【摘要】：目的:通過檢測慢性咳嗽患者外周血的血清IL-17及IL-33的水平,探討其與慢性咳嗽患者呼出氣NO濃度、肺功能的關(guān)系,評估IL-17及IL-33在慢性咳嗽發(fā)病機制中的作用。方法:選擇在2016年1月-2017年1月因慢性咳嗽長于8周就診于吉林大學(xué)第一醫(yī)院呼吸科門診的患者160例作為慢性咳嗽組,全部慢性咳嗽的診斷均符合中華醫(yī)學(xué)會呼吸病學(xué)分會哮喘學(xué)組制訂的《咳嗽的診斷與治療指南》,患者以咳嗽為唯一或主要癥狀、病程大于8周、胸部X線或胸部CT檢查未見明顯異常者。年齡17-70歲,性別不限,初次就診。所有患者均符合以下排除標(biāo)準(zhǔn):(1)有吸煙史;(2)就診前4周內(nèi)曾應(yīng)用糖皮質(zhì)激素;(3)不能配合Fe NO測定或肺功能檢查;(4)患有心理疾病者,服用ACEI類藥物者;(5)近6個月出現(xiàn)心腦血管意外、接受大手術(shù)治療、大創(chuàng)傷等應(yīng)激因素。(6)檢查當(dāng)天劇烈運動,檢查前飲用酒精、咖啡等飲料,服用高硝酸鹽食物者。此外健康對照組為我院體檢健康者60例。所有被選定對象均檢測血清IL-17及IL-33,所有慢性咳嗽組完成肺功能檢測、Fe NO的測定、綜合過敏原檢測。所有數(shù)據(jù)采用Graph Pad Prism統(tǒng)計軟件進(jìn)行處理。比較兩組的血清IL-17、IL-33水平;分析IL-17及IL-33水平與肺功能、呼出氣NO水平的相關(guān)性。結(jié)果:(1)共選取入組的慢性咳嗽患者160例,其中男性70例,女性90例,年齡(42.83±5.48)歲;入組的健康對照者60人,其中男性20例,女性40例,年齡(43.00±5.30)歲;各組間在年齡及性別無統(tǒng)計學(xué)差異(P0.05)。(2)慢性咳嗽組患者血清IL-17(64.01±4.70)高于健康對照組(28.14±2.34),差異存在統(tǒng)計學(xué)意義(t=6.829,P0.05);血清IL-33(58.06±6.02)高于健康對照組(31.86±2.66),差異存在統(tǒng)計學(xué)意義(t=4.041,P0.05)。(3)慢性咳嗽患者血清IL-17水平與患者FEV1%呈負(fù)相關(guān)(r=-0.6245,P0.0001);慢性咳嗽患者血清IL-33水平與患者FEV1%呈負(fù)相關(guān)(r=-0.6722,P0.0001)。(4)慢性咳嗽組Fe NO50ppb組患者血清IL-33水平高于Fe NO25-50ppb,Fe NO 25-50ppb組患者血清IL-33水平高于Fe NO25ppb,每兩組間差異存在統(tǒng)計學(xué)意義(P0.05);IL-17水平在Fe NO25ppb;25-50ppb;50ppb三個等級中每兩組間P值均大于0.05。(5)慢性咳嗽患者血清IL-33水平與患者Fe NO濃度有相關(guān)性,且呈正相關(guān),Fe NO濃度越高,患者血清IL-33水平越高(rs=0.758,P0.05)。(6)慢性咳嗽患者中總Ig E100IU/ml組的Fe NO的幾何均數(shù)(33ppb)明顯低于總Ig E200IU/ml組(78ppb)和總Ig E100IU/ml-200IU/ml(69ppb)組,P值均小于0.001;后兩組比較,P=0.0824。結(jié)論:(1)血清IL-17、IL-33可能作為一種促炎因子參與慢性咳嗽的發(fā)病機制。(2)血清IL-17、IL-33水平與肺通氣功能改變呈負(fù)相關(guān)性。(3)血清IL-33升高可能預(yù)測嗜酸粒細(xì)胞性氣道炎癥及反映嚴(yán)重程度。
[Abstract]:Objective: to investigate the relationship between serum IL-17 and IL-33 levels in peripheral blood of chronic cough patients and their relationship with exhalation NO concentration and pulmonary function, and to evaluate the role of IL-17 and IL-33 in the pathogenesis of chronic cough. Methods: 160 patients with chronic cough from January 2016 to January 2017 who had been admitted to the Department of Respiratory Department of the first Hospital of Jilin University for 8 weeks were selected as the chronic cough group. All the diagnoses of chronic cough were in accordance with the "guidelines for the diagnosis and treatment of cough" formulated by the Asthma Section of the Chinese Medical Association Respiratory Society. Cough was the only or main symptom in the patients, and the course of disease was longer than 8 weeks. Chest X-ray or chest CT showed no obvious abnormality. The age is 17-70 years old, the gender is not limited, the first visit. All patients met the following exclusion criteria: (1) smoking history; (2) use of glucocorticoid within 4 weeks before treatment; (3) failure