本文選題：IL-17 + YKL-40�。� 參考：《山東大學(xué)》2011年碩士論文

【摘要】：[研究背景和目的] 慢性鼻-鼻竇炎(Chronic rhinosinusitis, CRS)是臨床上的常見病和多發(fā)病,至今病因不清。近年來的研究傾向于多因素作用的病因?qū)W說,而細(xì)胞炎性因子在此過程中起重要作用。白介素17是一種促炎癥性細(xì)胞因子,主要是由活化的記憶CD4+T淋巴細(xì)胞所分泌,IL—17與其受體結(jié)合后可以誘導(dǎo)表達(dá)多種細(xì)胞因子以及粘附分子,這些細(xì)胞因子在造血過程以及免疫炎癥反應(yīng)等的不同階段具有不同的作用,例如能刺激產(chǎn)生IL-6和PGE-2,有助于增強(qiáng)局部炎癥的反應(yīng)；能促進(jìn)機(jī)體局部產(chǎn)生趨化因子MCP-1、Gro-a、IL-8等,有助于單核細(xì)胞和中性粒細(xì)胞的迅速聚集。YKL-40(人類軟骨糖蛋白39)是哺乳類動物甲殼酶蛋白家族的一員,但沒有殼質(zhì)酶活性。人體內(nèi)的多種細(xì)胞,如巨噬細(xì)胞、中性粒細(xì)胞、滑膜細(xì)胞及軟骨細(xì)胞等均能分泌YKL-40。已有研究表明,YKL-40可以在細(xì)胞外基質(zhì)降解、炎癥反應(yīng)、組織重建及刺激內(nèi)皮細(xì)胞遷移中起作用,同時(shí)也可參與惡性腫瘤的轉(zhuǎn)移過程。YKL-40的分泌和表達(dá)與組織或細(xì)胞的病理狀態(tài)有很大的關(guān)系,表明其在炎癥反應(yīng)和結(jié)締組織的修復(fù)過程中發(fā)揮重要作用。本實(shí)驗(yàn)旨在研究IL-17和YKL-40在慢性鼻-鼻竇炎患者血漿中的表達(dá)情況,探討其參與慢性鼻-鼻竇炎發(fā)生可能的機(jī)制。 [研究方法] 手術(shù)前空腹采血,收集伴有鼻息肉慢性鼻-鼻竇炎(CRSwNP)患者38例、不伴有鼻息肉慢性鼻-鼻竇炎(CRSsNP)患者32例的血液(檸檬酸鈉抗凝),對照組28例均來自于門診體檢健康者。血樣經(jīng)本人知情同意后采集,2000rpm離心15 min,分離血漿,于-80℃冰箱保存,采用ELISA法檢測血漿中IL-17和YKL-40的含量情況。 [結(jié)果] 1.正常對照組血漿IL-17濃度為1.6100(1.2575-1.9830)pg/ml:慢性鼻-鼻竇炎患者血漿IL-17濃度8.2483(4.8868-10.1075)pg/ml；伴有鼻息肉慢性鼻-鼻竇炎(CRSwNP)患者血漿濃度IL-17 8.2430(6.2778-10.3610)pg/ml；不伴有鼻息肉慢性鼻-鼻竇炎(CRSsNP)患者血漿IL-17濃度8.2550(4.8783-10.1650)pg/ml.IL-17在正常人與慢性鼻-鼻竇炎患者血漿中表達(dá)差別有顯著性(P0.05),在CRSwNP. CRSsNP組表達(dá)均明顯高于正常人,推測其在慢性鼻-鼻竇炎的發(fā)生發(fā)展中起重要作用；但在CRSwNP組與CRSsNP組之間差異無顯著性,支持我們將慢性鼻-鼻竇炎劃分為CRSwNP和CRSsNP. 2.正常對照組血漿YKL-40濃度為18.2145(12.5878-20.8250)ng/ml；慢性鼻-鼻竇炎患者血漿YKL-40濃度48.0236(35.1520-59.9180)ng/ml；伴有鼻息肉慢性鼻-鼻竇炎(CRSwNP)患者血漿YKL-40濃度50.9490(35.1373-63.4303)ng/ml；不伴有鼻息肉慢性鼻-鼻竇炎(CRSsNP)患者血漿YKL-40濃度46.0765(37.8620～55.3008)ng/ml.YKL-40在正常人與慢性鼻-鼻竇炎患者血漿中表達(dá)差別有顯著性(P0.05),在CRSwNP.CRSsNP組表達(dá)均明顯高于正常人,推測其在慢性鼻-鼻竇炎的發(fā)生發(fā)展中起重要作用；但在CRSwNP組與CRSsNP組之間差異無顯著性,也支持我們將慢性鼻-鼻竇炎劃分為CRSwNP和CRSsNP. 3.病情嚴(yán)重程度的評估 3.1 VAS評分CRSwNP組VAS評分為7.21±1.65,CRSsNP組VAS評分為6.53±1.91:CRSwNP組和CRSsNP組在癥狀嚴(yán)重程度評分方面差異無統(tǒng)計(jì)學(xué)意義。 3.2 CT檢查評分CRSwNP組鼻竇CT評分為16.01±5.98,CRSsNP組鼻竇CT評分為7.98±4.12: CRSwNP組CT評分顯著高于CRSsNP組。 3.3鼻內(nèi)鏡檢查評分CRSwNP組評分為11.75±5.68,CRSsN組評分為6.27±3.21；CRSwNP組鼻內(nèi)鏡檢查評分顯著高于CRSsNP組。 3.4病情嚴(yán)重程度與血漿IL-17水平之間的相關(guān)性分析統(tǒng)計(jì)結(jié)果顯示,鼻竇CT、鼻內(nèi)鏡檢查評分與患者血漿IL-17水平正相關(guān),相關(guān)系數(shù)分別為(r值分別為0.710.64 P0.05).VAS評分與患者血漿IL-17水平無相關(guān)性。 [結(jié)論] 1.IL-17在正常人與慢性鼻-鼻竇炎患者血漿中表達(dá)差別有顯著性(P0.05),在CRSwNP、CRSsNP組表達(dá)均明顯高于正常人,推測其在慢性鼻-鼻竇炎的發(fā)生發(fā)展中起重要作用；但在CRSwNP組與CRSsNP組之間差異無顯著性,支持我們將慢性鼻-鼻竇炎劃分為CRSwNP和CRSsNP。 2.YKL-40在正常人與慢性鼻-鼻竇炎患者血漿中表達(dá)差別有顯著性(P0.05),在CRSwNP、CRSsNP組表達(dá)均明顯高于正常人,推測其在慢性鼻-鼻竇炎的發(fā)生發(fā)展中起重要作用；但在CRSwNP組與CRSsNP組之間差異無顯著性,也支持我們將慢性鼻-鼻竇炎劃分為CRSwNP和CRSsNP。 3.IL-17及YKL-40在慢性鼻-鼻竇炎的發(fā)生發(fā)展機(jī)制中起重要作用,兩者可能存在某種協(xié)同作用,但其協(xié)同作用機(jī)制及兩者之間關(guān)系有待進(jìn)一步深入研究。 4.病情嚴(yán)重程度的評估方面,CRSwNP組和CRSsNP組在癥狀嚴(yán)重程度評分方面差異無統(tǒng)計(jì)學(xué)意義,而CT檢查評分及鼻內(nèi)鏡檢查評分CRSwNP組評分均高于CRSsNP組,表明CRSwNP有更為嚴(yán)重廣泛的粘膜病變。 [研究意義] 對于慢性鼻-鼻竇炎患者,IL-17及YKL-40在其發(fā)生發(fā)展中具有重要的作用,因此可以考慮降低其含量或者阻斷其作用的方式來進(jìn)行治療,例如開放竇口充分引流、手術(shù)摘除息肉、控制感染進(jìn)而降低感染等導(dǎo)致的IL-17及YKL-40高表達(dá)的因素,或者使用IL-17R、YKL-40R阻斷劑以阻斷其作用.
