慢性阻塞性肺疾病合并骨质疏松症患者血清高密度脂蛋白胆固醇水平的变化

发布时间：2018-03-21 05:17

本文选题：慢性阻塞性肺疾病　切入点：高密度脂蛋白胆固醇　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：通过观察慢性阻塞性肺疾病（COPD）患者骨密度(BMD)、高密度脂蛋白胆固醇(HDL-c)、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）和体重指数（BMI）等指标的变化，探讨COPD患者HDL-c与骨质疏松症（OP）的关系。方法：入选60例稳定期COPD患者作为COPD组，60例健康体检者作为对照组，两组年龄、性别均匹配。采用问卷调查的形式统计所有研究对象年龄、性别、吸烟指数等基本资料。用双能X线吸收测定法测定腰椎（L_(1-4)）和双侧股骨颈的BMD，COPD组根据BMD结果分为COPD-OP组和COPD非OP组。用免疫抑制直接法进行血清HDL-c检测，酶联免疫吸附法进行血清IL-6、TNF-α检测，并对COPD患者进行肺功能（FEV1占预计值％、FEV1／FVC％）、动脉血氧分压（PaO2）等指标的检测。结果： 1. COPD组BMI（23.21±3.20）kg/cm_2较对照组（24.97±3.03）kg/cm_2明显偏低，骨量异常的比例(55/60，91.67%)和OP的检出率(26/60，43.33%)与对照组[（25/60，41.67%）和(5/60，8.33%）]相比明显增加，差异均有统计学意义（P均0.05)。 2. COPD组血清HDL-c(1.29±0.32) mmol/L、IL-6(18.82±12.87) pg/ml及TNF-α(123.01±109.55) pg/ml水平明显高于对照组[(1.13±0.22)mmol/L、(12.62±3.96) pg/ml、(66.08±47.16) pg/ml]，差异均有统计学意义（P均0.05)。 3. COPD-OP组FEV1占预计值％(51.18±15.25 )和FEV1／FVC％(40.77±8.72)明显低于COPD非OP组[(62.15±20.12)、(47.91±11.29 )]，，差异均有统计学意义（P均0.05）；COPD-OP组BMI（22.07±3.12）kg/cm_2明显低于COPD非OP组（24.08±3.29）kg/cm_2，差异有统计学意义（P0.05）；两组平均年龄、吸烟指数、PaO2及血清IL-6无明显差异性。 4. COPD-OP组血清HDL-c (1.45±0.34) mmol/L和TNF-α(158 .97±116.84) pg/ml明显高于COPD非OP组[(1.17±0.24) mmol/L、（96.09±94.26）pg/ml]，差异均有统计学意义（P均0.05）。 5. COPD组左、右股骨颈BMD与HDL-c呈显著负相关(r值分别为-0.313、-0.350，P均0.05)，并与FEV1／FVC％和BMI呈显著正相关(r值分别0.333、0.363、0.395、0.392，P均0.05)。 6. COPD组HDL-c与FEV1占预计值％、FEV1／FVC％及BMI呈显著负相关(r值分别为-0.368、-0.397、-0.361，P均0.05)。 7. Logistic多因素回归分析HDL-c（P=0.026，OR=0.053）和BMI（P=0.032，OR=1.324）对OP有显著作用。结论：COPD患者BMD普遍降低而血清HDL-c水平明显升高，COPD合并OP患者HDL-c水平高于无OP患者，HDL-c与BMD及肺功能减退程度呈负相关性。
[Abstract]:Objective: to observe the changes of bone mineral density (BMD), high density lipoprotein cholesterol (HDL-C), interleukin-6 (IL-6), tumor necrosis factor- 伪 (TNF- 伪) and body mass index (BMI) in patients with chronic obstructive pulmonary disease (COPD), and to explore the relationship between HDL-c and Osteoporosis (Osteoporosis) in patients with chronic obstructive Pulmonary Disease (COPD). Methods: 60 stable COPD patients were selected as COPD group and 60 healthy persons as control group. The age and sex of the two groups were matched. The basic data such as smoking index were determined by dual-energy X-ray absorptiometry. The BMD-COPD group was divided into COPD-OP group and COPD non-op group according to the results of BMD. The serum HDL-c was detected by immunosuppressive direct method. Serum IL-6 TNF- 伪 was detected by enzyme-linked immunosorbent assay (Elisa), and the ratio of FEV1 / FVC-1 to the predicted value of FEV1 / FVC- 伪 was measured in patients with COPD. The arterial partial pressure of oxygen (Pao _ 2) was measured. Results:. 1. Compared with the control group, the BMI(23.21 卤3.20 kg / cm2 of COPD group was significantly lower than that of the control group (24.97 卤3.03 kg / cm ~ 2, the ratio of abnormal bone mass was 55 / 6091.67) and the detection rate of op was 26 / 6043.33), which was significantly higher than that of the control group [2560 / 41.67) and 55.60608.33 (P < 0.05). 2. The levels of serum HDL-c(1.29 卤0.32 mmol / L IL-6N 18.82 卤12.87 pg/ml and TNF- 伪 123.01 卤109.55 pg/ml in COPD group were significantly higher than those in control group (1.13 卤0.22 mmol / L, 12.62 卤3.96) PG 路ml / L, 66.08 卤47.16 pg/ml, respectively (P < 0.05). 3. FEV1 in COPD-OP group (51.18 卤15.25) and FEV1/FVC%(40.77 卤8.72) were significantly lower than those in COPD non-op group (62.15 卤20.12 卤47.91 卤11.29), and the difference was statistically significant (P < 0.05), which was significantly lower than that in COPD non-op group (24.08 卤3.29 kg / cm ~ (-2)), and there was no significant difference in mean age, smoking index (Pao _ 2) and serum IL-6 between the two groups. 4. The serum HDL-c levels in COPD-OP group (1.45 卤0.34) mmol/L and TNF- 伪 (158 .97 卤116.84) pg/ml were significantly higher than those in COPD non-op group (1.17 卤0.24) mmol / L, 96.09 卤94.26 mg / ml, respectively. 5. In COPD group, there was a significant negative correlation between BMD and HDL-c in left and right femoral neck (r = -0.313) -0.350 (P < 0.05), and a significant positive correlation with FEV1 / FVC% and BMI (0.3330.363n 0.3950.392P, 0.05P, respectively). 6. In COPD group, there was a significant negative correlation between HDL-c and FEV1 / FEV1 / FVC% and BMI (r = -0.368- 0.397- 0.361P, respectively). 7. Logistic multivariate regression analysis showed that HDL-cP0. 026 ORA (0.053) and BMIP0. 032 (OR1. 324) played a significant role in op. Conclusion the level of HDL-c in BMD patients with op was significantly higher than that in patients without op, and there was a negative correlation between HDL-c and BMD and the degree of pulmonary dysfunction.
【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】：R563.9

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