本文選題：支氣管哮喘 + 超敏　； 參考：《大連醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的：研究支氣管哮喘急性發(fā)作期患者血清超敏C反應(yīng)蛋白與誘導(dǎo)痰白細(xì)胞分類計(jì)數(shù)和肺功能及哮喘控制測試的相關(guān)性，探討其臨床應(yīng)用價(jià)值。 方法：收集2011年9月至2011年12月于大連醫(yī)科大學(xué)附屬第二醫(yī)院呼吸內(nèi)科住院治療的支氣管哮喘急性發(fā)作期患者30例，哮喘的診斷標(biāo)準(zhǔn)及急性發(fā)作期嚴(yán)重程度的分級標(biāo)準(zhǔn)，參照支氣管哮喘防治指南（2008版），哮喘組均排除存在感染及既往有吸煙史的患者。同時(shí)期健康體檢者14例為對照組。對照組均否認(rèn)肺部疾病史及吸煙史；測定對照組和哮喘組經(jīng)全身糖皮質(zhì)激素治療5～7d（甲潑尼龍40～80mg/d）前后的空腹血清hs-CRP水平。誘導(dǎo)痰操作方法參考《咳嗽的診斷與治療指南（2009版）》附件1高滲鹽水誘導(dǎo)痰檢測方法，并根據(jù)實(shí)際情況進(jìn)行改進(jìn)。在誘導(dǎo)期間檢測患者呼氣峰流速（PEF）變化，若PEF較誘導(dǎo)痰前下降20%，則停止誘導(dǎo)，必要時(shí)吸入支氣管擴(kuò)張劑治療。超聲霧化4.5%的高滲鹽水獲取誘導(dǎo)痰，顯微鏡下進(jìn)行誘導(dǎo)痰白細(xì)胞分類計(jì)數(shù)，分別計(jì)算對照組、哮喘組治療前后的嗜酸粒細(xì)胞百分比（EOS%），中性粒細(xì)胞百分比（N%），巨噬細(xì)胞百分比（M%），淋巴細(xì)胞百分比（L%）。測定對照組、哮喘組治療前后的肺功能指標(biāo)第一秒用力呼氣容積占預(yù)計(jì)值百分比（FEV1pred%）、第一秒用力呼氣容積占用力肺活量百分比（FEV1/FVC%）、最大呼氣中期流量占預(yù)計(jì)值的百分比（MMEFpred%）。哮喘組進(jìn)行哮喘控制測試（ACT）評分。利用SPSS17.0軟件分析對照組與哮喘組之間，哮喘組治療前后血清hs-CRP的差異性，利用Spearman's相關(guān)分析考察血清hs-CRP與誘導(dǎo)痰白細(xì)胞分類計(jì)數(shù)、肺功能指標(biāo)及ACT評分的相關(guān)性。利用ROC曲線（受試者工作特征曲線）分析血清hs-CRP評估支氣管哮喘急性發(fā)作期炎癥水平的效能。 結(jié)果：44例研究對象中，，哮喘組2例誘導(dǎo)痰失敗，對照組均誘導(dǎo)痰成功，誘導(dǎo)痰成功率為95.45%。哮喘組的血清hs-CRP水平4.18（11.12，2.12）mg/L明顯高于對照組1.48（4.81，1.03）mg/L，差異有統(tǒng)計(jì)學(xué)意義（Z=4.029，P=0.000），哮喘組患者經(jīng)糖皮質(zhì)激素治療后血清hs-CRP水平3.40（8.91，2.02）mg/L較治療前血清hs-CRP水平4.18（11.12，2.12）mg/L明顯下降，差異有統(tǒng)計(jì)學(xué)意義（Z=-2.755P=0.006）。哮喘組治療前患者的血清hs-CRP與誘導(dǎo)痰（EOS%）呈正相關(guān)（r=0.849,P=0.000），與FEV1pred%、FEV1/FVC%、MMEFpred%均呈負(fù)相關(guān)(r值分別為-0.617、-0.559、-0.398，P值分別為0.000、0.002、0.036)，與ACT評分呈負(fù)相關(guān)(r=-0.511, P=0.005)。血清hs-CRP的ROC曲線下面積（AUC）值為0.713，差異有統(tǒng)計(jì)學(xué)意義（P=0.003）；當(dāng)血清hs-CRP取最佳臨界點(diǎn)（BCOV）為3.65mg/L時(shí)，鑒別對照組與哮喘組的敏感度為0.643，特異度為0.667；血清hs-CRP的AUC值（0.713）略低于誘導(dǎo)痰EOS%的AUC值（0.794）。 結(jié)論：支氣管哮喘急性發(fā)作期患者血清hs-CRP與誘導(dǎo)痰嗜酸粒細(xì)胞百分比、肺功能、ACT評分具有良好相關(guān)性，是評價(jià)支氣管哮喘系統(tǒng)性炎癥水平的潛在標(biāo)志物。
[Abstract]:Objective : To study the correlation between hypersensitive C - reactive protein ( CRP ) and pulmonary function and asthma control test in patients with acute episode of bronchial asthma .

