【摘要】：肺炎是兒科的常見疾病,由于嬰幼兒本身的解剖和生理特點(diǎn),呼吸系統(tǒng)發(fā)育不成熟,極容易進(jìn)展為重癥肺炎,目前,重癥肺炎仍是我國嬰幼兒死亡的重要原因。細(xì)胞因子基質(zhì)金屬蛋白酶9(Matrix metalloproteinases-9,MMP-9)及基質(zhì)金屬蛋白酶抑制劑1(Tissue Inhibitors of Matrix Metalloproteinase-1,TIMP-1)是參與細(xì)胞外基質(zhì)新陳代謝的主要酶類。近年來關(guān)于MMP-9、TIMP-1與呼吸系統(tǒng)疾病的關(guān)系日益受到重視。研究發(fā)現(xiàn),MMP-9及其抑制劑TIMP-1在呼吸系統(tǒng)炎癥性疾病中發(fā)揮了一定作用,肺部炎癥性疾病時,MMP-9、TIMP-1的分泌量及活性有改變,本研究通過觀察嬰幼兒肺炎時,外周血血清中MMP-9、TIMP-1水平的變化,以及恢復(fù)期潮氣呼吸肺功能的情況,探討細(xì)胞因子MMP-9、TIMP-1與肺炎嚴(yán)重程度、不同病原學(xué)以及恢復(fù)期潮氣呼吸肺功能情況的相關(guān)性,推斷細(xì)胞因子MMP-9、TIMP-1與疾病嚴(yán)重程度及預(yù)后的關(guān)系,以便為臨床早期診斷、治療及治療后評估提供客觀依據(jù)。研究目的探討嬰幼兒重癥肺炎急性期外周血血清中MMP-9、TIMP-1的表達(dá)及臨床意義。研究方法選取2015年10月至2016年5月于鄭州大學(xué)第三附屬醫(yī)院重癥監(jiān)護(hù)病房住院的嬰幼兒重癥肺炎20例為重癥肺炎組,同期在本院普通呼吸病區(qū)住院的嬰幼兒輕癥肺炎25例為輕癥肺炎組;另依據(jù)病原學(xué)將上述所選取的45例患兒分為病毒組24例和非病毒組21例;20例同期健康體檢兒童為對照組�；純喝胱〔^(qū)后立即抽取外周靜脈血3-4ml,高速離心取上清液置于-80℃冰箱內(nèi)保存待檢測,采用酶聯(lián)免疫吸附法(ELISA)法測定外周血中MMP-9和TIMP-1水平。另待患兒病情臨床治愈出院前,行潮氣呼吸肺功能檢查。結(jié)果1急性期肺炎患兒外周血血清中細(xì)胞因子MMP-9、TIMP-1和MMP-9/TIMP-1水平均顯著高于對照組,重癥肺炎組高于輕癥肺炎組,病毒組高于非病毒組(均P0.05);2恢復(fù)期肺炎組患兒肺功能達(dá)峰時間比(TPTEF/TE)和達(dá)峰容積比(VPTEF/VE)均明顯低于對照組,重癥肺炎組明顯低于輕癥肺炎組,病毒組低于非病毒組(均P0.05);但患兒每公斤體重潮氣量(VT/Kg)的各組間比較無顯著差異。3外周血血清中MMP-9水平及MMP-9/TIMP-1比值與肺功能參數(shù)TPTEF/TE、VPTEF/VE均呈負(fù)相關(guān)(r1=-0.459,-0.376;r2=-0.413,-0.327;均P0.05)。結(jié)論嬰幼兒肺炎急性期外周血血清中MMP-9及MMP-9/TIMP-1水平可反映疾病嚴(yán)重程度、病原體種類和肺功能損傷的程度,可作為判斷預(yù)后的客觀指標(biāo)。
[Abstract]:Pneumonia is a common disease in pediatrics. Because of the anatomical and physiological characteristics of infants and young children, the respiratory system is immature, and it is easy to develop into severe pneumonia. At present, severe pneumonia is still an important cause of infant mortality in China. Cytokine matrix metalloproteinase 9 (Matrix metalloproteinases-9,MMP-9) and matrix metalloproteinase inhibitor 1 (Tissue Inhibitors of Matrix Metalloproteinase-1,TIMP-1 are the main enzymes involved in extracellular matrix metabolism. In recent years, more and more attention has been paid to the relationship between MMP-9,TIMP-1 and respiratory diseases. It was found that MMP-9 and its inhibitor TIMP-1 played a certain role in inflammatory diseases of the respiratory system. The secretion and activity of MMP-9,TIMP-1 were changed in patients with pulmonary inflammatory diseases. The changes of serum MMP-9,TIMP-1 level in peripheral blood and the respiratory and pulmonary function of tidal air during convalescence were studied to explore the relationship between cytokine MMP-9,TIMP-1 and the severity of pneumonia. The relationship between cytokine MMP-9,TIMP-1 and the severity and prognosis of the disease was inferred in order to provide objective basis for early clinical diagnosis, treatment and post-treatment evaluation. Objective to investigate the expression and clinical significance of MMP-9,TIMP-1 in peripheral blood of infants with severe pneumonia. Methods from October 2015 to May 2016, 20 infants with severe pneumonia in the intensive care unit of the third affiliated Hospital of Zhengzhou University were selected as the severe pneumonia group. At the same time, 25 cases of mild pneumonia in the common respiratory area of our hospital were treated with mild pneumonia. According to etiology, 45 children were divided into viral group (n = 24) and non-viral group (n = 21) and healthy children (n = 20) as control group. The peripheral venous blood was extracted from the patients at 3 ~ 4 ml. The supernatant was stored in the refrigerator at -80 鈩，

本文編號：2343567