發(fā)布時間：2018-07-10 00:44

  本文選題：腎上腺髓質(zhì)素 + 腎上腺髓質(zhì)素前體中段肽��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本研究擬在探討MR-proADM聯(lián)合PCT在嬰幼兒細菌性肺炎診斷與病情評估中的臨床參考價值;同時初步研究外源性ADM在幼齡小鼠細菌性肺炎轉(zhuǎn)歸中的干預(yù)作用,以期為嬰幼兒細菌性肺炎的診療提供新的思路。方法:1.選取132例出院確診為細菌性肺炎的患兒,根據(jù)入院時感染的嚴重程度分為局限性感染組49例,膿毒癥組40例,嚴重膿毒癥組35例,膿毒性休克組8例;選取同期病毒性肺炎患兒110例設(shè)為病毒感染組,將同期體檢正常兒童106例設(shè)為健康對照組。比較各組嬰幼兒MR-proADM與PCT水平,分析MR-proADM與PCT在細菌性肺炎中的診斷價值及聯(lián)合應(yīng)用后診斷性能的變化;通過Pearson相關(guān)分析論證MR-proADM、PCT與PCIS評分的相關(guān)性;對細菌感染不同程度組MR-proADM與PCT的診斷價值分別進行分析,計算二者聯(lián)合應(yīng)用后的后驗概率。實驗數(shù)據(jù)采用SPSS17.0軟件進行統(tǒng)計分析。2.選用健康清潔級雄性幼齡小鼠,建立幼齡小鼠肺炎克雷伯菌肺炎模型,取用造模成功小鼠60只,隨機分為肺炎感染組(PA組)30只,ADM干預(yù)組(ADM組)30只。選取健康幼齡小鼠30只設(shè)為正常對照組。三個實驗動物組分別在處理后第6h、12h、24h隨機抽取10只小鼠,用戊巴比妥鈉腹腔麻醉,收集各個時間點小鼠左肺灌洗液,留取0.5ml用于細菌培養(yǎng)及菌落計數(shù);將剩余灌洗液經(jīng)離心處理后用ELISA法檢測其中IL-10、IL-17、TNF-α的濃度。取小鼠右肺組織經(jīng)甲醛溶液固定,HE染色后,進行肺組織病理學(xué)評分,實驗數(shù)據(jù)采用SPSS17.0軟件進行統(tǒng)計分析。結(jié)果:1.嬰幼兒肺炎細菌感染組中MR-proADM水平顯著高于病毒感染組與健康對照組(P0.05),PCT水平顯著高于病毒感染組與健康對照組(P0.05)。2.MR-proADM與PCT聯(lián)合應(yīng)用后,細菌性肺炎診斷的敏感度增至98.05%,特異度增至96.21%,診斷符合率增至97.38%;MR-proADM、PCT與PCIS評分呈負相關(guān);細菌感染不同程度組MR-proADM與PCT聯(lián)合應(yīng)用后后驗概率均顯著升高。3.12h、24h ADM組肺泡灌洗液菌落計數(shù)均明顯低于PA組(P0.05);同一時間點肺組織病理學(xué)評分兩兩比較差異均有統(tǒng)計學(xué)意義(P0.05);同一時間點ADM組IL-17、TNF-α水平均顯著低于PA組(P0.05),而IL-10水平ADM組顯著高于PA組(P0.05)。結(jié)論:本研究證實了MR-proADM聯(lián)合PCT應(yīng)用可以進一步提高嬰幼兒細菌性肺炎診斷與病情評估的準確性;同時研究發(fā)現(xiàn)外源性ADM在幼齡小鼠細菌性肺炎中具有顯著的抗菌、抗炎效能,證明ADM在細菌性肺炎病程中對肺組織起到重要的保護作用,為嬰幼兒細菌性肺炎的診療提供了新的途徑。
[Abstract]:Objective: to explore the clinical reference value of MR-proADM combined with PCT in the diagnosis and evaluation of bacterial pneumonia in infants, and to study the effect of exogenous ADM on the prognosis of bacterial pneumonia in young mice. In order to provide new ideas for the diagnosis and treatment of infantile bacterial pneumonia. Method 1: 1. According to the severity of infection on admission, 132 children with bacterial pneumonia were divided into localized infection group (n = 49), sepsis group (n = 40), severe sepsis group (n = 35) and septic shock group (n = 8). 110 children with viral pneumonia were selected as viral infection group and 106 normal children as healthy control group. The levels of MR-proADM and PCT in infants were compared, the diagnostic value of MR-proADM and PCT in bacterial pneumonia and the changes of diagnostic performance after combined use were analyzed, and the correlation between MR-proADM and PCS score was demonstrated by Pearson correlation analysis. The diagnostic value of MR-proADM and PCT in groups with different degrees of bacterial infection was analyzed, and the posterior probability of the combined use of MR-proADM and PCT was calculated. The experimental data were analyzed by SPSS 17.0 software. The healthy and clean grade male young mice were selected to establish the pneumonia model of Klebsiella pneumoniae in young mice. Sixty successful mice were selected and randomly divided into two groups: pneumonia infection group (PA group) and ADM intervention group (ADM group). 30 healthy young mice were selected as normal control group. Ten mice were randomly selected from the three experimental groups at the 6th hour, 12h and 24h after treatment. The mice were anesthetized with pentobarbital sodium intraperitoneally. The left lung lavage fluid was collected at each time point, and 0.5ml was retained for bacterial culture and colony count. The concentration of IL-10, IL-17 and TNF- 偽 was detected by Elisa after centrifugation. The right lung tissue of mice was stained with HE in formaldehyde solution and the pathological score of lung tissue was evaluated. The experimental data were statistically analyzed by SPSS 17.0 software. The result is 1: 1. The levels of MR-proADM in infantile pneumonia bacterial infection group were significantly higher than those in viral infection group and healthy control group (P0.05). 2. After combined use of MR-proADM and PCT, the levels of MR-proADM in infantile pneumonia bacterial infection group were significantly higher than those in viral infection group and healthy control group (P0.05). The sensitivity and specificity of diagnosis of bacterial pneumonia increased to 98.05 and 96.21 respectively. The diagnostic coincidence rate increased to 97.38% and the PCT was negatively correlated with PCIS score. After combined use of MR-proADM and PCT in different degree of bacterial infection, the colony count of alveolar lavage fluid in ADM group was significantly higher than that in PA group (P0.05), and there were significant differences in lung histopathological score at the same time point. At the same time, the level of IL-17 TNF- 偽 in ADM group was significantly lower than that in PA group (P0.05), while IL-10 level in ADM group was significantly higher than that in PA group (P0.05). Conclusion: this study confirmed that MR-proADM combined with PCT can further improve the accuracy of diagnosis and evaluation of bacterial pneumonia in infants, and found that exogenous ADM has significant antibacterial and anti-inflammatory effects in young mice with bacterial pneumonia. It is proved that ADM plays an important role in the protection of lung tissue in the course of bacterial pneumonia and provides a new way for the diagnosis and treatment of infantile bacterial pneumonia.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R725.6

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