【摘要】：背景慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是以持續(xù)性的氣流受限為特征的呼吸系統(tǒng)的常見(jiàn)病和多發(fā)病,急性加重是慢阻肺患者重要的致死率和病情進(jìn)展因素,加重患者的經(jīng)濟(jì)負(fù)擔(dān),降低患者的生活質(zhì)量。慢性氣道炎癥和氣道重塑是慢阻肺重要的病理過(guò)程,對(duì)于慢阻肺的治療,特別是急性加重期,迅速控制炎癥反應(yīng)是控制患者癥狀及改善預(yù)后的關(guān)鍵。目前對(duì)于慢阻肺中炎癥介質(zhì)的研究眾多,關(guān)于炎癥反應(yīng)在COPD發(fā)展過(guò)程中的作用機(jī)制尚不明確,經(jīng)初步研究,中性粒細(xì)胞明膠酶相關(guān)脂質(zhì)運(yùn)載蛋白(NGAL,neutrophil gelatinase-associated lipocalin)作為一種炎癥介質(zhì),其在慢阻肺中表達(dá)上調(diào),可能參與了氣道的炎癥反應(yīng)及氣道重塑,或可用作控制慢阻肺急性加重時(shí)炎癥反應(yīng)的一個(gè)標(biāo)志物。目的分別觀察中性粒細(xì)胞明膠酶相關(guān)脂質(zhì)運(yùn)載蛋白在慢性阻塞性肺疾病急性加重(AECOPD,chronic obstructive pulmonary disease acute exacerbation)患者治療前、后及健康對(duì)照中的表達(dá),評(píng)價(jià)NGAL在評(píng)估慢阻肺急性發(fā)作期嚴(yán)重程度的價(jià)值。方法本實(shí)驗(yàn)采用自身前后對(duì)照研究,隨機(jī)選取2015年6月至2016年4月期間于阜陽(yáng)市人民醫(yī)院呼吸科因AECOPD住院的病例40例為實(shí)驗(yàn)組(初選46例,實(shí)驗(yàn)過(guò)程中排除6例),選取阜陽(yáng)市人民醫(yī)院體檢中心體檢結(jié)果為健康的25人為對(duì)照組。應(yīng)用酶聯(lián)免疫吸附法(ELISA)測(cè)定AECOPD患者治療前、后及對(duì)照組的血NGAL水平,同時(shí)采集患者的C-反應(yīng)蛋白(CRP)、外周血白細(xì)胞(WBC)和中性粒細(xì)胞百分比(NE%)、PO_2、PCO_2、SpO_2、FEV1%、近一年內(nèi)急性加重次數(shù)、住院時(shí)間等資料。結(jié)果1、AECOPD患者治療前后及對(duì)照組血NGAL濃度分別為(112.18±20.96)μg/L、(79.02±15.39)μg/L、(64.74±13.20)μg/L,3組間差異具有統(tǒng)計(jì)學(xué)意義(p0.05)2、慢阻肺急性加重患者治療后血CRP低于治療前,但較健康對(duì)照組高,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。3、慢阻肺患者外周WBC和中性粒細(xì)胞百分比治療后高于治療前,差異具有統(tǒng)計(jì)學(xué)意義(p0.05),而治療后與健康對(duì)照組相比無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)4.對(duì)NGAL、CRP、WBC、中性粒細(xì)胞百分比作ROC曲線,曲線下面積分別為(AUC=0.869,p㩳0.001)、(AUC=0.822,p㩳0.001)、(AUC=0.697,p=0.002)、(AUC=0.799,p㩳0.001),NGAL為92.58μg/L時(shí)取截?cái)帱c(diǎn),敏感度和特異度分別為80%、80%。5.慢阻肺急性加重患者中頻繁加重患者血NGAL高于一般患者。6.不同GOLD分級(jí)患者之間NGAL無(wú)顯著差異。7.AECOPD患者治療前血NGAL與CRP、中性粒細(xì)胞百分比、住院天數(shù)呈正相關(guān),與肺功能受損程度(FEV1%)呈負(fù)相關(guān),與白細(xì)胞計(jì)數(shù)、PO_2、PCO_2、SpO_2無(wú)顯著相關(guān)性。結(jié)論AECOPD患者血NGAL在治療后顯著降低,NGAL可作為NGAL可作協(xié)助診斷慢性阻塞性肺疾病急性加重的炎癥標(biāo)志物,評(píng)估AECOPD患者病情嚴(yán)重程度的指標(biāo)。
[Abstract]:Background chronic obstructive pulmonary disease (chronic obstructive pulmonary disease,COPD) is a common and frequently occurring respiratory disease characterized by persistent airflow restriction. Acute exacerbation is an important cause of mortality and progression in patients with chronic obstructive pulmonary disease (COPD). Increase the financial burden of patients, reduce the quality of life of patients. Chronic airway inflammation and airway remodeling are important pathological processes of COPD. For the treatment of COPD, especially in acute exacerbation, rapid control of inflammatory response is the key to control the symptoms and improve the prognosis of the patients. At present, there are many studies on inflammatory mediators in chronic obstructive lung, and the mechanism of inflammatory reaction in the development of COPD is not clear. After preliminary study, neutrophil gelatinase-associated lipid transport protein (NGAL,) has been studied. As an inflammatory medium, neutrophil gelatinase-associated lipocalin may be involved in airway inflammatory reaction and airway remodeling, or may be used as a marker to control the inflammatory response in the acute exacerbation of chronic obstructive lung disease (COPD), which may be involved in airway inflammation and airway remodeling. Objective to observe the expression of neutrophil gelatinase-associated lipid delivery protein in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD,chronic obstructive pulmonary disease acute exacerbation) before and after treatment and in healthy controls. To evaluate the value of NGAL in assessing the severity of acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods from June 2015 to April 2016, 40 cases of AECOPD hospitalized in the respiratory department of Fuyang people's Hospital from June 2015 to April 2016 were randomly selected as the experimental group (46 cases were primary selected, 6 cases were excluded during the experiment), and 40 cases were admitted to the respiratory department of Fuyang people's Hospital from June 2015 to April 2016. 