發(fā)布時間：2018-06-21 14:03

  本文選題：不同構型脂聯(lián)素 + 慢性阻塞性肺疾病��； 參考：《山西醫(yī)科大學》2012年碩士論文

【摘要】：研究背景慢性阻塞性肺疾�。╟hronic obstructive pulmonarydisease，COPD）以氣道、肺實質和肺血管的慢性炎癥以及氧化應激為主要發(fā)病特征。COPD患者常合并其他疾病，如心血管疾病，骨質疏松以及體重丟失等，然而其因果關系尚不清楚。脂聯(lián)素是一種由脂肪組織分泌的大分子蛋白質，并發(fā)揮抗炎，心血管保護以及抗肥胖作用。在血清中，脂聯(lián)素以全長結構[三倍體，六倍體以及高等分子量體（high molecular weight，HMW）]和球型結構域（globular adiponectin，gAd）存在。球型結構域主要激活脂聯(lián)素受體1，而脂聯(lián)素受體2主要由脂聯(lián)素全長結構激活。 目的通過測定COPD患者不同構型脂聯(lián)素的水平，以研究脂聯(lián)素與體重丟失，肺功能程度，缺氧，慢性肺源性心臟病以及系統(tǒng)性炎癥和氧化應激的相關性。 方法選擇2010年1月至2011年6月的COPD急性加重（acute exacerbationof chronicobstructive pulmonary disease，AECOPD）住院患者118例作為AECOPD組，其中男83例，女35例。選擇隨訪的穩(wěn)定期COPD患者57例作為穩(wěn)定期COPD組，其中男55例，女2例。選擇同期門診健康體檢者66例作為健康對照組，其中男29例，女37例。AECOPD組患者和穩(wěn)定期COPD組患者根據(jù)有無低氧血癥、慢性肺源性心臟病、不同程度肺功能以及體重指數(shù)（BMI）分為不同亞組。應用酶聯(lián)免疫吸附法測定所有研究對象血清HMW、gAd、TNF-α、IL-6以及氧化應激因子4-羥基壬烯醛（4-hydroxynonenal，4-HNE）的水平。 結果1 COPD患者血清脂聯(lián)素水平的改變 （1）控制年齡，性別，以及BMI后，AECOPD患者，HMW、gAd水平（6.78±1.41、31.19±13.69）均顯著高于健康對照組（5.26±1.38、20.30±13.89）和穩(wěn)定期COPD組（6.28±1.43、19.14±14.12），差異有統(tǒng)計學意義（P均＜0.01）。穩(wěn)定期COPD患者脂聯(lián)素HMW（6.28±1.43）顯著高于健康對照組（5.26±1.38），差異有統(tǒng)計學意義（P＜0.01）。但穩(wěn)定期COPD患者血清gAd水平（19.14±14.12）與健康對照組（20.30±13.89）差異無統(tǒng)計學意義（P＞0.05），只有下降趨勢。 （2）血清HMW水平：AECOPD組患者，不缺氧組患者[7.35（6.66-8.19）]明顯高于缺氧組患者[6.86（5.95-7.46）]，差異有統(tǒng)計學意義（P＜0.05）；肺心病組[6.91（6.15-7.65）]與無肺心病組[6.67（5.41-7.68）]相比，差異無統(tǒng)計學意義（P＞0.05）；低體重組[7.09（6.62-7.94）]、正常體重組[6.73（6.16-7.55）]以及高體重組[6.74（4.94-7.38）]差異無統(tǒng)計學意義（P＞0.05）。穩(wěn)定期COPD組患者，輕中度肺功能組[6.20（5.50-6.78）]與重度肺功能組[6.45（5.36-7.59）]相比，差異無統(tǒng)計學意義（P＞0.05）；低體重組[6.06（5.14-6.84）]，正常體重組[6.39（5.44-7.12）]以及高體重組[6.12（5.31-6.90）]相比，差異無統(tǒng)計學意義（P＞0.05）。 （3）血清gAd水平：AECOPD組患者，不缺氧組[27.85（21.70-31.44）]與缺氧組患者[28.58（20.08-39.10）]相比，差異無統(tǒng)計學意義（P＞0.05）；無肺心病組[31.63（25.50-51.36）]顯著高于肺心病組[27.23（19.71-35.75）]患者，差異有統(tǒng)計學意義（P＜0.05）；低體重組[32.28（22.26-42.90）]、正常體重組[27.95（22.33-42.38）]以及高體重組[25.95（16.95-36.65）]相比，差異無統(tǒng)計學意義（P＞0.05），只有降低趨勢。穩(wěn)定期COPD組患者，輕中度肺功能組[14.05（11.58-24.01）]與重度肺功能組[15.85（13.40-21.68）]相比，差異無統(tǒng)計學意義（P＞0.05）只有增高趨勢。低體重組[16.65（14.20-20.40）]、正常體重組[15.2（512.60-25.24）]以及高體重組[13.25（11.63-18.75）]相比，差異無統(tǒng)計學意義（P＞0.05），只有降低趨勢（見表4）。 2 COPD患者脂聯(lián)素與各指標的相關性 （1）穩(wěn)定期COPD患者中，發(fā)現(xiàn)脂聯(lián)素HMW與TNF-α，4-HNE呈正相關（r=0.580, P＜0.01，r=0.291, P=0.028）（見表5）。 （2）穩(wěn)定期COPD患者，脂聯(lián)素HMW與RV%呈負相關（r=-0.321, P=0.030）。但未發(fā)現(xiàn)脂聯(lián)素gAd與肺功能參數(shù)的相關性。