

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