發(fā)布時(shí)間：2018-03-28 13:07

  本文選題：嗜酸粒細(xì)胞性支氣管炎　切入點(diǎn)：嗜酸粒細(xì)胞祖細(xì)胞　出處：《廣州醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景:嗜酸粒細(xì)胞性支氣管炎(Eosinophiic bronchitis,EB)是慢性咳嗽最常見病因之一,以氣道嗜酸粒細(xì)胞性炎癥為主要特征,對(duì)激素治療敏感,但發(fā)病機(jī)制尚未完全明確。隨著治療,EB患者嗜酸性粒細(xì)胞水平下降至正常,但在癥狀復(fù)發(fā)時(shí)再度升高。嗜酸粒細(xì)胞的前體細(xì)胞為嗜酸粒細(xì)胞祖細(xì)胞(Eosinophil progenitors,EoP),來源于骨髓造血干細(xì)胞(Hematopoietic Progenitor Cell,HPC),主要存在于骨髓,大部分在骨髓內(nèi)分化為成熟嗜酸粒細(xì)胞后入血。但近年研究發(fā)現(xiàn)部分造血干細(xì)胞和嗜酸粒細(xì)胞祖細(xì)胞亦可由骨髓直接釋放入血并遷移至氣道后再進(jìn)行分化,參與肺臟局部/氣道的嗜酸粒細(xì)胞性炎癥的發(fā)生。但在嗜酸粒細(xì)胞性支氣管炎發(fā)病過程中,嗜酸粒細(xì)胞祖細(xì)胞是否亦可同樣參與氣道炎癥的發(fā)生,目前尚不明確。目的:通過檢測EB患者的誘導(dǎo)痰細(xì)胞以及外周血細(xì)胞中的干細(xì)胞以及嗜酸粒細(xì)胞祖細(xì)胞,觀察其分別在氣道局部以及系統(tǒng)循環(huán)中的水平,并觀察其治療后的變化,初步探討其參與EB發(fā)病機(jī)制的可能。方法:篩選廣州呼吸疾病研究所門診就診的EB及支氣管哮喘的首診患者,并納入健康志愿者作為對(duì)照。按照指南診治流程予以行誘導(dǎo)痰、呼出氣一氧化氮、血清TIgE、肺通氣功能+氣道反應(yīng)性、血常規(guī)等檢查。其中,誘導(dǎo)痰細(xì)胞除行常規(guī)炎癥細(xì)胞分類計(jì)數(shù)外,所剩痰細(xì)胞行流式細(xì)胞學(xué)檢測;采集靜脈血除行血細(xì)胞分類計(jì)數(shù)外,分離PBMC進(jìn)行流式細(xì)胞術(shù)檢測。流式細(xì)胞學(xué)檢測干細(xì)胞以及嗜酸粒細(xì)胞祖細(xì)胞數(shù)量。EB及支氣管哮喘患者治療后第四周進(jìn)行隨訪,予以留取血液及誘導(dǎo)痰再次行流式細(xì)胞學(xué)檢測。結(jié)果:1.共納入EB患者18例,哮喘患者28例(其中嗜酸粒細(xì)胞型哮喘EA 15例,非嗜酸粒細(xì)胞型哮喘NEA 11例,誘導(dǎo)痰失敗2例),健康對(duì)照14例;復(fù)診子集中,EB患者9例,哮喘患者16例(其中EA 10例,NEA 6例)。2.在氣道局部水平上,誘導(dǎo)痰EoP水平EB組[91(256)個(gè)/ml]及哮喘組[87(250)個(gè)/ml]明顯高于正常對(duì)照組[17(51)個(gè)/ml],(P均0.05),但EB組及哮喘組相比未見明顯差異(P0.05),NEA及EA組間未見差異(P0.05)。3.在系統(tǒng)循環(huán)水平上,外周血EoP水平EB組[70(115)個(gè)/ml]與健康對(duì)照組[118(127)個(gè)/ml]未見差異(P0.05)。但哮喘組[113(154)個(gè)/ml]較EB組有升高趨勢(P=0.10);尤其以EA組[121(156)個(gè)/ml]較EB組升高趨勢明顯(P=0.08)。4.吸入激素治療四周后,EB組誘導(dǎo)痰EoP水平較治療前明顯降低[7(200)vs 91(256)個(gè)/ml,P=0.05],但外周血EoP未見明顯改變[76(143)vs 68(219)個(gè)/ml,P0.05]。而哮喘組外周血及氣道EoP均較治療下降(P均0.05)。結(jié)論:1.EB患者氣道EoP水平增高,可能參與氣道嗜酸粒細(xì)胞性炎癥的發(fā)生。2.相比支氣管哮喘而言,EB患者炎癥可能更局限于氣道。
[Abstract]:Background: eosinophitic bronchitis (EBB) is one of the most common causes of chronic cough. It is characterized by airway eosinophil inflammation and is sensitive to hormone therapy. However, the pathogenesis of eosinophils in patients with EB was not completely clear, and the eosinophil level decreased to normal with the treatment of Epstein-Barr. The progenitor cells of eosinophil were Eosinophil progenitor cells (Eosinophil progenitor cells), derived from bone marrow hematopoietic stem cells (hematopoietic stem cells) and hematopoietic Progenitor cells (HPCs), which were mainly found in bone marrow, and Eosinophil progenitor cells (Eosinophil progenitor cells) were derived from bone marrow hematopoietic stem cells. Most of them differentiate into mature eosinophils in bone marrow and enter blood. But in recent years, some hematopoietic stem cells and eosinophil progenitor cells can also be directly released into blood from bone marrow and migrated to the airway before differentiation. Eosinophils are involved in the development of eosinophilic inflammation in the lung. But whether eosinophil progenitor cells are also involved in the development of airway inflammation in the course of eosinophil bronchitis. Objective: