多方法综合评估药物干预对哮喘的控制

发布时间：2018-03-18 09:19

本文选题：支气管哮喘　切入点：气道重塑　出处：《山西医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的： 1.利用哮喘控制测试(asthma control test,ACT)评分、HRCT (高分辨CT)、肺功能和生物标志物综合评估哮喘的控制情况； 2.从ACT评分、HRCT、肺功能和生物标志物三个方面探讨治疗性干预对哮喘患者气道重塑的改变。方法： 1.2008年就诊于山西医科大学第一医院的哮喘患者筛选48例,治疗前行高分辨CT、肺功能检查及诱导留取痰液。 2.根据GINA方案规范分级治疗1年后再次随访,利用ACT调查问卷评估哮喘控制情况,再次行上述检查,并行痰涂片计数嗜酸细胞百分比(EOS%),利用ELASA(enzyme linked immunosorbent assay)方法检测痰液中的MMP-9(matrix metalloproteinase-9基质金属蛋白酶-9)、TIMP-1(tissue-inhibitor metalloproteinase-1基质金属蛋白酶抑制剂-1)和TGF-β1(transforming growth factor-β1转化生长因子-β1)水平。 3.通过HRCT,测量WA%(Percentage airway wall area气道壁面积占气道面积的百分比)、2T/D (airway wall thickness to airway diameter气道壁厚度与气道直径之比2倍)及吸、呼气相肺组织密度。结果： 1.通过规律的药物干预治疗后,对哮喘患者进行1年来ACT评估：完全控制组15例,部分控制组12例,未控制组7例；各组间WA%、2T/D比较,完全控制组与部分控制组相比有统计学意义(P0.05),TGF-β1在完全控制组与部分控制组、未控制组比较有统计学意义(P0.05)。 2.高分辨CT哮喘患者的2T/D、WA%较治疗前有统计学意义(P0..05),并有所降低；治疗前后患者HRCT的肺组织密度在吸气相和呼气相比较无统计学意义(P0.05),但吸、呼气相的差值相比较有统计学意义。 3.治疗后痰液中的MMP-9、TIMP-1、TGF-β1浓度较治疗前有统计学意义(均P0.05),并有所减少。 4.治疗后患者HRCT的2T/D、WA%与痰液中的MMP-9、TIMP-1、MMP-9/TIMP-1及TGF-β1因子有较好的正相关性(P0.05),而与肺功能中的第一秒用力呼气容积百分比(FEV1%)、1秒率(FEV1/FVC%)、用力肺活量百分比(FVC%)有负相关性(P0.05)；且痰液中的EOS%与肺功能中的FEV1%、FEV1/FVC%有负相关性(P0.05)。结论： 1.ACT评分、高分辨CT、肺功能及痰液等可以更为综合全面的评价哮喘患者的控制情况。 2.药物干预治疗可使哮喘患者的气道壁厚度、气体潴留、肺功能得到改善，，并使炎症细胞因子有所下降，从而阻止哮喘的反复发作及不可逆气流阻塞的形成。
[Abstract]:Objective:. 1. The asthma control test was used to evaluate the control status of asthma by high resolution CT (HRCT), lung function and biomarkers. 2. To explore the changes of airway remodeling in asthmatic patients with therapeutic intervention from ACT score, pulmonary function and biomarkers. Methods:. 1. In 2008, 48 patients with asthma were selected from the first Hospital of Shanxi Medical University. Before treatment, high resolution CTS, pulmonary function test and induced sputum collection were performed. 2. According to the standard and graded treatment of GINA, the patients were followed up again after one year, and the control of asthma was evaluated by ACT questionnaire, and the above examinations were performed again. The percentage of eosinophils in sputum smear was counted. The levels of MMP-9(matrix metalloproteinase-9 matrix metalloproteinase-9 (TIMP-1) and TGF- 尾 _ 1transforming growth factor- 尾 _ 1 (TGF- 尾 _ 1transforming growth factor- 尾 _ 1) in sputum were detected by ELASA(enzyme linked immunosorbent assay. 3. The ratio of airway wall area to airway area of WA%(Percentage airway wall area was measured by HRCT. The ratio of airway wall thickness to airway diameter of WA%(Percentage airway wall area was 2 times that of wall thickness to airway diameter, and the density of lung tissue in expiratory phase was measured. Results:. 1.After regular drug intervention, ACT was evaluated in 15 cases of complete control group, 12 cases of partial control group, 7 cases of uncontrolled group, and the comparison of WAG 2T / D between groups, among which 15 cases were in complete control group, 12 cases in partial control group and 7 cases in uncontrolled group. Compared with partial control group, TGF- 尾 1 in the complete control group was significantly higher than that in the partial control group, and that in the non-control group was significantly higher than that in the non-control group. 2.The 2T / DGW% of the patients with high-resolution CT asthma was significantly lower than that of the patients before and after treatment, and the lung tissue density of the patients with HRCT before and after treatment had no significant difference in inspiratory phase and expiratory phase (P 0.05), but the difference between inhaling and expiratory phase was statistically significant. 3. The concentrations of MMP-9 and TIMP-1TGF- 尾 1 in sputum after treatment were significantly higher than those before treatment (all P 0.05, P < 0.05). 4.After treatment, there was a good positive correlation between 2T / DWA% of HRCT and MMP-9 / TIMP-1MMP-9 / TIMP-1 and TGF- 尾 1 factor in sputum, but there was a negative correlation with the percentage of forced expiratory volume of 1 second in pulmonary function and FEV1, 1 seconds rate of FEV1 / FVCCV, the percentage of forced lung vital capacity (FVC5); and the sputum sputum, the percentage of forced expiratory volume in sputum was negatively correlated with that of FEV1 / FVCV, and the percentage of FVC1 in sputum had a negative correlation (P0.05). There was a negative correlation between EOS% and FEV1 / FVC% in pulmonary function. Conclusion:. 1. ACT score, high resolution CTS, pulmonary function and sputum can be used to evaluate the control of asthma more comprehensively. 2. Drug intervention can improve airway wall thickness, gas retention, pulmonary function and inflammatory cytokines in asthmatic patients, thus preventing the recurrence of asthma and the formation of irreversible airflow obstruction.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R562.25

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