本文選題：間質(zhì)性肺疾病 + 誘導痰　； 參考：《吉林大學》2012年碩士論文

【摘要】：目的：通過誘導痰細胞學檢查手段比較間質(zhì)性肺疾中不同種類疾病患者痰中的細胞學分型，從而探討間質(zhì)性肺疾病不同種類疾病的發(fā)病機制和病理過程，試圖探索一種新型安全且準確的間質(zhì)性肺疾病的診斷檢查方法。 方法：選取吉林大學白求恩第一醫(yī)院2011年1月至2012年3月臨床明確診斷為間質(zhì)性肺疾病的在院患者30例，，其中特發(fā)性肺纖維化（IPF）患者16例、結(jié)節(jié)病（SA）患者14例，另選取非吸煙健康對照者10例。上述受試者均應(yīng)用超聲霧化的方法給予吸入3.5%濃度的高滲鹽水進行痰誘導試驗，吸入時間依次為2、4、8、16分鐘，每次吸入后間隔停頓1分鐘并進行肺功能檢查，確保受試者吸入高滲鹽水的總誘導時間不超過30分鐘。查看FEV1%預(yù)計值并觀察患者耐受情況。如果FEV1值較試驗前下降超過10%，則立即給予受試者吸入200μg沙丁胺醇，觀察患者呼吸情況并于10min后再次測量FEV1，若FEV1值改善至較實驗前下降不超過10%則可繼續(xù)進行霧化吸入誘導實驗；若FEV1值無明顯改善，較實驗前下降仍超過10%或者患者感到胸悶、喘息等不適，則立即終止試驗。誘導吸入后囑受試者漱口及清理鼻腔，鼓勵其咳深部痰，收集受試者痰液，在收集痰液后2小時內(nèi)進行痰液處理，即將痰液進行分解、過濾、離心和涂片制成樣片，在高倍顯微鏡下計數(shù)各個樣片的細胞總數(shù)，計算其中各炎癥及免疫效應(yīng)細胞所占的比例，利用統(tǒng)計學中的t檢驗方法在檢驗水平p=0.05時進行分析比較各個受試者痰液樣片中炎性細胞和淋巴細胞的數(shù)量和比率。 結(jié)果： 1.細胞總數(shù)：間質(zhì)性肺疾病患者誘導痰中炎性細胞及免疫效應(yīng)細胞總數(shù)目均明顯高于健康受試者。IPF組細胞總數(shù)為（4.4±2.3）×106/ml，SA組為（4.6±2.1）×106/ml，分別與對照組相比p＜0.05，差異有統(tǒng)計學意義。 2.巨噬細胞：對照組巨噬細胞比率為52.1±29.1%，IPF和SA組均低于對照組，IPF組為37.2±21.9%，SA組為36.7±22.6%，分別于對照組相比P＜0.05，差異有統(tǒng)計學意義。 3.中性粒細胞： IPF和SA組患者誘導痰中中性粒細胞比率均較對照組增高，但以IPF組增高較為顯著。IPF組為53.3±22.2%，與對照組比p＜0.05，差異有統(tǒng)計學意義； SA組為45.8±20.7%，與對照組相比，p＞0.05，差別不顯著。 4.淋巴細胞： IPF組和SA組患者誘導痰中淋巴細胞比率均較對照組增高，但以SA組增高較為顯著。SA組為12.4±7.4%，與對照組相比P＜0.05，差異有統(tǒng)計學意義；IPF組為8.7±5.5%，與對照組相比，p＞0.05，差別不顯著。 5.嗜酸性粒細胞：SA組嗜酸性粒細胞比例為1.9±2.6%，與健康對照組相比明顯增高，P＜0.05，差異有統(tǒng)計學意義，IPF組于對照組相比無明顯差別，P＞0.05。 結(jié)論： 1.間質(zhì)性肺疾病患者痰中炎癥細胞和免疫效應(yīng)細胞較健康人群增高。 2.不同病理機制的間質(zhì)性肺疾病患者誘導痰中炎癥細胞及免疫細胞比例不同，其結(jié)果符合病理學檢查。 3.痰誘導的方法對診斷間質(zhì)性疾病及研究間質(zhì)性肺疾病的發(fā)病機制及病理過程有一定臨床意義。
[Abstract]:Objective: through different types of disease in patients with sputum cytology of induced sputum cytology means of interstitial lung disease in type, and to explore the pathogenesis and pathological process of interstitial lung disease in different diseases, tries to explore a new safe and accurate interstitial lung disease diagnosis method.
Methods: from January 2011 to March 2012 in the first hospital of Jilin University Bethune clinical diagnosis of interstitial lung disease in 30 cases of patients with idiopathic pulmonary fibrosis (IPF) patients with 16 cases, 14 cases of patients with sarcoidosis (SA), the other selected non smoking 10 healthy subjects. The subjects were used ultrasonic atomization inhaling concentration of 3.5% hypertonic saline induced sputum test, inhalation time: 2,4,8,16 minutes, each time interval of 1 minutes after inhalation of pause and pulmonary function test, to ensure that the total subjects were induced by inhalation of hypertonic saline is not more than 30 minutes. See the FEV1% predicted and observed the patients tolerated if FEV1. Before the test value is decreased more than 10%, immediately give the subjects inhaled 200 g salbutamol, observe the patient breathing and 10min measured again after FEV1, if the FEV1 value is improved to fall before the experiment does not exceed 1 0% can continue inhalation induction experiment; if the FEV1 value was not improved compared to before drop is still more than 10% or the patients feel chest tightness, wheezing and other discomfort, immediately after inhalation induced termination of the trial. The subjects prescribed mouthwash and clean up the nasal cavity to encourage the deep sputum cough, sputum were collected. In the collection of sputum sputum within 2 hours after the treatment, the sputum decomposition, filtration, centrifugation and smear made samples under the microscope counting each sample cell number calculation, which accounted for the proportion of inflammatory and immune effector cells, using the t test method of statistics in the inspection level p=0.05 analysis comparison of various subjects the number and ratio of sputum samples in inflammatory cells and lymphocytes.
Result錛

本文編號：1733362