慢性阻塞性肺疾病肺泡隔病理学改变与肺功能的关系

发布时间：2018-05-25 05:16

本文选题：慢性阻塞性肺疾病 + 肺间质　；参考：《天津医科大学》2017年硕士论文

【摘要】：研究目的:探讨慢性阻塞性肺疾病(COPD)患者肺间质中肺泡隔的病理学改变及其与气流受限之间的关系。研究方法:采用单中心前瞻性研究方法,分析我院因肺部良恶性肿瘤行肺叶切除手术患者术后病理标本。根据纳入标准选择病例,并根据肺功能(FEV1/FVC%)将病例分为COPD组和正常对照组。术后病理标本选取距肿瘤部位大于2cm的胸膜下肺组织。行苏木精-伊红(HE)染色观察肺组织形态及肺泡隔厚度;Elastica Van Gieson(EVG)染色观察肺泡隔中弹力纤维和胶原纤维比例;免疫组化染色分析肺泡隔基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-2)、金属蛋白酶组织抑制因子-1(TIMP-1)表达水平。以第1秒用力呼气容积占预计值百分比(FEV1%pred)表示COPD气流受限严重程度并对COPD组患者进行严重程度分级。比较2组间及不同严重程度COPD组间肺间质中肺泡隔病理变化,并观察肺泡隔病理改变与FEV1%Pred、一氧化碳弥散量占预计值百分比(DLco%Pred)的关系以及肺泡隔病理改变与MMP-2,MMP-9及TIMP-1之间的关系。研究结果:1、共有60例患者纳入研究,其中COPD组40例,对照组20例。2组间性别、年龄、吸烟指数,标本获取部位比较无显著性差异(P0.05),重度COPD组DLco%Pred为61.51±12.83较轻、中度COPD组及对照组减低(P0.05)。2、COPD组镜下可见肺泡隔中纤维排列紊乱,肺泡隔断裂明显增多,肺泡腔扩张。3、COPD组肺泡隔厚度6.9±2.11um,肺泡隔中胶原纤维占47.6±12.62%较对照组增高;弹力纤维占37.43±12.96%,弹力纤维/胶原纤维为82.87±38.85%较对照组减低,差异有统计学意义(P0.05)。在COPD组中,重度COPD组肺泡隔厚度9.00±2.39um,胶原纤维占59.5±13.52%,较轻、中度COPD组增加,重度COPD患者弹力纤维占27.88%,弹力纤维/胶原纤维为48.38±17.97%较轻、中度COPD组减低,差异有统计学意义(P0.05)。4、肺泡隔病理改变与肺功能关系:(1)肺泡隔厚度、胶原纤维所占比例与FEV1%pred呈负相关(r值分别为-0.335、-0.472;p值分别为0.035、0.002),弹力纤维所占比例及弹力纤维/胶原纤维与FEV1%pred呈正相关(r值分别为0.316、0.522;P值分别为0.047、0.001);(2)肺泡隔胶原纤维所占比例与DLco%pred呈负相关(r-0.329,P=0.010),弹力纤维所占比例及弹力纤维/胶原纤维与DLco%pred呈正相关(r值分别为0.316、0.452;P值分别为0.014、0.000)。5、COPD组肺泡隔MMP-2、MMP-9、TIMP-1表达较对照组增加,差异有统计学意义(P0.05);COPD组中,重度COPD患者肺泡隔中MMP-2、MMP-9、TIMP-1表达较轻、中度COPD组增高,而MMP-2/TIMP-1、MMP-9/TIMP-1较轻、中度COPD组减低,差异有统计学意义(P0.05)。结论:COPD患者肺间质中肺泡隔纤维排列紊乱,肺泡隔断裂增多;COPD患者肺泡隔厚度增加,胶原纤维比例增多,弹力纤维比例减少。其中重度COPD组患者与轻、中度COPD患者比较肺泡隔病理变化更加明显。肺泡隔厚度及肺泡隔中胶原纤维比例与FEV1%pred呈负相关,而肺泡隔中弹力纤维比例及弹力纤维/胶原纤维与FEV1%pred呈正相关;肺泡隔胶原纤维比例与DLco%pred呈负相关,弹力纤维所占比例及弹力纤维/胶原纤维与DLco%pred呈正相关。COPD患者肺泡隔中MMP-2、MMP-9、TIMP-1表达增加,重度COPD患者较轻、中度COPD患者此种表现更加明显,并且重度COPD患者MMP-2/TIMP-1、MMP-9/TIMP-1较轻、中度COPD组减低。说明COPD患者肺泡隔病理学改变与其肺功能变化相关,MMP-2、MMP-9、TIMP-1表达及其比例变化在肺泡隔病理改变中起到重要作用。
[Abstract]:Objective: To investigate the pathological changes of pulmonary alveolar septum in the pulmonary interstitial tissue of patients with chronic obstructive pulmonary disease (COPD) and the relationship between the pulmonary alveolar septum and the airflow limitation. Methods: a single center prospective study was used to analyze the pathological specimens of patients with pulmonary benign and malignant tumors undergoing lobectomy. The cases were divided into COPD group and normal control group according to the pulmonary function (FEV1/FVC%). The pathological specimens were selected from the lower pleural tissue of the tumor larger than 2cm. The pulmonary tissue morphology and alveolar septum thickness were observed by hematoxylin eosin (HE) staining. The proportion of elastic and collagen fibers in the alveolar septum was observed by Elastica Van Gieson (EVG) staining; the immunological group was observed. Pulmonary alveolar matrix metalloproteinase -2 (MMP-2), matrix metalloproteinase -9 (MMP-2), and tissue inhibitor of metalloproteinase -1 (TIMP-1) expression level were analyzed by chemical staining. The percentage of forced expiratory volume (FEV1%pred) in the 1st second (FEV1%pred) expressed the severity of COPD airflow limitation and graded the severity of the patients in the COPD group. The comparison between the 2 groups was compared. The pathological changes of alveolar septum in the pulmonary interstitium with the COPD group, and the relationship between the pathological changes of the alveolar septum and FEV1%Pred, the percentage of the estimated carbon monoxide dispersion (DLco%Pred) and the relationship between the pathological changes of the alveolar septum and the MMP-2, MMP-9 and TIMP-1. The results were as follows: 1, 60 patients were included in the study, of which 40 cases were in group COPD. There was no significant difference in the sex, age, smoking index between the 20.2 groups, the DLco%Pred in the severe COPD group was 61.51 + 12.83, the moderate COPD group and the control group decreased (P0.05).2. The fiber arrangement disorder in the alveolar septum, the alveolar septum dilation and the alveolar septum thickness in the pulmonary alveolus were found in the COPD group. 