但在gAd＜26 ng/ml（n=50）時，其與FEV1%，F(xiàn)EV1/FVC呈負相關（r=-0.302, P=0.041；r=-0.293, P=0.048）。（見表5） （3）在控制心臟彩超的操作醫(yī)師后，AECOPD患者，當HMW＞6μg/ml（n=40）時，發(fā)現(xiàn)脂聯(lián)素HMW與右室舒末內徑呈負相關（r=-0.467, P=0.002）；當gAd＞23 ng/m（ln=30）時，其與右室流出道呈負相關（r=-0.513, P=0.004）。（見表5） 結論AECOPD患者血清脂聯(lián)素HMW以及gAd水平顯著增高。穩(wěn)定期COPD患者血清脂聯(lián)素HMW水平也顯著增高，然而，gAd水平只發(fā)現(xiàn)下降趨勢。穩(wěn)定期COPD患者，脂聯(lián)素HMW與RV%呈負相關。gAd與FEV1%，F(xiàn)EV1/FVC呈負相關。3.AECOPD患者，脂聯(lián)素HMW與右室舒末內徑呈負相關。gAd與右室流出道呈負相關。
[Abstract]:Background chronic obstructive pulmonary disease (chronic obstructive pulmonarydisease, COPD) with chronic inflammation of the airway, pulmonary parenchyma and pulmonary vessels and oxidative stress is the main pathogenesis of.COPD patients often associated with other diseases, such as cardiovascular disease, osteoporosis and loss of weight, but the causal relationship is not clear. Adiponectin is one of the diseases. Large molecular proteins secreted by adipose tissue and play an anti-inflammatory, cardiovascular protection and anti obesity effect. In serum, adiponectin exists in a full-length structure [triploid, six ploidy, high molecular weight, HMW) and globular adiponectin, gAd. The sphere domain mainly activates adiponectin. Body 1, adiponectin receptor 2 is mainly activated by the full length structure of adiponectin.
Objective to determine the correlation of adiponectin to body weight loss, pulmonary function, hypoxia, chronic pulmonary heart disease, and systemic inflammation and oxidative stress by measuring the level of different adiponectin in COPD patients.
Methods 118 hospitalized patients with acute exacerbationof ChronicObstructive pulmonary disease (AECOPD) from January 2010 to June 2011 were selected as AECOPD group, including 83 males and 35 females. 57 cases of stable COPD patients were selected as the stable COPD group, including 55 males and 2 women. 6 patients were selected in the same period of health check-up 6. 6 cases were used as a healthy control group, of which 29 were male, 37 women in.AECOPD and group COPD in stable period were divided into different subgroups based on hypoxemia, chronic pulmonary heart disease, different pulmonary function and body mass index (BMI). The serum HMW, gAd, TNF- a, IL-6, and oxidative stress were measured by enzyme linked immunosorbent assay. The level of factor 4- hydroxy nonenal (4-hydroxynonenal, 4-HNE).
