【作者】 张亮；

【导师】 侯松萍；

【作者基本信息】 吉林大学 ， 临床医学， 2016， 硕士

【摘要】 背景:弥漫性间质肺疾病(DILD)是一组临床特征相似,免疫病理过程各异的众多肺疾病组成的疾病谱,病因不明者占65%,其发病机制至今尚未完全清楚。病毒、细菌、真菌、吸入有害气体、药物、风湿病等均可导致间质性肺病。ILD涵盖许多疾病,各有其临床特点,诊断有其难处,治疗和预后又因诊断而异。在间质性肺疾病的诊断和鉴别诊断中结缔组织疾病占有重要的地位。结缔组织病患者出现间质性肺病变时,很难判断是感染、还是免疫异常造成肺损伤,临床上很难甄别这些情况。如果能通过实验室指标准确判断肺间质病变是感染所致,还是免疫损伤所致,或者两者并存,对于指导临床治疗,侧重抗感染治疗,还是应用激素或免疫抑制剂治疗,或抗感染与免疫抑制剂治疗并用有重要意义。现本文通过检测结缔组织疾病、非结缔组织疾病患者和正常人的外周血淋巴细胞的免疫分型变化,了解T细胞、B细胞、NK细胞等在结缔组织疾病患者并发肺间质病变时的变化,为指导临床治疗提供一定的参考价值。目的探讨外周血淋巴细胞免疫分型及NK细胞水平变化对于结缔组织疾病并发肺间质病变的原因甄别临床价值。研究方法:本课题选取吉林大学中日联谊医院于2012年5月至2014年12月期间收治的60例间质性肺病变患者。其中30例结缔组织疾病并发间质性肺病变患者,诊断按2012年风湿病新版全套指南标准,入组结缔组织疾病组;30例非结缔组织疾病并发间质性肺病变患者,入组非结缔组织疾病组;25例健康人作为正常对照组;采用流式细胞术检测30例结缔组织疾病组患者、30例非结缔组织疾病组患者、25例健康人外周血中CD3+、CD4+、CD8+、CD56+NK细胞、CD19+B淋巴细胞表达水平。并对两组患者的一般临床资料、主要临床症状、胸部CT影像改变、呼吸衰竭发生率进行比较。研究结果:结缔组织疾病组与非结缔组织疾病组相比,CD8+T细胞明显增高(p<0.01);结缔组织疾病组与正常对照组相比,CD8+T细胞也明显增高,但CD56+数明显降低,均p<0.05;非结缔组织疾病组与正常对照组相比,外周血T细胞各亚群均无明显差异。结缔组织疾病组与非结缔组织疾病组相比,两组患者的一般临床资料、主要临床症状、胸部CT影像改变、呼吸衰竭发生率均无显著差异(p>0.05)。结论:1.结缔组织疾病组外周血CD8+T细胞明显增高、NK细胞数明显降低;非结缔组织疾病组外周血T细胞各亚群未见明显异常,提示外周血淋巴细胞免疫分型有助于识别免疫性损伤引起的结缔组织疾病并发间质性肺病变。2.临床表现、胸部CT影像改变、是否发生呼吸衰竭对于结缔组织疾病并发肺间质病变与其它原因造成的肺间质改变无鉴别诊断价值。更多还原

【Abstract】 Objective Diffuse interstitial lung disease(DILD) is a set of clinical features are similar,different immune pathological process of pulmonary disease of disease,unknown etiology is 65%, its pathogenesis is not yet fully understood. Viruses,bacteria, fungi, inhaling harmful gas, drug can result in interstitial lung disease,rheumatism, etc. ILD covers many diseases, each has its clinical characteristics, diagnosis has its difficulties, treatment and prognosis for diagnosis. In the diagnosis and differential diagnosis of interstitial lung disease of connective tissue disease occupies an important position. Connective tissue disease appeared interstitial lung lesions, is difficult to judge infection, or abnormal immune cause lung injury, it is difficult to identify the clinical situation.If can through laboratory index accurate judgment interstitial lung disease is caused by infection, or immune injury caused by, or both, to guide clinical treatment, focusing on the anti-infection treatment, or application of hormones or immunosuppressive therapy, or anti-infection and immunosuppressant therapy and has important significance. Now based on the detection of connective tissue diseases, connective tissue disease and normal peripheral blood lymphocytes of the immune classification changes, understanding of T cells, B cells and NK cells in the connective tissue disease patients complicated with pulmonary interstitial lesions, provide the certain reference value for guiding clinical treatment.Purpose Explore the peripheral blood lymphocyte immune classification and NK cell level change for identifying the cause of connective tissue disease complicated by pulmonary interstitial lesions of clinical value.Methods This topic selection of in China-Japan Friendship Hospital, Jilin University from May 2012 to December 2014 admitted during the period of 60 patients with interstitial lung lesions. Among 30 cases of connective tissue disease patients complicated with interstitial lung disease, diagnosis according to the 2012 version of a full set of guidelines for standard rheumatism, into the connective tissue disease group; 30 cases of connective tissue disease patients complicated with interstitial lung disease, into a group of connective tissue disease; 25 cases of healthy people as the normal control group; Using flow cytometry detection of 30 patients with connective tissue disease group, 30 cases of patients with connective tissue disease group, 25 cases of healthy people in the peripheral blood of CD3 +, CD4 +, CD8 + CD56 + NK cells, CD19+ B lymphocytes expression level. And the general clinical data of two groups of patients, the main clinical symptoms, chest CT image change, comparing the incidence of respiratory failure.Results Connective tissue disease group compared with the connective tissue disease group, CD8 + T cells were significantly higher(p < 0.01); Connective tissue disease group compared with normal control group, CD8 + T cells also increased obviously, but the number of CD56 + significantly reduced, all p <0.05; The connective tissue disease group compared with normal control group, the peripheral blood T cells subgroup had no obvious difference.Connective tissue disease group and the connective tissue disease, compared to the general clinical data of two groups of patients, the main clinical symptoms, chest CT image change, the incidence of respiratory failure were no significant difference(p > 0.05).Discussions Peripheral blood CD8 + T cells, connective tissue disease group was obviously increased, the number of NK cells significantly decreased; The connective tissue disease group of peripheral blood T cells each subgroup not seen obvious abnormity, tip peripheral blood lymphocyte immune classification helps to identify caused by damage to the immunity of the connective tissue disease complicated with interstitial lung disease.Clinical manifestations, chest CT image change, whether the occurrence of respiratory failure for connective tissue disease complicated by pulmonary interstitial disease and other causes of pulmonary interstitial change without value in differential diagnosis.更多还原