本文選題：慢性阻塞性肺疾病　切入點(diǎn)：高密度脂蛋白膽固醇　出處：《山西醫(yī)科大學(xué)》2012年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：通過(guò)觀察慢性阻塞性肺疾�。–OPD）患者骨密度(BMD)、高密度脂蛋白膽固醇(HDL-c)、白細(xì)胞介素-6（IL-6）、腫瘤壞死因子-α（TNF-α）和體重指數(shù)（BMI）等指標(biāo)的變化，探討COPD患者HDL-c與骨質(zhì)疏松癥（OP）的關(guān)系。 方法：入選60例穩(wěn)定期COPD患者作為COPD組，60例健康體檢者作為對(duì)照組，兩組年齡、性別均匹配。采用問(wèn)卷調(diào)查的形式統(tǒng)計(jì)所有研究對(duì)象年齡、性別、吸煙指數(shù)等基本資料。用雙能X線吸收測(cè)定法測(cè)定腰椎（L_(1-4)）和雙側(cè)股骨頸的BMD，COPD組根據(jù)BMD結(jié)果分為COPD-OP組和COPD非OP組。用免疫抑制直接法進(jìn)行血清HDL-c檢測(cè)，酶聯(lián)免疫吸附法進(jìn)行血清IL-6、TNF-α檢測(cè)，并對(duì)COPD患者進(jìn)行肺功能（FEV1占預(yù)計(jì)值％、FEV1／FVC％）、動(dòng)脈血氧分壓（PaO2）等指標(biāo)的檢測(cè)。 結(jié)果： 1. COPD組BMI（23.21±3.20）kg/cm_2較對(duì)照組（24.97±3.03）kg/cm_2明顯偏低，骨量異常的比例(55/60，91.67%)和OP的檢出率(26/60，43.33%)與對(duì)照組[（25/60，41.67%）和(5/60，8.33%）]相比明顯增加，差異均有統(tǒng)計(jì)學(xué)意義（P均0.05)。 2. COPD組血清HDL-c(1.29±0.32) mmol/L、IL-6(18.82±12.87) pg/ml及TNF-α(123.01±109.55) pg/ml水平明顯高于對(duì)照組[(1.13±0.22)mmol/L、(12.62±3.96) pg/ml、(66.08±47.16) pg/ml]，差異均有統(tǒng)計(jì)學(xué)意義（P均0.05)。 3. COPD-OP組FEV1占預(yù)計(jì)值％(51.18±15.25 )和FEV1／FVC％(40.77±8.72)明顯低于COPD非OP組[(62.15±20.12)、(47.91±11.29 )]，，差異均有統(tǒng)計(jì)學(xué)意義（P均0.05）；COPD-OP組BMI（22.07±3.12）kg/cm_2明顯低于COPD非OP組（24.08±3.29）kg/cm_2，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；兩組平均年齡、吸煙指數(shù)、PaO2及血清IL-6無(wú)明顯差異性。 4. COPD-OP組血清HDL-c (1.45±0.34) mmol/L和TNF-α(158 .97±116.84) pg/ml明顯高于COPD非OP組[(1.17±0.24) mmol/L、（96.09±94.26）pg/ml]，差異均有統(tǒng)計(jì)學(xué)意義（P均0.05）。 5. COPD組左、右股骨頸BMD與HDL-c呈顯著負(fù)相關(guān)(r值分別為-0.313、-0.350，P均0.05)，并與FEV1／FVC％和BMI呈顯著正相關(guān)(r值分別0.333、0.363、0.395、0.392，P均0.05)。 6. COPD組HDL-c與FEV1占預(yù)計(jì)值％、FEV1／FVC％及BMI呈顯著負(fù)相關(guān)(r值分別為-0.368、-0.397、-0.361，P均0.05)。 7. Logistic多因素回歸分析HDL-c（P=0.026，OR=0.053）和BMI（P=0.032，OR=1.324）對(duì)OP有顯著作用。 結(jié)論：COPD患者BMD普遍降低而血清HDL-c水平明顯升高，COPD合并OP患者HDL-c水平高于無(wú)OP患者，HDL-c與BMD及肺功能減退程度呈負(fù)相關(guān)性。
[Abstract]:Objective: to observe the changes of bone mineral density (BMD), high density lipoprotein cholesterol (HDL-C), interleukin-6 (IL-6), tumor necrosis factor- 偽 (TNF- 偽) and body mass index (BMI) in patients with chronic obstructive pulmonary disease (COPD), and to explore the relationship between HDL-c and Osteoporosis (Osteoporosis) in patients with chronic obstructive Pulmonary Disease (COPD). Methods: 60 stable COPD patients were selected as COPD group and 60 healthy persons as control group. The age and sex of the two groups were matched. The basic data such as smoking index were determined by dual-energy X-ray absorptiometry. The BMD-COPD group was divided into COPD-OP group and COPD non-op group according to the results of BMD. The serum HDL-c was detected by immunosuppressive direct method. Serum IL-6 TNF- 偽 was detected by enzyme-linked immunosorbent assay (Elisa), and the ratio of FEV1 / FVC-1 to the predicted value of FEV1 / FVC- 偽 was measured in patients with COPD. The arterial partial pressure of oxygen (Pao _ 2) was measured. Results:. 