慢性阻塞性肺病患者肋间外肌线粒体相关功能的临床研究

发布时间：2018-03-09 07:44

本文选题：慢性阻塞性肺病　切入点：肋间外肌　出处：《西南医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:研究不同营养状况慢性阻塞性肺疾病(COPD)患者肋间外肌线粒体功能。方法:收集20例COPD患者和10例非COPD对照组,将COPD患者分为低BMI COPD组(BMI18.5)和正常BMI COPD组(18.5BMI24.99),非COPD患者作为对照组。对三组患者进行了肺功能检查、血气分析、评估三组患者病情严重程度;通过测定肋间外肌组织中IL-6、IL-8和TNF-α的浓度,以及应用光镜观察肋间外肌肌细胞形态,评估三组患者的肋间外肌基本情况;测定肋间外肌线粒体蛋白浓度、呼吸链复合酶I-IV和超氧化物歧化酶(SOD)活性、线粒体膜通透性开放孔(MPTP)动力学,以及应用电镜观察线粒体形态,评估三组患者肋间外肌线粒体功能。采用Pearson进行FEV1与炎性指标和线粒体指标相关性分析。结果:与非COPD对照组相比,COPD患者的肺功能指标(FVC%、VC%、FEV1%、FEV1/预测值、FEV1/FVC和DLco)均显著降低(P0.05),低BMI COPD组的FEV1/预测值、FEV1/FVC值和DLco显著低于正常BMI COPD组(P0.05)。血气分析检查显示,正常BMI COPD组血液pH值和paCO2值与非COPD对照组无显著性差异(P0.05);低BMI COPD组血液pH值低于正常BMI COPD组和非COPD对照组(P0.05),paCO2值高于正常BMI COPD组(P0.05);COPD患者血液paO2值显著低于非COPD对照组(P0.05),低BMI COPD组低于正常BMI COPD组(P0.05)。肋间外肌组织指标检查显示,COPD患者的肋间外肌组织中IL-6、IL-8和TNF-α浓度显著高于非COPD对照组(P0.05),且低BMI COPD组显著高于正常BMI COPD组(P0.05)。肋间外肌光镜观察结果显示,COPD患者肋间外肌肌纤维间距增大和肌细胞变形随着健康状况不良而增大明显,低BMI COPD患者的肋间外肌形态结构变化更加明显。线粒体功能指标测定结果显示,与非COPD对照组相比,COPD患者的肋间外肌线粒体蛋白含量显著下降(P0.05),呼吸链复合酶I-IV和超氧化物歧化酶SOD活性显著降低(P0.05),MPTP的吸光度值下降显著(P0.05),且低BMI COPD组的上述指标与正常BMI COPD组相比,差异有统计学意义(P0.05);电镜观察线粒体形态学发现随着COPD患者营养状况恶化,肋间外肌线粒体基质密度下降,肿胀及髓样变形,线粒体膜损坏、溶解情况逐渐加重,低BMI COPD患者的线粒体结构变化更加明显。FEV1与IL-6、IL-8和TNF-α呈负相关关系,与线粒体蛋白含量、线粒体呼吸链复合酶I-IV和SOD呈正相关关系。结论:COPD患者存在不同程度的炎症反应和肺功能障碍,引起机体酸碱失衡和缺氧、血液二氧化碳含量升高,以及线粒体功能异常;随着COPD患者营养状况恶化,其炎症反应、肺功能、病情逐渐加重,且线粒体功能异常更加明显。
[Abstract]:Objective: to study the mitochondrial function of extracostal muscles in patients with chronic obstructive pulmonary disease (COPD) with different nutritional status. Methods: 20 patients with COPD and 10 patients with non COPD control group were collected. Patients with COPD were divided into low BMI COPD group (BMI 18.5) and normal BMI COPD group (n = 18.5BMI24.99g). Non COPD patients were used as control group. Pulmonary function and blood gas analysis were performed to evaluate the severity of the disease in the three groups. By measuring the concentration of IL-6 IL-8 and TNF- 伪 in the extracostal muscle tissue and observing the morphology of the muscle cells under light microscope, the basic condition of the intercostal extracostal muscle in the three groups was evaluated, and the concentration of mitochondrial protein in the extracostal muscle was measured. The activities of respiratory chain complex enzyme I-IV and superoxide dismutase (SOD), the kinetics of mitochondrial membrane permeability open hole (MPTP), and the morphology of mitochondria were observed by electron microscopy. To evaluate the mitochondrial function of the intercostal extracostal muscles in the three groups. To analyze the correlation between FEV1 and inflammatory and mitochondrial indexes by Pearson. Results: compared with the non-COPD control group, the pulmonary function index of the patients with COPD was significantly lower than that of the control group. The predicted values of FEV1/ and DLco in low BMI COPD group were significantly lower than those in normal BMI COPD group (P 0.05). There was no significant difference in blood pH value and paCO2 value between normal BMI COPD group and non-#en3# control group (P 0.05), while the lower BMI COPD group was lower than that of normal BMI COPD group and non-#en8# control group (P 0.05), and the paO2 value of normal BMI COPD group was significantly lower than that of non-#en12# control group. The level of IL-6 IL-8 and TNF- 伪 in the extracostal muscles of the patients with BMI was significantly higher than that in the non-#en4# control group (P0.05), and that in the low BMI COPD group was significantly higher than that in the normal BMI COPD group (P0.05). The level of IL-6 IL-8 and TNF- 伪 in the extracostal muscles was significantly higher in the low BMI COPD group than in the normal BMI COPD group, and the level of TNF- 伪 in the extracostal muscle tissue was significantly higher than that in the normal BMI COPD group. The results of myoscopy showed that the spacing of intercostal muscle fibers and the deformation of muscle cells in COPD patients increased significantly with poor health. The morphological and structural changes of the intercostal muscles in patients with low BMI COPD were more obvious. Compared with the control group, the content of mitochondrial protein in the extracostal muscle decreased significantly, and the activities of respiratory chain compound enzyme I-IV and superoxide dismutase (SOD) significantly decreased the absorbance of P0.05 and P0.05 in the low BMI COPD group. Compared with the normal BMI COPD group, Electron microscope observation showed that with the deterioration of nutritional status in patients with COPD, the density of mitochondria matrix decreased, swelling and myeloid deformation, mitochondrial membrane damage, and dissolution gradually aggravated with the decrease of the density of mitochondria matrix in the intercostal muscles. The changes of mitochondrial structure were more obvious in patients with low BMI COPD. FEV1 was negatively correlated with IL-6, IL-8 and TNF- 伪, and correlated with the content of mitochondrial protein. Conclusion there are different degree of inflammatory reaction and pulmonary dysfunction in patients with mitochondrial respiratory chain complex enzyme I-IV and SOD, which lead to acid-base imbalance and hypoxia, elevated blood carbon dioxide content and abnormal mitochondrial function. With the deterioration of nutritional status in COPD patients, the inflammatory reaction, pulmonary function and condition were gradually aggravated, and the abnormal mitochondrial function was more obvious.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9

【参考文献】