本文關(guān)鍵詞： 肺脹 證型 ADPN AQP-5 相關(guān)性　出處：《云南中醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本課題旨在從現(xiàn)代醫(yī)學(xué)理論和中醫(yī)傳統(tǒng)醫(yī)學(xué)辨證的診療特點(diǎn)出發(fā),以檢測(cè)血清脂聯(lián)素(Adiponectin,ADPN)、水通道蛋白-5(Aquaporin-5,AQP-5)在肺脹肺腎氣虛證、陽(yáng)虛水泛證、痰熱郁肺證患者的變化為主要觀測(cè)內(nèi)容,輔以中醫(yī)癥狀評(píng)分及臨床血常規(guī)、心臟彩色多普勒超聲、肺功能等相關(guān)檢查,探討血清ADPN、AQP-5水平在肺脹常見(jiàn)三個(gè)證型之間的變化規(guī)律以及ADPN、AQP-5與肺脹三個(gè)證型的相關(guān)性,為肺脹的中醫(yī)臨床診療提供一定的參考。方法:本課題設(shè)計(jì)方案采用隨機(jī)平行對(duì)照觀察的方法,按病例納入標(biāo)準(zhǔn)分別納入肺腎氣虛證30例、陽(yáng)虛水泛30例、痰熱郁肺證30例,共90例。根據(jù)入院時(shí)的臨床表現(xiàn),評(píng)估主要癥狀及臨床體征,并于入院第二天采集空腹靜脈血進(jìn)行相關(guān)實(shí)驗(yàn)室檢查包括白細(xì)胞(White Blood Cell,WBC)、中性粒細(xì)胞百分比(Neutrophilic Granulocyte Percent,NEUT%)、腦鈉肽(Brain Natriuretic Peptide,BNP)等,依次進(jìn)行心臟彩色多普勒超聲、肺功能檢查,心臟彩色多普勒超聲選取右心室舒張末內(nèi)徑(Right Ventricular End-diastolic Diameter,RVEDd)、肺動(dòng)脈壓(Pulmonary Artery Pressure,PAP)為觀察指標(biāo),肺功能檢查選取FEV1/FVC、FEV1占預(yù)計(jì)值%、FVC占預(yù)計(jì)值%等相關(guān)指標(biāo)。用雙抗體一步夾心酶聯(lián)免疫吸附法檢測(cè)血清ADPN、AQP-5水平。評(píng)估肺脹陽(yáng)虛水泛證、肺腎氣虛證、痰熱郁肺證三個(gè)證型的癥狀評(píng)分,并收集記錄三個(gè)證型的各項(xiàng)輔助檢查資料。并對(duì)三個(gè)證型血清ADPN、AQP-5及各項(xiàng)輔助檢查資料、癥狀評(píng)分進(jìn)行統(tǒng)計(jì)分析,探討血清ADPN、AQP-5、以及相關(guān)輔助檢查資料在三證型中的差異性及相關(guān)性。結(jié)果:1.三證型血清ADPN水平比較,陽(yáng)虛水泛證組、肺腎氣虛證組分別與痰熱郁肺證組比較,差異均存在顯著統(tǒng)計(jì)學(xué)意義(P0.01);陽(yáng)虛水泛證組與肺腎氣虛證組比較,差異不存在統(tǒng)計(jì)學(xué)意義(P0.05)。2.三證型血清AQP-5水平比較,肺腎氣虛證組與陽(yáng)虛水泛證組比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05);痰熱郁肺證組與陽(yáng)虛水泛證組比較,差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01);痰熱郁肺證組與肺腎氣虛證組比較,差異不存在統(tǒng)計(jì)學(xué)意義(P0.05)。3.三證型咳嗽、咳痰、氣喘、紫紺評(píng)分比較,痰熱郁肺證組分別與陽(yáng)虛水泛證組、肺腎氣虛證組比較,差異均存在顯著統(tǒng)計(jì)學(xué)意義(P0.01);肺腎氣虛證組與陽(yáng)虛水泛證組比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。三證型水腫評(píng)分比較,陽(yáng)虛水泛證組分別與肺腎氣虛證組、痰熱郁肺證組比較,差異均有顯著統(tǒng)計(jì)學(xué)意義(P0.01);肺腎氣虛證組與痰熱郁肺證組比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。4.FEV1占預(yù)計(jì)值%、FEV1/FVC、FVC占預(yù)計(jì)值%分別在三證型之間比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。5.三證型WBC比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。三證型NEUT%比較,痰熱郁肺證組分別與陽(yáng)虛水泛證組、肺腎氣虛證組比較,差異均有顯著統(tǒng)計(jì)學(xué)意義(P0.01);肺腎氣虛證組與陽(yáng)虛水泛證組比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。6.三證型組之間RVEDd兩兩比較,差異均存在顯著統(tǒng)計(jì)學(xué)意義(P0.01)。7.三證型PAP比較,陽(yáng)虛水泛證組與痰熱郁肺證組比較,差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01);陽(yáng)虛水泛證組與肺腎氣虛證組比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05);肺腎氣虛證組與痰熱郁肺證組比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。8.三證型BNP比較,陽(yáng)虛水泛證組分別與肺腎氣虛證組、痰熱郁肺證組比較,差異均存在顯著統(tǒng)計(jì)學(xué)意義(P0.01);痰熱郁肺證組與肺腎氣虛證組比較,差異不存在統(tǒng)計(jì)學(xué)意義(P0.05)。9.在痰熱郁肺證組,ADPN與NEUT%呈正相關(guān),存在顯著統(tǒng)計(jì)學(xué)意義(P0.01),ADPN與WBC無(wú)相關(guān)性;AQP-5與RVEDd、PAP、BNP無(wú)相關(guān)性。10.在肺腎氣虛證組,ADPN與WBC、NEUT%均無(wú)相關(guān)性,AQP-5與RVEDd、PAP、BNP無(wú)相關(guān)性。11.在陽(yáng)虛水泛證組,ADPN與WBC、NEUT%均無(wú)相關(guān)性。AQP-5與RVEDd、PAP均呈正相關(guān),均存在顯著統(tǒng)計(jì)學(xué)意義(P0.01);AQP-5與BNP呈正相關(guān),存在統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.肺脹痰熱郁肺證與血清ADPN存在相關(guān)性,在痰熱郁肺證組中隨著NEUT%的升高ADPN呈上升趨勢(shì),ADPN可能參與了肺脹痰熱郁肺證的炎癥反應(yīng)過(guò)程。2.肺脹陽(yáng)虛水泛證與血清AQP-5存在相關(guān)性,在陽(yáng)虛水泛證組中隨著PAP、BNP的升高、RVEDd的增寬,AQP-5呈上升趨勢(shì),AQP-5可能參與了肺脹陽(yáng)虛水泛證水液代謝失衡的過(guò)程。
[Abstract]:Objective: the purpose of this study is to proceed from the characteristics of diagnosis and treatment of traditional Chinese medicine and modern medicine theory of syndrome differentiation, to detect serum adiponectin (Adiponectin, ADPN), aquaporin -5 (Aquaporin-5, AQP-5) in the lungs of lung and kidney qi deficiency, Yang deficiency and water pan card, change of phlegm heat obstructing lung syndrome patients as the main content of observation, supplemented by the TCM symptoms score and clinical blood routine, heart color Doppler ultrasound, pulmonary function examination, serum ADPN, AQP-5 level changes between common in lung distension syndrome type three and ADPN, the correlation between AQP-5 and lung distension syndrome type three, provide a reference for clinical diagnosis and treatment of lung distension. Methods: this topic design scheme using random parallel control observation method, according to the inclusion criteria were included in the lung and kidney qi deficiency syndrome in 30 cases, 30 cases of deficiency of Yang, phlegm heat obstructing lung syndrome 30 cases, a total of 90 cases. According to the clinical manifestations of admission, evaluation To clinical symptoms and signs, and fasting venous blood on the second day of admission related laboratory tests including white blood cells (White Blood Cell, WBC), the percentage of neutrophils (Neutrophilic Granulocyte, Percent, NEUT%), brain natriuretic peptide (Brain Natriuretic Peptide, BNP), followed by cardiac color Doppler ultrasound, pulmonary function test and the heart of color Doppler ultrasound selection of right ventricular end diastolic diameter (Right Ventricular End-diastolic Diameter, RVEDd), pulmonary artery pressure (Pulmonary, Artery