前列环素在慢性阻塞性肺病合并肺血栓栓塞患者血浆中的变化及意义

发布时间：2018-03-24 20:50

本文选题：慢性阻塞性肺疾病　切入点：肺血栓栓塞　出处：《河南科技大学》2012年硕士论文

【摘要】：目的慢性阻塞性肺疾病（COPD）是一类以气流受限为特征的肺部疾病，患病人数多，死亡率高，COPD的慢性炎症是血栓形成的中心环节，因此被认为是PTE的中等危险因素，COPD合并PTE后死亡率也明显升高。本研究旨在通过观察前列环素（PGI2）在COPD及COPD合并PTE血清中的变化，研究PTE对COPD患者血清PGI2有无影响，探讨其可能的诊断价值及保护作用机制。方法30例慢性阻塞性肺疾病（COPD）急性加重患者，26例慢性阻塞性肺疾病合并肺血栓栓塞（COPD合并PTE）患者，来自2010年12月至2011年12月河南科技大学第一附属医院呼吸科住院患者。30例对照者来自同期河南科技大学第一附属医院体检中心的健康体检者。入选后测量观察对象的身高、体重、记录吸烟指数、病程。采用酶联免疫吸附测定法(ELISA)检测入选者血清中PGI2、D-二聚体（D-D）的水平。各项数据均以均数±标准差(— X±s)表示，两组以上样本资料采用单因素方差分析(One way ANOVA)，其中两两比较，满足方差齐性检验用LDS．q检验，不满足方差齐性检验用Dunnett,s T3检验，两因素相关分析用Spearson直线相关分析，检验水准a=0.05，按P0.05有统计学意义，SPSS l3.0统计软件包处理数据。结果 1．COPD合并PTE组和COPD急性加重期组的Fbg明显升高，平均值明显高于正常对照组，并且COPD合并PTE组稍高于COPD急性加重期组，三组间比较差异有统计学意义(P0.01)，组间两两比较差异有统计学意义(P0.05)。 2．COPD合并PTE组和COPD急性加重期组的D-D明显升高，平均值明显高于正常对照组，并且COPD合并PTE组明显高于COPD急性加重期组，三组间比较差异有显著统计学意义(P0.01)，组间两两比较差异有统计学意义(P0.05)。 3．COPD合并PTE组和COPD急性加重期组的LDH明显升高，，平均值明显高于正常对照组，并且COPD合并PTE组稍高于COPD急性加重期组，三组间比较差异有显著统计学意义(P0.01)，组间两两比较差异有统计学意义(P0.05)。 4．COPD合并PTE组和COPD急性加重期组的PGI2明显降低，平均值均明显低于正常对照组，并且COPD合并PTE组低于COPD急性加重期组，三组间比较差异有显著统计学意义(P0.01)，组间两两比较差异有统计学意义(P0.05)。 5．PGI2在COPD合并PTE组中，与D-二聚体相关性比较，Spearman相关系数r=-0.549，P0.01,两者间存在显著的负相关关系；PGI2在COPD急性加重期组组中，与D-二聚体相关性比较，Spearman相关系数r=-0.429，P=0.018,两者间存在显著的负相关关系，相关性没有PGI2在COPD合并PTE组中显著。 6. PGI2在COPD合并PTE组中，与FEV1.0/FVC相关性比较，Spearman相关系数r=0.562，P0.01,两者间存在显著的正相关关系；PGI2在COPD急性加重期组组中，与D-二聚体相关性比较，Spearman相关系数r=-0.415，P=0．031,两者间存在正相关关系，相关性没有PGI2在COPD合并PTE组中显著。结论 1．血浆Fbg和D-D水平在COPD急性加重期组较正常对照组明显升高，提示COPD急性加重期患者存在高凝状态，处于血栓前期。 2．血浆Fbg和D-D水平在COPD急性加重期组和COPD合并PTE组均明显升高，提示血浆Fbg和D-D水平可用作预测COPD合并PTE可能性的参考指标。 3．血浆LDH水平在COPD急性加重期组和COPD合并PTE组均升高，提示炎症、缺氧导致心肌细胞损伤，与既往研究相符。 4．COPD急性加重期组PGI2明显低于正常对照组，提示可能肺血管内皮细胞的损伤，生成减少，与既往相关研究相符。 5．COPD合并PTE组较COPD急性加重期组的PGI2明显降低，提示可作为预测COPD合并PTE的参考指标。 6.本研究提示PGI2或PGI2类似物治疗可能会预防COPD合并PTE，是COPD治疗的新思路。
[Abstract]:Chronic obstructive pulmonary disease (COPD) is a kind of restricted flow characteristics of lung disease, morbidity, high mortality, chronic inflammation of COPD is the central link of thrombus formation, so it is considered to be moderate risk factors of PTE, COPD and PTE after the mortality rate was significantly increased. This study aims to observe the prostacyclin (PGI2) changes in COPD and COPD with PTE in serum, PTE has no effect on serum COPD in patients with PGI2, to investigate the possible diagnostic value and protection mechanism.
Methods 30 cases of chronic obstructive pulmonary disease (COPD) patients with acute exacerbation, 26 cases of chronic obstructive pulmonary disease complicated with pulmonary thromboembolism (COPD and PTE) patients from the First Affiliated Hospital of Henan University of Science and Technology from December 2010 to December 2011 in Department of respiration patients with.30 controls from the First Affiliated Hospital medical center of Henan University of Science and Technology in the same period of observation object in healthy people. After the selected measuring height, weight, smoking index records, course of the disease. By enzyme linked immunosorbent assay (ELISA) were detected in sera of patients with PGI2, two D- dimer (D-D) levels. The data are mean standard deviation (-
X + s) said that more than two groups of sample data using single factor analysis of variance (One way ANOVA), of which 22, meet the homogeneity of variance using LDS.q test, does not meet the homogeneity of variance with Dunnett test, s T3 test, correlation analysis of two factors with Spearson linear correlation, test level a=0.05, according to the statistical significance of P0.05, SPSS and l3.0 statistical software package for data processing.
Result
