本文選題：系統(tǒng)性硬化癥 + PTX3�。� 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討血清正五聚蛋白3(pentraxin3,PTX3)水平在系統(tǒng)性硬化癥(systemic sclerosis,SSc)患者血管病變中的意義。方法:1選取住院初治SSc患者37例作為實驗組,年齡及性別相匹配的健康人31例作為對照組。按皮膚受累程度將患者分為彌漫性硬皮病(diffuse systemic sclerosis,dSSc)組(n=6)及局限性硬皮病(limited systemic sclerosis,1SSc)組(n=31)。按2016年歐洲抗風(fēng)濕病聯(lián)盟硬皮病試驗研究組(EULAR Scleroderma Trials and Research group,EUSTAR)對SSc患者病情活動程度的修正參數(shù)(revised index)分為非活動組(revised index≤2.5,n=ll)和活動組(revisedindex2.5,n=26)。按SSc患者病程分為早期組(病程≤3年,n=23)及晚期組(病程3年,n=14)。按患者有無肢端潰瘍及肺動脈高壓,分為無肢端潰瘍(digital ulcer,DU)組(n=30)和DU組(n=7);無肺動脈高壓(pulmonary arterial hypertension,PAH)組(n=28)和 PAH 組(n=9)。2 采用酶聯(lián)免疫吸附法(enzyme linked immunosorbent assay,ELISA)檢測血清PTX3及成纖維細(xì)胞生長因子2(fibroblast growth factor 2,FGF2)水平。應(yīng)用改良Rodnan皮膚評分(modified Rodnan skin score,mRss)等級標(biāo)準(zhǔn)對所有SSc患者皮膚變厚程度進行打分,記錄改良后皮膚總分(total skin score,TSS)。所有患者接受甲襞微循環(huán)檢查,記錄甲襞微循環(huán)總積分(nilfold capillary total score,NCTS)。3記錄SSc患者一般情況、體重指數(shù)(body mass index,BMI)、臨床表現(xiàn)、實驗室指標(biāo)及其他輔助檢查結(jié)果。比較各組間血清PTX3、FGF2水平差異,并與臨床及實驗室各項指標(biāo)進行相關(guān)性分析。結(jié)果:1SSc組血清PTX3及FGF2水平均高于健康對照組(P0.05),不同病程間比較無統(tǒng)計學(xué)差異(P0.05)。2 dSSc與1SSc組血清PTX3及FGF2水平比較無統(tǒng)計學(xué)差異(P0.05)。3 SSc疾病活動組PTX3水平顯著高于非活動組和健康對照組(P0.05);而活動組FGF2水平僅高于健康對照組(P0.05),與非活動組比較無統(tǒng)計學(xué)差異。4SSc疾病DU組PTX3、PTX3/FGF2水平均顯著高于無DU組(P0.05);FGF2水平差異無統(tǒng)計學(xué)意義(P0.05)。5SSc疾病PAH組PTX3、PTX3/FGF2水平均高于無PAH組(P0.05);FGF2水平無統(tǒng)計學(xué)差異(P0.05)。6 SSc組有肺間質(zhì)病變、低一氧化碳彌散量百分比(percentage diffusion capacity for carbon monoxide,DLCO%)、低高密度脂蛋 白(high density lipoprotein,HDL)、高膽固醇(cholesterol,CHOL)及高低密度脂蛋白(low density lipoprotein,LDL)的患者血清PTX3 明顯升高(P0.05)。7 SSc組血清PTX3水平與TSS、NCTS、CHOL、LDL呈正相關(guān)(P0.01),與DLCO%負(fù)相關(guān)(P0.05);FGF2水平與DLCO%呈負(fù)相關(guān)(P0.05)。8 Logistic回歸分析結(jié)果提示PTX3/FGF2、LDL升高的SSc患者更易出現(xiàn)PAH(P=0.043,OR=1.028;P=0.025,OR=1.122)。結(jié)論:1 SSc患者血清PTX3水平在疾病活動判斷方面呈有一定臨床意義。2 PTX3可能通過抑制FGF2促進內(nèi)皮細(xì)胞遷移及血管形成等功能參與SSc血管病變過程,二者比值的失衡或許有助于預(yù)測患者將來是否發(fā)生DU 和(或)PAH。3血清PTX3水平升高的SSc患者可能更容易并發(fā)動脈粥樣硬化。4 PTX3、FGF2可能均參與了 SSc患者皮膚和(或)肺臟纖維化過程。5 PTX3/FGF2、LDL可能是SSc患者合并PAH的獨立危險因素。
[Abstract]:Objective: To explore the significance of serum positive five polyprotein 3 (pentraxin3, PTX3) level in patients with systemic sclerosis (systemic sclerosis, SSc). Methods: 1 select 37 cases of early hospitalized SSc patients as experimental group, and 31 healthy persons with matched age and sex as the control group. Diffuse systemic sclerosis (dSSc) group (n=6) and localized scleroderma (limited systemic sclerosis, 1SSc) group (n=31). According to the 2016 European Union hard skin disease test group of scleroderma (EULAR Scleroderma), the modified parameters of the degree of activity of the patients were divided into inactive groups Vised index < 2.5, n=ll) and active group (revisedindex2.5, n=26). According to the course of SSc patients, they were divided into early group (course of disease < 