Results the changes of serum adiponectin level in 1 COPD patients
(1) after the control of age, sex, and BMI, the level of AECOPD, HMW, and gAd (6.78 + 1.41,31.19 + 13.69) were significantly higher than those in the healthy control group (5.26 + 1.38,20.30 + 13.89) and the stable COPD group (6.28 + 1.43,19.14 + 14.12), and the difference was statistically significant (P < 0.01). The adiponectin HMW (6.28 + 1.43) in the stable phase COPD was significantly higher than that in the healthy control group (5.2. 6 + 1.38), the difference was statistically significant (P < 0.01), but the level of serum gAd (19.14 + 14.12) in the stable COPD patients and the healthy control group (20.30 + 13.89) had no statistical significance (P > 0.05), only the decline trend.
(2) serum HMW level: AECOPD group, [7.35 (6.66-8.19) in no anoxic group was significantly higher than [6.86 (5.95-7.46) in anoxic group (P < 0.05); [6.91 (6.15-7.65) in cor pulmonale group) was not significantly different from [6.67 (5.41-7.68) in cor pulmonale group (P > 0.05). There was no significant difference between the body weight group [6.73 (6.16-7.55)] and the high body recombinant [6.74 (4.94-7.38)] (P > 0.05). There was no significant difference between the stable stage COPD group, the mild and moderate lung function group [6.20 (5.50-6.78)] and the severe lung function group [6.45 (P > 0.05) (P > 0.05), and the low body recombination [6.06 (4.94-7.38), and the normal weight group. There was no significant difference between the high body recombinant [6.12 (5.31-6.90)] and the high body recombinant (P > 0.05).
(3) serum gAd level: AECOPD group, no hypoxia group [27.85 (21.70-31.44)] compared with [28.58 (20.08-39.10) in anoxia group, there was no statistical difference (P > 0.05), no pulmonary heart disease group [31.63 (25.50-51.36) was significantly higher than that of pulmonary heart disease group [27.23 (19.71-35.75)] patients, the difference was statistically significant (P < 0.05); 42.90)] there was no significant difference between normal weight group [27.95 (22.33-42.38)] and high body recombinant [25.95 (16.95-36.65)], and there was no significant difference (P > 0.05), only decreasing trend. There was no significant difference between the patients of stable COPD group, mild to moderate lung function group [14.05 (11.58-24.01)] and severe lung function group [15.85 (13.40-21.68)] (P > 0.05). There was no significant difference between the high trend, the low body recombinant [16.65 (14.20-20.40)], the normal weight group [15.2 (512.60-25.24)] and the high body recombinant [13.25 (11.63-18.75)] (P > 0.05), only the decreasing trend (see Table 4).
Association of 2 COPD adiponectin with each index
(1) in stable COPD patients, adiponectin HMW was positively correlated with TNF- alpha and 4-HNE (r=0.580, P < 0.01, r=0.291, P=0.028) (see Table 5).
(2) there was a negative correlation between adiponectin HMW and RV% (r=-0.321, P=0.030) in stable COPD patients (r=-0.321, P=0.030). But there was no correlation between adiponectin gAd and pulmonary function parameters. But when gAd < 26 ng/ml (n=50), it was negatively correlated with FEV1%, FEV1/FVC (r=-0.302, table 5).
(3) after the operation of cardiac color Doppler ultrasound, AECOPD patients, when HMW > 6 g/ml (n=40), found that the adiponectin HMW was negatively correlated with the right ventricular diastolic diameter (r=-0.467, P=0.002); when gAd > 23 ng/m (ln=30), it was negatively correlated with the right ventricular outflow tract (r=-0.513, P=0.004). (see Table 5)
Conclusion the level of serum adiponectin HMW and gAd increased significantly in patients with AECOPD. The level of serum adiponectin HMW in patients with stable COPD was also significantly higher, but the level of gAd was only decreasing. In stable COPD patients, the adiponectin HMW and RV% were negatively correlated with.GAd and FEV1%, FEV1/FVC showed negative correlation, and the adiponectin and right ventricular diastolic diameter was negative. The related.GAd was negatively correlated with the right ventricular outflow tract.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R563.9

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本文編號：2048934