CRP和TNF-α在慢阻肺急性加重期病情嚴(yán)重程度判斷中的意義
發(fā)布時(shí)間：2018-07-14 20:25
【摘要】：研究背景慢性阻塞性肺疾�。╟hronicobstructivepulmonarydisease，COPD，簡稱慢阻肺）是以氣道、肺實(shí)質(zhì)和肺血管的慢性炎癥為特征的疾病。感染是慢阻肺急性加重導(dǎo)致炎癥反應(yīng)的常見誘因。慢性阻塞性肺疾病急性加重（acuteexacerbationofchronicobstructivepulmonarydisease，AECOPD），，是指疾病發(fā)展過程中患者的呼吸困難、咳嗽和/或咳痰在基礎(chǔ)水平上出現(xiàn)急性改變，超出每天的日常變異，需改變治療方案。慢阻肺急性加重期，已有研究表明約2/3由感染引起。在感染導(dǎo)致其炎癥反應(yīng)過程中有許多細(xì)胞因子的參與，腫瘤壞死因子α（tumornecrosisfactoralpha，TNF-α）作為一種細(xì)胞因子近年來被廣泛研究。有研究表明TNF-α參與COPD氣道炎癥的形成,它能誘導(dǎo)炎癥反應(yīng)、促進(jìn)中性粒細(xì)胞黏附、增強(qiáng)對(duì)細(xì)胞外彈性蛋白的溶解活性，在COPD發(fā)生發(fā)展過程中起重要作用[1,2]。TNF-α是COPD的一個(gè)重要指標(biāo),它在COPD發(fā)病機(jī)制中的作用深受大家重視。C反應(yīng)蛋白（C-reactiveprotein，CRP）是肝臟產(chǎn)生的一種急性時(shí)相蛋白，在伴有炎癥和組織壞死疾病的急性期常常升高，并且是一種表明細(xì)菌性感染的敏感指標(biāo)，它優(yōu)于體溫、血沉、白細(xì)胞計(jì)數(shù)及中性粒細(xì)胞百分?jǐn)?shù)等[3]。CRP可作為診斷AECOPD的敏感標(biāo)志和反應(yīng)AECOPD治療效果的標(biāo)志，當(dāng)出現(xiàn)細(xì)菌感染時(shí)，CRP值迅速升高，隨著患者病情好轉(zhuǎn)，CRP值隨之下降,這樣有助于我們對(duì)疾病的預(yù)后判斷。 目的通過研究AECOPD患者外周血清CRP和TNF-α水平的變化，探討二者在AECOPD患者病情嚴(yán)重程度判斷中的意義。 方法采用酶聯(lián)免疫吸附測定法（ELISA）檢測58例AECOPD患者治療前后和60例健康對(duì)照者血清CRP和TNF-α的水平，以及常規(guī)檢測AECOPD患者治療前白細(xì)胞計(jì)數(shù)（WBC）和中性粒細(xì)胞百分?jǐn)?shù)（N%）。根據(jù)有無合并呼吸衰竭及肺心病分別分為AECOPD合并呼衰組（31例）、AECOPD無呼衰組（27例）、AECOPD合并肺心病組（25例）和AECOPD無肺心病組（33例）。 結(jié)果 1.AECOPD患者治療前血清中CRP（47.16±49.27）和TNF-α（39.72±8.62）水平與治療后（5.98±9.17，19.58±2.71）和對(duì)照組（1.34±0.75，10.86±1.30）比較，差異具有統(tǒng)計(jì)學(xué)意義(P均0.001)；治療后血清TNF-α水平與對(duì)照組比較，差異具有統(tǒng)計(jì)學(xué)意義(P0.001)；治療后血清CRP水平與對(duì)照組比較，差異無統(tǒng)計(jì)學(xué)意義(P0.05)見表1 2.AECOPD合并呼衰組血清CRP(74.57±48.19)和TNF-α(44.46±8.63)水平與AECOPD無呼衰組(12.83±11.72,34.29±4.40)比較，差異具有統(tǒng)計(jì)學(xué)意義(P均0.001)見表2 3.AECOPD合并肺心病組TNF-α水平(43.36±9.91)與無肺心病組(36.07±7.77)比較，差異具有統(tǒng)計(jì)學(xué)意義(P0.01)；而血清CRP水平(41.51±34.04)與無肺心病組(49.10±55.79)比較，差異無統(tǒng)計(jì)學(xué)意義(P0.05)見表2 4.58例AECOPD患者中治療前有54例CRP陽性，陽性率為93.10%;21例WBC增高,陽性率為36.2%;39例N%增高,陽性率為67.2%。CRP陽性率顯著高于白細(xì)胞計(jì)數(shù)增高和中性粒細(xì)胞百分?jǐn)?shù)增高的陽性率。差異有統(tǒng)計(jì)學(xué)意義(P均0.005)見表3、4 結(jié)論CRP對(duì)判斷COPD急性加重優(yōu)于血常規(guī)；CRP和TNF-α對(duì)AECOPD患者病情嚴(yán)重程度的判斷有一定的臨床意義。
[Abstract]:Background chronic obstructive pulmonary disease (chronicobstructivepulmonarydisease, COPD) is a disease characterized by chronic inflammation of the airway, lung parenchyma and pulmonary vessels. Infection is a common cause of acute exacerbation of chronic obstructive pulmonary disease and acute exacerbation of chronic obstructive pulmonary disease (acuteexacerbationofchronicobstructive Pulmonarydisease, AECOPD) refers to the acute changes in the patient's breathing, coughing and / or phlegm at the basic level during the development of the disease. Beyond daily variation, the treatment