煤工尘肺患者外周血T细胞表达水平及其与肺功能的相关性研究

发布时间：2018-01-12 01:06

本文关键词：煤工尘肺患者外周血T细胞表达水平及其与肺功能的相关性研究　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

更多相关文章： 煤工尘肺 T细胞 肺功能 相关性

【摘要】：目的:煤工尘肺(coal workers’pneumoconiosis,CWP)目前存在病情呈进行性进展、临床缺乏早期诊断手段、缺乏有效的治疗措施等问题,本研究在对CWP患者年龄、触尘时间、肺功能等指标分析的基础上,通过检测患者外周血CD3~+、CD3~+CD4~+、CD3~+CD8~+、CD4~+CD25highCD127low细胞表达水平,并对各指标之间的相关性进行研究,旨在为CWP疾病的发病机制和诊治预防提供新的思路和理论参考。方法:根据GBZ 70-2009《尘肺病诊断标准》,本研究共收集111例CWP患者,根据病情严重程度分为CWP I期组(30例)、CWP II期组(60例)及CWP III期组(21例),CWP期别由尘肺鉴定小组进行独立判定,同时以30例健康体检者作为对照组。排除冠心病、脑血管疾病、高血压、糖尿病,近期肺部感染、严重肝肾功能不全、近期使用过免疫抑制剂者等。本研究已通过医院伦理审查委员会的审查和批准,并取得所有入组者的知情同意,并签署知情同意书。本研究对所有患者进行肺功能、外周血CD3~+、CD3~+CD4~+、CD3~+CD8~+及CD4~+CD25highCD127low细胞表达水平检测,并分析各指标之间的相关性。本研究所涉及的所有数据均采用SPSS 19.0统计软件进行统计分析,t检验进行两均数比较,相关性采用Pearson检验并计算相关系数。所有假设检验均采用双侧检验,以P0.05为差异有统计学意义。结果:1 CWP患者的肺活量(VC)、一秒用力呼气容积与预计值的比值(FEV1/Pre)、一秒用力呼气容积与用力肺活量的比值(FEV1/FVC)、肺比弥散量(TLCO/VA)均明显低于健康对照组,随着CWP期别的上升,肺功能指标VC、FEV1/Pre、FEV1/FVC、TLCO/VA均逐渐降低(P0.05)。2与对照组比较,CWP各组CD3~+细胞、CD3~+CD8~+细胞水平均较低(P0.05);CWP各组CD3~+CD4~+细胞、CD3~+CD4~+/CD3~+CD8~+比值、CD4~+CD25highCD127low细胞显著增高(P0.05);随着CWP期别的上升,患者外周血CD3~+、CD3~+CD8~+细胞水平呈下降趋势,经两组间配对t检验,差异均具有统计学意义(P0.05);CD3~+CD4~+细胞、CD3~+CD4~+/CD3~+CD8~+比值、CD4~+CD25highCD127low细胞水平均呈上升趋势(P0.05)。3相关性分析结果显示,CD3~+CD4~+细胞、CD3~+CD4~+/CD3~+CD8~+比值、CD4~+CD25highCD127low细胞水平与VC、FEV1/Pre、FEV1/FVC呈显著负相关(P0.05);CD3~+CD8~+细胞水平与VC、FEV1/Pre、FEV1/FVC、TLCO/VA呈显著正相关(P0.05);CD3~+CD4~+/CD3~+CD8~+比值与TLCO/VA呈显著负相关(P0.05);CD3~+细胞水平与TLCO/VA呈显著正相关(P0.05);CD3~+CD4~+细胞、CD4~+CD25highCD127low细胞水平与TLCO/VA之间无明显相关性(P0.05);CD3~+细胞水平与VC、FEV1/Pre、FEV1/FVC之间亦无明显相关性(P0.05)。结论:1随着年龄、触尘时间的增加,CWP患者的疾病期别随之上升,病情严重亦随之增加;2随着CWP病情的进展,患者肺功能呈现出进行性损伤,主要表现为限制性和混合性通气功能障碍,肺弥散功能亦明显降低,肺功能的早期改变可以敏感的反映CWP病情的进展,监测肺功能的变化可为CWP的诊断提供早期预警;3随着CWP患者T细胞免疫调节活性的增加,免疫抑制能力增强,CWP患者的机体内环境紊乱情况加剧,病情严重程度随之进展,提示CWP患者体内免疫T细胞紊乱可能是CWP的重要发病机制;4外周血T细胞水平与肺功能指标具有显著的相关关系,外周血T细胞的表达水平可在一定程度上反映肺功能的损伤程度及评估患者病情的发展变化。
[Abstract]:Objective: pneumoconiosis (coal workers pneumoconiosis, CWP) has showed a progressive clinical progress, the lack of early diagnosis, the lack of effective treatment measures, on the age of patients with CWP, touch time, analyzing the pulmonary function, through the detection of peripheral blood of patients with CD3~+. CD3~+CD4~+, CD3~+CD8~+, the expression level in CD4~+CD25highCD127low cells, and to study the correlation between the index of CWP, aimed at the pathogenesis of the disease and the diagnosis and treatment to provide new ideas and theoretical reference for prevention of GBZ 70-2009<. Methods: according to the diagnostic criteria of pneumoconiosis ", this study collected 111 cases of CWP patients according to the severity of the disease is divided into CWP I group (30 cases), CWP II group (60 cases) and CWP III group (21 cases), CWP stage independently determined by pneumoconiosis identification group, and 30 healthy cases as control group without coronary heart disease, Cerebrovascular disease, hypertension, diabetes, recent pulmonary infection, severe liver and kidney dysfunction, recently used immunosuppressive agents. This study has been adopted and approved by the hospital ethics review committee review, and obtain informed consent from all participants, and signed the informed consent form. The study on pulmonary function in all patients