本文選題：慢性阻塞性肺疾病 + 急性加重�。� 參考：《山東大學(xué)》2016年碩士論文

【摘要】：研究背景慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是一種以持續(xù)性、不完全可逆性及進(jìn)行性氣流受限為特征的慢性肺部炎癥疾病,在全球范圍內(nèi)具有很高的發(fā)病率和死亡率。慢性阻塞性肺疾病急性加重(acute exacerbation of chronic pulmonary obstructive disease, AECOPD)是指一種急性起病過(guò)程,患者呼吸系統(tǒng)癥狀惡化,超出日常的變異范圍,并且需要改變現(xiàn)有的藥物治療。目前,AECOPD的診斷主要依據(jù)患者的臨床表現(xiàn)及藥物使用情況,具有較強(qiáng)的主觀性,缺乏高效、客觀的生物學(xué)標(biāo)記物。正五聚蛋白3 (Pentraxin 3,PTX3),與C-反應(yīng)蛋白(c-reactive protein, CRP)同屬五聚素家族,它作為一種急性期反應(yīng)蛋白,在多種炎癥過(guò)程中表達(dá)增高,而目前關(guān)于PTX3與／ECOPD的關(guān)系在國(guó)內(nèi)外缺少相關(guān)報(bào)道。本研究旨在檢測(cè)慢阻肺急性加重期患者血清的PTX3表達(dá)水平,并研究其與其他炎癥標(biāo)記物、相關(guān)臨床參數(shù)的相關(guān)性,從而進(jìn)一步探討PTX3在AECOPD患者中的臨床價(jià)值。方法選取自2015年4月至2015年12月于山東大學(xué)第二醫(yī)院呼吸內(nèi)科住院的慢性阻塞性肺疾病急性加重期患者48例,同時(shí)選取山東大學(xué)第二醫(yī)院查體中心健康體檢人員22例作為健康對(duì)照組。收集并記錄兩組研究對(duì)象的基本資料包括年齡、性別、吸煙史。AECOPD組患者于入院當(dāng)天或次日清晨、健康體檢者于查體當(dāng)天抽取肘部空腹靜脈血。采用酶聯(lián)免疫吸附法(enzyme linked immunosorbent assay, ELISA)檢測(cè)AECOPD組患者和健康對(duì)照組血清PTX3水平。慢性阻塞性肺疾病急性加重期患者于入院24小時(shí)內(nèi)完成超敏CRP、降鈣素原(procalcitonin, PCT)、白細(xì)胞計(jì)數(shù)(white blood count, WBC),及中性粒細(xì)胞百分比(N%)值等指標(biāo)檢測(cè),以及完成慢性阻塞性肺疾病評(píng)估測(cè)試(COPD Assessment Test, CAT)、動(dòng)脈血?dú)夥治鰴z測(cè)。我們也對(duì)健康對(duì)照組對(duì)象進(jìn)行CRP、PCT、WBC及N%的檢測(cè)。本實(shí)驗(yàn)采用SPSS17.0統(tǒng)計(jì)學(xué)軟件進(jìn)行數(shù)據(jù)分析,計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)(x±s)差表示,計(jì)量資料間比較采用t檢驗(yàn)。如果變量符合正態(tài)分布,變量之間的相關(guān)性采用Person法分析；如果變量不符合正態(tài)分布,變量之間的相關(guān)性采用Spearman法分析。P0.05則差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果1.AECOPD患者血清PTX3水平高于健康對(duì)照組患者,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2.相關(guān)性分析顯示AECOPD患者血清PTX3水平與中性粒細(xì)胞百分比、CAT評(píng)分、CRP水平呈正相關(guān)(P0.05),與PCT水平、白細(xì)胞計(jì)數(shù)、PCO2、PO2無(wú)相關(guān)性(P0.05)。結(jié)論AECOPD患者血清PTX3水平表達(dá)增高,可能與慢阻肺急性加重期患者的中性粒細(xì)胞比例增加有關(guān),且PTX3可能與AECOPD患者的疾病嚴(yán)重程度相關(guān)。
[Abstract]:Background chronic obstructive pulmonary disease (chronic obstructive pulmonary) is a chronic pulmonary inflammatory disease characterized by persistent, incomplete reversible and progressive airflow limitation. Acute exacerbation of chronic obstructive pulmonary disease (acute exacerbation of chronic pulmonary obstructive disease, AECOPD) refers to an acute onset process in which the respiratory system symptoms deteriorate beyond the range of daily variations and require changes in existing medication. At present, the diagnosis of AECOPD is mainly based on the clinical manifestations of patients and drug use, with strong subjectivity, lack of efficient and objective biological markers. Pentraxin 3 (PTX3) belongs to the c-reactive family. As an acute phase reactive protein, it is highly expressed in various inflammatory processes. However, there are few reports on the relationship between PTX3 and / or ECOPD at home and abroad. The aim of this study was to detect the expression of PTX3 in serum of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and to study the correlation between PTX3 and other inflammatory markers and related clinical parameters in order to further explore the clinical value of PTX3 in AECOPD patients. Methods from April 2015 to December 2015, 48 patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) were enrolled in Department of Respiratory Medicine, second Hospital of Shandong University. At the same time, 22 health examiners in the physical examination center of the second Hospital of Shandong University were selected as the healthy control group. The basic data of the two groups were collected and recorded, including age, sex, smoking history. The patients in AECOPD group were collected on the day of admission or early in the next day. The serum levels of PTX3 in patients with AECOPD and healthy controls were detected by (enzyme linked immunosorbent assay, Elisa. In patients with acute exacerbation of chronic obstructive pulmonary disease, hypersensitive CRP, procalcitonin (PCT), white blood cell count (white blood count, WBC) and neutrophil percentage (N%) were detected within 24 hours after admission. Assessment test (cat) and arterial blood gas analysis were completed. We also detected the WBC and N% of CRPG PCT in healthy control subjects. In this experiment, SPSS 17.0 statistical software was used to analyze the data. The mean 鹵standard (x 鹵s) difference was used to measure the data, and t test was used to compare the measured data. If variables conform to normal distribution, the correlation between variables is analyzed by person method; if variables do not conform to normal distribution, the correlation between variables is analyzed by Spearman method. Results 1. The level of serum PTX3 in AECOPD patients was significantly higher than that in healthy controls (P0.05). 2. Correlation analysis showed that the serum PTX3 level in AECOPD patients was positively correlated with the level of neutrophil percentage cat score and CRP (P0.05), but had no correlation with PCT level and white blood cell count (PCO2PO2) (P0.05). Conclusion the increase of serum PTX3 expression in patients with AECOPD may be related to the increase of neutrophil ratio in patients with acute exacerbation of COPD, and PTX3 may be related to the severity of AECOPD.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R563.9

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