肾上腺髓质素在婴幼儿细菌性肺炎的诊断及小鼠体内干预作用的初探

发布时间：2018-07-10 00:44

本文选题：肾上腺髓质素 + 肾上腺髓质素前体中段肽　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:本研究拟在探讨MR-proADM联合PCT在婴幼儿细菌性肺炎诊断与病情评估中的临床参考价值;同时初步研究外源性ADM在幼龄小鼠细菌性肺炎转归中的干预作用,以期为婴幼儿细菌性肺炎的诊疗提供新的思路。方法:1.选取132例出院确诊为细菌性肺炎的患儿,根据入院时感染的严重程度分为局限性感染组49例,脓毒症组40例,严重脓毒症组35例,脓毒性休克组8例;选取同期病毒性肺炎患儿110例设为病毒感染组,将同期体检正常儿童106例设为健康对照组。比较各组婴幼儿MR-proADM与PCT水平,分析MR-proADM与PCT在细菌性肺炎中的诊断价值及联合应用后诊断性能的变化;通过Pearson相关分析论证MR-proADM、PCT与PCIS评分的相关性;对细菌感染不同程度组MR-proADM与PCT的诊断价值分别进行分析,计算二者联合应用后的后验概率。实验数据采用SPSS17.0软件进行统计分析。2.选用健康清洁级雄性幼龄小鼠,建立幼龄小鼠肺炎克雷伯菌肺炎模型,取用造模成功小鼠60只,随机分为肺炎感染组(PA组)30只,ADM干预组(ADM组)30只。选取健康幼龄小鼠30只设为正常对照组。三个实验动物组分别在处理后第6h、12h、24h随机抽取10只小鼠,用戊巴比妥钠腹腔麻醉,收集各个时间点小鼠左肺灌洗液,留取0.5ml用于细菌培养及菌落计数;将剩余灌洗液经离心处理后用ELISA法检测其中IL-10、IL-17、TNF-α的浓度。取小鼠右肺组织经甲醛溶液固定,HE染色后,进行肺组织病理学评分,实验数据采用SPSS17.0软件进行统计分析。结果:1.婴幼儿肺炎细菌感染组中MR-proADM水平显著高于病毒感染组与健康对照组(P0.05),PCT水平显著高于病毒感染组与健康对照组(P0.05)。2.MR-proADM与PCT联合应用后,细菌性肺炎诊断的敏感度增至98.05%,特异度增至96.21%,诊断符合率增至97.38%;MR-proADM、PCT与PCIS评分呈负相关;细菌感染不同程度组MR-proADM与PCT联合应用后后验概率均显著升高。3.12h、24h ADM组肺泡灌洗液菌落计数均明显低于PA组(P0.05);同一时间点肺组织病理学评分两两比较差异均有统计学意义(P0.05);同一时间点ADM组IL-17、TNF-α水平均显著低于PA组(P0.05),而IL-10水平ADM组显著高于PA组(P0.05)。结论:本研究证实了MR-proADM联合PCT应用可以进一步提高婴幼儿细菌性肺炎诊断与病情评估的准确性;同时研究发现外源性ADM在幼龄小鼠细菌性肺炎中具有显著的抗菌、抗炎效能,证明ADM在细菌性肺炎病程中对肺组织起到重要的保护作用,为婴幼儿细菌性肺炎的诊疗提供了新的途径。
[Abstract]:Objective: to explore the clinical reference value of MR-proADM combined with PCT in the diagnosis and evaluation of bacterial pneumonia in infants, and to study the effect of exogenous ADM on the prognosis of bacterial pneumonia in young mice. In order to provide new ideas for the diagnosis and treatment of infantile bacterial pneumonia. Method 1: 1. According to the severity of infection on admission, 132 children with bacterial pneumonia were divided into localized infection group (n = 49), sepsis group (n = 40), severe sepsis group (n = 35) and septic shock group (n = 8). 110 children with viral pneumonia were selected as viral infection group and 106 normal children as healthy control group. The levels of MR-proADM and PCT in infants were compared, the diagnostic value of MR-proADM and PCT in bacterial pneumonia and the changes of diagnostic performance after combined use were analyzed, and the correlation between MR-proADM and PCS score was demonstrated by Pearson correlation analysis. The diagnostic value of MR-proADM and PCT in groups with different degrees of bacterial infection was analyzed, and the posterior probability of the combined use of MR-proADM and PCT was calculated. The experimental data were analyzed by SPSS 17.0 software. The healthy and clean grade male young mice were selected to establish the pneumonia model of Klebsiella pneumoniae in young mice. Sixty successful mice were selected and randomly divided into two groups: pneumonia infection group (PA group) and ADM intervention group (ADM group). 30 healthy young mice were selected as normal control group. Ten mice were randomly selected from the three experimental groups at the 6th hour, 12h and 24h after treatment. The mice were anesthetized with pentobarbital sodium intraperitoneally. The left lung lavage fluid was collected at each time point, and 0.5ml was retained for bacterial culture and colony count. The concentration of IL-10, IL-17 and TNF- 伪 was detected by Elisa after centrifugation. The right lung tissue of mice was stained with HE in formaldehyde solution and the pathological score of lung tissue was evaluated. The experimental data were statistically analyzed by SPSS 17.0 software. The result is 1: 1. The levels of MR-proADM in infantile pneumonia bacterial infection group were significantly higher than those in viral infection group and healthy control group (P0.05). 2. After combined use of MR-proADM and PCT, the levels of MR-proADM in infantile pneumonia bacterial infection group were significantly higher than those in viral infection group and healthy control group (P0.05). The sensitivity and specificity of diagnosis of bacterial pneumonia increased to 98.05 and 96.21 respectively. The diagnostic coincidence rate increased to 97.38% and the PCT was negatively correlated with PCIS score. After combined use of MR-proADM and PCT in different degree of bacterial infection, the colony count of alveolar lavage fluid in ADM group was significantly higher than that in PA group (P0.05), and there were significant differences in lung histopathological score at the same time point. At the same time, the level of IL-17 TNF- 伪 in ADM group was significantly lower than that in PA group (P0.05), while IL-10 level in ADM group was significantly higher than that in PA group (P0.05). Conclusion: this study confirmed that MR-proADM combined with PCT can further improve the accuracy of diagnosis and evaluation of bacterial pneumonia in infants, and found that exogenous ADM has significant antibacterial and anti-inflammatory effects in young mice with bacterial pneumonia. It is proved that ADM plays an important role in the protection of lung tissue in the course of bacterial pneumonia and provides a new way for the diagnosis and treatment of infantile bacterial pneumonia.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.6

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