25 healthy controls were selected from the physical examination center of Fuyang people's Hospital. Serum NGAL levels were measured by enzyme-linked immunosorbent assay (ELISA) before and after treatment in patients with AECOPD and in the control group. (WBC) and neutrophil percentage (NE%) of peripheral blood leukocytes and neutrophil percentage (NE%) of patients with C-reactive protein (CRP), were collected at the same time. PO_2, The data of acute exacerbation, length of hospitalization and so on in PCO_2,SpO_2,FEV1%, in recent one year. Results 1Serum NGAL concentrations were (112.18 鹵20.96) 渭 g / L, (79.02 鹵15.39) 渭 g / L and (64.74 鹵13.20) 渭 g / L respectively before and after treatment. The serum CRP in patients with acute exacerbation of chronic obstructive pulmonary disease was lower than that before treatment, but higher than that in healthy control group (p0.05). 3. The percentage of peripheral WBC and neutrophil in patients with chronic obstructive pulmonary disease after treatment was higher than that before treatment. The difference was statistically significant (p0.05), but there was no significant difference between the treatment group and the healthy control group (p0.05) 4. The percentage of neutrophil in NGAL,CRP,WBC, was compared to ROC curve, and the area under the curve was (AUC=0.869,p?0.001), (AUC=0.822,p?0.001), (AUC=0.697,p=0.002), (AUC=0.799,p?0.001). When NGAL was 92.58 渭 g / L, the sensitivity and specificity were 80% and 80% respectively. The serum NGAL in patients with acute exacerbation of chronic obstructive pulmonary disease was higher than that in patients with acute exacerbation of chronic obstructive pulmonary disease. 6. 7. There was a positive correlation between serum NGAL and CRP, neutrophil percentage, length of hospitalization, negative correlation with degree of lung function impairment (FEV1%), white blood cell count and PO_2, before treatment in patients with AECOPD. 7. There was no significant difference in NGAL between patients with different GOLD grades and the percentage of neutrophils in CRP, before treatment. There was no significant correlation between PCO_2,SpO_2. Conclusion the serum NGAL in patients with AECOPD is significantly decreased after treatment. NGAL can be used as a marker of inflammation in the diagnosis of acute exacerbation of chronic obstructive pulmonary disease (COPD) and can be used as a marker to evaluate the severity of AECOPD patients with chronic obstructive pulmonary disease (COPD).
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R563.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李春艷;周麗婷;王樹(shù)越;葉琳;;大氣污染對(duì)慢性阻塞性肺疾病住院影響的Meta分析[J];中國(guó)老年學(xué)雜志;2016年05期

2 李力;;慢性阻塞性肺疾病患者血清PCT、CRP、IL-6、TNF-α的表達(dá)水平及臨床意義[J];實(shí)用臨床醫(yī)藥雜志;2016年03期

3 金宇亭;高海翟;張宇;黃晶;;人中性粒細(xì)胞載脂蛋白的臨床應(yīng)用進(jìn)展[J];廣東醫(yī)學(xué);2015年11期

4 謝尹晶;段晉燕;張洪瑞;劉一凡;吳小利;唐紅衛(wèi);楊繼勇;羅燕萍;王成彬;;中性粒細(xì)胞明膠酶相關(guān)脂質(zhì)運(yùn)載蛋白鑒別革蘭陽(yáng)性菌與革蘭陰性菌感染的實(shí)驗(yàn)研究[J];中華醫(yī)院感染學(xué)雜志;2015年09期

5 唐健;李捷;李少軍;李t煵，

本文編號(hào)：2450201