炎症标志物和自身抗体在慢性阻塞性肺疾病中的意义及与疾病加重的关系

发布时间：2018-01-02 00:29

本文关键词：炎症标志物和自身抗体在慢性阻塞性肺疾病中的意义及与疾病加重的关系　出处：《华中科技大学》2014年博士论文　论文类型：学位论文

【摘要】：研究背景慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是一种异质性疾病,不仅存在肺部异常,也存在肺外全身系统的异常。单纯依据肺功能检查并不能充分描述疾病的复杂性,也不利于疾病的控制。近来的研究发现有一部分稳定期COPD患者血液中炎症标志物的水平是升高的,有另一部分稳定期COPD患者血液中可检测到自身抗体,炎症标志物水平的升高与系统性炎症相关,自身抗体阳性则与自身免疫相关,两种因素可能都参与了COPD的疾病进展,并与预后存在一定的关系。目的本研究旨在明确稳定期COPD中是否存在炎症标志物水平的升高和自身抗体的出现,探索炎症标志物和自身抗体在COPD的意义及与COPD加重的关系。方法选择稳定期COPD患者和健康人入组,运用ELISA法检测血清中的炎症标志物：TNF-α IL-6. IL-8、CRP,运用间接免疫荧光法检测血清中的自身抗体：抗核抗体、抗弹力蛋白抗体。根据血液检测结果对COPD患者分组并随访1年,收集COPD加重事件,分析炎症标志物、自身抗体与COPD加重的关系。结果稳定期COPD患者入组75例,健康人入组20例,与健康对照组比较,有12例(16.0%) COPD患者血清中炎症标志物升高。有34例(45.3%)COPD患者血清中自身抗体阳性。其中有9例(12%)患者同时存在系统性炎症和自身免疫。相关性分析表明,IL-8与抗弹力蛋白抗体存在明显的正相关关系(r=0.331,p=0.004)。在1年的随访时间里,炎症标志物升高的患者平均加重次数次明显高于炎症标志物正常的患者[1.0(0.2)vs0.5(0.1),p=0.024],自身抗体阳性的患者平均加重次数也明显高于自身抗体阴性的患者[0.8(0.1)vs0.3(0.1),p=0.001]。结论有一部分稳定期COPD患者血液中炎症标志物的水平会升高,提示系统性炎症存在于COPD中,有另一部分稳定期COPD患者血液中可检测到自身抗体,提示自身免疫也存在于COPD中,炎症标志物与自身抗体正相关,提示系统性炎症与自身免疫存在相关性,两种因素可能相互影响,共同参与了COPD的疾病进展。炎症标志物升高(存在系统性炎症)或自身抗体阳性(存在自身免疫)的COPD患者可能具有更高的加重风险即更差的预后。
[Abstract]:Research background Chronic obstructive pulmonary disease (copd) is a heterogeneous disease. There are not only pulmonary abnormalities, but also abnormalities of the systemic system outside the lungs. The complexity of the disease can not be fully described by pulmonary function tests alone. Recent studies have found that levels of inflammatory markers in the blood of some stable COPD patients are elevated. Autoantibodies can be detected in the blood of other stable COPD patients. The increase of inflammatory markers is related to systemic inflammation, and autoantibody positive is associated with autoimmunity. Both factors may be involved in the progression of COPD and may be related to prognosis. Purpose The purpose of this study was to determine whether there were elevated levels of inflammatory markers and the presence of autoantibodies in stable COPD. To explore the significance of inflammatory markers and autoantibodies in COPD and its relationship with the aggravation of COPD. Method Patients with stable COPD and healthy persons were selected to enter the group. The inflammatory marker: TNF- 伪 IL-6. IL-8CRP in serum was detected by ELISA method. Indirect immunofluorescence assay was used to detect the autoantibodies in serum: antinuclear antibody and anti-elastin antibody. According to the results of blood test, the patients with COPD were divided into groups and followed up for one year to collect the aggravating events of COPD. To analyze the relationship between inflammatory markers, autoantibodies and COPD aggravation. Results 75 patients with stable COPD and 20 healthy persons were enrolled in the group, which was compared with the healthy control group. In 12 patients with COPD, the inflammatory markers were increased. 34 patients were positive for autoantibodies, 9 of them were positive for autoantibodies. Both systemic inflammation and autoimmunity were found in the patients. There was a significant positive correlation between IL-8 and anti-elastin antibody. The average exacerbation times of patients with elevated inflammatory markers were significantly higher than those with normal inflammatory markers. [The average exacerbation times of autoantibody positive patients were significantly higher than those of autoantibody negative patients. [(0. 0. 0. 0. 3, 0. 1 0. 0. 0. 0. 0. 0. 0. 0. 0. 1). Conclusion In some stable COPD patients, the level of inflammatory markers in the blood will increase, suggesting that systemic inflammation exists in COPD. Another part of stable COPD patients can detect autoantibodies in the blood, suggesting that autoimmunity also exists in COPD, inflammatory markers and autoantibodies are positively correlated. The results suggest that systemic inflammation is related to autoimmunity, and the two factors may influence each other. Co-involved in the progression of COPD. Elevated inflammatory markers (systemic inflammation) or autoantibodies (autoimmune). Ten percent of COPD patients may have a higher risk of exacerbation, or worse prognosis.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R563.9

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