本文選題：鼻粘膜電位差 + 缺氧性肺損傷　； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景鼻粘膜電位差(Nasal potential difference,NPD)是肺囊性纖維化一個(gè)很好的臨床檢測(cè)方法,它能夠反映呼吸道上皮陽離子和陰離子的跨上皮轉(zhuǎn)運(yùn)。攜帶電荷的離子的跨上皮轉(zhuǎn)運(yùn)會(huì)形成跨上皮電壓,即電位差。呼吸道上皮電位差可以通過鼻腔測(cè)定,即NPD。影響鼻粘膜電位差的離子通道主要有調(diào)節(jié)鈉離子的上皮鈉離子通道(ENaC)、調(diào)節(jié)氯離子的囊性纖維化跨膜傳導(dǎo)調(diào)節(jié)因子(CFTR)以及提供能量的Na+/K+-ATP酶等,ENaC是一種對(duì)氧敏感的離子通道,缺氧會(huì)損傷ENaC,進(jìn)而影響離子的跨膜轉(zhuǎn)運(yùn),影響電位差。目的通過分析NPD總的基線值以及各組成部分的值在缺氧性肺損傷病人中的變化,分析出NPD能否應(yīng)用于缺氧性肺損傷的輔助診斷。方法制定檢索策略以及文獻(xiàn)的納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),用PubMed、EMBASE、Scopus、Web of Science、Ovid MEDLINE和Google Scholar等數(shù)據(jù)庫進(jìn)行檢索文獻(xiàn),從11篇無偏倚的研究,包括7篇HAPE和4篇RDS中提取數(shù)據(jù),提取的數(shù)據(jù)用均數(shù)±標(biāo)準(zhǔn)差(x±s)形式表示,若原始數(shù)據(jù)不是x±s形式則用相關(guān)公式計(jì)算轉(zhuǎn)化為x±s形式,用RevMan、Stata和R軟件分析這些數(shù)據(jù),分析得出的主要結(jié)果用權(quán)重均數(shù)差(WMD)及95%可信區(qū)間(CI)表示。結(jié)果肺損傷病人中總NPD值(WMD-5.27 mV,95%CI:-6.03到-4.52,P0.00001,I2=42%)、阿米洛利敏感部分(ENaC)NPD值(WMD-2.87 mV,95%CI:-4.02到-1.72,P0.00001,I2=51%)和抗阿米洛利部分NPD值(WMD-3.91 mV,95%CI:-7.64到-0.18,P=0.04,I2=95%)均有明顯降低。對(duì)HAPE和RDS進(jìn)行亞組分析得出,在HAPE中,這三部分NPD值同樣明顯降低,而在RDS中抗阿米洛利部分NPD值無明顯降低。另外,SpO2僅在病人中和ENaC相關(guān)部分的NPD呈正相關(guān)關(guān)系,與其它部分NPD及健康人中任何部分NPD都無相關(guān)關(guān)系。病人組中ENaC相關(guān)部分的NPD值和海拔高度之間呈負(fù)相關(guān)關(guān)系證實(shí)了這些相關(guān)性,因?yàn)楹０胃叨群蚐pO2水平呈負(fù)相關(guān)關(guān)系。海拔高度與病人組及健康人組中其它部分NPD無相關(guān)關(guān)系�？偟幕�NPD無論在病人中還是健康人中都和抗阿米洛利部分NPD明顯呈正相關(guān)關(guān)系,而和其它部分NPD沒有相關(guān)關(guān)系。結(jié)論我們的分析結(jié)果表明和系統(tǒng)缺氧相關(guān)的急性肺損傷是以NPD功能失調(diào)為特點(diǎn)的,ENaC NPD部分可以用來表明肺泡液重吸收情況,NPD可以作為缺氧性肺損傷的輔助診斷方法,同時(shí)為將來開展使用床旁測(cè)量NPD技術(shù)評(píng)估HAPE和RDS病人中水腫液重吸收情況的臨床試驗(yàn)提供了數(shù)據(jù)基礎(chǔ)。
[Abstract]:Background Nasal potential difference (NPD) is a good clinical method for detecting pulmonary cystic fibrosis. It can reflect the trans epithelial transport of the cationic and anions of the respiratory tract. The trans epithelial transport of the charged ions will form a cross epithelial voltage, that is, the potential difference of the respiratory epithelium can pass through the nose. Cavity determination, that is, NPD. affects the nasal mucosal potential difference in the ionic channel, which regulates the sodium ion channel (ENaC), modulates the cystic fibrosis transmembrane conduction regulator (CFTR) and the Na+/K+-ATP enzyme that provides energy. ENaC is an oxygen sensitive ion channel. Hypoxia will damage ENaC and then affect the ion span. Membrane transport, affecting the potential difference. Objective by analyzing the total baseline values of NPD and the changes in the values of each component in the patients with hypoxic lung injury, we analyzed whether NPD could be applied to the auxiliary diagnosis of hypoxic lung injury. Methods the retrieval strategy and the inclusion criteria and exclusion criteria of the literature were formulated, and PubMed, EMBASE, Scopus, Web of Science, Ovi. D MEDLINE and Google Scholar data are retrieved from 11 unbiased studies, including 7 HAPE and 4 RDS, and the extracted data are expressed in the form of mean mean standard deviation (x + s). If the original data is not x + s form, the data is converted to x s form by correlation formula. The main results of the analysis were the weight mean difference (WMD) and the 95% confidence interval (CI). Results the total NPD value of the patients with lung injury (WMD-5.27 mV, 95%CI:-6.03 to -4.52, P0.00001, I2=42%), and the NPD value of the amiloride sensitive part (ENaC). 64 to -0.18, P=0.04, I2=95%) were significantly reduced. The subgroup analysis of HAPE and RDS showed that in HAPE, the NPD values of these three parts decreased significantly, while the NPD value of amiloride in RDS was not significantly reduced. In addition, SpO2 was only in positive correlation with NPD in the patient and ENaC related parts, with other parts and any part of the healthy person. There was no correlation between NPD. The correlation between the NPD value of the ENaC related parts in the patient group and the altitude was negatively correlated, because the elevation was negatively correlated with the level of SpO2. The altitude was not related to the other parts of the patient group and the other part of the healthy group. The total baseline NPD was both in the patient and in the healthy person. Both of them have a positive correlation with the anti amiloride NPD, and there is no correlation with other parts of the NPD. Conclusion our analysis showed that the acute lung injury associated with the system hypoxia is characterized by NPD dysfunction, and the ENaC NPD part can be used to indicate the re absorption of alveolar fluid, and NPD can be used as a hypoxic lung injury. The auxiliary diagnostic method also provides a data basis for future clinical trials using bedside survey NPD technique to assess the reabsorption of edema fluid in HAPE and RDS patients.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563

【參考文獻(xiàn)】

中國期刊全文數(shù)據(jù)庫 前1條

1 白春學(xué);吳學(xué)玲;蔣進(jìn)軍;;急性呼吸窘迫綜合征——危重醫(yī)學(xué)的重點(diǎn)[J];中華急診醫(yī)學(xué)雜志;2011年04期

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本文編號(hào)：1901736