小儿毛细支气管炎血皮质醇、ACTH、11β-HSD2水平变化的研究

发布时间：2018-04-11 03:34

本文选题：毛细支气管炎 + 皮质醇　；参考：《吉林大学》2012年硕士论文

【摘要】：毛细支气管炎是一种婴幼儿较常见的下呼吸道感染性疾病，多由于呼吸道合胞病毒（RSV）感染引起。RSV除可直接引起气道黏膜损伤，还可作为变应原诱导机体抗RSV免疫应答，若免疫反应过度则可造成免疫损伤。目前毛细支气管炎的治疗主要包括抗病毒，防治细菌感染、止喘等对症支持治疗。临床上常应用糖皮质激素作为止喘抗炎药物，但糖皮质激素在毛支治疗中的作用和利弊还存在争议。为明确ACTH、皮质醇及11β-HSD2在毛支中的水平和三者的关系，以指导毛支治疗中糖皮质激素应用，评价毛支预后和转归。我们选取2010年1月～2011年5月在我科住院的毛细支气管炎患儿24例，均符合诸福棠实用儿科学中毛细支气管炎的诊断标准，入院后经血清酶联免疫吸附试验（enzymelinkedimmunosorbentassay，ELISA）证实为RSV感染。其中18例（急性期皮质醇及ACTH均降低），于恢复期（肺部哮鸣音和水泡音消失3天后）复查。正常对照组选取同时期在我院进行健康体检的同年龄段小儿20例。血浆ACTH采应用电化学发光法，血清皮质醇应用化学发光免疫分析法，血清11β-HSD2水平测定采用ELISA双抗体夹心法检测。全部数据采用SPSS17.0统计分析软件进行处理。皮质醇、ACTH水平用中位数和四分位间距（M±Q）表示；11β-HSD2水平用平均数和标准差（x±s）表示。皮质醇、ACTH的急性期与恢复期、正常对照组比较均采用Kruskal-Wallis秩和检验，11β-HSD2组间比较采用t检验，以P0.05为差异有统计学意义。皮质醇与ACTH的相关性分析采用Spearman方法。研究结果显示，24例毛支患儿急性期皮质醇浓度[M±Q值（81.31±98.40）nmol/L]较正常对照组[M±Q值（226.05±143.90）nmol/L]显著性降低（P0.01）；恢复期皮质醇[M±Q值为（188.01±210.9）nmol/L]有不同程度的升高，与急性期相比，皮质醇升高有统计学意义（P0.01），与正常对照组相比无统计学意义（P0.05）。24例毛支患儿急性期ACTH浓度[M±Q值（1.11±2.77）pmol/L]与正常对照组[M±Q值（6.16±7.73）pmol/L]相比显著降低（P0.01）；恢复期有不同程度的升高[M±Q值（4.54±8.62）pmol/L]，部分可恢复至正常，与急性期相比水平升高（P0.01），恢复期与正常对照组相比虽然降低，但差异无统计学意义（P0.05）。皮质醇与ACTH水平相关性分析呈正相关。24例毛支患儿急性期11β-HSD2浓度[x±s值为（28.39±6.32）ng/ml]，与正常对照组[x±s值（29.89±5.63）ng/ml]和恢复期[x±s值为（31.50±5.45）ng/ml]比较、恢复期与正常对照组相比均无统计学意义（P0.05）。研究结果提示，毛细支气管炎患儿皮质醇、ACTH水平呈一致性降低，皮质醇和ACTH降低可能与毛支发病机制及病理改变有关；在毛支急性期，给予外源性糖皮质激素可有效补充内源性皮质醇生成不足，发挥皮质醇的局部抗炎作用。毛细支气管炎患儿皮质醇、ACTH水平检测可作为应用激素的指征，ACTH水平较皮质醇更敏感，恢复更早。有研究报道哮喘患儿血皮质醇水平明显低于正常儿童，在我们研究中，部分毛支患儿恢复期皮质醇、ACTH水平未恢复至正常，尤其ACTH未恢复正常患儿，是否较其他患儿以后易发展至哮喘，，尚待随访结果进一步证实。而能否作为毛支转化为哮喘发作的预测指标有待进一步研究。毛细支气管炎皮质醇水平降低，不是由于11β-HSD2水平升高所致。
[Abstract]:Bronchiolitis is a common infantile respiratory infection diseases, due to respiratory syncytial virus (RSV) infection caused by.RSV can directly cause airway mucosal injury, but also can be used as allergen induced anti RSV immune response, if excessive immune response can cause immune injury. The treatment of bronchiolitis include anti-virus and the prevention and treatment of bacterial infection, relieving asthma and other symptomatic and supportive treatment. The common clinical application of glucocorticoids as Zhichuan anti-inflammatory drugs, but the pros and cons of glucocorticoid in the treatment of bronchiolitis in effect is still controversial.
Clear ACTH, relationship between cortisol and beta -HSD2 in bronchiolitis in 11 level and the three, in order to guide the treatment of bronchiolitis glucocorticoid application, evaluation of prognosis and outcome of bronchiolitis. We selected from January 2010 to May 2011 in our hospital 24 cases of bronchiolitis were accorded with the diagnostic criteria of Fu Tang capillary practical in the science of bronchitis, after admission by serum enzyme linked immunosorbent assay (enzymelinkedimmunosorbentassay, ELISA) confirmed RSV infection. Among them 18 cases (acute cortisol and ACTH were significantly decreased in the recovery period (), wheezing and water bubble sound disappear after 3 days). 