本文選題：慢性阻塞性肺疾病急性加重 + 應(yīng)激�。� 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過檢測慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者急性發(fā)作時血清皮質(zhì)醇、促腎上腺皮質(zhì)激素(Adrenocorticotropic hormone,ACTH)、腎素、血管緊張素水平,探討COPD患者急性加重時是否存在應(yīng)激,觀察不同應(yīng)激激素水平對患者癥狀、病情程度,以及患者出院后生活質(zhì)量的改善程度、再發(fā)急性加重風(fēng)險(xiǎn)的影響。方法:采用前瞻性研究的方法,于2015年12月至2016年8月,對符合COPD急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)診斷并入住廣西醫(yī)科大學(xué)第一附屬醫(yī)院老年呼吸科的老年患者逐一入選。1.分別對入選患者進(jìn)行病情評估,采用2013年頒布的COPD全球倡議中的COPD綜合評估系統(tǒng),通過癥狀評估、肺功能評估、急性加重風(fēng)險(xiǎn)評估將患者分為A、B、C、D四組;2.采用BODE預(yù)后指數(shù),即體重指數(shù)(body-mass index,B),氣流受限程度(the degree of airflow obstruction,O),呼吸困難評分(dyspnea,D)和運(yùn)動耐量(exercise capacity,E),對入選患者進(jìn)行預(yù)后評分;3.采用放射免疫法對患者血清皮質(zhì)醇、ACTH、腎素、血管緊張素Ⅱ進(jìn)行檢測。4.入選患者出院后,對其進(jìn)行半年的隨訪,包括電話隨訪和門診、住院隨訪,觀察患者存活率和治療后生活質(zhì)量。結(jié)果:1.COPD病人急性加重時血清腎素、血管緊張素Ⅱ水平明顯升高(P0.05),而血清皮質(zhì)醇、ACTH水平較對照組低但無統(tǒng)計(jì)學(xué)差異(P0.05);2.應(yīng)激組病人急性加重時血清皮質(zhì)醇水平明顯升高(P0.05),癥狀較無應(yīng)激組明顯(P0.05),住院時間長(P0.05),出院后6個月內(nèi)出現(xiàn)再次急性加重的例數(shù)較無應(yīng)激組多(P0.01),癥狀緩解程度差(P0.05)。結(jié)論:1.大多數(shù)COPD病人急性加重時存在不同程度的應(yīng)激。2.老年AECOPD患者的應(yīng)激特征表現(xiàn)為不完全應(yīng)激,即血清腎素、AngⅡ水平增高,而促腎上腺激素和皮質(zhì)醇水平增高不明顯。3.與無應(yīng)激患者比,應(yīng)激增加了COPD患者出院后6個月內(nèi)再發(fā)急性加重的風(fēng)險(xiǎn)。
[Abstract]:Objective: to detect the levels of serum cortisol, adrenocorticotropin, renin and angiotensin in patients with chronic obstructive pulmonary disease (COPD) during acute attack.To observe the effect of different stress hormone levels on symptoms, severity of illness, and quality of life of patients after discharge, and the risk of recurrent acute exacerbation.Methods: from December 2015 to August 2016, the elderly patients with acute exacerbation of chronic obstructive pulmonary disease diagnosed and admitted to the Department of Geriatric Respiratory in the first affiliated Hospital of Guangxi Medical University were selected from December 2015 to August 2016.The patients were evaluated by the COPD comprehensive assessment system of the COPD Global Initiative published in 2013. The patients were divided into four groups by symptom assessment, pulmonary function assessment and acute exacerbation risk assessment.BODE prognostic index, body mass index, degree of airflow obstruction, dyspnea score and exercise exercise capacity were used to evaluate the prognosis of the selected patients.Serum cortisol ACTH, renin and angiotensin 鈪，

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