Pressure, PAP) as observation indexes, pulmonary function tests including FEV1/FVC, FEV1% PRED, FVC% PRED and other related indicators. Using double antibody sandwich enzyme-linked step immunoassay for detection of serum ADPN, AQP-5 levels. Assessment of lung distension edema syndrome due to Yang deficiency, lung qi deficiency symptoms score, phlegm heat obstructing lung syndrome type three, and the collection of the auxiliary examination records of three types Check the information. And the three types of serum ADPN, AQP-5 and the auxiliary examination data, statistical analysis was carried out to investigate the symptom score, serum ADPN, AQP-5, the difference in the three type and correlation and related auxiliary examination data. Results: the serum level of ADPN 1. in water type, Yang Deficiency Syndrome group, lung kidney deficiency syndrome group were compared with the phlegm heat stasis syndrome group, the differences were statistically significant (P0.01); water pan Yang deficiency syndrome group and lung qi deficiency group, the difference was not statistically significant (P0.05) between the level of serum AQP-5.2. syndromes, lung and kidney qi deficiency syndrome group and deficiency of Yang syndrome group. The difference was statistically significant (P0.05); phlegm heat stasis syndrome group and deficiency of Yang syndrome group, the difference was statistically significant (P0.01); phlegm heat stasis syndrome group and lung qi deficiency group, the difference was not statistically significant (P0.05).3. syndromes of cough, expectoration, shortness of breath, Cyanosis scores of phlegm heat obstructing lung syndrome group and deficiency of Yang syndrome group, comparison of lung and kidney qi deficiency group, the differences were statistically significant (P0.01); group of lung and kidney qi deficiency and Yang water pan card group, there were no significant differences (P0.05). Comparing the three patterns of edema scores, Yang pan water C group and lung qi deficiency group, comparison of phlegm heat obstructing lung syndrome group, the difference was statistically significant (P0.01); group comparison of lung and kidney qi deficiency and phlegm heat obstructing lung syndrome group, the difference was not statistically significant (P0.05).4.FEV1% PRED, FEV1/FVC, FVC% predicted respectively in three patterns between comparison, there were no significant differences between the three patterns of.5. (P0.05) WBC, the difference was not statistically significant (P0.05). Three NEUT%, phlegm heat obstructing lung syndrome group and deficiency of Yang syndrome group, comparison of lung and kidney qi deficiency group, the differences were statistically significant (P0.01); lung qi deficiency group Compared with water Yang deficiency syndrome group, the difference was not statistically significant (P0.05) compared to RVEDd 22 among the three patterns of.6. group, the differences were statistically significant (P0.01) compared the three patterns of.7. PAP, comparison of edema syndrome due to Yang deficiency group and phlegm heat stasis syndrome group, the difference was statistically significant (P0.01); Yang water pan lung and kidney qi deficiency syndrome group and the comparison group, the difference was statistically significant (P0.05); group comparison of lung and kidney qi deficiency and phlegm heat obstructing lung syndrome group, there was no significant difference between the three patterns of.8. (P0.05) BNP, edema syndrome due to Yang deficiency group and lung qi deficiency group, comparison of phlegm heat obstructing lung syndrome group. The differences were statistically significant (P0.01); phlegm heat stasis syndrome group and lung qi deficiency group, the difference was not statistically significant (P0.05).9. in phlegm heat stasis syndrome group, ADPN was positively associated with NEUT%, there was statistical significance (P0.01), there is no correlation between ADPN and WBC; AQP-5 and RVEDd. PAP, B There was no correlation between NP.10. in lung and kidney qi deficiency syndrome group, ADPN and WBC, NEUT% had no correlation with RVEDd, AQP-5, PAP, BNP and.11. have no correlation in water Yang deficiency syndrome group, ADPN and WBC, NEUT% showed no correlation between.AQP-5 and RVEDd, PAP were positively correlated, there were statistically significant (P0.01); AQP-5. Associated with BNP, there were statistical significance (P0.05). Conclusion: there is a correlation between the lung heat phlegm obstructing lung 1. and ADPN in serum, phlegm heat obstructing lung syndrome group with the increase of NEUT% ADPN increased, the correlation between ADPN may be involved in the lungs caused by phlegm inflammation.2. during lung distension Yang pan water syndrome and serum AQP-5 in edema syndrome due to Yang deficiency group with PAP, BNP increased, RVEDd widened, AQP-5 showed a rising trend, AQP-5 may be involved in the process of lung edema syndrome due to Yang deficiency water metabolism imbalance.

