慢性阻塞性肺疾病与瘦素、甲状腺素相关性分析

发布时间：2018-06-02 22:52

本文选题：COPD + 急性期　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性发作期及稳定期患者与健康人群比较,了解两者间瘦素(Leptin)及甲状腺素水平的变化,以明确瘦素及甲状腺素对于评估COPD患者病情及预后的意义。方法:1.研究对象:1.1 COPD组:选择我院2014年1月到2015年12月因COPD急性加重而入院,但入院前根据慢阻肺综合评估为D组的男性患者50例,年龄55-75岁,平均年龄62.7岁。BMI为19-24kg/m2,平均BMI为21.1kg/m2,所有患者诊断均符合中华医学会呼吸病学会慢性阻塞性肺疾病学组制定的《慢性阻塞性肺疾病诊治指南》(2013年修订版)慢阻肺急性加重及稳定期的诊断标准。1.2对照组:选取来院体检男性健康者30例作为对照组,年龄55-75岁,平均年龄62.9岁。BMI为19-24kg/m2,平均BMI为21.3kg/m2。2.研究方法:COPD急性发作患者次日清晨空腹抽血,作为发作期血样,经抗感染、化痰、平喘、吸氧等治疗后症状稳定后,再次于清晨空腹抽血作为稳定期血样,对照组于体检当天空腹抽血。检测指标为血清瘦素(Leptin)及甲状腺素指标TT3(血清三碘甲状腺原氨酸)、TT4(血清甲状腺素)、FT3(血清游离三碘甲状腺原氨酸)、FT4(血清游离甲状腺素)、TSH(促甲状腺激素)。采用SPSS17.0统计软件处理,所有数据均以(x_±s)表示,组间比较用t检验,P0.05表示差异有统计学意义。3.结果:3.1瘦素的测定:COPD急性发作期瘦素水平较对照组和稳定期均有所升高,且具有统计学意义(P0.05);COPD稳定期瘦素水平较对照组差异无明显统计学意义(P0.05)。3.2甲状腺素的测定:COPD急性发作期与对照组相比TT3、FT3下降显著,具有统计学意义(P0.05);稳定期与对照组相比TT3、FT3略有下降,但无明显统计学意义(P0.05)。COPD急性发作期及稳定期与对照组相比TT4、FT4及TSH均稍有下降,但均无明显差异(P0.05)。结论:1.COPD急性发作期病人瘦素水平较稳定期出现显著升高。考虑与患者呼吸功能受损及COPD急性发作时的炎性反应相关。瘦素作为一种促炎症因子,与炎症因子相互作用,参加了全身的炎症经过,所以瘦素或许是一项病情恶化的炎性标志物。稳定期瘦素浓度较前降低,且瘦素浓度与患者体重呈正相关,这或许是机体的一种自我保护性变化,由于瘦素浓度下降有助于减少对能量的消耗以及对摄食的增加,因此防止了COPD病人体重继续降低以及营养状态的继续变差。2.COPD急性发作期TT3、FT3下降显著,稳定期与对照组相比TT3、FT3略有下降,但无明确统计学意义。COPD急性发作期及稳定期TT4、FT4及TSH均稍有下降,但均无明显统计学意义。甲功的变化,与缺氧、感染产生细胞因子、应用糖皮质激素等原因有关,也可视为这可能是机体的一种保护机制,随着病情的好转,甲状腺功能可恢复至接近正常或正常,提示甲状腺激素的改变与COPD预后存在密切关系。3.瘦素及甲状腺素对COPD患者在了解病情、判断预后方面都具有一定的临床价值,值得临床医师重视。
[Abstract]:Objective: to investigate the changes of leptin and thyroxine levels in patients with chronic obstructive pulmonary disease during acute attack and stable stage compared with healthy people. To determine the significance of leptin and thyroxine in evaluating the condition and prognosis of patients with COPD. Method 1: 1. Study participants: one hundred and fifty male patients, aged 55-75 years, who were admitted to our hospital for acute exacerbation of COPD from January 2014 to December 2015, were enrolled in the study group from January 2014 to December 2015, according to the comprehensive assessment of chronic obstructive pulmonary disease (COPD) before admission. The mean age was 62.7 years. BMI was 19-24 kg / m ~ (2) and average BMI was 21.1kg / m ~ (2). All the patients were diagnosed in accordance with the guidelines for the diagnosis and treatment of chronic obstructive Pulmonary Disease (COPD) (2013 revised edition) developed by the Group of chronic obstructive Pulmonary Disease (COPD) of the Chinese Medical Association. The diagnostic criteria of aggravation and stability. 1.2 control group: 30 healthy male patients were selected as control group. Age 55-75 years, mean age 62.9 years. BMI is 19-24 kg / m ~ (2), average BMI is 21.3 kg / m ~ (2.2). Methods the patients with acute COPD were taken blood samples on an empty stomach the next morning, which were taken as blood samples during the attack period. After the treatment of anti-infection, phlegm, asthma, oxygen inhalation and so on, the symptoms were stable, and the fasting blood samples were taken as stable blood samples again in the morning. The control group took blood on an empty stomach on the day of physical examination. Serum leptin (leptin) and thyroxine (Thyrotropin) and thyroxine (TSH) were measured in serum and serum thyroxine triiodothyronine (TSH) and thyrotropin (TSH) in serum respectively. SPSS17.0 statistical software was used to process all the data in the form of X _ 卤s, and the difference between groups was statistically significant by using t test (P0.05). Results the level of leptin in the acute phase of COPD was higher than that in the control group and the stable stage, and the level of leptin in the control group was higher than that in the control group. There was no significant difference in leptin level between stable stage of COPD and control group. The determination of thyroxine in 10% COPD patients during acute attack was significantly lower than that in control group, and that in control group was significantly lower than that in control group, and there was no significant difference in leptin level between the two groups. Compared with the control group, TT3 FT3 decreased slightly in the stable phase, but there was no significant difference between the stable phase and the control group, but there was no significant difference between the two groups in the acute attack phase and the stable phase, but there was no significant difference (P 0.05). Conclusion: 1. Leptin level in COPD patients with acute exacerbation was significantly higher than that in stable stage. The relationship between respiratory dysfunction and inflammatory response during acute COPD attack was considered. Leptin, a pro-inflammatory factor, interacts with inflammatory factors and participates in systemic inflammatory processes, so leptin may be an inflammatory marker of exacerbation. Leptin concentration in stable period was lower than before, and leptin concentration was positively correlated with body weight. This may be a self-protective change of body, because the decrease of leptin concentration can reduce energy consumption and increase food intake. Therefore, it prevented the body weight loss and nutritional status of COPD patients from becoming worse. 2. TT3 FT3 decreased significantly in acute phase of COPD, and decreased slightly in stable phase compared with control group. However, there was no statistical significance. TT _ 4 FT _ 4 and TSH decreased slightly in acute and stable phase of COPD, but there was no significant difference between them. The changes of hypothyroidism are related to hypoxia, infection, cytokines, glucocorticoids, and so on. It can also be regarded as a protective mechanism of the body. With the improvement of the condition, thyroid function can be restored to near normal or normal. It suggests that thyroid hormone changes are closely related to the prognosis of COPD. 3. 3. Leptin and thyroxine have certain clinical value in understanding the condition and judging prognosis of patients with COPD, and deserve attention of clinicians.
【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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