the peripheral blood, CD3~+, CD3~+CD4~+, CD3~+CD8~+ and CD4~+CD25highCD127low cells to detect the expression level, and analyze the correlation between the index. All the data involved in this study were performed by SPSS 19 statistical software for statistical analysis, t test were two were compared using Pearson test, correlation and calculation of correlation coefficient. All hypothesis tests are used to P0.05 for the two-sided test, the difference was statistically significant. Results: 1 patients with CWP (VC), vital capacity ratio of forced expiratory volume in one second and the expected value (FEV1/Pre), a second force The ratio of expiratory volume and forced vital capacity (FEV1/FVC), ratio of lung diffusing capacity (TLCO/VA) were significantly lower than the healthy control group, along with other CWP increased, lung function index VC, FEV1/Pre, FEV1/FVC, TLCO/VA (P0.05).2 decreased compared with the control group, CWP group and CD3~ + cells, CD3~+CD8~+ cells were more low (P0.05); CWP group of CD3~+CD4~+ cell, CD3~+CD4~+/CD3~+CD8~+ ratio, CD4~+CD25highCD127low cells increased significantly (P0.05); CWP with other increase in peripheral blood of patients with CD3~+, CD3~+CD8~+ cells decreased, the two groups paired t test, the difference was statistically significant (P0.05); CD3~+CD4~+ cells, CD3~+CD4~+/CD3~+CD8~+ ratio, CD4~+CD25highCD127low the cell level increased (P0.05).3 correlation analysis showed that CD3~+CD4~+ cells, CD3~+CD4~+/CD3~+ cells and CD8~+ ratio, CD4~+CD25highCD127low level VC, FEV1/Pr E was negatively related to FEV1/FVC (P0.05); CD3~+CD8~+ cells with the level of VC, FEV1/Pre, FEV1/FVC, TLCO/VA showed a significant positive correlation (P0.05); CD3~+CD4~+/CD3~+CD8~+ was negatively correlated with the ratio of TLCO/VA (P0.05); CD3~+ cell level was positively correlated with TLCO/VA (P0.05); CD3~+CD4~+ cells, there was no correlation between CD4~+CD25highCD127low cell with the level of TLCO/VA (P0.05); CD3~+ cells with the level of VC, FEV1/Pre, FEV1/FVC have no significant correlation (P0.05). Conclusion: 1 with the increase of age, touch time, patients with CWP disease don't rise, serious illness also increases; 2 with progression of CWP disease and pulmonary function in patients showing progressive damage, mainly for limiting and mixed ventilatory dysfunction, pulmonary function also significantly reduced, progress can reflect the sensitivity of the CWP disease early changes in lung function, lung function monitoring can change Provide an early warning for the diagnosis of CWP; 3 with the increase of T cells in patients with CWP immune activity, enhancing immune suppression ability of CWP patients, the imbalance of internal environment intensified and the severity of the disease will progress, suggesting that CWP in patients with T cell immune disorders may be the pathogenesis of heavy CWP; 4 T cells in peripheral blood the level and lung function index has significant correlation, the development and change of the expression level of T cells in peripheral blood can reflect disease severity and evaluate the pulmonary function of patients in a certain extent.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R135.2

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