慢性阻塞性肺疾病急性加重期血清皮質(zhì)醇的表達(dá)特征
發(fā)布時(shí)間：2018-09-10 21:16
【摘要】：目的 通過(guò)檢測(cè)COPD組及非COPD組患者血清皮質(zhì)醇及血漿促腎上腺皮質(zhì)激素,了解COPD患者與非COPD患者之間以及AECOPD患者不同病情嚴(yán)重程度的血清皮質(zhì)醇的表達(dá)特征及其與病情的相關(guān)性,為之后的干預(yù)治療提供理論及實(shí)驗(yàn)依據(jù),從而提高患者的生活質(zhì)量,減輕社會(huì)及經(jīng)濟(jì)負(fù)擔(dān)。 方法 隨機(jī)選取2011年10月至2012年10月在我院住院治療的AECOPD患者65例為COPD組。根據(jù)肺功能結(jié)果及第七版《內(nèi)科學(xué)》(人民衛(wèi)生出版社)COPD的嚴(yán)重程度分級(jí)標(biāo)準(zhǔn)分為輕中度組及重度、極重度組。隨機(jī)選取同期住院的非COPD患者33例為非COPD組。所有研究對(duì)象均經(jīng)病史詢問(wèn)、體格檢查、相關(guān)實(shí)驗(yàn)室檢查及輔助檢查等排除合并糖尿病及糖尿病家族史、心肝腎疾病、高血壓、睡眠呼吸暫停低通氣綜合征、庫(kù)欣綜合征、肺結(jié)核肺纖維化、支氣管擴(kuò)張、支氣管哮喘、彌漫性泛細(xì)支氣管炎及其他代謝障礙等疾病,并且近3個(gè)月未曾接受過(guò)糖皮質(zhì)激素治療。 全部研究對(duì)象分別于入院后第二天的8am、4pm及Oam三個(gè)時(shí)間段各抽取2管肘靜脈血,每管2-4ml,每份標(biāo)本均做好標(biāo)記。其中一管分離出血清后用電化學(xué)發(fā)光法檢測(cè)皮質(zhì)醇(cortisol, COR)水平,另一管分離出血漿后用電化學(xué)發(fā)光法檢測(cè)促腎上腺皮質(zhì)激素(adrenocor ticotropic hormore, ACTH)水平。 統(tǒng)計(jì)學(xué)處理：運(yùn)用SPSS13.0統(tǒng)計(jì)分析軟件進(jìn)行數(shù)據(jù)分析。計(jì)量資料以(?)±s表示,多樣本均數(shù)比較采用單因素方差分析,兩兩比較方差齊者采用SNK-q檢驗(yàn)；偏態(tài)資料或方差不齊者采用Games-Howell檢驗(yàn)或者秩和檢驗(yàn),以P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果 1.三組間皮質(zhì)醇水平在三個(gè)不同時(shí)間段比較差異均有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。進(jìn)一步行兩兩比較,因方差不齊,采用Games-Howell檢驗(yàn),三個(gè)不同時(shí)間段輕、中度組及重度、極重度組皮質(zhì)醇水平與非COPD組之間比較差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01)；8am時(shí)段輕、中度組與重度、極重度組之間比較差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01),但在4pm、Oam時(shí)間段輕、中度組與重、極重度組之間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 2.三組間促腎上腺皮質(zhì)激素水平在8am時(shí)間段比較差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01),在4pm、Oam時(shí)間段比較差別有統(tǒng)計(jì)學(xué)意義(P0.05)。進(jìn)一步行兩兩比較,因方差不齊,采用Games-Howell檢驗(yàn)。三個(gè)不同時(shí)間段輕、中度組及重度、極重度組腎上腺皮質(zhì)激素水平與非COPD組之間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),但輕、中度組與重、極重度組之間比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論 1. COPD患者在三個(gè)不同時(shí)間段(8am、4pm、Oam)皮質(zhì)醇水平均較非COPD患者降低,差異均有顯著統(tǒng)計(jì)學(xué)意義(P0.01),其中早上8時(shí)這一時(shí)間段重度、極重度患者皮質(zhì)醇水平又低于輕、重度組,差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。 2. COPD患者在下午4時(shí)、凌晨0時(shí)這兩個(gè)時(shí)間段促腎上腺皮質(zhì)激素水平較非COPD患者升高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)；而在上午8時(shí)這個(gè)時(shí)間段促腎上腺皮質(zhì)激素水平較非COPD患者升高明顯,差異具有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。而在三個(gè)不同時(shí)間段病情不同程度的AECOPD患者促腎上腺皮質(zhì)激素水平變化不明顯,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 3. AECOPD患者可能存在腎上腺皮質(zhì)代謝紊亂,表現(xiàn)為血清皮質(zhì)醇水平降低,促腎上腺皮質(zhì)激素水平升高。
[Abstract]:objective
The serum cortisol and plasma adrenocorticotropic hormone were detected in COPD group and non-COPD group. The expression characteristics of serum cortisol and its correlation with the severity of COPD and non-COPD patients and AECOPD patients were investigated. The results provide theoretical and experimental basis for the subsequent intervention and treatment to improve the patients'condition. Quality of life, reduce social and economic burden.
