本文選題：毛細(xì)支氣管炎 + 皮質(zhì)醇�。� 參考：《吉林大學(xué)》2012年碩士論文

【摘要】：毛細(xì)支氣管炎是一種嬰幼兒較常見(jiàn)的下呼吸道感染性疾病，多由于呼吸道合胞病毒（RSV）感染引起。RSV除可直接引起氣道黏膜損傷，還可作為變應(yīng)原誘導(dǎo)機(jī)體抗RSV免疫應(yīng)答，若免疫反應(yīng)過(guò)度則可造成免疫損傷。目前毛細(xì)支氣管炎的治療主要包括抗病毒，防治細(xì)菌感染、止喘等對(duì)癥支持治療。臨床上常應(yīng)用糖皮質(zhì)激素作為止喘抗炎藥物，但糖皮質(zhì)激素在毛支治療中的作用和利弊還存在爭(zhēng)議。 為明確ACTH、皮質(zhì)醇及11β-HSD2在毛支中的水平和三者的關(guān)系，以指導(dǎo)毛支治療中糖皮質(zhì)激素應(yīng)用，評(píng)價(jià)毛支預(yù)后和轉(zhuǎn)歸。我們選取2010年1月～2011年5月在我科住院的毛細(xì)支氣管炎患兒24例，均符合諸福棠實(shí)用兒科學(xué)中毛細(xì)支氣管炎的診斷標(biāo)準(zhǔn)，入院后經(jīng)血清酶聯(lián)免疫吸附試驗(yàn)（enzymelinkedimmunosorbentassay，ELISA）證實(shí)為RSV感染。其中18例（急性期皮質(zhì)醇及ACTH均降低），于恢復(fù)期（肺部哮鳴音和水泡音消失3天后）復(fù)查。正常對(duì)照組選取同時(shí)期在我院進(jìn)行健康體檢的同年齡段小兒20例。血漿ACTH采應(yīng)用電化學(xué)發(fā)光法，血清皮質(zhì)醇應(yīng)用化學(xué)發(fā)光免疫分析法，血清11β-HSD2水平測(cè)定采用ELISA雙抗體夾心法檢測(cè)。全部數(shù)據(jù)采用SPSS17.0統(tǒng)計(jì)分析軟件進(jìn)行處理。皮質(zhì)醇、ACTH水平用中位數(shù)和四分位間距（M±Q）表示；11β-HSD2水平用平均數(shù)和標(biāo)準(zhǔn)差（x±s）表示。皮質(zhì)醇、ACTH的急性期與恢復(fù)期、正常對(duì)照組比較均采用Kruskal-Wallis秩和檢驗(yàn)，11β-HSD2組間比較采用t檢驗(yàn)，以P0.05為差異有統(tǒng)計(jì)學(xué)意義。皮質(zhì)醇與ACTH的相關(guān)性分析采用Spearman方法。 研究結(jié)果顯示，24例毛支患兒急性期皮質(zhì)醇濃度[M±Q值（81.31±98.40）nmol/L]較正常對(duì)照組[M±Q值（226.05±143.90）nmol/L]顯著性降低（P0.01）；恢復(fù)期皮質(zhì)醇[M±Q值為（188.01±210.9）nmol/L]有不同程度的升高，與急性期相比，皮質(zhì)醇升高有統(tǒng)計(jì)學(xué)意義（P0.01），與正常對(duì)照組相比無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。24例毛支患兒急性期ACTH濃度[M±Q值（1.11±2.77）pmol/L]與正常對(duì)照組[M±Q值（6.16±7.73）pmol/L]相比顯著降低（P0.01）；恢復(fù)期有不同程度的升高[M±Q值（4.54±8.62）pmol/L]，部分可恢復(fù)至正常，與急性期相比水平升高（P0.01），恢復(fù)期與正常對(duì)照組相比雖然降低，但差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。皮質(zhì)醇與ACTH水平相關(guān)性分析呈正相關(guān)。24例毛支患兒急性期11β-HSD2濃度[x±s值為（28.39±6.32）ng/ml]，與正常對(duì)照組[x±s值（29.89±5.63）ng/ml]和恢復(fù)期[x±s值為（31.50±5.45）ng/ml]比較、恢復(fù)期與正常對(duì)照組相比均無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。 研究結(jié)果提示，毛細(xì)支氣管炎患兒皮質(zhì)醇、ACTH水平呈一致性降低，皮質(zhì)醇和ACTH降低可能與毛支發(fā)病機(jī)制及病理改變有關(guān)；在毛支急性期，給予外源性糖皮質(zhì)激素可有效補(bǔ)充內(nèi)源性皮質(zhì)醇生成不足，發(fā)揮皮質(zhì)醇的局部抗炎作用。毛細(xì)支氣管炎患兒皮質(zhì)醇、ACTH水平檢測(cè)可作為應(yīng)用激素的指征，ACTH水平較皮質(zhì)醇更敏感，恢復(fù)更早。有研究報(bào)道哮喘患兒血皮質(zhì)醇水平明顯低于正常兒童，在我們研究中，部分毛支患兒恢復(fù)期皮質(zhì)醇、ACTH水平未恢復(fù)至正常，尤其ACTH未恢復(fù)正�；純�，是否較其他患兒以后易發(fā)展至哮喘，，尚待隨訪結(jié)果進(jìn)一步證實(shí)。而能否作為毛支轉(zhuǎn)化為哮喘發(fā)作的預(yù)測(cè)指標(biāo)有待進(jìn)一步研究。毛細(xì)支氣管炎皮質(zhì)醇水平降低，不是由于11β-HSD2水平升高所致。
[Abstract]:Bronchiolitis is a common infantile respiratory infection diseases, due to respiratory syncytial virus (RSV) infection caused by.RSV can directly cause airway mucosal injury, but also can be used as allergen induced anti RSV immune response, if excessive immune response can cause immune injury. The treatment of bronchiolitis include anti-virus and the prevention and treatment of bacterial infection, relieving asthma and other symptomatic and supportive treatment. The common clinical application of glucocorticoids as Zhichuan anti-inflammatory drugs, but the pros and cons of glucocorticoid in the treatment of bronchiolitis in effect is still controversial.