6.9 + 2.11um, the collagen fiber in the alveolar septum was 47.6 + 12.62% higher than the control group, the elastic fiber was 37.43 + 12.96%, the elastic fiber / collagen fiber was 82.87 + 38.85% lower than the control group. The difference was statistically significant (P0.05). In the group COPD, the thickness of the alveolar septum was 9 + 2.39um, the collagen fibers accounted for 59.5 + 13.52%, and the moderate COPD group increased. Plus, the elastic fiber of severe COPD patients was 27.88%, elastic fiber / collagen fiber was 48.38 + 17.97% light, and the moderate COPD group decreased. The difference was statistically significant (P0.05).4. The relationship between pulmonary alveolar septum pathological changes and pulmonary function was (1) the thickness of alveolar septum, the proportion of collagen fiber was negatively correlated with FEV1%pred (r value was -0.335, -0.472, P value respectively 0.035,0, respectively, 0.035,0. .002), the proportion of elastic fibers and elastic fiber / collagen fibers were positively correlated with FEV1%pred (r value was 0.316,0.522, P was 0.047,0.001 respectively); (2) the proportion of collagen fibers in alveolar septum was negatively correlated with DLco%pred (r-0.329, P=0.010), the proportion of elastic fibers and elastic fiber / collagen fibers were positively correlated with DLco%pred (r value, respectively) 0.316,0.452, P value was 0.014,0.000).5, COPD group alveolar septum MMP-2, MMP-9, TIMP-1 expression increased compared with the control group, the difference was statistically significant (P0.05). Significance (P0.05). Conclusion: pulmonary alveolar septum fibers in the pulmonary interstitium of COPD patients were in disorder, alveolar septum fracture increased, alveolar septum thickness increased in COPD patients, the proportion of collagen fibers increased, and the proportion of elastic fibers decreased. The pathological changes of alveolar septum in patients with severe and moderate COPD were more obvious. The thickness of alveolar septum and collagen in the alveolar septum were more obvious in patients with severe COPD. The ratio of fiber to FEV1%pred was negatively correlated, and the elastic fiber ratio in the alveolar septum and the elastic fiber / collagen fiber were positively correlated with the FEV1%pred; the proportion of collagen fibers in the alveolar septum was negatively correlated with DLco%pred, the proportion of elastic fibers and the elastic fiber / collagen fiber and MMP-2, MMP-9, TIMP-1 expression in the alveolar septum of DLco%pred Cheng Zhengxiang patients with.COPD. In patients with severe COPD, severe and moderate COPD patients had more obvious performance, and severe COPD patients were MMP-2/TIMP-1, MMP-9/TIMP-1 was lighter, and moderate COPD decreased. The pathological changes of alveolar septum in COPD patients were related to changes in pulmonary function, and the changes in MMP-2, MMP-9, TIMP-1 expression and the proportion of TIMP-1 were important in the pathological changes of alveolar septum. Use.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9

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