to investigate the level of induced sputum cells and peripheral blood stem cells and eosinophils progenitor cells in patients with EB. The changes after treatment were observed and the possibility of its involvement in the pathogenesis of EB was preliminarily discussed. Methods: EB and bronchial asthma patients in outpatient clinic of Guangzhou Institute of Respiratory Diseases were selected. The healthy volunteers were included as control group. Induced phlegm, exhaled nitric oxide, serum tige, pulmonary ventilation function airway reactivity, blood routine examination were performed according to the procedure of diagnosis and treatment. In addition to routine inflammatory cell classification count, the remaining sputum cells were detected by flow cytology, venous blood was collected except for blood cell classification count. The stem cells and eosinophils progenitor cells were detected by flow cytometry. EB was detected by flow cytometry and followed up for the fourth week after treatment with bronchial asthma. Blood was collected and sputum was reexamined by flow cytology. Results 1. 18 cases of EB and 28 cases of asthma (including 15 cases of eosinophil asthma EA and 11 cases of NEA of non-eosinophil asthma) were included. There were 2 cases of induced sputum failure, 14 cases of healthy control, 9 cases of EB patients and 16 cases of asthma (EA 10 cases 6 cases of NEA). The level of EoP in induced sputum in EB group [91: 256 / ml] and asthma group [87 / 250 / ml] was significantly higher than that in normal control group [17: 51] / ml] P 0.05, but there was no significant difference between EB group and asthma group. There was no significant difference between EB group and asthma group. There was no difference in peripheral blood EoP level between EB group [70 鹵115 / ml] and healthy control group [1188 / 127 / ml], but there was a tendency to increase in asthma group [113 / 154 / ml] than that in EB group, especially in EA group [121156 / ml] and EB group after inhaling hormone for four weeks. The level of induced phlegm EoP was significantly lower than that before treatment [7(200)vs 91: 256) / ml / ml P0. 05], but the peripheral blood EoP did not change [76(143)vs 682 19 / ml P 0.05]. However, the level of EoP in peripheral blood and airway in asthma group was significantly lower than that before treatment (P < 0 05). Conclusion 1. The level of EoP in the airway of patients with 1 / EB was significantly higher than that of the control group (P < 0. 05). May be involved in airway eosinophils inflammation. 2. Epstein-Barr inflammation may be more limited to the airway than bronchial asthma.
【學(xué)位授予單位】：廣州醫(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)】：R562.21

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 中華醫(yī)學(xué)會(huì)呼吸病學(xué)分會(huì)哮喘學(xué)組;咳嗽的診斷與治療指南(草案)[J];中華結(jié)核和呼吸雜志;2005年11期

2 羅煒,賴克方,陳如沖,劉春麗,曾運(yùn)祥,鐘淑卿,李德容,吳華,何夢璋,鐘南山;嗜酸粒細(xì)胞性支氣管炎患者氣道炎癥細(xì)胞及介質(zhì)特征的探討[J];中華結(jié)核和呼吸雜志;2005年09期

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本文編號(hào)：1676451