本文選題：COPD　切入點(diǎn)：人軟骨糖蛋白　出處：《瀘州醫(yī)學(xué)院》2013年碩士論文

【摘要】：目的：通過檢測(cè)COPD患者血清人軟骨蛋白（YKL-40）水平，探討YKL-40在COPD患者血清中的表達(dá)及臨床意義。 方法:采用ELISA法（免疫夾心抗體法）檢測(cè)2012年1月到2012年12月期間瀘州醫(yī)學(xué)院附屬醫(yī)院住院COPD急性加重期患者60例，COPD緩解期患者65例，瀘州醫(yī)學(xué)院附屬醫(yī)院體檢中心健康者20例(正常對(duì)照組)血清中YKL-40、金屬蛋白酶9（MMP-9）、降鈣素原（PCT）、超敏C反應(yīng)蛋白（hs-CRP）表達(dá)水平。同時(shí)測(cè)定各組病例的肺功能，記錄吸煙狀況，細(xì)菌感染狀況，，預(yù)后情況，通過統(tǒng)計(jì)軟件分析了解COPD患者血清中YKL-40水平與吸煙等COPD發(fā)病危險(xiǎn)因素的相關(guān)性；COPD患者血清YKL-40水平與MMP-9、hs-CRP的相關(guān)性， COPD患者血清中YKL-40水平與肺功能及疾病預(yù)后的相關(guān)性；COPD患者血清YKL-40水平與PCT比較在COPD合并細(xì)菌感染患者中的標(biāo)記作用。 結(jié)果： 1、COPD急性加重期組、COPD緩解期組患者血清中YKL-40表達(dá)水平升高，且與正常對(duì)照組比較有統(tǒng)計(jì)學(xué)差異(P0．01)。 2、在對(duì)照組、COPD組、AECOPD組中，吸煙者血清中YKL-40表達(dá)水平高于未吸煙者,血清YKL-40水平的升高和吸煙有關(guān)。 3、在COPD緩解期組中，血清中YKL-40表達(dá)水平與肺功能FEV1.0％pred呈負(fù)相關(guān)（r=-0．5，PO．01)；血清YKL-40表達(dá)水平與MMP-9水平呈正相關(guān)（r=0.751,PO．01),與hs-CRP水平呈正相關(guān)（r=0,503,PO．01)。在AECOPD組中血清中YKL-40表達(dá)水平與PCT水平呈正相關(guān)（r=0,486,PO．01)。 4、在COPD急性加重期組，臨床預(yù)后較差者血清中YKL-40表達(dá)水平高于預(yù)后良好者，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。 5、在COPD急性加重期組，合并細(xì)菌感染者血清YKL-40水平、PCT水平均較未合并細(xì)菌感染患者高，差異有統(tǒng)計(jì)學(xué)意義（P0.01） 結(jié)論： 1、COPD緩解期和急性加重期患者血清YKL-40水平較正常對(duì)照組升高，急性加重期患者血清YKL-40水平高于臨床緩解期；吸煙者血清YKL-40表達(dá)水平較未吸煙者升高。 2、YKL-40水平與MMP-9、hs-CRP水平呈正相關(guān)，提示YKL-40可能是COPD發(fā)病機(jī)制中的新通路；血清YKL-40水平與肺功能FEV1.0％pred呈負(fù)相關(guān)，提示YKL-40是COPD的一個(gè)炎癥因子，可以預(yù)測(cè)COPD病情的嚴(yán)重程度。 3、在COPD急性加重期患者中，合并細(xì)菌感染者血清YKL-40水平、PCT水平均較未合并細(xì)菌感染患者高，血清YKL-40水平與血清PCT水平呈正相關(guān)；血清YKL-40水平在COPD急性加重期患者中預(yù)后較差者高于預(yù)后較好者。提示血清YKL-40水平在判斷AECOPD患者是否合并感染以及預(yù)測(cè)預(yù)后方面有臨床價(jià)值，但其參考水平需進(jìn)一步研究。
[Abstract]:Objective: to investigate the expression and clinical significance of YKL-40 in the serum of COPD patients by detecting the level of human chondroprotein (YKL-40) in serum of patients with COPD.Methods: from January 2012 to December 2012, 60 patients with acute exacerbation of COPD in affiliated Hospital of Luzhou Medical College were detected by ELISA method.The expression levels of YKL-40, MMP-9, PCTX and hs-CRP in serum of 20 healthy subjects (normal control group) in the affiliated hospital of Luzhou Medical College.At the same time, the lung function, smoking status, bacterial infection and prognosis of each group were measured.The correlation of serum YKL-40 level with smoking and other risk factors of COPD was analyzed by statistical software. The correlation between serum YKL-40 level and MMP-9 hs-CRP in COPD patients, and the correlation between serum YKL-40 level and pulmonary function and disease prognosis in COPD patients were analyzed.Serum YKL-40 levels were compared with PCT in COPD patients with bacterial infection.Results:1the expression of YKL-40 in serum of patients with acute exacerbation of COPD was significantly higher than that of normal controls (P 0.01).2. In the control group, the expression of YKL-40 in serum of smokers was higher than that of non-smokers, and the increase of serum YKL-40 level was related to smoking.In AECOPD group, the expression of YKL-40 was positively correlated with the level of PCT.4. In the group of acute exacerbation of COPD, the expression of YKL-40 in the serum of the patients with poor prognosis was higher than that of the patients with good prognosis, and the difference was statistically significant (P 0.05).5. In the acute exacerbation stage of COPD group, the serum YKL-40 level in the patients with bacterial infection was higher than that in the patients without bacterial infection, and the difference was statistically significant (P 0.01).Conclusion:1the serum YKL-40 level in patients with acute exacerbation and remission was higher than that in normal controls, and the level of serum YKL-40 in patients with acute exacerbation was higher than that in patients with acute exacerbation, and the level of serum YKL-40 in smokers was higher than that in non-smokers.2YKL-40 level was positively correlated with MMP-9 hs-CRP level, suggesting that YKL-40 may be a new pathway in the pathogenesis of COPD, and serum YKL-40 level was negatively correlated with pulmonary function FEV1.0%pred, suggesting that YKL-40 is an inflammatory factor of COPD and can predict the severity of COPD.3. In patients with acute exacerbation of COPD, the level of serum YKL-40 in patients with bacterial infection was higher than that in patients without bacterial infection, and the level of serum YKL-40 was positively correlated with the level of serum PCT.The level of serum YKL-40 in patients with acute exacerbation of COPD was higher than that in patients with poor prognosis.The results suggest that the serum YKL-40 level has clinical value in judging the co-infection and predicting the prognosis of AECOPD patients, but its reference level needs to be further studied.
【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【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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本文編號(hào)：1701049