1. Compared with the control group, the BMI(23.21 鹵3.20 kg / cm2 of COPD group was significantly lower than that of the control group (24.97 鹵3.03 kg / cm ~ 2, the ratio of abnormal bone mass was 55 / 6091.67) and the detection rate of op was 26 / 6043.33), which was significantly higher than that of the control group [2560 / 41.67) and 55.60608.33 (P < 0.05). 2. The levels of serum HDL-c(1.29 鹵0.32 mmol / L IL-6N 18.82 鹵12.87 pg/ml and TNF- 偽 123.01 鹵109.55 pg/ml in COPD group were significantly higher than those in control group (1.13 鹵0.22 mmol / L, 12.62 鹵3.96) PG 路ml / L, 66.08 鹵47.16 pg/ml, respectively (P < 0.05). 3. FEV1 in COPD-OP group (51.18 鹵15.25) and FEV1/FVC%(40.77 鹵8.72) were significantly lower than those in COPD non-op group (62.15 鹵20.12 鹵47.91 鹵11.29), and the difference was statistically significant (P < 0.05), which was significantly lower than that in COPD non-op group (24.08 鹵3.29 kg / cm ~ (-2)), and there was no significant difference in mean age, smoking index (Pao _ 2) and serum IL-6 between the two groups. 4. The serum HDL-c levels in COPD-OP group (1.45 鹵0.34) mmol/L and TNF- 偽 (158 .97 鹵116.84) pg/ml were significantly higher than those in COPD non-op group (1.17 鹵0.24) mmol / L, 96.09 鹵94.26 mg / ml, respectively. 5. In COPD group, there was a significant negative correlation between BMD and HDL-c in left and right femoral neck (r = -0.313) -0.350 (P < 0.05), and a significant positive correlation with FEV1 / FVC% and BMI (0.3330.363n 0.3950.392P, 0.05P, respectively). 6. In COPD group, there was a significant negative correlation between HDL-c and FEV1 / FEV1 / FVC% and BMI (r = -0.368- 0.397- 0.361P, respectively). 7. Logistic multivariate regression analysis showed that HDL-cP0. 026 ORA (0.053) and BMIP0. 032 (OR1. 324) played a significant role in op. Conclusion the level of HDL-c in BMD patients with op was significantly higher than that in patients without op, and there was a negative correlation between HDL-c and BMD and the degree of pulmonary dysfunction.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R563.9

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1 王中京,游曉華,孔德勇;2型糖尿病患者血漿腫瘤壞死因子水平與部分骨代謝生化指標(biāo)的相關(guān)探討[J];實(shí)用醫(yī)學(xué)雜志;2003年04期

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