COPD患者血清YKL-40的表达及临床意义

发布时间：2018-04-02 15:33

本文选题：COPD　切入点：人软骨糖蛋白　出处：《泸州医学院》2013年硕士论文

【摘要】：目的：通过检测COPD患者血清人软骨蛋白（YKL-40）水平，探讨YKL-40在COPD患者血清中的表达及临床意义。方法:采用ELISA法（免疫夹心抗体法）检测2012年1月到2012年12月期间泸州医学院附属医院住院COPD急性加重期患者60例，COPD缓解期患者65例，泸州医学院附属医院体检中心健康者20例(正常对照组)血清中YKL-40、金属蛋白酶9（MMP-9）、降钙素原（PCT）、超敏C反应蛋白（hs-CRP）表达水平。同时测定各组病例的肺功能，记录吸烟状况，细菌感染状况，，预后情况，通过统计软件分析了解COPD患者血清中YKL-40水平与吸烟等COPD发病危险因素的相关性；COPD患者血清YKL-40水平与MMP-9、hs-CRP的相关性， COPD患者血清中YKL-40水平与肺功能及疾病预后的相关性；COPD患者血清YKL-40水平与PCT比较在COPD合并细菌感染患者中的标记作用。结果： 1、COPD急性加重期组、COPD缓解期组患者血清中YKL-40表达水平升高，且与正常对照组比较有统计学差异(P0．01)。 2、在对照组、COPD组、AECOPD组中，吸烟者血清中YKL-40表达水平高于未吸烟者,血清YKL-40水平的升高和吸烟有关。 3、在COPD缓解期组中，血清中YKL-40表达水平与肺功能FEV1.0％pred呈负相关（r=-0．5，PO．01)；血清YKL-40表达水平与MMP-9水平呈正相关（r=0.751,PO．01),与hs-CRP水平呈正相关（r=0,503,PO．01)。在AECOPD组中血清中YKL-40表达水平与PCT水平呈正相关（r=0,486,PO．01)。 4、在COPD急性加重期组，临床预后较差者血清中YKL-40表达水平高于预后良好者，差异有统计学意义（P0.05）。 5、在COPD急性加重期组，合并细菌感染者血清YKL-40水平、PCT水平均较未合并细菌感染患者高，差异有统计学意义（P0.01）结论： 1、COPD缓解期和急性加重期患者血清YKL-40水平较正常对照组升高，急性加重期患者血清YKL-40水平高于临床缓解期；吸烟者血清YKL-40表达水平较未吸烟者升高。 2、YKL-40水平与MMP-9、hs-CRP水平呈正相关，提示YKL-40可能是COPD发病机制中的新通路；血清YKL-40水平与肺功能FEV1.0％pred呈负相关，提示YKL-40是COPD的一个炎症因子，可以预测COPD病情的严重程度。 3、在COPD急性加重期患者中，合并细菌感染者血清YKL-40水平、PCT水平均较未合并细菌感染患者高，血清YKL-40水平与血清PCT水平呈正相关；血清YKL-40水平在COPD急性加重期患者中预后较差者高于预后较好者。提示血清YKL-40水平在判断AECOPD患者是否合并感染以及预测预后方面有临床价值，但其参考水平需进一步研究。
[Abstract]:Objective: to investigate the expression and clinical significance of YKL-40 in the serum of COPD patients by detecting the level of human chondroprotein (YKL-40) in serum of patients with COPD.Methods: from January 2012 to December 2012, 60 patients with acute exacerbation of COPD in affiliated Hospital of Luzhou Medical College were detected by ELISA method.The expression levels of YKL-40, MMP-9, PCTX and hs-CRP in serum of 20 healthy subjects (normal control group) in the affiliated hospital of Luzhou Medical College.At the same time, the lung function, smoking status, bacterial infection and prognosis of each group were measured.The correlation of serum YKL-40 level with smoking and other risk factors of COPD was analyzed by statistical software. The correlation between serum YKL-40 level and MMP-9 hs-CRP in COPD patients, and the correlation between serum YKL-40 level and pulmonary function and disease prognosis in COPD patients were analyzed.Serum YKL-40 levels were compared with PCT in COPD patients with bacterial infection.Results:1the expression of YKL-40 in serum of patients with acute exacerbation of COPD was significantly higher than that of normal controls (P 0.01).2. In the control group, the expression of YKL-40 in serum of smokers was higher than that of non-smokers, and the increase of serum YKL-40 level was related to smoking.In AECOPD group, the expression of YKL-40 was positively correlated with the level of PCT.4. In the group of acute exacerbation of COPD, the expression of YKL-40 in the serum of the patients with poor prognosis was higher than that of the patients with good prognosis, and the difference was statistically significant (P 0.05).5. In the acute exacerbation stage of COPD group, the serum YKL-40 level in the patients with bacterial infection was higher than that in the patients without bacterial infection, and the difference was statistically significant (P 0.01).Conclusion:1the serum YKL-40 level in patients with acute exacerbation and remission was higher than that in normal controls, and the level of serum YKL-40 in patients with acute exacerbation was higher than that in patients with acute exacerbation, and the level of serum YKL-40 in smokers was higher than that in non-smokers.2YKL-40 level was positively correlated with MMP-9 hs-CRP level, suggesting that YKL-40 may be a new pathway in the pathogenesis of COPD, and serum YKL-40 level was negatively correlated with pulmonary function FEV1.0%pred, suggesting that YKL-40 is an inflammatory factor of COPD and can predict the severity of COPD.3. In patients with acute exacerbation of COPD, the level of serum YKL-40 in patients with bacterial infection was higher than that in patients without bacterial infection, and the level of serum YKL-40 was positively correlated with the level of serum PCT.The level of serum YKL-40 in patients with acute exacerbation of COPD was higher than that in patients with poor prognosis.The results suggest that the serum YKL-40 level has clinical value in judging the co-infection and predicting the prognosis of AECOPD patients, but its reference level needs to be further studied.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.9

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