本文關(guān)鍵詞： 慢性缺氧 慢性阻塞性肺疾病 腎損害 生物標(biāo)記物 心腎綜合征　出處：《寧夏醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的分析和評(píng)估慢性阻塞性肺疾�。–hronicobstructivepulmonarydisease,COPD）患者慢性缺氧早期腎臟功能損傷的生物標(biāo)志物及早期心腎損害的相關(guān)性。方法分組：COPD組（病例組）60例，對(duì)照組（健康體檢者）53例；COPD組患者進(jìn)一步依據(jù)血?dú)夥治鲋醒醴謮撼潭确譃檩p、中、重度缺氧三個(gè)亞組；依據(jù)心臟彩色多普勒超聲中有無肺動(dòng)脈高壓分為肺動(dòng)脈高壓組和無肺動(dòng)脈高壓組。測定相關(guān)指標(biāo)：血清β_2微球蛋白（β_2-MG）、血清胱抑素C(CysC)、血清肌酐（Scr）、尿素氮（BUN）、超敏C反應(yīng)蛋白（CRP）、視黃醇結(jié)合蛋白（RBP）及估算腎小球?yàn)V過率（eGFR）、左室射血分?jǐn)?shù)（LVEF）、肺動(dòng)脈收縮壓（PASP）、左室舒張末期內(nèi)徑（LVEDD）。結(jié)果與對(duì)照組比較，COPD組血清β_2-MG、CysC明顯增高，eGFR明顯降低，差異均有統(tǒng)計(jì)學(xué)意義（P0.05）。而血清Scr、BUN、RBP與對(duì)照組比較差異無統(tǒng)計(jì)學(xué)差異；進(jìn)一步亞組分析：與對(duì)照組相比較，血清CysC、β_2-MG在輕、中、重度缺氧組均明顯升高，eGFR僅在中、重度缺氧組明顯降低，差異存在統(tǒng)計(jì)學(xué)意義（P0.05）。血清CysC、β_2-MG在COPD組增高比例分別占41.67%和45%，二者血清濃度增高與氧分壓、eGFR均存在良好負(fù)性相關(guān)關(guān)系。β_2-MG與CRP呈正相關(guān)（P＜0.05），受炎癥等因素影響。血清CysC和β_2-MG在不同缺氧程度亞組間增高的比例隨缺氧程度加重而升高，，在重度缺氧組增高的比例明顯高于輕和中度缺氧組，存在統(tǒng)計(jì)學(xué)差異（P0.05）；在有和無肺動(dòng)脈高壓組中血清CysC、β_2-MG較對(duì)照組明顯增高，比例分別是36.67%和43.33%，肺動(dòng)脈高壓組增高的比例明顯高于無肺動(dòng)脈高壓組，有統(tǒng)計(jì)學(xué)差異（P0.05）；進(jìn)一步分析COPD組早期心腎損傷關(guān)系：與對(duì)照組相比，COPD組LVEDD、CRP明顯升高，LVEF明顯降低，差異均有統(tǒng)計(jì)學(xué)意義（P0.05）。左室舒張功能減低、心肌缺血、二尖瓣、三尖瓣、肺動(dòng)脈瓣、主動(dòng)脈瓣反流，分別占61.60%、30.00%、51.66%、66.66%、68.33%、45.00%，均明顯高于對(duì)照組，有統(tǒng)計(jì)學(xué)差異（P0.05）；Pearson相關(guān)性分析：eGFR與LVEF呈正相關(guān)，β_2-MG、CysC、Scr、LVEDD與LVEF呈負(fù)相關(guān)（P＜0.001），eGFR與LVEDD呈負(fù)相關(guān)（P＜0.05）。結(jié)論COPD慢性缺氧可以引起早期腎臟功能損傷，血清CysC、β_2-MG、eGFR是評(píng)估COPD患者早期腎損害的靈敏指標(biāo)。β_2-MG易受炎癥等因素影響，不能單獨(dú)評(píng)估COPD患者腎功能早期損傷，血清CysC更具優(yōu)越性；隨缺氧程度加重和缺氧時(shí)間延長腎功能損傷加重；COPD慢性缺氧可引起早期心腎功能同時(shí)受損，表現(xiàn)為早期心腎綜合征；LVEF、LVEDD值為COPD慢性缺氧患者心功能受損監(jiān)測指標(biāo)。
[Abstract]:Objective to analyze and evaluate the correlation between early renal function damage and early cardiorenal damage in patients with chronic obstructive pulmonary disease (COPDD). Methods 60 patients with chronic obstructive pulmonary disease (COPD) were divided into two groups: 60 patients with chronic obstructive pulmonary disease (COPD), 60 patients with chronic obstructive pulmonary disease (COPD) and 60 patients with chronic obstructive pulmonary disease (COPD). In the control group, 53 patients with COPD were further divided into three subgroups: mild, moderate and severe hypoxia according to the degree of oxygen partial pressure in blood gas analysis. Pulmonary hypertension was divided into pulmonary hypertension group and non pulmonary hypertension group according to color Doppler echocardiography. Serum 尾 2 microglobulin (尾 2 MGG), cystatin C cystatin CysCU, serum creatinine creatinine Scrn, urea nitrogen bun, hypersensitive C reverse reaction were measured. Serum 尾 2-MGCysC in COPD group was significantly higher than that in control group (P < 0.05), and the estimation of glomerular filtration rate (GFR), left