鼻粘膜电位差在缺氧性肺损伤中应用的meta分析

发布时间：2018-05-17 14:29

  本文选题：鼻粘膜电位差 + 缺氧性肺损伤　； 参考：《新乡医学院》2017年硕士论文

【摘要】：背景鼻粘膜电位差(Nasal potential difference,NPD)是肺囊性纤维化一个很好的临床检测方法,它能够反映呼吸道上皮阳离子和阴离子的跨上皮转运。携带电荷的离子的跨上皮转运会形成跨上皮电压,即电位差。呼吸道上皮电位差可以通过鼻腔测定,即NPD。影响鼻粘膜电位差的离子通道主要有调节钠离子的上皮钠离子通道(ENaC)、调节氯离子的囊性纤维化跨膜传导调节因子(CFTR)以及提供能量的Na+/K+-ATP酶等,ENaC是一种对氧敏感的离子通道,缺氧会损伤ENaC,进而影响离子的跨膜转运,影响电位差。目的通过分析NPD总的基线值以及各组成部分的值在缺氧性肺损伤病人中的变化,分析出NPD能否应用于缺氧性肺损伤的辅助诊断。方法制定检索策略以及文献的纳入标准和排除标准,用PubMed、EMBASE、Scopus、Web of Science、Ovid MEDLINE和Google Scholar等数据库进行检索文献,从11篇无偏倚的研究,包括7篇HAPE和4篇RDS中提取数据,提取的数据用均数±标准差(x±s)形式表示,若原始数据不是x±s形式则用相关公式计算转化为x±s形式,用RevMan、Stata和R软件分析这些数据,分析得出的主要结果用权重均数差(WMD)及95%可信区间(CI)表示。结果肺损伤病人中总NPD值(WMD-5.27 mV,95%CI:-6.03到-4.52,P0.00001,I2=42%)、阿米洛利敏感部分(ENaC)NPD值(WMD-2.87 mV,95%CI:-4.02到-1.72,P0.00001,I2=51%)和抗阿米洛利部分NPD值(WMD-3.91 mV,95%CI:-7.64到-0.18,P=0.04,I2=95%)均有明显降低。对HAPE和RDS进行亚组分析得出,在HAPE中,这三部分NPD值同样明显降低,而在RDS中抗阿米洛利部分NPD值无明显降低。另外,SpO2仅在病人中和ENaC相关部分的NPD呈正相关关系,与其它部分NPD及健康人中任何部分NPD都无相关关系。病人组中ENaC相关部分的NPD值和海拔高度之间呈负相关关系证实了这些相关性,因为海拔高度和SpO2水平呈负相关关系。海拔高度与病人组及健康人组中其它部分NPD无相关关系。总的基线NPD无论在病人中还是健康人中都和抗阿米洛利部分NPD明显呈正相关关系,而和其它部分NPD没有相关关系。结论我们的分析结果表明和系统缺氧相关的急性肺损伤是以NPD功能失调为特点的,ENaC NPD部分可以用来表明肺泡液重吸收情况,NPD可以作为缺氧性肺损伤的辅助诊断方法,同时为将来开展使用床旁测量NPD技术评估HAPE和RDS病人中水肿液重吸收情况的临床试验提供了数据基础。
[Abstract]:Background Nasal potential difference (NPD) is a good clinical method for detecting pulmonary cystic fibrosis. It can reflect the trans epithelial transport of the cationic and anions of the respiratory tract. The trans epithelial transport of the charged ions will form a cross epithelial voltage, that is, the potential difference of the respiratory epithelium can pass through the nose. Cavity determination, that is, NPD. affects the nasal mucosal potential difference in the ionic channel, which regulates the sodium ion channel (ENaC), modulates the cystic fibrosis transmembrane conduction regulator (CFTR) and the Na+/K+-ATP enzyme that provides energy. ENaC is an oxygen sensitive ion channel. Hypoxia will damage ENaC and then affect the ion span. Membrane transport, affecting the potential difference. Objective by analyzing the total baseline values of NPD and the changes in the values of each component in the patients with hypoxic lung injury, we analyzed whether NPD could be applied to the auxiliary diagnosis of hypoxic lung injury. Methods the retrieval strategy and the inclusion criteria and exclusion criteria of the literature were formulated, and PubMed, EMBASE, Scopus, Web of Science, Ovi. D MEDLINE and Google Scholar data are retrieved from 11 unbiased studies, including 7 HAPE and 4 RDS, and the extracted data are expressed in the form of mean mean standard deviation (x + s). If the original data is not x + s form, the data is converted to x s form by correlation formula. The main results of the analysis were the weight mean difference (WMD) and the 95% confidence interval (CI). Results the total NPD value of the patients with lung injury (WMD-5.27 mV, 95%CI:-6.03 to -4.52, P0.00001, I2=42%), and the NPD value of the amiloride sensitive part (ENaC). 64 to -0.18, P=0.04, I2=95%) were significantly reduced. The subgroup analysis of HAPE and RDS showed that in HAPE, the NPD values of these three parts decreased significantly, while the NPD value of amiloride in RDS was not significantly reduced. In addition, SpO2 was only in positive correlation with NPD in the patient and ENaC related parts, with other parts and any part of the healthy person. There was no correlation between NPD. The correlation between the NPD value of the ENaC related parts in the patient group and the altitude was negatively correlated, because the elevation was negatively correlated with the level of SpO2. The altitude was not related to the other parts of the patient group and the other part of the healthy group. The total baseline NPD was both in the patient and in the healthy person. Both of them have a positive correlation with the anti amiloride NPD, and there is no correlation with other parts of the NPD. Conclusion our analysis showed that the acute lung injury associated with the system hypoxia is characterized by NPD dysfunction, and the ENaC NPD part can be used to indicate the re absorption of alveolar fluid, and NPD can be used as a hypoxic lung injury. The auxiliary diagnostic method also provides a data basis for future clinical trials using bedside survey NPD technique to assess the reabsorption of edema fluid in HAPE and RDS patients.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563

【参考文献】

中国期刊全文数据库 前1条

1 白春学;吴学玲;蒋进军;;急性呼吸窘迫综合征——危重医学的重点[J];中华急诊医学杂志;2011年04期

，

本文编号：1901736