20 cases of normal control were the same age group in children select the same period in our hospital for physical examination. Plasma ACTH by Electrochemiluminescence Method, the serum cortisol by chemiluminescent immunoassay, serum -HSD2 11 beta ELISA level by double antibody clip method to detect heart. Part of the data using SPSS17.0 statistical analysis software for processing. The level of cortisol, ACTH median and four percentile interval (M + Q); 11 beta -HSD2 level with the average number and standard deviation (x + s). Cortisol, ACTH in acute stage and recovery period, the normal control group were compared using the Kruskal-Wallis rank sum comparison of 11 beta test, -HSD2 group using t test with P0.05, the difference was statistically significant. Correlation between cortisol and ACTH by Spearman method.
The results of the study showed that 24 cases of bronchiolitis in children with acute cortisol concentration of [M + Q value (81.31 + 98.40) nmol/L] compared with normal control group, [M + Q (226.05 + 143.90) nmol/L] decreased significantly (P0.01); recovery period [M + Q = cortisol (188.01 + 210.9) nmol/L] have different degrees of rise and compared with the acute stage, cortisol was statistically significant (P0.01), compared with the normal control group had no statistical significance (P0.05).24 patients with bronchiolitis in acute stage of ACTH concentration of [M + Q value (1.11 + 2.77) pmol/L] and [M in normal control group. The value of Q (6.16 + 7.73) significantly decreased (compared to pmol/L] P0.01); recovery period with different degrees of elevated [M + Q (4.54 + 8.62) pmol/L], can be restored to normal levels, compared with the acute stage (P0.01), the recovery period compared with the normal control group while decreased, but the difference was not statistically significant (P0.05). The correlation between cortisol and ACTH levels of positive analysis.24 cases of hair In the acute phase, the 11 beta -HSD2 concentration [x + s value is (28.39 + 6.32) ng/ml], compared with the normal control group, [x + s value (29.89 + 5.63) ng/ml] and recovery phase [x + s value is (31.50 + 5.45) ng/ml], the recovery period has no statistical significance compared with the normal control group (P0.05).
The results suggest that children with bronchiolitis cortisol, ACTH level showed a consistent decrease to reduce cortisol and ACTH may be related to the pathogenesis and pathological changes of bronchiolitis in acute stage; bronchiolitis, exogenous glucocorticoid can effectively supplement endogenous cortisol production is not sufficient, play local anti-inflammatory effects of cortisol. Cortisol in children with bronchiolitis. To detect the level of ACTH can be used as an indication of hormone level is more sensitive to cortisol, ACTH, recovery. Earlier studies have reported the blood of children with asthma cortisol levels were significantly lower than normal children, in our study, part of bronchiolitis recovery period of cortisol, ACTH levels were restored to normal, especially ACTH did not return to normal children, whether it is after the other children were prone to asthma, remains to be further confirmed. And the follow-up results can be transformed into bronchiolitis asthma refers to a forecast Step study. The decrease of cortisol levels in bronchiolitis is not due to a rise in the level of 11 beta -HSD2.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.6

【参考文献】