needs to be changed. The acute exacerbation of the chronic obstructive pulmonary disease, which has been studied, shows that there are many cells in the process of inflammation that lead to many cells in the process of inflammation. The involvement of factors, tumornecrosisfactoralpha (TNF- alpha), as a cytokine, has been widely studied in recent years. Some studies have shown that TNF- alpha is involved in the formation of airway inflammation in COPD. It can induce inflammatory response, promote neutrophil adhesion, enhance the dissolution of extracellular elastin, and develop in the process of COPD development. [1,2].TNF- alpha plays an important role in the pathogenesis of COPD, and its role in the pathogenesis of COPD is highly valued as an acute phase protein produced by the.C reactive protein (C-reactiveprotein, CRP), which is often elevated in the acute phase of inflammation and tissue necrosis, and is a sensitive finger indicating bacterial infection. Standard, it is superior to body temperature, blood sedimentation, leukocyte count and neutrophils percentage, such as [3].CRP can be used as a sensitive marker for diagnosis of AECOPD and the marker of response to AECOPD treatment. When bacterial infection occurs, the value of CRP increases rapidly, and as the patient's condition improves, the CRP value decreases, which helps us to judge the prognosis of the disease.
Objective to explore the significance of the two in the judgement of the severity of AECOPD patients by studying the changes of serum CRP and TNF- alpha levels in patients with AECOPD.
Methods the serum levels of CRP and TNF- alpha were detected by enzyme linked immunosorbent assay (ELISA) in 58 patients with AECOPD and 60 healthy controls, and the routine examination of leukocyte count (WBC) and the percentage of neutrophils (N%) before treatment for AECOPD patients were divided into AECOPD combined respiratory failure group, respectively (or without combined respiratory failure and pulmonary heart disease). 31 cases), AECOPD without respiratory failure group (27 cases), AECOPD combined with pulmonary heart disease group (25 cases) and AECOPD without cor pulmonale group (33 cases).
Result
The serum levels of CRP (47.16 + 49.27) and TNF- alpha (39.72 + 8.62) before treatment were compared with the control group (5.98 + 9.17,19.58 + 2.71) and the control group (1.34 + 0.75,10.86 + 1.30), the difference was statistically significant (P 0.001). The serum TNF- alpha level was statistically significant (P0.001) after treatment (P0.001) and serum CRP after treatment. There was no significant difference between the control group and the control group (P0.05) in Table 1.