Clear ACTH, relationship between cortisol and beta -HSD2 in bronchiolitis in 11 level and the three, in order to guide the treatment of bronchiolitis glucocorticoid application, evaluation of prognosis and outcome of bronchiolitis. We selected from January 2010 to May 2011 in our hospital 24 cases of bronchiolitis were accorded with the diagnostic criteria of Fu Tang capillary practical in the science of bronchitis, after admission by serum enzyme linked immunosorbent assay (enzymelinkedimmunosorbentassay, ELISA) confirmed RSV infection. Among them 18 cases (acute cortisol and ACTH were significantly decreased in the recovery period (), wheezing and water bubble sound disappear after 3 days). 20 cases of normal control were the same age group in children select the same period in our hospital for physical examination. Plasma ACTH by Electrochemiluminescence Method, the serum cortisol by chemiluminescent immunoassay, serum -HSD2 11 beta ELISA level by double antibody clip method to detect heart. Part of the data using SPSS17.0 statistical analysis software for processing. The level of cortisol, ACTH median and four percentile interval (M + Q); 11 beta -HSD2 level with the average number and standard deviation (x + s). Cortisol, ACTH in acute stage and recovery period, the normal control group were compared using the Kruskal-Wallis rank sum comparison of 11 beta test, -HSD2 group using t test with P0.05, the difference was statistically significant. Correlation between cortisol and ACTH by Spearman method.
The results of the study showed that 24 cases of bronchiolitis in children with acute cortisol concentration of [M + Q value (81.31 + 98.40) nmol/L] compared with normal control group, [M + Q (226.05 + 143.90) nmol/L] decreased significantly (P0.01); recovery period [M + Q = cortisol (188.01 + 210.9) nmol/L] have different degrees of rise and compared with the acute stage, cortisol was statistically significant (P0.01), compared with the normal control group had no statistical significance (P0.05).24 patients with bronchiolitis in acute stage of ACTH concentration of [M + Q value (1.11 + 2.77) pmol/L] and [M in normal control group. The value of Q (6.16 + 7.73) significantly decreased (compared to pmol/L] P0.01); recovery period with different degrees of elevated [M + Q (4.54 + 8.62) pmol/L], can be restored to normal levels, compared with the acute stage (P0.01), the recovery period compared with the normal control group while decreased, but the difference was not statistically significant (P0.05). The correlation between cortisol and ACTH levels of positive analysis.24 cases of hair In the acute phase, the 11 beta -HSD2 concentration [x + s value is (28.39 + 6.32) ng/ml], compared with the normal control group, [x + s value (29.89 + 5.63) ng/ml] and recovery phase [x + s value is (31.50 + 5.45) ng/ml], the recovery period has no statistical significance compared with the normal control group (P0.05).
The results suggest that children with bronchiolitis cortisol, ACTH level showed a consistent decrease to reduce cortisol and ACTH may be related to the pathogenesis and pathological changes of bronchiolitis in acute stage; bronchiolitis, exogenous glucocorticoid can effectively supplement endogenous cortisol production is not sufficient, play local anti-inflammatory effects of cortisol. Cortisol in children with bronchiolitis. To detect the level of ACTH can be used as an indication of hormone level is more sensitive to cortisol, ACTH, recovery. Earlier studies have reported the blood of children with asthma cortisol levels were significantly lower than normal children, in our study, part of bronchiolitis recovery period of cortisol, ACTH levels were restored to normal, especially ACTH did not return to normal children, whether it is after the other children were prone to asthma, remains to be further confirmed. And the follow-up results can be transformed into bronchiolitis asthma refers to a forecast Step study. The decrease of cortisol levels in bronchiolitis is not due to a rise in the level of 11 beta -HSD2.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R725.6

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