[Abstract]:[research background and purpose]
Chronic rhinosinusitis (Chronic rhinosinusitis, CRS) is a common and frequently occurring disease in the clinic, and so far the etiology is not clear. In recent years, the study of the etiology of multiple factors has tended to play an important role in this process. Interleukin 17 is an inflammatory cytokine, mainly by activating the memory of CD4+T lymph nodes. The cell secreted, IL - 17, binding to their receptors, can induce a variety of cytokines and adhesion molecules. These cytokines have different roles in different stages of hematopoietic and immune inflammatory reactions, such as stimulating the production of IL-6 and PGE-2, enhancing the response to local inflammation, and promoting the local production of the body. Chemical factors MCP-1, Gro-a, IL-8, and so on, contribute to the rapid aggregation of monocytes and neutrophils,.YKL-40 (human cartilage glycoprotein 39) is a member of the family of mammalian crustaceans, but no chitinase activity. Many cells in the human body, such as macrophages, neutrophils, synoviocytes and chondrocytes, can secrete YKL-40. Some studies have shown that YKL-40 can play a role in the degradation of extracellular matrix, inflammatory reaction, tissue reconstruction and stimulation of endothelial cell migration, and can also participate in the metastasis of malignant tumor. The secretion and expression of.YKL-40 have a great relationship with the pathological state of tissue or cell. It shows that it is in the process of the repair of inflammatory reaction and connective tissue. The purpose of this study was to investigate the expression of IL-17 and YKL-40 in the plasma of patients with chronic rhinosinusitis and to explore the possible mechanism of their involvement in the occurrence of chronic rhinosinusitis.
[research methods]
Blood sampling before operation, collected 38 cases of chronic rhinosinusitis (CRSwNP) with nasal polyps and 32 cases of chronic rhinosinusitis (CRSsNP) without nasal polyps (sodium citrate anticoagulant), 28 cases in the control group were from the healthy persons in the outpatient medical examination. The blood samples were collected after my informed consent, 2000rpm centrifugation 15 min, separation plasma, at -80 centigrade ice The contents of IL-17 and YKL-40 in plasma were detected by ELISA.
