發(fā)布時間：2018-06-02 22:52

  本文選題：COPD + 急性期　； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性發(fā)作期及穩(wěn)定期患者與健康人群比較,了解兩者間瘦素(Leptin)及甲狀腺素水平的變化,以明確瘦素及甲狀腺素對于評估COPD患者病情及預(yù)后的意義。方法:1.研究對象:1.1 COPD組:選擇我院2014年1月到2015年12月因COPD急性加重而入院,但入院前根據(jù)慢阻肺綜合評估為D組的男性患者50例,年齡55-75歲,平均年齡62.7歲。BMI為19-24kg/m2,平均BMI為21.1kg/m2,所有患者診斷均符合中華醫(yī)學(xué)會呼吸病學(xué)會慢性阻塞性肺疾病學(xué)組制定的《慢性阻塞性肺疾病診治指南》(2013年修訂版)慢阻肺急性加重及穩(wěn)定期的診斷標(biāo)準(zhǔn)。1.2對照組:選取來院體檢男性健康者30例作為對照組,年齡55-75歲,平均年齡62.9歲。BMI為19-24kg/m2,平均BMI為21.3kg/m2。2.研究方法:COPD急性發(fā)作患者次日清晨空腹抽血,作為發(fā)作期血樣,經(jīng)抗感染、化痰、平喘、吸氧等治療后癥狀穩(wěn)定后,再次于清晨空腹抽血作為穩(wěn)定期血樣,對照組于體檢當(dāng)天空腹抽血。檢測指標(biāo)為血清瘦素(Leptin)及甲狀腺素指標(biāo)TT3(血清三碘甲狀腺原氨酸)、TT4(血清甲狀腺素)、FT3(血清游離三碘甲狀腺原氨酸)、FT4(血清游離甲狀腺素)、TSH(促甲狀腺激素)。采用SPSS17.0統(tǒng)計軟件處理,所有數(shù)據(jù)均以(x_±s)表示,組間比較用t檢驗,P0.05表示差異有統(tǒng)計學(xué)意義。3.結(jié)果:3.1瘦素的測定:COPD急性發(fā)作期瘦素水平較對照組和穩(wěn)定期均有所升高,且具有統(tǒng)計學(xué)意義(P0.05);COPD穩(wěn)定期瘦素水平較對照組差異無明顯統(tǒng)計學(xué)意義(P0.05)。3.2甲狀腺素的測定:COPD急性發(fā)作期與對照組相比TT3、FT3下降顯著,具有統(tǒng)計學(xué)意義(P0.05);穩(wěn)定期與對照組相比TT3、FT3略有下降,但無明顯統(tǒng)計學(xué)意義(P0.05)。COPD急性發(fā)作期及穩(wěn)定期與對照組相比TT4、FT4及TSH均稍有下降,但均無明顯差異(P0.05)。結(jié)論:1.COPD急性發(fā)作期病人瘦素水平較穩(wěn)定期出現(xiàn)顯著升高。考慮與患者呼吸功能受損及COPD急性發(fā)作時的炎性反應(yīng)相關(guān)。瘦素作為一種促炎癥因子,與炎癥因子相互作用,參加了全身的炎癥經(jīng)過,所以瘦素或許是一項病情惡化的炎性標(biāo)志物。穩(wěn)定期瘦素濃度較前降低,且瘦素濃度與患者體重呈正相關(guān),這或許是機體的一種自我保護性變化,由于瘦素濃度下降有助于減少對能量的消耗以及對攝食的增加,因此防止了COPD病人體重繼續(xù)降低以及營養(yǎng)狀態(tài)的繼續(xù)變差。2.COPD急性發(fā)作期TT3、FT3下降顯著,穩(wěn)定期與對照組相比TT3、FT3略有下降,但無明確統(tǒng)計學(xué)意義。COPD急性發(fā)作期及穩(wěn)定期TT4、FT4及TSH均稍有下降,但均無明顯統(tǒng)計學(xué)意義。甲功的變化,與缺氧、感染產(chǎn)生細(xì)胞因子、應(yīng)用糖皮質(zhì)激素等原因有關(guān),也可視為這可能是機體的一種保護機制,隨著病情的好轉(zhuǎn),甲狀腺功能可恢復(fù)至接近正常或正常,提示甲狀腺激素的改變與COPD預(yù)后存在密切關(guān)系。3.瘦素及甲狀腺素對COPD患者在了解病情、判斷預(yù)后方面都具有一定的臨床價值,值得臨床醫(yī)師重視。
[Abstract]:Objective: to investigate the changes of leptin and thyroxine levels in patients with chronic obstructive pulmonary disease during acute attack and stable stage compared with healthy people. To determine the significance of leptin and thyroxine in evaluating the condition and prognosis of patients with COPD. Method 1: 1. Study participants: one hundred and fifty male patients, aged 55-75 years, who were admitted to our hospital for acute exacerbation of COPD from January 2014 to December 2015, were enrolled in the study group from January 2014 to December 2015, according to the comprehensive assessment of chronic obstructive pulmonary disease (COPD) before admission. The mean age was 62.7 years. BMI was 19-24 kg / m ~ (2) and average BMI was 21.1kg / m ~ (2). All the patients were diagnosed in accordance with the guidelines for the diagnosis and treatment of chronic obstructive Pulmonary Disease (COPD) (2013 revised edition) developed by the Group of chronic obstructive Pulmonary Disease (COPD) of the Chinese Medical Association. The diagnostic criteria of aggravation and stability. 