五色流式细胞术检测煤工尘肺患者外周血白细胞及意义

发布时间：2018-05-02 19:47

本文选题：五色流式细胞术 + 煤工尘肺　；参考：《华北理工大学》2017年硕士论文

【摘要】：目的煤工尘肺(Coal worker’s pneumoconiosis,CWP)为煤矿工人长期吸入煤尘和/或矽尘引起的肺组织弥漫性纤维化疾病。粉尘颗粒进入机体导致巨噬细胞活化或损伤,释放细胞毒性氧化剂、蛋白酶、细胞因子,促使炎症细胞到达肺泡上皮细胞表面引起肺泡炎症和损伤,而炎症细胞所释放的毒性氧衍生物和蛋白水解酶可进一步引起细胞DNA损伤、细胞凋亡和相关的细胞外基质沉积,导致肺纤维化的发生。本研究通过检测壹期CWP患者外周血粒细胞、CD16+和CD16-单核细胞、B淋巴细胞、细胞毒性T+NK、非细胞毒性T细胞等16种白细胞亚群,探讨各细胞水平变化在CWP发生发展中的作用,为CWP的机制探究、临床诊断及治疗提供新思路。方法1选取2015-2016年在开滦职业病防治院住院的部分壹期CWP患者66例(CWP组),依照《尘肺诊断标准》(GBZ-2009)进行确诊,选取与CWP组相同接尘条件的井下接尘矿工47例(接尘组)和开滦集团非接尘的井上健康查体人员40例(正常组)。3组间性别、年龄、接尘年限均匹配;所有查体人员均于清晨空腹采集静脉血2 ml于EDTA-K2抗凝管中,其中住院患者均在治疗前采集;采用五色流式细胞术检测外周血粒细胞、CD16+和CD16-单核细胞、B淋巴细胞、细胞毒性T+NK、非细胞毒性T细胞等16种白细胞亚群。2运用SPSS 17.0统计软件分析。对符合正态分布的计量资料,以均数±标准差(x±s)表示,三组间均数比较采用单因素方差分析;对符合偏态分布的计量资料,用中位数(M)和四分位数间距(P25-P75)表示,Kruskal-Wallis H检验用于多组间比较,Nemenyi检验用于多组间两两比较,两组间比较采用Mann-Whitney U检验,以P0.05为差异有统计学意义。结果1 CWP组、接尘组及正常组外周血白细胞亚群水平变化:与正常组相比,CWP组外周血B淋巴细胞、CD16-单核细胞、总单核细胞、嗜酸性粒细胞、嗜碱性粒细胞水平显著增高,差异有统计学意义(P0.05);与接尘组相比,CWP组外周血B淋巴细胞、嗜酸性粒细胞水平显著增高,细胞毒性T+NK显著降低,差异有统计学意义(P0.05);接尘组外周血细胞毒性T+NK、CD16-单核细胞、CD16+单核细胞水平显著高于正常组,差异有统计学意义(P0.05);中性粒细胞在CWP中呈下降趋势;其他指标间比较,差异无统计学意义(P0.05)。2 CWP并发COPD组与单纯CWP组外周血白细胞亚群变化:CWP并发COPD组和单纯CWP组结果比较,外周血白细胞亚群水平无明显改变,差异无统计学意义(P0.05)。3不同接尘年限与不同接尘类别壹期CWP患者外周血白细胞亚群水平变化:接尘年限小于30年和大于30年2组结果比较,外周血白细胞亚群水平无明显改变;接触煤尘和矽尘2组结果比较,外周血白细胞亚群水平也无明显改变,差异均无统计学意义(P0.05)。4不同肺功能壹期CWP患者外周血白细胞亚群水平变化:肺功能正常、轻度障碍和中-重度障碍3组结果比较,外周血白细胞亚群水平无明显改变,差异无统计学意义(P0.05)。5吸烟与非吸烟的壹期CWP患者外周血白细胞亚群水平变化:与非吸烟组相比,吸烟组外周血总淋巴细胞、B淋巴细胞显著增高,成熟的中性粒细胞显著降低,差异有统计学意义(P0.05);其他指标间比较,差异无统计学意义(P0.05)。结论1 B淋巴细胞、细胞毒性T+NK、CD16+和CD16-单核细胞、中性粒细胞、嗜酸性粒细胞、嗜碱性粒细胞均参与CWP的发生发展。2 CD16+、CD16-单核细胞水平升高可能与粉尘刺激有关,嗜酸性粒细胞、B淋巴细胞水平升高可能与肺损伤纤维化有关,细胞毒性T+NK水平变化可能贯穿于CWP发生发展过程。CWP患者外周血白细胞亚群水平变化可能受吸烟影响。
[Abstract]:Objective coal workers' pneumoconiosis (Coal worker 's pneumoconiosis, CWP) is a diffuse fibrosis disease of lung tissue caused by coal dust and / or silica dust inhalation of coal workers for a long time. Dust particles enter the body to cause activation or damage of macrophages, release cytotoxic oxidants, protease, and cell factors to induce inflammatory cells to reach the alveolar epithelial cell surface. The toxic oxygen derivatives and protein hydrolase released by inflammatory cells can further cause DNA damage, apoptosis and related extracellular matrix deposition, leading to pulmonary fibrosis. This study was conducted by detecting peripheral blood granulocytes, CD16+ and CD16- mononuclear cells, and B lymphocytes in one stage CWP patients. Cytotoxic T+NK, non cytotoxic T cells and other 16 leukocyte subgroups, to explore the role of cell level changes in the development of CWP, to explore the mechanism of CWP, to provide new ideas for clinical diagnosis and treatment. Method 1 select 66 cases of CWP patients (group CWP) for 2015-2016 years in the hospital of Kailuan occupational disease prevention and treatment hospital (group CWP), according to the diagnosis of pneumoconiosis 47 cases of dusty miners (dust receiving group) and Kailuan Group, 40 cases of undusty well health checkup in Kailuan Group (normal group) were selected for diagnosis, and the sex, age and age of.3 were all matched in 40 cases (normal group) of the 47 cases (the dust group) and the Kailuan group. All the lookup personnel collected 2 ml in the EDTA-K2 anticoagulant tube on the morning of the morning of the Qing Dynasty. The patients were collected before treatment; the peripheral blood granulocyte, CD16+ and CD16- mononuclear cells, B