【作者】 王伟；

【导师】 蒋萍；

【作者基本信息】 天津医科大学 ， 内科学 呼吸系病（专业学位）， 2017， 硕士

【摘要】 目的:探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性发作期及稳定期患者与健康人群比较,了解两者间瘦素(Leptin)及甲状腺素水平的变化,以明确瘦素及甲状腺素对于评估COPD患者病情及预后的意义。方法:1.研究对象:1.1 COPD组:选择我院2014年1月到2015年12月因COPD急性加重而入院,但入院前根据慢阻肺综合评估为D组的男性患者50例,年龄55-75岁,平均年龄62.7岁。BMI为19-24kg/m2,平均BMI为21.1kg/m2,所有患者诊断均符合中华医学会呼吸病学会慢性阻塞性肺疾病学组制定的《慢性阻塞性肺疾病诊治指南》(2013年修订版)慢阻肺急性加重及稳定期的诊断标准。1.2对照组:选取来院体检男性健康者30例作为对照组,年龄55-75岁,平均年龄62.9岁。BMI为19-24kg/m2,平均BMI为21.3kg/m2。2.研究方法:COPD急性发作患者次日清晨空腹抽血,作为发作期血样,经抗感染、化痰、平喘、吸氧等治疗后症状稳定后,再次于清晨空腹抽血作为稳定期血样,对照组于体检当天空腹抽血。检测指标为血清瘦素(Leptin)及甲状腺素指标TT3(血清三碘甲状腺原氨酸)、TT4(血清甲状腺素)、FT3(血清游离三碘甲状腺原氨酸)、FT4(血清游离甲状腺素)、TSH(促甲状腺激素)。采用SPSS17.0统计软件处理,所有数据均以(x_±s)表示,组间比较用t检验,P<0.05表示差异有统计学意义。3.结果:3.1瘦素的测定:COPD急性发作期瘦素水平较对照组和稳定期均有所升高,且具有统计学意义(P<0.05);COPD稳定期瘦素水平较对照组差异无明显统计学意义(P>0.05)。3.2甲状腺素的测定:COPD急性发作期与对照组相比TT3、FT3下降显著,具有统计学意义(P<0.05);稳定期与对照组相比TT3、FT3略有下降,但无明显统计学意义(P>0.05)。COPD急性发作期及稳定期与对照组相比TT4、FT4及TSH均稍有下降,但均无明显差异(P>0.05)。结论:1.COPD急性发作期病人瘦素水平较稳定期出现显著升高。考虑与患者呼吸功能受损及COPD急性发作时的炎性反应相关。瘦素作为一种促炎症因子,与炎症因子相互作用,参加了全身的炎症经过,所以瘦素或许是一项病情恶化的炎性标志物。稳定期瘦素浓度较前降低,且瘦素浓度与患者体重呈正相关,这或许是机体的一种自我保护性变化,由于瘦素浓度下降有助于减少对能量的消耗以及对摄食的增加,因此防止了COPD病人体重继续降低以及营养状态的继续变差。2.COPD急性发作期TT3、FT3下降显著,稳定期与对照组相比TT3、FT3略有下降,但无明确统计学意义。COPD急性发作期及稳定期TT4、FT4及TSH均稍有下降,但均无明显统计学意义。甲功的变化,与缺氧、感染产生细胞因子、应用糖皮质激素等原因有关,也可视为这可能是机体的一种保护机制,随着病情的好转,甲状腺功能可恢复至接近正常或正常,提示甲状腺激素的改变与COPD预后存在密切关系。3.瘦素及甲状腺素对COPD患者在了解病情、判断预后方面都具有一定的临床价值,值得临床医师重视。更多还原

【Abstract】 Objective: To investigate the chronic obstructive lung disease(COPD)acute attack period and stable period and healthy population changes in the control of leptin and thyroid function to clarify leptin and thyroid hormone in the pathogenetic condition and prognosis of patients with chronic obstructive pulmonary disease(COPD)judgement.Method: 1.Research objects: 1.1 Group COPD: In our hospital from January 2014 to December 2015 50 cases of hospitalized male patients with acute COPD exacerbation,who were admitted to the D based on COPD before admission,age 55-75 years old,the average age of 62.7 years.BMI was 19-24kg/m2,the average BMI was 21.1kg/m2.All patients were diagnosed according to Chinese Thoracic Socity,chronic obstructive pulmonary disease study group to develop the "chronic obstructive pulmonary disease diagnosis and treatment guidelines"(revised version of the 2013)COPD acute exacerbation and the remission criteria.1.2 Control group: Select healthy male hospital physical examination in 30 cases as control group,aged 55-75 years old,the average age of 62.9 years.BMI was 19-24kg/m2,the average BMI was 21.3kg/m2 2.Methods: The patients with acute exacerbation were drowed blood in the next morning as the acute period blood;After treatment of symptoms,again in the morning drowing blood samples as remission.The control group on the examination day fasting blood.Indicator for the detection of serum leptin and thyroid function parameters of TT3(serum three iodine thyroid original ammonia acid),TT4(serum thyroxine),FT3(serum free triiodothyronine triiodothyronine),FT4(serum free thyroxine),TSH(thyroid stimulating hormone)。 Using SPSS17.0 statistical software,all the data were to(x_±s)said that between groups were compared with t test,P < 0.05 said there was a statistically significant difference..3.Result: 3.1 The determination of leptin: Comparison with the control group and stable period were higher leptin levels in the acute attack of COPD,which has statistical significance(P<0.05);leptin levels in stable COPD compared with the control group,the difference was not statistically significant(P>0.05)3.2: Determination of thyroid function: In acute stage of COPD compared with the control group,TT3 and FT3 decreased significantly,with statistical significance(P<0.05);Remission compared with the control group,TT3 and FT3 decreased slightly,but no statistical significance(P>0.05).During the period of acute attack and remission,compared with the control group COPD,FT4、TT4 and TSH was slightly decreased,but showed no significant difference(P>0.05).Conclusion: 1.Acute exacerbation and stable stage comparison with COPD,leptin levels increased significantly.With the consideration of the acute inflammation of important inflammatory markers,and respiratory function in patients with impaired.Leptin as a pro-inflammatory factor,and the interaction of inflammatory factor implicated in the inflammatory process,so leptin may be a marker for inflammatory exacerbations.Remission of leptin level was decreased,and the weight was positively related with leptin.This is likely to the body of a self protection reaction,because of low leptin levels is helpful to reduce energy consumption and stimulate feeding,so as to avoid a further decline in the weight loss and nutritional status of further deterioration in patients with chronic obstructive pulmonary disease(COPD).2.In acute stage of COPD compared with the control group,TT3 and FT3 decreased significantly,Remission compared with the control group,TT3 and FT3 decreased slightly,but no statistical significance.During the period of acute attack and remission,compared with the control group COPD,FT4、TT4 and TSH was slightly decreased,but showed no significant difference.Hypoxia,infection of cytokines and glucocorticoids cause changes in thyroid function.As this may be a protective mechanism of the body,with the improvement of the disease,thyroid function can be restored to normal or almost normal,suggesting that changes in thyroid hormone associated with the prognosis of COPD.3.Leptin and thyroxine has certain clinical value on the prognosis of COPD patients in the understanding of the disease,Clinicians should be pay attention.更多还原