1.2 control group: 30 healthy male patients were selected as control group. Age 55-75 years, mean age 62.9 years. BMI is 19-24 kg / m ~ (2), average BMI is 21.3 kg / m ~ (2.2). Methods the patients with acute COPD were taken blood samples on an empty stomach the next morning, which were taken as blood samples during the attack period. After the treatment of anti-infection, phlegm, asthma, oxygen inhalation and so on, the symptoms were stable, and the fasting blood samples were taken as stable blood samples again in the morning. The control group took blood on an empty stomach on the day of physical examination. Serum leptin (leptin) and thyroxine (Thyrotropin) and thyroxine (TSH) were measured in serum and serum thyroxine triiodothyronine (TSH) and thyrotropin (TSH) in serum respectively. SPSS17.0 statistical software was used to process all the data in the form of X _ 鹵s, and the difference between groups was statistically significant by using t test (P0.05). Results the level of leptin in the acute phase of COPD was higher than that in the control group and the stable stage, and the level of leptin in the control group was higher than that in the control group. There was no significant difference in leptin level between stable stage of COPD and control group. The determination of thyroxine in 10% COPD patients during acute attack was significantly lower than that in control group, and that in control group was significantly lower than that in control group, and there was no significant difference in leptin level between the two groups. Compared with the control group, TT3 FT3 decreased slightly in the stable phase, but there was no significant difference between the stable phase and the control group, but there was no significant difference between the two groups in the acute attack phase and the stable phase, but there was no significant difference (P 0.05). Conclusion: 1. Leptin level in COPD patients with acute exacerbation was significantly higher than that in stable stage. The relationship between respiratory dysfunction and inflammatory response during acute COPD attack was considered. Leptin, a pro-inflammatory factor, interacts with inflammatory factors and participates in systemic inflammatory processes, so leptin may be an inflammatory marker of exacerbation. Leptin concentration in stable period was lower than before, and leptin concentration was positively correlated with body weight. This may be a self-protective change of body, because the decrease of leptin concentration can reduce energy consumption and increase food intake. Therefore, it prevented the body weight loss and nutritional status of COPD patients from becoming worse. 2. TT3 FT3 decreased significantly in acute phase of COPD, and decreased slightly in stable phase compared with control group. However, there was no statistical significance. TT _ 4 FT _ 4 and TSH decreased slightly in acute and stable phase of COPD, but there was no significant difference between them. The changes of hypothyroidism are related to hypoxia, infection, cytokines, glucocorticoids, and so on. It can also be regarded as a protective mechanism of the body. With the improvement of the condition, thyroid function can be restored to near normal or normal. It suggests that thyroid hormone changes are closely related to the prognosis of COPD. 3. 3. Leptin and thyroxine have certain clinical value in understanding the condition and judging prognosis of patients with COPD, and deserve attention of clinicians.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R563.9

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