to cooperate with Fe NO test or pulmonary function test; (4) patients with mental illness, who took ACEI drugs; (5) there were cardiovascular and cerebrovascular accidents in the last 6 months. (6) those who had severe exercise on the day of examination, who drank alcohol, coffee and high nitrate food before examination. In addition, the healthy control group consisted of 60 healthy persons in our hospital. All the selected subjects were tested for serum IL-17 and IL-33,. All chronic cough groups were tested for pulmonary function, Fe NO and comprehensive allergen. All data are processed by Graph Pad Prism statistical software. Serum IL-17,IL-33 levels were compared, and the correlation between IL-17 and IL-33 levels and pulmonary function, exhalation and NO levels were analyzed. Results: (1) 160 patients with chronic cough were selected, including 70 males and 90 females, aged (42.83 鹵5.48) years. There were 60 healthy controls, including 20 males and 40 females, aged (43.00 鹵5.30) years. There was no significant difference in age and sex among the groups (P0.05). (2). The serum IL-17 of chronic cough group (64.01 鹵4.70) was higher than that of healthy control group (28.14 鹵2.34), and the difference was statistically significant (P 0.05). Serum IL-33 (58.06 鹵6.02) was significantly higher than that in healthy controls (31.86 鹵2.66). P0.05). (3) the level of serum IL-17 in patients with chronic cough was negatively correlated with FEV1% (r = 0.6245, P 0.0001). The serum IL-33 level in chronic cough patients was negatively correlated with FEV1% (r = -0.6722, P 0.0001). (4). The serum IL-33 level of chronic cough group in Fe NO50ppb group was higher than that in Fe NO25-50ppb, group. The level of serum IL-33 in Fe NO 25-50ppb group was significantly higher than that in Fe NO25ppb, group (P0.05). IL-17 level in Fe NO25ppb;25-50ppb; P value in each of the three grades of 50ppb was greater than 0.05. (5) there was a correlation between serum IL-33 level and Fe NO concentration in patients with chronic cough, and the higher the positive correlation, Fe NO concentration was, the higher the serum IL-33 level was (rs=0.758,). P0.05). (6) the geometric mean of Fe NO (33ppb) in total Ig E100IU/ml group was significantly lower than that in total Ig E200IU/ml group (78ppb) and total Ig E100IU/ml-200IU/ml (69ppb) group (P < 0.001). Compared with the latter two groups, Pu 0.0824. Conclusion: (1) Serum IL-17,IL-33 may be a proinflammatory factor involved in the pathogenesis of chronic cough. (2) Serum IL-17,. (3) elevated serum IL-33 may predict eosinophils airway inflammation and reflect severity.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R56

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