【作者】 曹秀丽；

【导师】 韩书芝；

【作者基本信息】 河北医科大学 ， 内科学， 2016， 硕士

【摘要】 目的:通过对C反应蛋白(CRP)、白介素-6(IL-6)、及B型脑尿钠肽(BNP)的检测,观察炎症反应与慢性阻塞性肺疾病(COPD)并发肺动脉高压的关系。方法:1研究对象选取2015年1月至2015年11月就诊于河北北方学院附属第三医院呼吸内科住院的慢性阻塞性肺疾病患者71例(男性41名,女性30名,平均年龄71.2±6.3岁)。入选者均符合中华医学会呼吸病学分会慢性阻塞性肺疾病学组2013年制定的(慢性阻塞性肺疾病诊治指南)的诊断标准:吸入支气管舒张剂后,FEV1/FVC<70%表明存在持续气流受限。2肺功能测定入选的慢阻肺患者于入院当日例行肺功能检测,主要测定指标为第一秒用力呼气容积(FEVl)、用力肺活量(FVC)、FEVl占预计值的百分比(FEVl%)和FEVl/FVC。3肺动脉收缩压测定彩色多普勒超声心动图检测:所有入选的COPD患者在安静状态下,由我院功能科专业医生通过彩色多普勒超声心动图检测肺动脉收缩压(PASP),以36mmHg为分界值,将患者分为两组:(1)肺动脉收缩压≥36mmHg,为COPD并发肺动脉高压组(COPD-PH组);(2)肺动脉收缩压<36mmHg,为COPD肺动脉压正常组(COPD组)。4 CRP、IL-6、BNP因子测定方法CRP、IL-6检测:所有受试者于入院第二日清晨取空腹静脉血4mL3500 r/min离心,离心5分钟后取血清,置于-70℃保存待测。采用免疫比浊法(PETIA)测定血清C反应蛋白(CRP),酶联免疫吸附法(ELISA)测定血清白介素-6(IL-6)。BNP检测:取空腹静脉血4mL,3500r/min离心,离心5分钟后取血浆,化学发光微粒子免疫检测法(CMIA)测定BNP。结果:1 COPD合并肺动脉高压组与COPD肺动脉压正常组两组间比较性别、年龄、吸烟状况、体质量指数,差异无统计学意义(P>0.05)。2 COPD并发肺动脉高压组与COPD肺动脉压正常组肺功能指标比较,第一秒用力呼气容积占预计值百分比(FEV1%预计值)、第一秒用力呼气容积占用力肺活量百分比(FEV1/FVC)、用力肺活量占预计值百分比(FVC%预计值),两组间差异均无统计学意义(P>0.05)。3 COPD肺动脉高压组与COPD肺动脉压正常组通过彩色多普勒超声心动图比较肺动脉收缩压(PASP),肺动脉高压组较肺动脉压正常组明显增加,差异有统计学意义(P<0.05)。4 COPD肺动脉高压组CRP、IL-6及BNP均高于COPD肺动脉压正常组患者,差异均具有统计学意义(P<0.05)。5相关性分析:PASP与CRP、IL-6、BNP均存在正相关性,r值分别为0.521,0.507,0.602,P<0.05。结论:COPD肺动脉高压组血清炎症因子CRP、IL-6高于COPD肺动脉压正常组,并且肺动脉高压组血浆BNP水平高于单纯COPD组,差异均有统计学意义(P<0.05)。相关性分析显示,PASP与CRP、IL-6及BNP均存在正相关性。综上提示系统性炎症反应可能与COPD并发肺动脉高压有关,BNP可作为COPD肺动脉高压的早期监测指标。更多还原

【Abstract】 Objective: Based on c-reactive protein(CRP)and interleukin-6(IL-6),and b-type brain natriuretic peptide(BNP)detection,to observe the relationship between inflammatory response and Chronic obstructive pulmonary disease(COPD)complicated with pulmonary hypertension.Methods:1 Subjects: From January 2015 to November,71 cases of chronic obstructive pulmonary disease(41 males and 30 females,mean age 71.2± 6.3 years)in the department of respiratory medicine of Third Affiliated Hospital of Hebei North University were selected.The subjects were in accordance with the diagnostic criteria of chronic obstructive pulmonary disease(COPD)established in 2013 by the Chinese Association of respiratory diseases branch of the Chinese Medical Association,Post bronchodilator,FEV1 / FVC<70% showed persistent airflow limitation.All the selected patients were in accordance with the COPD diagnosis standard established in 2013,which was formulated by the respiratory disease branch of the Chinese Medical Association: FEV1 / FVC<70%,after inhalation of bronchial diastolic agent,indicating the presence of persistent airflow limitation.2 Lung function testPulmonary function test was performed in all selected patients after admission,the main indicators: the first second forced expiratory volume(FEV1),forced vital capacity(FVC),FEV1 accounted for the estimated percentage(FEV1%)and FEV1 / FVC.3 Measurement of pulmonary artery systolic pressureColor Doppler echocardiography detection: in a quiet state,all the selected COPD patients were detected in the pulmonary artery systolic blood pressure(PASP)by professional doctors by color Doppler echocardiography in functional section of our hospital.To 36 mm Hg as the boundary values,The patients were divided into two groups: 1.PASP ≥36 mm Hg,COPD complicated with pulmonary hypertension group(COPD-PH group);PASP < 36 mm Hg,COPD pulmonary pressure normal group(COPD group).4 Determination of CRP,IL-6 and BNPCRP,IL-6 detection:On the second day of admission,all subjects were taken fasting venous blood 4m L,3500 r /min centrifugation,remove serum after 5 minutes of centrifugation,Placed-70 degrees Celsius to save for the test.Serum C reactive protein(CRP)was determined by immune assay(PETIA),serum interleukin-6(IL-6)was determinated by enzyme linked immunosorbent assay(ELISA).BNP detection: take the fasting venous blood 4ml,3500 r /min centrifugation.Remove plasma after 5 minutes of centrifugation,chemiluminescence microparticle Immuno Assay(CMIA)for the detection of BNP.Result:1 There was no significant difference in gender,age,smoking index and body mass index between the two groups of COPD complicated with pulmonary hypertension group and COPD group(P>0.05).2 Comparison of pulmonary function index of COPD complicated with pulmonary hypertension group and pulmonary pressure normal group,the difference between the two groups had no statistical significance(P>0.05),pulmonary function index including :Forced expiratory volume in one second(FEVl),forced vital capacity(FVC),FEVl percentage of predicted value(FEVl%)and FEVl / FVC.3 Comparison of pulmonary artery systolic pressure(PASP)in COPD complicated with pulmonary hypertension group and COPD group by color Doppler echocardiography show:PASP in pulmonary hypertension group was significantly increased,and the difference was statistically significant(P< 0.05).4 CRP,IL-6 and BNP in COPD complicated with pulmonary hypertension group was higher than those with normal pulmonary pressure,and the difference was statistically significant(P<0.05).5 Correlation analysis: PASP and CRP,IL-6,BNP paribas has positive correlation,r values were respectively 0.521,0.507,0.602,P<0.05.Conclusion: The serum inflammatory factor CRP and IL-6 in COPD complicated with pulmonary hypertension group was higher than COPD group,and plasma BNP levels in pulmonary hypertension group was higher than COPD group,the difference was significant(P<0.05).Correlation analysis: there was a positive correlation between PASP and IL-6,CRP,BNP.These suggest that inflammation response may be related to COPD complicated with pulmonary hypertension,and BNP can be used as early monitoring index of COPD complicated with pulmonary hypertension.更多还原