本文選題：支氣管擴(kuò)張癥合并哮喘 + 臨床特征�。� 參考：《吉林大學(xué)》2016年碩士論文

【摘要】：目的:探討支氣管擴(kuò)張癥合并哮喘患者的臨床特征以及血清IL-4、IFN-γ的表達(dá)水平,旨在對支氣管擴(kuò)張合并哮喘患者的發(fā)病機(jī)制有更進(jìn)一步的認(rèn)識,為其早期診治提供依據(jù)。方法:參照2012年成人支氣管擴(kuò)張癥診治專家共識及2008年中國哮喘防治指南,收集2014年10月至2015年10月期間吉林大學(xué)第二醫(yī)院呼吸內(nèi)科收治的29例支氣管擴(kuò)張患者及12例哮喘患者。其中單純支氣管擴(kuò)張患者為14例,設(shè)為A組;12例單純哮喘患者為B組;支氣管擴(kuò)張患者中合并哮喘的有15例,設(shè)為C組;健康體檢者共7例為D組。對四組患者的基線資料、FENO測定及血清學(xué)IL-4、IFN-γ的表達(dá)水平等方面進(jìn)行對比分析。結(jié)果:1、各組基線水平測定結(jié)果(1)各組自然資料測定結(jié)果單純支擴(kuò)、單純哮喘、支擴(kuò)合并哮喘及正常對照組患者年齡、性別間差異無統(tǒng)計(jì)學(xué)意義(P0.05);單純支擴(kuò)與支擴(kuò)合并哮喘患者在過敏史方面差異有統(tǒng)計(jì)學(xué)意義(P0.05),單純哮喘與支擴(kuò)合并哮喘患者在過敏史方面差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(2)各組肺功能指標(biāo)測定結(jié)果(1)單純支擴(kuò)組和支擴(kuò)合并哮喘組患者在吸入支氣管舒張劑前FEV1(%)、FEV1/FVC(%)、MMEF75/25、MMEF75/25(%)比較有統(tǒng)計(jì)學(xué)差異(P均0.05)。(2)單純支擴(kuò)和支擴(kuò)合并哮喘患者在吸入支氣管舒張劑后FVC改善率、FEV1改善率、MMEF75/25改善率比較差異有統(tǒng)計(jì)學(xué)意義(P均0.01),且FEV1/FVC(%)比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)單純哮喘和支擴(kuò)合并哮喘患者各項(xiàng)肺功能指標(biāo)差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(3)各組患者患病年限單純支擴(kuò)組患者患病年限平均為9.15年,單純哮喘組患者患病年限平均為14.68年,支擴(kuò)合并哮喘組患者患有支擴(kuò)及哮喘的平均年限分別為14.35年和4.28年,其中有14例患者先出現(xiàn)支擴(kuò)后合并哮喘,在合并哮喘前支擴(kuò)平均患病年限為10.07年。2、呼出氣一氧化氮(FENO)測定(1)支擴(kuò)合并哮喘組FENO測定平均為37.95±13.03ppb,單純哮喘組為58.96±15.17ppb均高于正常對照組16.95±4.97ppb,差異有統(tǒng)計(jì)學(xué)意義(P均0.01)。(2)單純支擴(kuò)組FENO水平為11.05±5.35ppb低于正常對照組,差異統(tǒng)計(jì)學(xué)意義(P0.05);支擴(kuò)合并哮喘組FENO水平高于單純支擴(kuò)組,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。(3)支擴(kuò)合并哮喘組FENO水平低于單純哮喘組,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。(4)其中支擴(kuò)合并哮喘組痰培養(yǎng)示銅綠假單胞菌(PA)感染的患者有5例,測定FENO平均為26.78±5.69ppb低于非PA感染的患者43.54±12.03ppb,差異有統(tǒng)計(jì)學(xué)意義(P0.05);單純支擴(kuò)組中痰培養(yǎng)示PA感染的患者有3例,測定FENO平均為6.77±1.88ppb,非PA感染的患者測定FENO平均為12.13±5.67ppb,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。3、血清白介素-4(IL-4)的表達(dá)水平支擴(kuò)合并哮喘組患者血清中IL-4表達(dá)水平為317.02±53.53ng/L,單純支擴(kuò)組為279.02±44.24ng/L,單純哮喘組為367.60±45.10ng/L,均高于正常對照組215.33±46.33ng/L,差異有統(tǒng)計(jì)學(xué)意義(P均0.01);支擴(kuò)合并哮喘組IL-4的表達(dá)水平高于單純支擴(kuò)組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);支擴(kuò)合并哮喘組IL-4的表達(dá)水平低于單純哮喘組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4、γ干擾素(IFN-γ)的表達(dá)水平支擴(kuò)合并哮喘患者血清中IFN-γ表達(dá)水平為241.68±50.33ng/L高于正常對照組192.14±25.99ng/L,差異有統(tǒng)計(jì)學(xué)意義(P0.05);單純支擴(kuò)組為295.65±77.10ng/L高于正常對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.01);單純哮喘組IFN-γ表達(dá)水平為153.76±26.69ng/L,低于正常對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);支擴(kuò)合并哮喘組患者血清中IFN-γ的表達(dá)水平低于單純支擴(kuò)組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);支擴(kuò)合并哮喘組患者血清中IFN-γ的表達(dá)水平高于單純哮喘組,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。結(jié)論:1.支氣管擴(kuò)張患者患病年限大約在10.07年后合并哮喘的危險(xiǎn)性增加。2.支氣管擴(kuò)張患者呼出氣一氧化氮測定明顯低于支擴(kuò)合并哮喘組及單純哮喘組,說明支氣管擴(kuò)張的發(fā)病機(jī)制與氣道嗜酸性浸潤關(guān)系不大。3.血清中IL-4、IFN-γ的表達(dá)水平有可能成為支擴(kuò)合并哮喘患者的早期診斷依據(jù)。
[Abstract]:Objective: To explore the clinical features of bronchiectasis with asthma and the level of the expression of serum IL-4 and IFN- gamma. The purpose of this study is to further understand the pathogenesis of bronchiectasis with asthma and to provide a basis for its early diagnosis and treatment. Methods: to consult the expert consensus of the diagnosis and treatment of adult bronchiectasis in 2012 and the Chinese asthma in 2008. 29 cases of bronchiectasis and 12 asthma patients were collected from October 2014 to October 2015 in the respiratory medicine department of the second hospital of Jilin University. Among them, 14 patients with simple bronchiectasis were set up as group A; 12 patients with simple asthma were group B; 15 cases with asthma in bronchiectasis were set up as group C and healthy body. A total of 7 cases were in group D. The baseline data of four groups, FENO determination, serological IL-4, IFN- gamma expression level were compared. Results: 1, baseline levels of each group were measured (1) simple bronchiectasis, simple asthma, bronchiectasis, asthma and normal control group age. There was no statistical difference between sex. Learning significance (P0.05); there was significant difference in allergic history between simple bronchiectasis and bronchiectasis (P0.05). There was no significant difference in allergy history between simple asthmatic and bronchiectasis patients (P0.05). (2) the results of pulmonary function indexes in each group (1) simple bronchiectasis group and bronchiectasis combined with asthma