本文選題：慢性阻塞性肺病　切入點(diǎn)：肋間外肌　出處：《西南醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:研究不同營(yíng)養(yǎng)狀況慢性阻塞性肺疾病(COPD)患者肋間外肌線粒體功能。方法:收集20例COPD患者和10例非COPD對(duì)照組,將COPD患者分為低BMI COPD組(BMI18.5)和正常BMI COPD組(18.5BMI24.99),非COPD患者作為對(duì)照組。對(duì)三組患者進(jìn)行了肺功能檢查、血?dú)夥治�、評(píng)估三組患者病情嚴(yán)重程度;通過(guò)測(cè)定肋間外肌組織中IL-6、IL-8和TNF-α的濃度,以及應(yīng)用光鏡觀察肋間外肌肌細(xì)胞形態(tài),評(píng)估三組患者的肋間外肌基本情況;測(cè)定肋間外肌線粒體蛋白濃度、呼吸鏈復(fù)合酶I-IV和超氧化物歧化酶(SOD)活性、線粒體膜通透性開(kāi)放孔(MPTP)動(dòng)力學(xué),以及應(yīng)用電鏡觀察線粒體形態(tài),評(píng)估三組患者肋間外肌線粒體功能。采用Pearson進(jìn)行FEV1與炎性指標(biāo)和線粒體指標(biāo)相關(guān)性分析。結(jié)果:與非COPD對(duì)照組相比,COPD患者的肺功能指標(biāo)(FVC%、VC%、FEV1%、FEV1/預(yù)測(cè)值、FEV1/FVC和DLco)均顯著降低(P0.05),低BMI COPD組的FEV1/預(yù)測(cè)值、FEV1/FVC值和DLco顯著低于正常BMI COPD組(P0.05)。血?dú)夥治鰴z查顯示,正常BMI COPD組血液pH值和paCO2值與非COPD對(duì)照組無(wú)顯著性差異(P0.05);低BMI COPD組血液pH值低于正常BMI COPD組和非COPD對(duì)照組(P0.05),paCO2值高于正常BMI COPD組(P0.05);COPD患者血液paO2值顯著低于非COPD對(duì)照組(P0.05),低BMI COPD組低于正常BMI COPD組(P0.05)。肋間外肌組織指標(biāo)檢查顯示,COPD患者的肋間外肌組織中IL-6、IL-8和TNF-α濃度顯著高于非COPD對(duì)照組(P0.05),且低BMI COPD組顯著高于正常BMI COPD組(P0.05)。肋間外肌光鏡觀察結(jié)果顯示,COPD患者肋間外肌肌纖維間距增大和肌細(xì)胞變形隨著健康狀況不良而增大明顯,低BMI COPD患者的肋間外肌形態(tài)結(jié)構(gòu)變化更加明顯。線粒體功能指標(biāo)測(cè)定結(jié)果顯示,與非COPD對(duì)照組相比,COPD患者的肋間外肌線粒體蛋白含量顯著下降(P0.05),呼吸鏈復(fù)合酶I-IV和超氧化物歧化酶SOD活性顯著降低(P0.05),MPTP的吸光度值下降顯著(P0.05),且低BMI COPD組的上述指標(biāo)與正常BMI COPD組相比,差異有統(tǒng)計(jì)學(xué)意義(P0.05);電鏡觀察線粒體形態(tài)學(xué)發(fā)現(xiàn)隨著COPD患者營(yíng)養(yǎng)狀況惡化,肋間外肌線粒體基質(zhì)密度下降,腫脹及髓樣變形,線粒體膜損壞、溶解情況逐漸加重,低BMI COPD患者的線粒體結(jié)構(gòu)變化更加明顯。FEV1與IL-6、IL-8和TNF-α呈負(fù)相關(guān)關(guān)系,與線粒體蛋白含量、線粒體呼吸鏈復(fù)合酶I-IV和SOD呈正相關(guān)關(guān)系。結(jié)論:COPD患者存在不同程度的炎癥反應(yīng)和肺功能障礙,引起機(jī)體酸堿失衡和缺氧、血液二氧化碳含量升高,以及線粒體功能異常;隨著COPD患者營(yíng)養(yǎng)狀況惡化,其炎癥反應(yīng)、肺功能、病情逐漸加重,且線粒體功能異常更加明顯。
[Abstract]:Objective: to study the mitochondrial function of extracostal muscles in patients with chronic obstructive pulmonary disease (COPD) with different nutritional status. Methods: 20 patients with COPD and 10 patients with non COPD control group were collected. Patients with COPD were divided into low BMI COPD group (BMI 18.5) and normal BMI COPD group (n = 18.5BMI24.99g). Non COPD patients were used as control group. Pulmonary function and blood gas analysis were performed to evaluate the severity of the disease in the three groups. By measuring the concentration of IL-6 IL-8 and TNF- 偽 in the extracostal muscle tissue and observing the morphology of the muscle cells under light microscope, the basic condition of the intercostal extracostal muscle in the three groups was evaluated, and the concentration of mitochondrial protein in the extracostal muscle was measured. The activities of respiratory chain complex enzyme I-IV and superoxide dismutase (SOD), the kinetics of mitochondrial membrane permeability open hole (MPTP), and the morphology of mitochondria were observed by electron microscopy. To evaluate the mitochondrial function of the intercostal extracostal muscles in the three groups. To analyze the correlation between FEV1 and inflammatory