【學(xué)位授予單位】：云南中醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R256.14

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 趙娜;謝才德;;血漿B型腦鈉肽水平在慢性阻塞性肺疾病近遠(yuǎn)期治療預(yù)后評(píng)估中的價(jià)值[J];臨床肺科雜志;2017年03期

2 黃恒燦;;血漿N端腦鈉肽前體與COPD合并慢性肺源性心臟病患者肺動(dòng)脈壓的相關(guān)性分析[J];蛇志;2016年04期

3 曾偉;孫昊鑫;馬廣強(qiáng);朱金華;葉荷平;;二冬膏對(duì)LPS致急性肺損傷大鼠肺組織TNF-α、IL-6及AQP-1、AQP-5的影響[J];中藥藥理與臨床;2016年06期

4 周紅;;再造散加減對(duì)肺腎氣虛型慢性阻塞性肺疾病患者的臨床療效觀察[J];湖北中醫(yī)雜志;2016年12期

5 陳新坡;;桑白皮湯合莫西沙星治療痰熱郁肺型肺脹65例[J];福建中醫(yī)藥;2016年05期

6 白淑榮;吳源;王艷;劉軍;李萍;沈樂(lè);楊靜;;百令膠囊聯(lián)合補(bǔ)肺活血膠囊對(duì)肺腎氣虛證慢性阻塞性肺疾病穩(wěn)定期患者肺康復(fù)的影響[J];中國(guó)實(shí)驗(yàn)方劑學(xué)雜志;2016年24期

7 岳勝;朱平;岳磊;喬國(guó)華;;急性肺損傷大鼠呼吸膜AQP1和AQP5的表達(dá)[J];中國(guó)比較醫(yī)學(xué)雜志;2016年08期

8 湯兵;陳敏;練祥忠;朱巧玲;付敏;張彤彤;王飛;;阻塞性肺疾病急性加重期痰熱壅肺證與臨床指標(biāo)的相關(guān)性研究[J];中國(guó)循證醫(yī)學(xué)雜志;2016年08期

9 朱燕亭;劉璐;蔣昊翔;兀小娟;宋e，

本文編號(hào)：1546179