patients in the inhalation bronchus There were significant differences in FEV1 (%), FEV1/FVC (%), MMEF75/25, MMEF75/25 (%) before diastolic agent (P 0.05). (2) the improvement rate of FVC, FEV1 improvement rate and MMEF75/25 improvement rate in patients with bronchial dilatation with simple bronchiectasis and bronchiectasis were statistically significant (P 0.01), and FEV1/FVC (%) was statistically significant (P0.05). (3) there was no significant difference in the pulmonary function indexes of the patients with simple asthma and bronchiectasis (P0.05). (3) the average age of the patients in the simple bronchiectasis group was 9.15 years, the average age of the patients in the simple asthmatic group was 14.68 years, and the average age of the bronchiectasis and asthma patients in the bronchiectasis and asthma group was 14.3, respectively. In the 5 and 4.28 years, 14 patients were first treated with bronchiectasis with asthma. The average age of the prevalence of bronchiectasis before the combined asthma was 10.07 years.2, the exhalation of nitric oxide (FENO) was measured (1) and the average of FENO in the bronchiectasis group was 37.95 + 13.03ppb, and the simple asthma group was 58.96 + 15.17ppb higher than that of the normal control group (16.95 + 4.97ppb). The significance of the study (P 0.01). (2) the level of FENO in the simple bronchiectasis group was 11.05 + 5.35ppb lower than the normal control group, and the difference was statistically significant (P0.05); the FENO level in the bronchiectasis combined with asthma group was higher than that of the simple bronchiectasis group (P0.01). (3) the level of FENO in the bronchiectasis and asthma group was lower than that of the simple asthma group (P0.01). (4) it was statistically significant (4). There were 5 cases of Pseudomonas aeruginosa (PA) infection in the medium bronchiectasis and asthma group, and the average of 26.78 + 5.69ppb was 26.78 + 5.69ppb lower than that of non PA infection. The difference was statistically significant (P0.05). There were 3 cases of PA infection in the simple bronchiectasis group, and the average of FENO was 6.77 + 1.88ppb, and the non PA infection patients were measured. The mean FENO was 12.13 + 5.67ppb, the difference was not statistically significant (P0.05).3, the expression level of serum interleukins -4 (IL-4) in the patients with asthma group was 317.02 + 53.53ng/L, the simple bronchiectasis group was 279.02 + 44.24ng/L, and the simple asthmatic group was 367.60 + 45.10ng/L, all higher than that of the normal control group, 215.33 + 46.33ng/L, the difference was found. Statistical significance (P 0.01); the expression level of IL-4 in the bronchiectasis group was higher than that of the simple bronchiectasis group, the difference was statistically significant (P0.05); the expression level of IL-4 in the bronchiectasis and asthma group was lower than that of the simple asthma group (P0.05).4. The expression level of interferon gamma (IFN- gamma) was combined with IFN- gamma expression water in the serum of asthmatic patients. The level of 241.68 + 50.33ng/L was higher than that of the normal control group (192.14 + 25.99ng/L), the difference was statistically significant (P0.05); the simple bronchiectasis group was 295.65 + 77.10ng/L higher than the normal control group, the difference was statistically significant (P0.01); the level of IFN- gamma expression in the simple asthma group was 153.76 + 26.69ng/L, lower than the normal control group, the difference was statistically significant (P0.05). The expression level of IFN- gamma in serum of patients with asthma group was lower than that in simple bronchiectasis group (P0.05). The expression level of IFN- gamma in serum of patients with bronchiectasis and asthma group was higher than that of simple asthma group, the difference was statistically significant (P0.01). Conclusion: 1. the risk of asthma in patients with bronchiectasis is about 10.07 years later. The determination of exhaled nitric oxide in.2. bronchiectasis was significantly lower than that of bronchiectasis combined with asthma and asthma alone. It was suggested that the pathogenesis of bronchiectasis was not related to the eosinophilic infiltration of the airway in.3. serum IL-4, and the expression level of IFN- gamma may be the early diagnostic basis for the patients with bronchiectasis and asthma.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R562.2

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