【摘要】：目的肺表面活性蛋白A(SP-A)是肺組織中表達(dá)最豐富、信號(hào)最強(qiáng)烈的肺表面活性物質(zhì)相關(guān)蛋白(約占50%),主要由II型肺泡上皮細(xì)胞和氣道clara細(xì)胞合成和分泌,有維持肺泡穩(wěn)定性、抗炎殺菌以及調(diào)節(jié)免疫等功能。在正常條件下,SP-A可以避免煙霧、粉塵、油煙、微生物等各種危險(xiǎn)因素引起的肺損傷和肺感染,保護(hù)肺組織的作用。肺組織中SP-A表達(dá)越多,維持肺內(nèi)穩(wěn)態(tài)和抵御炎性損傷的能力越強(qiáng)。促進(jìn)SP-A的表達(dá)合成,對(duì)保護(hù)肺組織有重要意義。作為呼吸科常用藥的氨溴索和布地奈德能提高內(nèi)源性SP-A表達(dá)。術(shù)前肺保護(hù)藥物治療可以有效改善肺功能,肺功能與肺組織中SP-A表達(dá)水平有一定相關(guān)性。本研究探討術(shù)前肺保護(hù)治療對(duì)非小細(xì)胞肺癌(NSCLC)合并慢性阻塞性肺疾病(COPD)患者肺組織中SP-A表達(dá)及術(shù)后并發(fā)癥的影響。方法入組2015年1月至2016年6月就診于天津市胸科醫(yī)院胸外科行手術(shù)治療的非小細(xì)胞肺癌合并慢性阻塞性肺疾病患者60例,對(duì)照組和肺保護(hù)組各30例,對(duì)照組予以常規(guī)術(shù)前準(zhǔn)備后行手術(shù)治療,肺保護(hù)組在常規(guī)術(shù)前準(zhǔn)備的基礎(chǔ)上給予1周術(shù)前肺保護(hù)治療后再行手術(shù)治療,肺保護(hù)治療藥物包括氨溴索、多索茶堿、布的奈德、異丙托溴銨等,用便攜式呼出冷凝液收集裝置收集入院及術(shù)前呼出氣冷凝液(EBC)并復(fù)查肺功能,酶聯(lián)免疫吸附測(cè)定(ELISA)法檢測(cè)EBC中SP-A的含量。術(shù)中快速收集肺組織標(biāo)本,距病灶5cm以上取大小約1cm3肺組織2塊,免疫印跡法(Western blotting)測(cè)定肺組織SP-A水平。術(shù)后予以相關(guān)康復(fù)治療,如有并發(fā)癥及時(shí)處理,并記錄患者并發(fā)癥的情況,按照Clavien-Dindo分級(jí)系統(tǒng)進(jìn)行術(shù)后并發(fā)癥分析。比較兩組之間肺組織SP-A表達(dá)水平及術(shù)后并發(fā)癥情況。結(jié)果1.肺保護(hù)組中肺組織SP-A水平高于對(duì)照組(1.05±0.21 vs 0.93±0.16),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2.肺保護(hù)組術(shù)前EBC中SP-A含量較入院時(shí)提高[(5.51±1.48)ng/L vs(4.99±1.32)ng/L],差異有統(tǒng)計(jì)學(xué)意義(P0.01)。術(shù)前EBC中SP-A含量與肺組織中SP-A水平呈正相關(guān)(r=0.460,P0.01)。3.經(jīng)肺保護(hù)治療后,術(shù)前肺功能指標(biāo)FEV1、FEV1%、FEV1/FVC、FVC、FVC%較入院時(shí)提高,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。且入院EBC中SP-A含量同入院肺功能中的FEV1%呈正相關(guān)(r=0.343,P=0.007)。4.兩組患者術(shù)后并發(fā)癥、Clavien-Dindo并發(fā)癥分級(jí)差異無統(tǒng)計(jì)學(xué)意義(P0.05),兩組患者手術(shù)時(shí)長、術(shù)中出血量、術(shù)后帶管時(shí)長差異無統(tǒng)計(jì)學(xué)意義(P0.05),肺保護(hù)組術(shù)后平均住院日少于對(duì)照組[(9.2±3.1)d vs(11.6±4.8)d],差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.術(shù)前肺保護(hù)能提高肺組織中SP-A表達(dá)含量。2.經(jīng)過術(shù)前肺保護(hù)治療,術(shù)前EBC中SP-A含量較入院時(shí)提高,與肺組織中SP-A變化趨勢(shì)一致。3.術(shù)前肺保護(hù)能夠改善肺功能和縮短術(shù)后住院時(shí)間。4.術(shù)前肺保護(hù)在術(shù)后并發(fā)癥及Clavien-Dindo并發(fā)癥分級(jí)系統(tǒng)并未體現(xiàn)出統(tǒng)計(jì)學(xué)優(yōu)勢(shì)。
[Abstract]:Objective Pulmonary surfactant protein A (SP-A) is the most highly expressed and strongly expressed surfactant associated protein (50%) in lung tissues. It is mainly synthesized and secreted by type II alveolar epithelial cells and airway clara cells. Anti-inflammatory sterilization and regulation of immune function. Under normal conditions, SP-A can avoid lung injury and infection caused by smoke, dust, oil fume and microorganism, and protect lung tissue. The higher the expression of SP-A in lung tissue, the stronger the ability of maintaining stable state and resisting inflammatory injury. Promoting the expression and synthesis of SP-A plays an important role in protecting lung tissue. Ambroxol and budesonide, which are commonly used in respiratory department, can increase endogenous SP-A expression. Preoperative lung protection therapy can effectively improve lung function, and lung function is correlated with the expression of SP-A in lung tissue. This study was to investigate the effect of preoperative lung protection therapy on the expression of SP-A and