【摘要】：研究目的:觀察慢性阻塞性肺疾病(COPD)患者臟層胸膜的病理改變,以及該改變與COPD氣流受限的關(guān)系。研究方法:選取2014年5月—2015年8月于天津市胸科醫(yī)院胸外科因肺部腫物,行全肺葉或部分肺葉切除手術(shù)患者70例。根據(jù)患者肺功能檢查結(jié)果分為COPD組[吸入支氣管舒張劑后,第一秒用力呼氣容積(FEV1)/用力肺活量(FVC)70%,40例]與對(duì)照組(FEV1/FVC≥70%,30例)。并在COPD組內(nèi)根據(jù)FEV1/FEV1預(yù)計(jì)值(FEV1%pre)對(duì)COPD組患者進(jìn)行嚴(yán)重程度分級(jí),并根據(jù)嚴(yán)重程度再次分組。FEV1%pre≥80%為輕度COPD;50%≤FEV1%pre80%為中度COPD;FEV1%pre50%為重度COPD。將輕度COPD患者納入輕度COPD組(21例),將中度及重度COPD患者納入中重度COPD組(19例)。對(duì)手術(shù)所獲取肺組織進(jìn)行取材(取材部位未被病變浸潤,距離病變區(qū)域2cm)、制作組織切片,使用蘇木精—伊紅染色法(HE)及彈力纖維染色法(EVG)進(jìn)行染色;顯微鏡下觀察并計(jì)算各標(biāo)本臟層胸膜的厚度及彈力纖維所占比例。研究結(jié)果:1.COPD組與對(duì)照組肺上、中葉臟層胸膜厚度均明顯小于肺下葉(P0.05)。2.COPD組臟層胸膜厚度以及臟層胸膜中彈力纖維成分所占比例均明顯小于對(duì)照組(均P0.01)。3.輕度COPD組臟層胸膜厚度以及臟層胸膜中彈力纖維所占比例均明顯大于中重度COPD組(均P0.05)。結(jié)論:1.肺上、中葉臟層胸膜厚度小于肺下葉。2.COPD患者臟層胸膜變薄,彈力纖維減少。3.COPD患者臟層胸膜變薄以及彈力纖維減少,可能是呼氣氣流受限的原因之一。
[Abstract]:Objective: To observe the pathological changes of the filthy pleura in patients with chronic obstructive pulmonary disease (COPD) and the relationship between this change and the limitation of COPD airflow. Methods: 70 cases of all pulmonary lobectomy or partial lobectomy were selected from May 2014 to August 2015 in Department of thoracic surgery, Tianjin Thoracic Hospital. The results were divided into COPD Group [after inhaled bronchodilator, the first second forced expiratory volume (FEV1) / forced vital capacity (FVC) 70%, 40 cases] and the control group (FEV1/FVC > 70%, 30 cases). In group COPD, the severity of COPD patients was classified according to the FEV1/FEV1 predicted value (FEV1%pre), and the severity was again divided into.FEV1%pre more than 80% as mild COPD. 50% < FEV1%pre80% as moderate COPD; FEV1%pre50% for severe COPD. and mild COPD patients in a mild COPD group (21 cases), and moderate and severe COPD patients were included in the moderate and severe COPD group (19 cases). The lung tissue obtained from the operation was taken from the lung tissue (the site was not infiltrated by the lesion, apart from the lesion area 2cm), and the tissue section was made, and the hematoxylin Yi Hong was used. Dyeing (HE) and elastic fiber staining (EVG), the thickness of the pleura and the proportion of elastic fibers were observed and calculated under the microscope. The results were as follows: the thickness of the pleura in the lungs of the 1.COPD group and the control group was significantly smaller than that in the lower lobe of the lung (P0.05).2.COPD group, and the elastic fiber in the pleura of the.2.COPD group. The proportion of the components was significantly smaller than that of the control group (P0.01), the thickness of the pleura in the dirty layer of the.3. COPD group and the proportion of the elastic fibers in the pleura of the dirty layer were obviously larger than those in the moderate and severe COPD group (P0.05). Conclusion: on 1. lungs, the thickness of the pleura in the middle lobe of the middle lobe is smaller than the.2.COPD in the lower lobe of the lung, and the elastic fiber reduces the visceral layer of the.3.COPD patients. Thinning of pleural membrane and decrease of elastic fibers may be one of the reasons for expiratory airflow limitation.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.9

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