The levels of serum CRP (74.57 + 48.19) and TNF- alpha (44.46 + 8.63) in the group of 2.AECOPD combined with respiratory failure were compared with that of AECOPD without respiratory failure group (12.83 + 11.72,34.29 4.40). The difference was statistically significant (P 0.001), as shown in Table 2.
The level of TNF- alpha in 3.AECOPD combined with cor pulmonale group (43.36 + 9.91) was compared with that of no cor pulmonale group (36.07 + 7.77), and the difference was statistically significant (P0.01), while the serum CRP level (41.51 + 34.04) was compared with that of cor pulmonale group (49.10 + 55.79), the difference was not statistically significant (P0.05) in Table 2.
In 4.58 AECOPD patients, 54 cases were positive before treatment, the positive rate was 93.10%, 21 cases of WBC increased, the positive rate was 36.2%, 39 cases of N% increased, the positive rate of 67.2%.CRP positive rate was significantly higher than the increase of white cell count and the increase of neutrophils percentage. The difference was statistically significant (P 0.005) see table 3,4
Conclusion CRP is superior to routine blood test in judging acute exacerbation of COPD. CRP and TNF- alpha have certain clinical significance in judging the severity of AECOPD patients.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R563.9
本文編號(hào)：2122849
[Abstract]:Background chronic obstructive pulmonary disease (chronicobstructivepulmonarydisease, COPD) is a disease characterized by chronic inflammation of the airway, lung parenchyma and pulmonary vessels. Infection is a common cause of acute exacerbation of chronic obstructive pulmonary disease and acute exacerbation of chronic obstructive pulmonary disease (acuteexacerbationofchronicobstructive Pulmonarydisease, AECOPD) refers to the acute changes in the patient's breathing, coughing and / or phlegm at the basic level during the development of the disease. Beyond daily variation, the treatment needs to be changed. The acute exacerbation of the chronic obstructive pulmonary disease, which has been studied, shows that there are many cells in the process of inflammation that lead to many cells in the process of inflammation. The involvement of factors, tumornecrosisfactoralpha (TNF- alpha), as a cytokine, has been widely studied in recent years. Some studies have shown that TNF- alpha is involved in the formation of airway inflammation in COPD. It can induce inflammatory response, promote neutrophil adhesion, enhance the dissolution of extracellular elastin, and develop in the process of COPD development. [1,2].TNF- alpha plays an important role in the pathogenesis of COPD, and its role in the pathogenesis of COPD is highly valued as an acute phase protein produced by the.C reactive protein (C-reactiveprotein, CRP), which is often elevated in the acute phase of inflammation and tissue necrosis, and is a sensitive finger indicating bacterial infection. Standard, it is superior to body temperature, blood sedimentation, leukocyte count and neutrophils percentage, such as [3].CRP can be used as a sensitive marker for diagnosis of AECOPD and the marker of response to AECOPD treatment. When bacterial infection occurs, the value of CRP increases rapidly, and as the patient's condition improves, the CRP value decreases, which helps us to judge the prognosis of the disease.
Objective to explore the significance of the two in the judgement of the severity of AECOPD patients by studying the changes of serum CRP and TNF- alpha levels in patients with AECOPD.
Methods the serum levels of CRP and TNF- alpha were detected by enzyme linked immunosorbent assay (ELISA) in 58 patients with AECOPD and 60 healthy controls, and the routine examination of leukocyte count (WBC) and the percentage of neutrophils (N%) before treatment for AECOPD patients were divided into AECOPD combined respiratory failure group, respectively (or without combined respiratory failure and pulmonary heart disease). 31 cases), AECOPD without respiratory failure group (27 cases), AECOPD combined with pulmonary heart disease group (25 cases) and AECOPD without cor pulmonale group (33 cases).