[results]
1. the plasma concentration of IL-17 in the normal control group was 1.6100 (1.2575-1.9830) pg/ml: chronic rhinosinusitis patients with IL-17 concentration 8.2483 (4.8868-10.1075) pg/ml and IL-17 8.2430 (6.2778-10.3610) pg/ml in patients with chronic nasal sinusitis (CRSwNP) with nasal polyps, and the plasma IL-17 concentration of patients with chronic rhinosinusitis (CRSsNP) without nasal polyps The expression of degree 8.2550 (4.8783-10.1650) pg/ml.IL-17 in the normal and chronic rhinosinusitis patients was significantly different (P0.05), and the expression in the CRSwNP. CRSsNP group was significantly higher than that of the normal people. It was presumed that it played an important role in the development of chronic rhinosinusitis, but there was no significant difference between the CRSwNP group and the CRSsNP group, which supported us. Chronic rhinosinusitis was divided into CRSwNP and CRSsNP.
2. the plasma YKL-40 concentration was 18.2145 (12.5878-20.8250) ng/ml in the normal control group; the plasma YKL-40 concentration of the patients with chronic rhinosinusitis was 48.0236 (35.1520-59.9180) ng/ml; the plasma YKL-40 concentration was 50.9490 (35.1373-63.4303) ng/ ml in patients with nasal polyps chronic rhinosinusitis (CRSwNP); the blood of patients with chronic rhinosinusitis (CRSsNP) was not accompanied by nasal polyps. The plasma YKL-40 concentration of 46.0765 (37.8620 ~ 55.3008) ng/ml.YKL-40 was significantly different in the normal and chronic rhinosinusitis patients (P0.05), and the expression in the CRSwNP.CRSsNP group was significantly higher than that of the normal people. It was presumed that it played an important role in the development of chronic rhinosinusitis, but there was no significant difference between the CRSwNP group and the CRSsNP group. Sex also supports our division of chronic rhinosinusitis into CRSwNP and CRSsNP..
3. assessment of the severity of the disease
The VAS score of group CRSwNP in 3.1 VAS score was 7.21 + 1.65, and there was no significant difference in symptom severity score between group CRSsNP and group CRSsNP, and group CRSsNP in group CRSsNP.
3.2 CT examination score CRSwNP group sinus CT score was 16.01 + 5.98, CRSsNP group sinus sinus CT score was 7.98 + 4.12: CRSwNP group CT score was significantly higher than that of CRSsNP group.
3.3 nasal endoscopic examination score CRSwNP group was 11.75 + 5.68, CRSsN group score was 6.27 + 3.21; CRSwNP group nasal endoscopic examination score was significantly higher than CRSsNP group.
