本文選題：慢性阻塞性肺疾病　切入點：肺血栓栓塞　出處：《河南科技大學》2012年碩士論文

【摘要】：目的慢性阻塞性肺疾�。–OPD）是一類以氣流受限為特征的肺部疾病，患病人數(shù)多，死亡率高，COPD的慢性炎癥是血栓形成的中心環(huán)節(jié)，因此被認為是PTE的中等危險因素，COPD合并PTE后死亡率也明顯升高。本研究旨在通過觀察前列環(huán)素（PGI2）在COPD及COPD合并PTE血清中的變化，研究PTE對COPD患者血清PGI2有無影響，探討其可能的診斷價值及保護作用機制。 方法30例慢性阻塞性肺疾�。–OPD）急性加重患者，26例慢性阻塞性肺疾病合并肺血栓栓塞（COPD合并PTE）患者，來自2010年12月至2011年12月河南科技大學第一附屬醫(yī)院呼吸科住院患者。30例對照者來自同期河南科技大學第一附屬醫(yī)院體檢中心的健康體檢者。入選后測量觀察對象的身高、體重、記錄吸煙指數(shù)、病程。采用酶聯(lián)免疫吸附測定法(ELISA)檢測入選者血清中PGI2、D-二聚體（D-D）的水平。各項數(shù)據(jù)均以均數(shù)±標準差(— X±s)表示，兩組以上樣本資料采用單因素方差分析(One way ANOVA)，其中兩兩比較，滿足方差齊性檢驗用LDS．q檢驗，不滿足方差齊性檢驗用Dunnett,s T3檢驗，兩因素相關(guān)分析用Spearson直線相關(guān)分析，檢驗水準a=0.05，按P0.05有統(tǒng)計學意義，SPSS l3.0統(tǒng)計軟件包處理數(shù)據(jù)。 結(jié)果 1．COPD合并PTE組和COPD急性加重期組的Fbg明顯升高，平均值明顯高于正常對照組，并且COPD合并PTE組稍高于COPD急性加重期組，三組間比較差異有統(tǒng)計學意義(P0.01)，組間兩兩比較差異有統(tǒng)計學意義(P0.05)。 2．COPD合并PTE組和COPD急性加重期組的D-D明顯升高，平均值明顯高于正常對照組，并且COPD合并PTE組明顯高于COPD急性加重期組，三組間比較差異有顯著統(tǒng)計學意義(P0.01)，組間兩兩比較差異有統(tǒng)計學意義(P0.05)。 3．COPD合并PTE組和COPD急性加重期組的LDH明顯升高，，平均值明顯高于正常對照組，并且COPD合并PTE組稍高于COPD急性加重期組，三組間比較差異有顯著統(tǒng)計學意義(P0.01)，組間兩兩比較差異有統(tǒng)計學意義(P0.05)。 4．COPD合并PTE組和COPD急性加重期組的PGI2明顯降低，平均值均明顯低于正常對照組，并且COPD合并PTE組低于COPD急性加重期組，三組間比較差異有顯著統(tǒng)計學意義(P0.01)，組間兩兩比較差異有統(tǒng)計學意義(P0.05)。 5．PGI2在COPD合并PTE組中，與D-二聚體相關(guān)性比較，Spearman相關(guān)系數(shù)r=-0.549，P0.01,兩者間存在顯著的負相關(guān)關(guān)系；PGI2在COPD急性加重期組組中，與D-二聚體相關(guān)性比較，Spearman相關(guān)系數(shù)r=-0.429，P=0.018,兩者間存在顯著的負相關(guān)關(guān)系，相關(guān)性沒有PGI2在COPD合并PTE組中顯著。 6. PGI2在COPD合并PTE組中，與FEV1.0/FVC相關(guān)性比較，Spearman相關(guān)系數(shù)r=0.562，P0.01,兩者間存在顯著的正相關(guān)關(guān)系；PGI2在COPD急性加重期組組中，與D-二聚體相關(guān)性比較，Spearman相關(guān)系數(shù)r=-0.415，P=0．031,兩者間存在正相關(guān)關(guān)系，相關(guān)性沒有PGI2在COPD合并PTE組中顯著。 結(jié)論 1．血漿Fbg和D-D水平在COPD急性加重期組較正常對照組明顯升高，提示COPD急性加重期患者存在高凝狀態(tài)，處于血栓前期。 2．血漿Fbg和D-D水平在COPD急性加重期組和COPD合并PTE組均明顯升高，提示血漿Fbg和D-D水平可用作預測COPD合并PTE可能性的參考指標。 3．血漿LDH水平在COPD急性加重期組和COPD合并PTE組均升高，提示炎癥、缺氧導致心肌細胞損傷，與既往研究相符。 4．COPD急性加重期組PGI2明顯低于正常對照組，提示可能肺血管內(nèi)皮細胞的損傷，生成減少，與既往相關(guān)研究相符。 5．COPD合并PTE組較COPD急性加重期組的PGI2明顯降低，提示可作為預測COPD合并PTE的參考指標。 6.本研究提示PGI2或PGI2類似物治療可能會預防COPD合并PTE，是COPD治療的新思路。
[Abstract]:Chronic obstructive pulmonary disease (COPD) is a kind of restricted flow characteristics of lung disease, morbidity, high mortality, chronic inflammation of COPD is the central link of thrombus formation, so it is considered to be moderate risk factors of PTE, COPD and PTE after the mortality rate was significantly increased. This study aims to observe the prostacyclin (PGI2) changes in COPD and COPD with PTE in serum, PTE has no effect on serum COPD in patients with PGI2, to investigate the possible diagnostic value and protection mechanism.
Methods 30 cases of chronic obstructive pulmonary disease (COPD) patients with acute exacerbation, 26 cases of chronic obstructive pulmonary disease complicated with pulmonary thromboembolism (COPD and PTE) patients from the First Affiliated Hospital of Henan University of Science and Technology from December 2010 to December 2011 in Department of respiration patients with.30 controls from the First Affiliated Hospital medical center of Henan University of Science and Technology in the same period of observation object in healthy people. After the selected measuring height, weight, smoking index records, course of the disease. By enzyme linked immunosorbent assay (ELISA) were detected in sera of patients with PGI2, two D- dimer (D-D) levels. The data are mean standard deviation (-
X + s) said that more than two groups of sample data using single factor analysis of variance (One way ANOVA), of which 22, meet the homogeneity of variance using LDS.q test, does not meet the homogeneity of variance with Dunnett test, s T3 test, correlation analysis of two factors with Spearson linear correlation, test level a=0.05, according to the statistical significance of P0.05, SPSS and l3.0 statistical software package for data processing.
Result
