间质性肺疾病诱导痰细胞学分型的分析研究

发布时间：2018-04-10 23:14

  本文选题：间质性肺疾病 + 诱导痰　； 参考：《吉林大学》2012年硕士论文

【摘要】：目的：通过诱导痰细胞学检查手段比较间质性肺疾中不同种类疾病患者痰中的细胞学分型，从而探讨间质性肺疾病不同种类疾病的发病机制和病理过程，试图探索一种新型安全且准确的间质性肺疾病的诊断检查方法。 方法：选取吉林大学白求恩第一医院2011年1月至2012年3月临床明确诊断为间质性肺疾病的在院患者30例，，其中特发性肺纤维化（IPF）患者16例、结节病（SA）患者14例，另选取非吸烟健康对照者10例。上述受试者均应用超声雾化的方法给予吸入3.5%浓度的高渗盐水进行痰诱导试验，吸入时间依次为2、4、8、16分钟，每次吸入后间隔停顿1分钟并进行肺功能检查，确保受试者吸入高渗盐水的总诱导时间不超过30分钟。查看FEV1%预计值并观察患者耐受情况。如果FEV1值较试验前下降超过10%，则立即给予受试者吸入200μg沙丁胺醇，观察患者呼吸情况并于10min后再次测量FEV1，若FEV1值改善至较实验前下降不超过10%则可继续进行雾化吸入诱导实验；若FEV1值无明显改善，较实验前下降仍超过10%或者患者感到胸闷、喘息等不适，则立即终止试验。诱导吸入后嘱受试者漱口及清理鼻腔，鼓励其咳深部痰，收集受试者痰液，在收集痰液后2小时内进行痰液处理，即将痰液进行分解、过滤、离心和涂片制成样片，在高倍显微镜下计数各个样片的细胞总数，计算其中各炎症及免疫效应细胞所占的比例，利用统计学中的t检验方法在检验水平p=0.05时进行分析比较各个受试者痰液样片中炎性细胞和淋巴细胞的数量和比率。 结果： 1.细胞总数：间质性肺疾病患者诱导痰中炎性细胞及免疫效应细胞总数目均明显高于健康受试者。IPF组细胞总数为（4.4±2.3）×106/ml，SA组为（4.6±2.1）×106/ml，分别与对照组相比p＜0.05，差异有统计学意义。 2.巨噬细胞：对照组巨噬细胞比率为52.1±29.1%，IPF和SA组均低于对照组，IPF组为37.2±21.9%，SA组为36.7±22.6%，分别于对照组相比P＜0.05，差异有统计学意义。 3.中性粒细胞： IPF和SA组患者诱导痰中中性粒细胞比率均较对照组增高，但以IPF组增高较为显著。IPF组为53.3±22.2%，与对照组比p＜0.05，差异有统计学意义； SA组为45.8±20.7%，与对照组相比，p＞0.05，差别不显著。 4.淋巴细胞： IPF组和SA组患者诱导痰中淋巴细胞比率均较对照组增高，但以SA组增高较为显著。SA组为12.4±7.4%，与对照组相比P＜0.05，差异有统计学意义；IPF组为8.7±5.5%，与对照组相比，p＞0.05，差别不显著。 5.嗜酸性粒细胞：SA组嗜酸性粒细胞比例为1.9±2.6%，与健康对照组相比明显增高，P＜0.05，差异有统计学意义，IPF组于对照组相比无明显差别，P＞0.05。 结论： 1.间质性肺疾病患者痰中炎症细胞和免疫效应细胞较健康人群增高。 2.不同病理机制的间质性肺疾病患者诱导痰中炎症细胞及免疫细胞比例不同，其结果符合病理学检查。 3.痰诱导的方法对诊断间质性疾病及研究间质性肺疾病的发病机制及病理过程有一定临床意义。
[Abstract]:Objective: through different types of disease in patients with sputum cytology of induced sputum cytology means of interstitial lung disease in type, and to explore the pathogenesis and pathological process of interstitial lung disease in different diseases, tries to explore a new safe and accurate interstitial lung disease diagnosis method.
Methods: from January 2011 to March 2012 in the first hospital of Jilin University Bethune clinical diagnosis of interstitial lung disease in 30 cases of patients with idiopathic pulmonary fibrosis (IPF) patients with 16 cases, 14 cases of patients with sarcoidosis (SA), the other selected non smoking 10 healthy subjects. The subjects were used ultrasonic atomization inhaling concentration of 3.5% hypertonic saline induced sputum test, inhalation time: 2,4,8,16 minutes, each time interval of 1 minutes after inhalation of pause and pulmonary function test, to ensure that the total subjects were induced by inhalation of hypertonic saline is not more than 30 minutes. See the FEV1% predicted and observed the patients tolerated if FEV1. Before the test value is decreased more than 10%, immediately give the subjects inhaled 200 g salbutamol, observe the patient breathing and 10min measured again after FEV1, if the FEV1 value is improved to fall before the experiment does not exceed 1 0% can continue inhalation induction experiment; if the FEV1 value was not improved compared to before drop is still more than 10% or the patients feel chest tightness, wheezing and other discomfort, immediately after inhalation induced termination of the trial. The subjects prescribed mouthwash and clean up the nasal cavity to encourage the deep sputum cough, sputum were collected. In the collection of sputum sputum within 2 hours after the treatment, the sputum decomposition, filtration, centrifugation and smear made samples under the microscope counting each sample cell number calculation, which accounted for the proportion of inflammatory and immune effector cells, using the t test method of statistics in the inspection level p=0.05 analysis comparison of various subjects the number and ratio of sputum samples in inflammatory cells and lymphocytes.
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