Methods : From September 2011 to December 2011 , 30 patients with acute episode of bronchial asthma who were hospitalized in the Second Affiliated Hospital of Dalian Medical University were collected , and the criteria for diagnosis of asthma and the severity of acute attack were included .
The levels of serum hs - CRP were measured before and after treatment with systemic glucocorticoid in the control group and in the asthmatic group . The results were as follows : the percentage of pulmonary function ( EOS % ) , the percentage of neutrophil percentage ( N % ) , the percentage of macrophages ( M % ) and the percentage of lymphocytes ( L % ) were measured .

Results : The serum hs - CRP levels in the asthmatic group were significantly higher than those in the control group ( r = - 2.07 55P = 0.006 ) . The serum hs - CRP levels were significantly correlated with those in the control group ( r = 4.29 , P = 0.000 ) . The serum hs - CRP levels in the asthmatic group were significantly correlated with those in the control group ( r = 4.29 , P = 0.000 ) . The levels of serum hs - CRP and induced sputum ( EOS % ) in the asthma group were significantly negative ( r = - 0.617 , - 0.5559 , - 0.398 , P = 0.000 , 0.002 , 0.036 ) , which was negatively correlated with ACT scores ( r = - 0.511 , P = 0.005 ) . The area under ROC curve of serum hs - CRP was 0.713 ( P = 0.003 ) .
When the optimal critical point ( BCOV ) of serum hs - CRP was 3.65 mg / L , the sensitivity of the control group to the asthma group was 0.643 and the specificity was 0.667 ;
The AUC values of serum hs - CRP ( 0.713 ) were slightly lower than the AUC values induced sputum EOS % ( 0.794 ) .

Conclusion : The serum hs - CRP in patients with bronchial asthma has a good correlation with the percentage of induced sputum eosinophils , pulmonary function and ACT score , which is a potential marker for evaluating the systemic inflammatory level of bronchial asthma .
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R562.25

【參考文獻(xiàn)】

中國期刊全文數(shù)據(jù)庫 前8條

1 王靜;喬學(xué)英;盧付河;周志國;宋玉芝;霍俊杰;劉欣;;誘導(dǎo)痰及血清TGF-β1水平對非小細(xì)胞肺癌急性放射性肺炎的預(yù)測價(jià)值[J];癌癥;2010年03期

2 程東軍;熊盛道;;哮喘患者誘導(dǎo)痰嗜酸粒細(xì)胞測定的意義[J];實(shí)用診斷與治療雜志;2007年09期

3 羅煒;陳橋麗;王慧;陳如沖;;不同年齡段健康人群誘導(dǎo)痰細(xì)胞比例的變化[J];熱帶醫(yī)學(xué)雜志;2011年03期

4 蔣延文;孫永昌;蓋曉燕;周慶濤;曹文利;姚婉貞;;誘導(dǎo)痰氣道炎癥指標(biāo)與支氣管哮喘病情關(guān)系的探討[J];中國實(shí)用內(nèi)科雜志;2008年06期

5 魏敦雙;曾曉敬;;誘導(dǎo)痰炎性標(biāo)志物評價(jià)哮喘分期和程度分級的臨床價(jià)值[J];實(shí)用醫(yī)學(xué)雜志;2008年01期

6 王法霞;賴克方;陳橋麗;羅煒;陳如沖;李斌愷;鐘南山;;誘導(dǎo)痰嗜酸性粒細(xì)胞與慢性持續(xù)期哮喘病情嚴(yán)重程度的關(guān)系[J];中華肺部疾病雜志(電子版);2010年01期

7 王彥;王斌;陳華萍;唐咸軍;張巧;程曉明;林科雄;馬千里;王長征;;中性粒細(xì)胞性哮喘臨床特征分析[J];中國呼吸與危重監(jiān)護(hù)雜志;2011年04期

8 沈鋒,趙鳴武,賀蓓,王玉柱,姚婉貞;慢性阻塞性肺疾病和支氣管哮喘患者誘導(dǎo)痰中白細(xì)胞介素-17水平及其意義[J];中華內(nèi)科雜志;2004年12期

本文編號：1992629