1.COPD combined with PTE group and acute exacerbation of COPD group Fbg increased significantly, the average values were significantly higher than the normal control group, and COPD combined with PTE group was slightly higher than that of acute exacerbation of COPD group, there were significant differences between the three groups (P0.01), there was statistical significance between the 22 groups the difference (P0.05).
2.COPD combined with PTE group and acute exacerbation of COPD group D-D increased significantly, the average values were significantly higher than the normal control group, and COPD combined with PTE group was significantly higher than that of acute exacerbation of COPD group, there was significant difference between three groups (P0.01), between the 22 groups had a significant difference (P0.05).
3.COPD combined with PTE group and acute exacerbation of COPD group LDH increased significantly, the average values were significantly higher than the normal control group, and COPD combined with PTE group was slightly higher than that of acute exacerbation of COPD group, there was significant difference between three groups (P0.01), there was statistical significance between the 22 groups the difference (P0.05).
4.COPD combined with PTE group and COPD group of acute exacerbation of PGI2 was significantly reduced, the average value was significantly lower than that in normal control group, and PTE group was lower than that of COPD with acute exacerbation of COPD group, there was significant difference between three groups (P0.01), there was statistical significance between the 22 groups the difference (P0.05).
5.PGI2 in COPD with PTE group, compared with two D- dimer correlation, Spearman correlation coefficient r=-0.549, P0.01, there was a significant negative correlation between the two; PGI2 in acute exacerbation of COPD group, compared with two D- dimer correlation, Spearman correlation coefficient r=-0.429, P=0.018, there is a significant negative correlation between the two no significant correlation between PGI2 in COPD and PTE groups.
6. PGI2 in COPD with PTE group, compared with the FEV1.0/FVC correlation, Spearman correlation coefficient r=0.562, P0.01, there was a positive correlation between the two; PGI2 in acute exacerbation of COPD group, compared with two D- dimer correlation, Spearman correlation coefficient r=-0.415, P=0.031, there is a positive correlation between the two, no correlation PGI2 was in COPD with PTE group.
conclusion
1. plasma Fbg and D-D levels in COPD acute exacerbation group were significantly higher than those in the normal control group, suggesting that patients with acute exacerbation of COPD had hypercoagulable state and were in pre thrombotic stage.
2. the level of plasma Fbg and D-D in COPD acute exacerbation group and COPD combined PTE group increased significantly, suggesting that plasma Fbg and D-D levels can be used as a reference index to predict the possibility of COPD combined with PTE.
3. the level of plasma LDH increased in both the COPD acute exacerbation group and the COPD combined with the PTE group, suggesting that inflammation and hypoxia lead to myocardial damage, which is consistent with previous studies.
The PGI2 in the acute exacerbation group of 4.COPD was significantly lower than that in the normal control group, suggesting that the injury of the pulmonary vascular endothelial cells may be reduced and the formation of the cells was reduced, which was consistent with the previous related research.
The 5.COPD combined with PTE group was significantly lower than the PGI2 in the COPD acute exacerbation group, suggesting that it could be used as a reference index for predicting COPD combined with PTE.
6. this study suggests that the treatment of PGI2 or PGI2 analogues may prevent COPD with PTE, which is a new idea for the treatment of COPD.

【學位授予單位】：河南科技大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R563.9

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