【摘要】 目的:比较不同病情慢性阻塞性肺疾病患者血炎症因子水平、动脉血气分析指标测定结果,分析血清瘦素、C反应蛋白与血炎症因子水平、动脉血气分析指标和肺功能指标的相关性。方法:①选择2002-05/2003-05广州市红十字会医院呼吸科住院的慢阻肺急性加重期患者56例,男40例,女16例。对实验目的及观察项目均知情同意。②采用放射免疫法测定血清瘦素;常规测定C反应蛋白、血清白蛋白;采用速率散射浊度法测定C3补体,C4补体;采用型血气分析仪分析动脉血气(pH,动脉血氧分压,动脉血二氧化碳分压,动脉血氧饱和度);采用肺功能仪测定肺功能(第1秒用力呼气量,第1秒用力呼气量占用力肺活量的百分比,呼吸总阻抗,气道总阻力,中心气道阻力,呼吸阻抗中弹性阻力和惯性阻力之和,中心阻力,周边阻力,共振频率)。③计量资料差异比较采用独立样本的t检验,分析数据间相关性采有直线相关分析。结果:慢性阻塞性肺疾病患者56例均进入结果分析。①急性加重期慢性阻塞性肺疾病患者血清瘦素、C反应蛋白、C3补体、C4补体、动脉血二氧化碳分压明显高于稳定期(t=3.136～5.660,P<0.01)。血清白蛋白、pH、动脉血氧分压、动脉血氧饱和度明显低于稳定期(t=3.200～5.114,P<0.01)。②急性加重期慢性阻塞性肺疾病患者血清瘦素与血pH值、血清白蛋白、第1秒用力呼气量呈显著负相关(r=-0.366,-0.527,-0.656,P<0.05～0.01)。与C反应蛋白、动脉血二氧化碳分压、C3补体、C4补体、呼吸总阻抗、气道总阻力、中心气道阻力、中心阻力呈显著正相关(r=0.348～0.738P<0.05～0.01)。③急性加重期慢性阻塞性肺疾病患者血清C反应蛋白与血pH值、动脉血氧分压、动脉血氧饱和度、第1秒用力呼气量、第1秒用力呼气量占用力肺活量的百分比呈显著负相关(r=-0.421～-0.507,P<0.05)。与瘦素、C3补体、C4补体、动脉血二氧化碳分压、呼吸总阻抗、气道总阻力、中心气道阻力、中心阻力、呼吸阻抗中弹性阻力和惯性阻力之和呈显著正相关(r=0.443～0.982,P<0.05～0.01)。结论:①C反应蛋白、瘦素的表达与应激及炎症反应有关,急性加重期升高,稳定期降低,可作为慢阻肺急性加重期的炎症标志物。②C反应蛋白、瘦素与反映气道阻力的呼吸总阻抗、气道总阻力、中心气道阻力、中心阻力及反映气道弹性及肺顺应性的呼吸阻抗中弹性阻力和惯性阻力之和与反映肺通气功能的第1秒用力呼气量和第1秒用力呼气量占用力肺活量百分比均存在良好的相关性。可用来评价气道阻塞的严重性及对预后有重要的预测价值。更多还原

【Abstract】 AIM To compare the level of blood inflamed factors arterial blood gas analysis and analyze the correlation of serum leptin C-reactive protein and the blood inflamed factors arterial blood gas analysis index and the index of pulmonary function in patients with chronic obstructive pulmonary disease COPD of different condition. METHODS ① Fifty-six inpatient with COPD in acute exacerbation were selected from Department of Respiration Guangzhou Red Cross Hospital from May 2002 to May 2003 including 40 males and 16 females. They all knew the objective of the experiment and the observation program and agreed. ② The serum leptin was detected by the radioimmunity method. The C-reactive protein and serum albumin were detected routinely. The complements of C3 and C4 were measured with the ratenephelometry method. The arterial blood gas pH arterial pO/2 partial pressure of arterial carbondioxide arterial oxygen saturation was analyzed with the type IL1620 blood gas analyzer. The pulmonary function forced expiratory volume in first second FEV1 percentage of FEV1 and forced vital capacity FVC respiratory impedance Zrs total airway resistance R5 central airway resistance R20 sum of elastic resistance and inertia resistance in the respiratory impedance central resistance peripheral resistance resonance frequence was detected by the pulmonary function meter. ③ The difference of measurement data was compared with the independent t-test. The linear correlation was used to analyze the correlation among the data. RESULTS Totally 56 patients with COPD were involved in the result analysis. ① The serum leptin C-reactive protein the complement of C3 and C4 partial pressure of arterial carbondioxide in patients with COPD in the acute exacerbation phase were higher significantly than those in the stationary phase (t=3.136-5.660, P < 0.01). The serum albumin pH arterial pO/2 and arterial oxygen saturation were lower significantly than those in the stationary phase (t=3.200-5.114,P < 0.01). ② The serum leptin in patients with COPD in the acute exacerbation phase had significantly negative correlation with the pH value serum albumin and FEV in first second r=-0.366 -0.527 -0.656 P < 0.05-0.01 and had significantly positive correlation with C-reactive protein partial pressure of arterial carbondioxide the complement of C3 and C4 Zrs R5 R20 and central resistance r=0.348-0.738 P < 0.05-0.01. ③ The C-reactive protein had significantly negative correlation with pH value arterial pO/2 arterial oxygen saturation FEV1 FEV1/FVC r=-0.421 to -0.507, P < 0.05 in patients with COPD in the acute exacerbation and had significantly positive correlation with leptin complement of C3 and C4 partial pressure of arterial carbondioxide Zrs R5 R20 central resistance sum of elastic resistance and inertia resistance in the respiration impedance (r =0.443-0.982 P < 0.05-0.01=. CONCLUSION ① The expression of C-reactive protein and leptin has relation with stress and inflammatory reaction increasing in the acute exacerbation phase and decreasing in the stationary phase which can be taken as the inflammation mark in the acute exacerbation phase of COPD. ② The C-reactive protein leptin Zrs that reflect the airway resistance R5 R20 central resistance sum of elastic resistance and inertia resistance in the respiratory impedance that reflect the spring of airway and the lung compliance with FEV1 that reflects the pulmonary ventilation function and the FEV1/FVC have good correlation. It can be used to evaluate the severity of airway obstruction and has important predictive value for prognosis.更多还原