炎性标志物影响慢阻肺急性加重患者治疗的临床研究

发布时间：2018-03-26 02:42

本文选题：慢阻肺急性加重　切入点：嗜酸性粒细胞　出处：《扬州大学》2016年硕士论文

【摘要】：目的：通过对慢性阻塞性肺病(慢阻肺)急性加重患者进行临床表型分组,观察不同表型患者血清中性粒细胞/淋巴细胞(NLR)、C-反应蛋白(CRP)、嗜酸性粒细胞(EOS)等炎性标志物的变化及其对患者临床症状、肺功能和生活质量的影响。方法：1选择2015年02月至2015年12月期间在我院呼吸内科治疗的240例患者,其中男性189例,女性51例,年龄43-90岁。所有患者均符合中华医学会呼吸病学分会2014年修订的《慢性阻塞性肺疾病诊治指南》标准中急性加重的诊断标准,并根据Bafadhel对慢阻肺急性加重表型的分类方法,将入选患者分为嗜酸性粒细胞表型组及细菌感染表型组。2嗜酸性粒细胞表型患者给予糖皮质激素为主的综合治疗共7天,总结血清EOS%≥2%(A组)及EOS%2%(B组)患者,分别评估并比较治疗前后两组患者的血清标志物、肺功能、呼吸困难指数评分和临床症状(CAT问卷)的变化。3细菌感染表型患者给予抗感染为主的综合治疗共7天,总结CRP≥4mg/L且NLR2.56(A组)及CRP4mg/L且NLR2.56(B组)患者,分别评估并比较治疗前后两组患者的血清标志物、肺功能、呼吸困难指数评分和临床症状(CAT问卷)的变化。4所有数据应用SPSS17.0进行数据分析。结果：1嗜酸性粒细胞表型患者中,与B组相比,治疗后A组患者的血清EOS明显下降,CAT评分、FEV1、FEV1(%)及呼吸困难指数评分有明显改善(P0.05)。2细菌感染表型患者中,与B组相比,治疗后A组患者血清CRP及NLR明显下降,CAT评分、FEV1、 FEV1(%)及呼吸困难指数评分有明显改善(P0.05)。结论：1慢阻肺急性加重嗜酸性粒细胞表型患者中,血清EOS%2%患者,对糖皮质激素治疗更敏感；2慢阻肺急性加重细菌感染表型患者中,CRP≥4mg/L且NLR2.56的患者,抗生素治疗的效果更好。3血清中炎性标志物的表达可指导慢阻肺急性加重患者的个体化冶疗。
[Abstract]:Objective: to chronic obstructive pulmonary disease (COPD) in patients with acute exacerbation of clinical observation group, lymphocyte serum in patients with different phenotypes of neutral granulocyte / (NLR), C- reactive protein (CRP), eosinophils (EOS) and the variation of inflammatory markers and its clinical symptoms, lung the function and quality of life. Methods: 240 cases in the treatment of respiratory medicine in our hospital from 1 to December 2015 2015 02 month period of the patients, including 189 cases of male, female 51 cases, age 43-90 years old. All patients met the diagnostic criteria of Chinese medical association respiratory disease credits will be revised in 2014: guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease on the standard of acute exacerbation, and according to the Bafadhel of acute COPD exacerbation phenotype classification method, the patients were divided into eosinophil phenotype group and bacterial infection group.2 phenotype eosinophilic phenotypes were treated with sugar Corticosteroid therapy for 7 days, more than 2% summary of serum EOS% (A group) and EOS%2% patients (B group), were assessed before and after treatment were compared two groups of patients with serum markers, lung function, dyspnea index score and clinical symptoms (CAT questionnaire) the changes of bacterial infection were treated with.3 phenotype comprehensive treatment of anti infection. A total of 7 days, up more than 4mg/L and NLR2.56 CRP (A group) and CRP4mg/L and NLR2.56 (group B) were assessed before and after treatment were compared two groups of patients with serum markers, lung function, dyspnea index score and clinical symptoms (CAT questionnaire) the change of.4 all data applications SPSS17.0 for data analysis. Results: 1 patients with eosinophilic phenotypes, compared with the B group, after treatment of serum EOS in A group were significantly decreased, CAT score, FEV1, FEV1 (%) and dyspnea index score was significantly improved (P0.05).2 phenotype in patients with bacterial infection, and B Group compared with A group after treatment of serum CRP and NLR decreased significantly, the scores of CAT, FEV1, FEV1 (%) and dyspnea index score was significantly improved (P0.05). Conclusion: 1 patients with acute exacerbation of COPD eosinophilic phenotypes in patients with serum EOS%2% were more sensitive to glucocorticoid therapy 2; COPD acute exacerbation of bacterial infection in patients with CRP phenotype, 4mg/L and NLR2.56 in patients with inflammatory markers can guide COPD acute exacerbation of individual therapy in patients with serum performed better.3 antibiotic treatment.

【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R563.9

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