1.COPD combined with PTE group and acute exacerbation of COPD group Fbg increased significantly, the average values were significantly higher than the normal control group, and COPD combined with PTE group was slightly higher than that of acute exacerbation of COPD group, there were significant differences between the three groups (P0.01), there was statistical significance between the 22 groups the difference (P0.05).
2.COPD combined with PTE group and acute exacerbation of COPD group D-D increased significantly, the average values were significantly higher than the normal control group, and COPD combined with PTE group was significantly higher than that of acute exacerbation of COPD group, there was significant difference between three groups (P0.01), between the 22 groups had a significant difference (P0.05).
3.COPD combined with PTE group and acute exacerbation of COPD group LDH increased significantly, the average values were significantly higher than the normal control group, and COPD combined with PTE group was slightly higher than that of acute exacerbation of COPD group, there was significant difference between three groups (P0.01), there was statistical significance between the 22 groups the difference (P0.05).
4.COPD combined with PTE group and COPD group of acute exacerbation of PGI2 was significantly reduced, the average value was significantly lower than that in normal control group, and PTE group was lower than that of COPD with acute exacerbation of COPD group, there was significant difference between three groups (P0.01), there was statistical significance between the 22 groups the difference (P0.05).
5.PGI2 in COPD with PTE group, compared with two D- dimer correlation, Spearman correlation coefficient r=-0.549, P0.01, there was a significant negative correlation between the two; PGI2 in acute exacerbation of COPD group, compared with two D- dimer correlation, Spearman correlation coefficient r=-0.429, P=0.018, there is a significant negative correlation between the two no significant correlation between PGI2 in COPD and PTE groups.
6. PGI2 in COPD with PTE group, compared with the FEV1.0/FVC correlation, Spearman correlation coefficient r=0.562, P0.01, there was a positive correlation between the two; PGI2 in acute exacerbation of COPD group, compared with two D- dimer correlation, Spearman correlation coefficient r=-0.415, P=0.031, there is a positive correlation between the two, no correlation PGI2 was in COPD with PTE group.
conclusion
1. plasma Fbg and D-D levels in COPD acute exacerbation group were significantly higher than those in the normal control group, suggesting that patients with acute exacerbation of COPD had hypercoagulable state and were in pre thrombotic stage.
2. the level of plasma Fbg and D-D in COPD acute exacerbation group and COPD combined PTE group increased significantly, suggesting that plasma Fbg and D-D levels can be used as a reference index to predict the possibility of COPD combined with PTE.
3. the level of plasma LDH increased in both the COPD acute exacerbation group and the COPD combined with the PTE group, suggesting that inflammation and hypoxia lead to myocardial damage, which is consistent with previous studies.
The PGI2 in the acute exacerbation group of 4.COPD was significantly lower than that in the normal control group, suggesting that the injury of the pulmonary vascular endothelial cells may be reduced and the formation of the cells was reduced, which was consistent with the previous related research.
The 5.COPD combined with PTE group was significantly lower than the PGI2 in the COPD acute exacerbation group, suggesting that it could be used as a reference index for predicting COPD combined with PTE.
6. this study suggests that the treatment of PGI2 or PGI2 analogues may prevent COPD with PTE, which is a new idea for the treatment of COPD.

【学位授予单位】：河南科技大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.9

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