ventricular ejection fraction (LVEF), pulmonary systolic pressure (PAP) and left ventricular end-diastolic diameter (LVEDDD) were significantly higher in COPD group than in control group, and the serum 尾 2-MGCysC level in COPD group was significantly higher than that in control group. Compared with the control group, the serum CysC, 尾 2-MG were significantly increased in the mild, moderate and severe hypoxia groups, and the serum CysCand 尾 2-MG increased significantly in the moderate, moderate and severe hypoxia groups, but there was no significant difference in the serum Scr-BUNRBP between the control group and the control group, and the further subgroup analysis showed that the serum CysCand 尾 2-MG increased significantly in the mild, moderate and severe hypoxia groups. Severe hypoxia group significantly decreased, Serum CysCand 尾 2-MG increased in COPD group (41.67% and 45, respectively). There was a good negative correlation between the increase of serum concentration and oxygen partial pressure (P0. 05). There was a positive correlation between 尾-2-MG and CRP (P < 0. 05), which was affected by inflammation and other factors. The increased proportion of subgroups with different degrees of hypoxia and 尾 2-MG increased with the severity of hypoxia. The proportion of serum CysC and 尾 2-MG in severe hypoxia group was significantly higher than that in mild and moderate hypoxia group (P 0.05), and serum CysC and 尾 2-MG in patients with and without pulmonary hypertension were significantly higher than those in control group. The proportion of pulmonary hypertension group was significantly higher than that of no pulmonary hypertension group (P 0.05). Further analysis of the relationship between heart and kidney injury in COPD group: compared with control group, LVEDD CRP significantly increased and LVEF significantly decreased. There were significant differences in left ventricular diastolic function, myocardial ischemia, mitral valve, tricuspid valve, pulmonary valve, aortic valve regurgitation, respectively. There was a positive correlation between LVEF and LVEF, and a negative correlation between LVEF and LVEF (P < 0.001). Conclusion chronic hypoxia of COPD can cause early renal function damage. Serum CysC, 尾 -2 MGG GFR is a sensitive index for evaluating early renal damage in patients with COPD. Serum CysC is superior in evaluating early renal function damage in patients with COPD because it is easy to be affected by inflammation and other factors. Chronic hypoxia may lead to early cardiorenal function damage along with the severity of hypoxia and the prolongation of hypoxic time. LVEF and LVEDD value of early cardiorenal syndrome is the monitoring index of heart function impairment in COPD patients with chronic hypoxia.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R563.9

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