Result
The serum levels of CRP (47.16 + 49.27) and TNF- alpha (39.72 + 8.62) before treatment were compared with the control group (5.98 + 9.17,19.58 + 2.71) and the control group (1.34 + 0.75,10.86 + 1.30), the difference was statistically significant (P 0.001). The serum TNF- alpha level was statistically significant (P0.001) after treatment (P0.001) and serum CRP after treatment. There was no significant difference between the control group and the control group (P0.05) in Table 1.
The levels of serum CRP (74.57 + 48.19) and TNF- alpha (44.46 + 8.63) in the group of 2.AECOPD combined with respiratory failure were compared with that of AECOPD without respiratory failure group (12.83 + 11.72,34.29 4.40). The difference was statistically significant (P 0.001), as shown in Table 2.
The level of TNF- alpha in 3.AECOPD combined with cor pulmonale group (43.36 + 9.91) was compared with that of no cor pulmonale group (36.07 + 7.77), and the difference was statistically significant (P0.01), while the serum CRP level (41.51 + 34.04) was compared with that of cor pulmonale group (49.10 + 55.79), the difference was not statistically significant (P0.05) in Table 2.
In 4.58 AECOPD patients, 54 cases were positive before treatment, the positive rate was 93.10%, 21 cases of WBC increased, the positive rate was 36.2%, 39 cases of N% increased, the positive rate of 67.2%.CRP positive rate was significantly higher than the increase of white cell count and the increase of neutrophils percentage. The difference was statistically significant (P 0.005) see table 3,4
Conclusion CRP is superior to routine blood test in judging acute exacerbation of COPD. CRP and TNF- alpha have certain clinical significance in judging the severity of AECOPD patients.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R563.9
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 楊丙臣;慢性阻塞性肺疾病患者血清IL-8及TNF-α的意義[J];臨床醫(yī)學(xué);2005年04期
2 張琳;;超敏C反應(yīng)蛋白臨床應(yīng)用進(jìn)展[J];河北醫(yī)藥;2006年06期
3 張?jiān)蒲?;支氣管哮喘患兒治療前后血清hs-CRP、GM-CSF、IGF-Ⅱ水平檢測的臨床意義[J];淮海醫(yī)藥;2009年06期
4 胡偉貞;陳小龍;朱金霞;;COPD急性加重期患者血清IL-8與C反應(yīng)蛋白變化及臨床意義[J];臨床肺科雜志;2007年01期
5 劉艷;毛毅敏;孫瑜霞;;超敏C反應(yīng)蛋白測定對(duì)老年社區(qū)獲得性肺炎早期診斷價(jià)值[J];河南科技大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2009年04期
6 孫學(xué)東;鄭世良;徐偉華;董春曉;;血清高敏C反應(yīng)蛋白和血清降鈣素原在慢性阻塞性肺疾病急性發(fā)作期中的表達(dá)及意義[J];臨床合理用藥雜志;2010年02期
7 葉熊;李永春;;慢性阻塞性肺疾病研究進(jìn)展[J];中國全科醫(yī)學(xué);2007年05期
8 韓麗萍;王秋月;麥洪珍;侯剛;康健;;慢性阻塞性肺疾病患者血清IL-8、hsCRP水平及臨床意義的探討[J];中國醫(yī)科大學(xué)學(xué)報(bào);2009年12期
9 ;發(fā)展具有中國特色的慢性阻塞性肺疾病的防治研究——訪廣州呼吸疾病研究所鐘南山院士[J];中華結(jié)核和呼吸雜志;2002年08期
10 ;慢性阻塞性肺疾病診治指南(2007年修訂版)[J];中華結(jié)核和呼吸雜志;2007年01期
本文編號(hào)：2122849
本文鏈接：http://sikaile.net/yixuelunwen/huxijib/2122849.html
最近更新
教材專著
