支气管扩张症合并哮喘患者的临床分析及IL-4和IFN-γ的作用

发布时间：2018-05-20 21:43

本文选题：支气管扩张症合并哮喘 + 临床特征　；参考：《吉林大学》2016年硕士论文

【摘要】：目的:探讨支气管扩张症合并哮喘患者的临床特征以及血清IL-4、IFN-γ的表达水平,旨在对支气管扩张合并哮喘患者的发病机制有更进一步的认识,为其早期诊治提供依据。方法:参照2012年成人支气管扩张症诊治专家共识及2008年中国哮喘防治指南,收集2014年10月至2015年10月期间吉林大学第二医院呼吸内科收治的29例支气管扩张患者及12例哮喘患者。其中单纯支气管扩张患者为14例,设为A组;12例单纯哮喘患者为B组;支气管扩张患者中合并哮喘的有15例,设为C组;健康体检者共7例为D组。对四组患者的基线资料、FENO测定及血清学IL-4、IFN-γ的表达水平等方面进行对比分析。结果:1、各组基线水平测定结果(1)各组自然资料测定结果单纯支扩、单纯哮喘、支扩合并哮喘及正常对照组患者年龄、性别间差异无统计学意义(P0.05);单纯支扩与支扩合并哮喘患者在过敏史方面差异有统计学意义(P0.05),单纯哮喘与支扩合并哮喘患者在过敏史方面差异无统计学意义(P0.05)。(2)各组肺功能指标测定结果(1)单纯支扩组和支扩合并哮喘组患者在吸入支气管舒张剂前FEV1(%)、FEV1/FVC(%)、MMEF75/25、MMEF75/25(%)比较有统计学差异(P均0.05)。(2)单纯支扩和支扩合并哮喘患者在吸入支气管舒张剂后FVC改善率、FEV1改善率、MMEF75/25改善率比较差异有统计学意义(P均0.01),且FEV1/FVC(%)比较差异有统计学意义(P0.05)。(3)单纯哮喘和支扩合并哮喘患者各项肺功能指标差异无统计学意义(P0.05)。(3)各组患者患病年限单纯支扩组患者患病年限平均为9.15年,单纯哮喘组患者患病年限平均为14.68年,支扩合并哮喘组患者患有支扩及哮喘的平均年限分别为14.35年和4.28年,其中有14例患者先出现支扩后合并哮喘,在合并哮喘前支扩平均患病年限为10.07年。2、呼出气一氧化氮(FENO)测定(1)支扩合并哮喘组FENO测定平均为37.95±13.03ppb,单纯哮喘组为58.96±15.17ppb均高于正常对照组16.95±4.97ppb,差异有统计学意义(P均0.01)。(2)单纯支扩组FENO水平为11.05±5.35ppb低于正常对照组,差异统计学意义(P0.05);支扩合并哮喘组FENO水平高于单纯支扩组,差异有统计学意义(P0.01)。(3)支扩合并哮喘组FENO水平低于单纯哮喘组,差异有统计学意义(P0.01)。(4)其中支扩合并哮喘组痰培养示铜绿假单胞菌(PA)感染的患者有5例,测定FENO平均为26.78±5.69ppb低于非PA感染的患者43.54±12.03ppb,差异有统计学意义(P0.05);单纯支扩组中痰培养示PA感染的患者有3例,测定FENO平均为6.77±1.88ppb,非PA感染的患者测定FENO平均为12.13±5.67ppb,差异无统计学意义(P0.05)。3、血清白介素-4(IL-4)的表达水平支扩合并哮喘组患者血清中IL-4表达水平为317.02±53.53ng/L,单纯支扩组为279.02±44.24ng/L,单纯哮喘组为367.60±45.10ng/L,均高于正常对照组215.33±46.33ng/L,差异有统计学意义(P均0.01);支扩合并哮喘组IL-4的表达水平高于单纯支扩组,差异有统计学意义(P0.05);支扩合并哮喘组IL-4的表达水平低于单纯哮喘组,差异有统计学意义(P0.05)。4、γ干扰素(IFN-γ)的表达水平支扩合并哮喘患者血清中IFN-γ表达水平为241.68±50.33ng/L高于正常对照组192.14±25.99ng/L,差异有统计学意义(P0.05);单纯支扩组为295.65±77.10ng/L高于正常对照组,差异有统计学意义(P0.01);单纯哮喘组IFN-γ表达水平为153.76±26.69ng/L,低于正常对照组,差异有统计学意义(P0.05);支扩合并哮喘组患者血清中IFN-γ的表达水平低于单纯支扩组,差异有统计学意义(P0.05);支扩合并哮喘组患者血清中IFN-γ的表达水平高于单纯哮喘组,差异有统计学意义(P0.01)。结论:1.支气管扩张患者患病年限大约在10.07年后合并哮喘的危险性增加。2.支气管扩张患者呼出气一氧化氮测定明显低于支扩合并哮喘组及单纯哮喘组,说明支气管扩张的发病机制与气道嗜酸性浸润关系不大。3.血清中IL-4、IFN-γ的表达水平有可能成为支扩合并哮喘患者的早期诊断依据。
[Abstract]:Objective: To explore the clinical features of bronchiectasis with asthma and the level of the expression of serum IL-4 and IFN- gamma. The purpose of this study is to further understand the pathogenesis of bronchiectasis with asthma and to provide a basis for its early diagnosis and treatment. Methods: to consult the expert consensus of the diagnosis and treatment of adult bronchiectasis in 2012 and the Chinese asthma in 2008. 29 cases of bronchiectasis and 12 asthma patients were collected from October 2014 to October 2015 in the respiratory medicine department of the second hospital of Jilin University. Among them, 14 patients with simple bronchiectasis were set up as group A; 12 patients with simple asthma were group B; 15 cases with asthma in bronchiectasis were set up as group C and healthy body. A total of 7 cases were in group D. The baseline data of four groups, FENO determination, serological IL-4, IFN- gamma expression level were compared. Results: 1, baseline levels of each group were measured (1) simple bronchiectasis, simple asthma, bronchiectasis, asthma and normal control group age. There was no statistical difference between sex. Learning significance (P0.05); there was significant difference in allergic history between simple bronchiectasis and bronchiectasis (P0.05). There was no significant difference in allergy history between simple asthmatic and bronchiectasis patients (P0.05). (2) the results of pulmonary function indexes in each group (1) simple bronchiectasis group and bronchiectasis combined with asthma patients in the inhalation bronchus There were significant differences in FEV1 (%), FEV1/FVC (%), MMEF75/25, MMEF75/25 (%) before diastolic agent (P 0.05). (2) the improvement rate of FVC, FEV1 improvement rate and MMEF75/25 improvement rate in patients with bronchial dilatation with simple bronchiectasis and bronchiectasis were statistically significant (P 0.01), and FEV1/FVC (%) was statistically significant (P0.05). (3) there was no significant difference in the