3 years, n=23) and late group (course of disease 3 years, n=14). The PAH group (n=28) and group PAH (n=9).2 were used to detect the level of serum PTX3 and fibroblast growth factor 2 by enzyme linked immunosorbent assay (enzyme linked immunosorbent assay, ELISA). The total score (total skin score, TSS) was recorded. All patients received nailfold microcirculation, and the total score of nailfold microcirculation (nilfold capillary total score, NCTS).3 recorded the general condition of the SSc patients, body mass index (body), clinical manifestations, laboratory indicators and other auxiliary examination results. The serum levels of PTX3 and FGF2 were different and correlated with the clinical and laboratory indexes. Results: the serum levels of PTX3 and FGF2 in the 1SSc group were higher than those in the healthy control group (P0.05), and there was no statistical difference between the different course of disease (P0.05) and there was no statistical difference between the.2 dSSc and the 1SSc group, and there was no statistical difference between the PTX3 and the FGF2 level. The level of PTX3 was significantly higher than that in the non active group and the healthy control group (P0.05), while the FGF2 level in the active group was only higher than that in the healthy control group (P0.05), but there was no statistical difference between the non active group and the non active group. The level of PTX3/FGF2 in the DU group of.4SSc disease was significantly higher than that in the non DU group (P0.05), and the FGF2 level difference was not statistically significant (P0.05). The level of FGF2 was not statistically significant (P0.05), and there was no statistical difference in FGF2 (P0.05) in group.6 SSc with pulmonary interstitial lesions, the percentage of low carbon monoxide dispersion (percentage diffusion capacity for carbon monoxide), low density lipoprotein, high density lipoprotein and high and low density lipoprotein (high-density lipoprotein) The serum level of PTX3 in patients with lipoprotein, LDL (P0.05) was positively correlated with TSS, NCTS, CHOL, LDL, and negative correlation with TSS, NCTS, CHOL, LDL. Conclusion: the level of serum PTX3 in 1 SSc patients has certain clinical significance in judging the activity of disease..2 PTX3 may participate in the process of SSc vascular lesions by inhibiting FGF2 to promote endothelial cell migration and angiogenesis. The imbalance of the ratio of the two may be helpful to predict whether the patients' DU and / or PAH.3 serum PTX3 level increases in the future of S. Sc patients may be more likely to be associated with atherosclerotic.4 PTX3, and FGF2 may be involved in.5 PTX3/FGF2 in the skin and / or pulmonary fibrosis of SSc patients, and LDL may be an independent risk factor for PAH in patients with SSc.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R593.2

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