and mitochondrial indexes by Pearson. Results: compared with the non-COPD control group, the pulmonary function index of the patients with COPD was significantly lower than that of the control group. The predicted values of FEV1/ and DLco in low BMI COPD group were significantly lower than those in normal BMI COPD group (P 0.05). There was no significant difference in blood pH value and paCO2 value between normal BMI COPD group and non-#en3# control group (P 0.05), while the lower BMI COPD group was lower than that of normal BMI COPD group and non-#en8# control group (P 0.05), and the paO2 value of normal BMI COPD group was significantly lower than that of non-#en12# control group. The level of IL-6 IL-8 and TNF- 偽 in the extracostal muscles of the patients with BMI was significantly higher than that in the non-#en4# control group (P0.05), and that in the low BMI COPD group was significantly higher than that in the normal BMI COPD group (P0.05). The level of IL-6 IL-8 and TNF- 偽 in the extracostal muscles was significantly higher in the low BMI COPD group than in the normal BMI COPD group, and the level of TNF- 偽 in the extracostal muscle tissue was significantly higher than that in the normal BMI COPD group. The results of myoscopy showed that the spacing of intercostal muscle fibers and the deformation of muscle cells in COPD patients increased significantly with poor health. The morphological and structural changes of the intercostal muscles in patients with low BMI COPD were more obvious. Compared with the control group, the content of mitochondrial protein in the extracostal muscle decreased significantly, and the activities of respiratory chain compound enzyme I-IV and superoxide dismutase (SOD) significantly decreased the absorbance of P0.05 and P0.05 in the low BMI COPD group. Compared with the normal BMI COPD group, Electron microscope observation showed that with the deterioration of nutritional status in patients with COPD, the density of mitochondria matrix decreased, swelling and myeloid deformation, mitochondrial membrane damage, and dissolution gradually aggravated with the decrease of the density of mitochondria matrix in the intercostal muscles. The changes of mitochondrial structure were more obvious in patients with low BMI COPD. FEV1 was negatively correlated with IL-6, IL-8 and TNF- 偽, and correlated with the content of mitochondrial protein. Conclusion there are different degree of inflammatory reaction and pulmonary dysfunction in patients with mitochondrial respiratory chain complex enzyme I-IV and SOD, which lead to acid-base imbalance and hypoxia, elevated blood carbon dioxide content and abnormal mitochondrial function. With the deterioration of nutritional status in COPD patients, the inflammatory reaction, pulmonary function and condition were gradually aggravated, and the abnormal mitochondrial function was more obvious.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.9

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