pulmonary function indexes of the patients with simple asthma and bronchiectasis (P0.05). (3) the average age of the patients in the simple bronchiectasis group was 9.15 years, the average age of the patients in the simple asthmatic group was 14.68 years, and the average age of the bronchiectasis and asthma patients in the bronchiectasis and asthma group was 14.3, respectively. In the 5 and 4.28 years, 14 patients were first treated with bronchiectasis with asthma. The average age of the prevalence of bronchiectasis before the combined asthma was 10.07 years.2, the exhalation of nitric oxide (FENO) was measured (1) and the average of FENO in the bronchiectasis group was 37.95 + 13.03ppb, and the simple asthma group was 58.96 + 15.17ppb higher than that of the normal control group (16.95 + 4.97ppb). The significance of the study (P 0.01). (2) the level of FENO in the simple bronchiectasis group was 11.05 + 5.35ppb lower than the normal control group, and the difference was statistically significant (P0.05); the FENO level in the bronchiectasis combined with asthma group was higher than that of the simple bronchiectasis group (P0.01). (3) the level of FENO in the bronchiectasis and asthma group was lower than that of the simple asthma group (P0.01). (4) it was statistically significant (4). There were 5 cases of Pseudomonas aeruginosa (PA) infection in the medium bronchiectasis and asthma group, and the average of 26.78 + 5.69ppb was 26.78 + 5.69ppb lower than that of non PA infection. The difference was statistically significant (P0.05). There were 3 cases of PA infection in the simple bronchiectasis group, and the average of FENO was 6.77 + 1.88ppb, and the non PA infection patients were measured. The mean FENO was 12.13 + 5.67ppb, the difference was not statistically significant (P0.05).3, the expression level of serum interleukins -4 (IL-4) in the patients with asthma group was 317.02 + 53.53ng/L, the simple bronchiectasis group was 279.02 + 44.24ng/L, and the simple asthmatic group was 367.60 + 45.10ng/L, all higher than that of the normal control group, 215.33 + 46.33ng/L, the difference was found. Statistical significance (P 0.01); the expression level of IL-4 in the bronchiectasis group was higher than that of the simple bronchiectasis group, the difference was statistically significant (P0.05); the expression level of IL-4 in the bronchiectasis and asthma group was lower than that of the simple asthma group (P0.05).4. The expression level of interferon gamma (IFN- gamma) was combined with IFN- gamma expression water in the serum of asthmatic patients. The level of 241.68 + 50.33ng/L was higher than that of the normal control group (192.14 + 25.99ng/L), the difference was statistically significant (P0.05); the simple bronchiectasis group was 295.65 + 77.10ng/L higher than the normal control group, the difference was statistically significant (P0.01); the level of IFN- gamma expression in the simple asthma group was 153.76 + 26.69ng/L, lower than the normal control group, the difference was statistically significant (P0.05). The expression level of IFN- gamma in serum of patients with asthma group was lower than that in simple bronchiectasis group (P0.05). The expression level of IFN- gamma in serum of patients with bronchiectasis and asthma group was higher than that of simple asthma group, the difference was statistically significant (P0.01). Conclusion: 1. the risk of asthma in patients with bronchiectasis is about 10.07 years later. The determination of exhaled nitric oxide in.2. bronchiectasis was significantly lower than that of bronchiectasis combined with asthma and asthma alone. It was suggested that the pathogenesis of bronchiectasis was not related to the eosinophilic infiltration of the airway in.3. serum IL-4, and the expression level of IFN- gamma may be the early diagnostic basis for the patients with bronchiectasis and asthma.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R562.2

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