Method
Sixty-five patients with AECOPD hospitalized in our hospital from October 2011 to October 2012 were randomly selected as COPD group. According to the results of pulmonary function and the severity grading criteria of COPD in the seventh edition of "Internal Medicine" (People's Health Publishing House), they were divided into mild-moderate group and severe-severe group. The subjects were excluded from the family history of diabetes mellitus and diabetes mellitus, heart, liver and kidney disease, hypertension, sleep apnea hypopnea syndrome, Cushing's syndrome, pulmonary tuberculosis, pulmonary fibrosis, bronchiectasis, bronchial asthma, diffuse panbronchiolitis and other metabolites by medical history, physical examination, laboratory examination and auxiliary examination. Disorders such as disorders, and have not received glucocorticoid treatment in the past 3 months.
Two elbow venous blood samples were collected at 8 am, 4 pm and Oam on the second day after admission, and each sample was marked with 2-4 ml. Cortisol (COR) level was detected by electrochemiluminescence after one tube was separated from bleeding serum, and adrenocorticotrophic epithelium was detected by electrochemiluminescence after the other tube was separated from bleeding plasma. Adrenocor ticotropic hormore (ACTH) level.
Statistical analysis: SPSS13.0 statistical analysis software was used for data analysis. The measurement data was (?) + s. The mean of multiple samples was analyzed by one-way ANOVA. The SNK-q test was used for the two-way ANOVA. Game-Howell test or rank sum test were used for the skewed data or the uneven variance, and the difference was statistically significant (P 0.05).
Result
1. There were significant differences in cortisol levels among the three groups at three different times (P 0.01). There was a significant difference between the mild, moderate, severe and very severe groups (P 0.01), but there was no significant difference between the mild, moderate and severe groups (P 0.05).
2. There was a significant difference in the levels of corticotrophin between the three groups at 8 am (P 0.01). There was a significant difference at 4 pm and Oam time intervals (P 0.05). Further, two-to-two comparisons were performed, and games-Howell test was used because of uneven variance. There were significant differences in serum levels between non-COPD and mild, moderate and severe groups (P 0.05).
conclusion
1. Cortisol levels of COPD patients in three different time periods (8 am, 4 pm, Oam) were lower than those of non-COPD patients, the difference was statistically significant (P 0.01). Cortisol levels of severe COPD patients at 8 am were lower than those of light COPD patients and severe COPD patients, the difference was statistically significant (P 0.01).
