应激激素对慢性阻塞性肺疾病患者急性加重风险的影响

发布时间：2018-04-11 08:32

  本文选题：慢性阻塞性肺疾病急性加重 + 应激　； 参考：《广西医科大学》2017年硕士论文

【摘要】：目的:通过检测慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者急性发作时血清皮质醇、促肾上腺皮质激素(Adrenocorticotropic hormone,ACTH)、肾素、血管紧张素水平,探讨COPD患者急性加重时是否存在应激,观察不同应激激素水平对患者症状、病情程度,以及患者出院后生活质量的改善程度、再发急性加重风险的影响。方法:采用前瞻性研究的方法,于2015年12月至2016年8月,对符合COPD急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)诊断并入住广西医科大学第一附属医院老年呼吸科的老年患者逐一入选。1.分别对入选患者进行病情评估,采用2013年颁布的COPD全球倡议中的COPD综合评估系统,通过症状评估、肺功能评估、急性加重风险评估将患者分为A、B、C、D四组;2.采用BODE预后指数,即体重指数(body-mass index,B),气流受限程度(the degree of airflow obstruction,O),呼吸困难评分(dyspnea,D)和运动耐量(exercise capacity,E),对入选患者进行预后评分;3.采用放射免疫法对患者血清皮质醇、ACTH、肾素、血管紧张素Ⅱ进行检测。4.入选患者出院后,对其进行半年的随访,包括电话随访和门诊、住院随访,观察患者存活率和治疗后生活质量。结果:1.COPD病人急性加重时血清肾素、血管紧张素Ⅱ水平明显升高(P0.05),而血清皮质醇、ACTH水平较对照组低但无统计学差异(P0.05);2.应激组病人急性加重时血清皮质醇水平明显升高(P0.05),症状较无应激组明显(P0.05),住院时间长(P0.05),出院后6个月内出现再次急性加重的例数较无应激组多(P0.01),症状缓解程度差(P0.05)。结论:1.大多数COPD病人急性加重时存在不同程度的应激。2.老年AECOPD患者的应激特征表现为不完全应激,即血清肾素、AngⅡ水平增高,而促肾上腺激素和皮质醇水平增高不明显。3.与无应激患者比,应激增加了COPD患者出院后6个月内再发急性加重的风险。
[Abstract]:Objective: to detect the levels of serum cortisol, adrenocorticotropin, renin and angiotensin in patients with chronic obstructive pulmonary disease (COPD) during acute attack.To observe the effect of different stress hormone levels on symptoms, severity of illness, and quality of life of patients after discharge, and the risk of recurrent acute exacerbation.Methods: from December 2015 to August 2016, the elderly patients with acute exacerbation of chronic obstructive pulmonary disease diagnosed and admitted to the Department of Geriatric Respiratory in the first affiliated Hospital of Guangxi Medical University were selected from December 2015 to August 2016.The patients were evaluated by the COPD comprehensive assessment system of the COPD Global Initiative published in 2013. The patients were divided into four groups by symptom assessment, pulmonary function assessment and acute exacerbation risk assessment.BODE prognostic index, body mass index, degree of airflow obstruction, dyspnea score and exercise exercise capacity were used to evaluate the prognosis of the selected patients.Serum cortisol ACTH, renin and angiotensin 鈪，

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