3.4 the correlation analysis between the severity of the disease and the plasma IL-17 level showed that the sinus CT, the nasal endoscopy score was positively related to the plasma IL-17 level in the patients, and the correlation coefficient was (R respectively 0.710.64 P0.05).VAS score and the plasma IL-17 level was not related to the patient.
[Conclusion]
The expression of 1.IL-17 in normal people and patients with chronic rhinosinusitis was significantly different (P0.05). In CRSwNP, the expression in group CRSsNP was significantly higher than that of normal people. It was presumed that it played an important role in the development of chronic rhinosinusitis, but there was no significant difference between the CRSwNP group and the CRSsNP group, supporting us to divide the chronic rhinosinusitis from the chronic rhinosinusitis. For CRSwNP and CRSsNP.
The expression of 2.YKL-40 in normal people and patients with chronic rhinosinusitis was significantly different (P0.05). In CRSwNP, the expression in group CRSsNP was significantly higher than that of normal people. It was presumed that it played an important role in the development of chronic rhinosinusitis, but there was no significant difference between the CRSwNP group and the CRSsNP group, and it also supported us to delimit chronic rhinosinusitis. It is divided into CRSwNP and CRSsNP.
3.IL-17 and YKL-40 play an important role in the pathogenesis of chronic rhinosinusitis, and there may be some synergistic effects, but the mechanism of synergism and the relationship between them need to be further studied.
4. in evaluating the severity of the disease, there was no significant difference in the symptom severity score between the CRSwNP group and the CRSsNP group, while the CT score and the nasal endoscopy score of the CRSwNP group were all higher than those in the CRSsNP group, indicating that CRSwNP had a more severe and extensive mucosal lesion.
[research significance]
For patients with chronic rhinosinusitis, IL-17 and YKL-40 play an important role in their development, so it is possible to consider ways to reduce their content or block their effects, such as open sinus full drainage, surgical removal of polyps, and control of infection and the reduction of IL-17 and YKL-40 expression factors, or Use IL-17R, YKL-40R blocker to block its effect.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R765

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 王成碩,董震,楊占泉;TNF-α及CD_(68)在鼻息肉中的表達(dá)和意義[J];耳鼻咽喉頭頸外科;2001年01期

2 沈敏,曾學(xué)軍,唐福林;人類軟骨糖蛋白-39在類風(fēng)濕關(guān)節(jié)炎發(fā)病中的作用[J];中華風(fēng)濕病學(xué)雜志;2002年06期

3 周兵,李華斌,韓德民,劉仲燕;黏附分子-1對鼻息肉中嗜酸性粒細(xì)胞聚集及臨床預(yù)后的意義[J];臨床耳鼻咽喉科雜志;2004年02期

4 張欣欣,郭永清,張文杰,董震,楊占泉;Na~+通道與鼻息肉形成關(guān)系的初步研究[J];中華耳鼻咽喉科雜志;2000年05期

，

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