postoperative complications in patients with (NSCLC) complicated with chronic obstructive pulmonary disease (COPD) in non-small cell lung cancer (NSCLC). Methods from January 2015 to June 2016, 60 patients with non-small cell lung cancer (NSCLC) complicated with chronic obstructive pulmonary disease (COPD), 30 patients in control group and 30 patients in lung protection group were treated by thoracic surgery in Tianjin chest Hospital. The control group was treated with routine preoperative preparation, the lung protection group was treated with preoperative lung protection therapy after 1 week of preoperative lung protection therapy, and the lung protection drugs included ambroxol, doxofylline and bupropion. Ipratropium bromide was used to collect (EBC) from admission and preoperative exhalation condensate with portable exhalation condensate collection device and to examine the pulmonary function. The content of SP-A in EBC was detected by (ELISA) method. The lung tissue samples were collected quickly during the operation. The size of 1cm3 lung tissue was about 2 from the lesion 5cm. The SP-A level of lung tissue was measured by Western blot (Western blotting). The postoperative complications were analyzed according to the Clavien-Dindo grading system. The expression of SP-A and postoperative complications were compared between the two groups. Result 1. The level of SP-A in lung protection group was significantly higher than that in control group (1.05 鹵0.21 vs 0.93 鹵0.16) (P0.05). In the lung protection group, the level of SP-A in preoperative EBC was significantly higher than that at admission [(5.51 鹵1.48) ng/L vs (4.99 鹵1.32) ng/L] (P0.01). There was a positive correlation between the content of SP-A in EBC and the level of SP-A in lung tissue before operation (r = 0.460, P 0.01). After lung protection treatment, the preoperative FEV1 / FEV1 / FEV1 / FVC+ FVCU FVC% was significantly higher than that on admission (P0.01). There was a positive correlation between the content of SP-A in EBC and FEV1% in pulmonary function (r = 0.343P0. 007) .4. There was no significant difference in the classification of postoperative complications between the two groups (P0.05). There was no significant difference in the length of the tube after operation (P0.05), and the average length of hospitalization in the lung protection group was less than that in the control group [(9.2 鹵3.1) d vs (11.6 鹵4.8) days], and the difference was statistically significant (P0.05). Conclusion 1. Preoperative lung protection can increase the expression of SP-A in lung tissue. 2. 2. After preoperative lung protection therapy, the content of SP-A in preoperative EBC was higher than that in admission, which was consistent with the trend of SP-A in lung tissue. 3. Preoperative lung protection can improve lung function and shorten postoperative hospitalization time. 4. 4. Preoperative lung protection did not show statistical advantage in postoperative complications and Clavien-Dindo complication classification system.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2;R563.9

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本文編號(hào)：2196693