2. The levels of adrenocorticotropic hormone in COPD patients were significantly higher than those in non-COPD patients at 4 pm and 0 am (P 0.05), while the levels of adrenocorticotropic hormone in 8 am were significantly higher than those in non-COPD patients (P 0.01). There was no significant difference in the levels of adrenocorticotropic hormone between AECOPD patients with different degrees of interval disease (P 0.05).
3. AECOPD patients may have adrenocortical metabolic disorders, characterized by decreased serum cortisol levels and elevated corticotropic hormone levels.
【學(xué)位授予單位】：廣西醫(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)：2235632
[Abstract]:objective
The serum cortisol and plasma adrenocorticotropic hormone were detected in COPD group and non-COPD group. The expression characteristics of serum cortisol and its correlation with the severity of COPD and non-COPD patients and AECOPD patients were investigated. The results provide theoretical and experimental basis for the subsequent intervention and treatment to improve the patients'condition. Quality of life, reduce social and economic burden.
Method
Sixty-five patients with AECOPD hospitalized in our hospital from October 2011 to October 2012 were randomly selected as COPD group. According to the results of pulmonary function and the severity grading criteria of COPD in the seventh edition of "Internal Medicine" (People's Health Publishing House), they were divided into mild-moderate group and severe-severe group. The subjects were excluded from the family history of diabetes mellitus and diabetes mellitus, heart, liver and kidney disease, hypertension, sleep apnea hypopnea syndrome, Cushing's syndrome, pulmonary tuberculosis, pulmonary fibrosis, bronchiectasis, bronchial asthma, diffuse panbronchiolitis and other metabolites by medical history, physical examination, laboratory examination and auxiliary examination. Disorders such as disorders, and have not received glucocorticoid treatment in the past 3 months.
Two elbow venous blood samples were collected at 8 am, 4 pm and Oam on the second day after admission, and each sample was marked with 2-4 ml. Cortisol (COR) level was detected by electrochemiluminescence after one tube was separated from bleeding serum, and adrenocorticotrophic epithelium was detected by electrochemiluminescence after the other tube was separated from bleeding plasma. Adrenocor ticotropic hormore (ACTH) level.
Statistical analysis: SPSS13.0 statistical analysis software was used for data analysis. The measurement data was (?) + s. The mean of multiple samples was analyzed by one-way ANOVA. The SNK-q test was used for the two-way ANOVA. Game-Howell test or rank sum test were used for the skewed data or the uneven variance, and the difference was statistically significant (P 0.05).
Result
1. There were significant differences in cortisol levels among the three groups at three different times (P 0.01). There was a significant difference between the mild, moderate, severe and very severe groups (P 0.01), but there was no significant difference between the mild, moderate and severe groups (P 0.05).
2. There was a significant difference in the levels of corticotrophin between the three groups at 8 am (P 0.01). There was a significant difference at 4 pm and Oam time intervals (P 0.05). Further, two-to-two comparisons were performed, and games-Howell test was used because of uneven variance. There were significant differences in serum levels between non-COPD and mild, moderate and severe groups (P 0.05).
conclusion
1. Cortisol levels of COPD patients in three different time periods (8 am, 4 pm, Oam) were lower than those of non-COPD patients, the difference was statistically significant (P 0.01). Cortisol levels of severe COPD patients at 8 am were lower than those of light COPD patients and severe COPD patients, the difference was statistically significant (P 0.01).
2. The levels of adrenocorticotropic hormone in COPD patients were significantly higher than those in non-COPD patients at 4 pm and 0 am (P 0.05), while the levels of adrenocorticotropic hormone in 8 am were significantly higher than those in non-COPD patients (P 0.01). There was no significant difference in the levels of adrenocorticotropic hormone between AECOPD patients with different degrees of interval disease (P 0.05).
3. AECOPD patients may have adrenocortical metabolic disorders, characterized by decreased serum cortisol levels and elevated corticotropic hormone levels.
【學(xué)位授予單位】：廣西醫(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
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