lymphocyte, cytotoxic T+NK, non cytotoxic T cells and other 16 leukocyte subgroups.2 were analyzed by SPSS 17 software, and three groups were expressed with mean number + standard deviation (x + s). A single factor analysis of variance was used for the comparison of the average numbers; the median (M) and four quantile spacing (P25-P75) were used for the measurement data conforming to the partial distribution. The Kruskal-Wallis H test was used in the multi group comparison, and the Nemenyi test was used for the 22 comparison among the multiple groups. The two groups were compared with the Mann-Whitney U test. The difference was statistically significant with P0.05. Results 1 CWP group, dust group and normal group peripheral blood leucocyte subgroup level changes: compared with the normal group, CWP group peripheral blood B lymphocyte, CD16- monocyte, total monocyte, eosinophil, basophil level significantly increased, the difference was statistically significant (P0.05); compared with the dust group, the CWP group peripheral blood B lymphocyte, eosinophil fine Cytotoxic T+NK was significantly decreased, and the difference was statistically significant (P0.05). The level of peripheral blood cell toxicity T+NK, CD16- monocyte and CD16+ monocyte were significantly higher than that of the normal group (P0.05), and neutrophils decreased in CWP, and there was no statistical difference between the other indexes. (P0.05).2 CWP concurrent COPD group and simple CWP group peripheral blood leukocyte Subgroup Changes: CWP complicated with COPD group and simple CWP group results, the peripheral blood leukocyte subgroup level has no significant change, the difference is not statistically significant (P0.05).3 different dust life and different dust category one stage CWP patients with the peripheral blood leukocyte subgroup level changes: the dust age Compared with the results of 2 groups of less than 30 years and more than 30 years, there was no obvious change in the level of leukocyte subgroup in peripheral blood; compared with the 2 groups of coal dust and silica dust, there was no significant change in the level of leukocyte subgroup in peripheral blood (P0.05) the level of peripheral blood leucocyte subgroup in CWP patients with different lung function.4: normal, light lung function Compared with the 3 groups, the level of leukocyte subsets in peripheral blood was not significantly changed in the 3 groups. There was no significant difference in the level of peripheral blood leucocyte subgroup in.5 smoking and non smoking CWP patients: compared with the non-smoking group, the total peripheral blood lymphocytic cells in the peripheral blood, the B lymphocyte significantly increased, and the mature neutrophils compared with the non-smoking group. The difference was statistically significant (P0.05), and there was no significant difference between other indexes (P0.05). Conclusion 1 B lymphocytes, cytotoxic T+NK, CD16+ and CD16- monocytes, neutrophils, eosinophils and basophils all participate in the development of.2 CD16+, and the level of CD16- mononuclear cells may be elevated. The increase of eosinophil and B lymphocyte may be related to pulmonary fibrosis. The change of cytotoxic T+NK level may run through the development of CWP, and the level of peripheral blood leucocyte subgroup in.CWP patients may be affected by smoking.

【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R135.2;R446.1

【参考文献】