血清超敏C反应蛋白在支气管哮喘急性发作期的临床应用价值

发布时间：2018-06-07 20:02

  本文选题：支气管哮喘 + 超敏　； 参考：《大连医科大学》2012年硕士论文

【摘要】：目的：研究支气管哮喘急性发作期患者血清超敏C反应蛋白与诱导痰白细胞分类计数和肺功能及哮喘控制测试的相关性，探讨其临床应用价值。 方法：收集2011年9月至2011年12月于大连医科大学附属第二医院呼吸内科住院治疗的支气管哮喘急性发作期患者30例，哮喘的诊断标准及急性发作期严重程度的分级标准，参照支气管哮喘防治指南（2008版），哮喘组均排除存在感染及既往有吸烟史的患者。同时期健康体检者14例为对照组。对照组均否认肺部疾病史及吸烟史；测定对照组和哮喘组经全身糖皮质激素治疗5～7d（甲泼尼龙40～80mg/d）前后的空腹血清hs-CRP水平。诱导痰操作方法参考《咳嗽的诊断与治疗指南（2009版）》附件1高渗盐水诱导痰检测方法，并根据实际情况进行改进。在诱导期间检测患者呼气峰流速（PEF）变化，若PEF较诱导痰前下降20%，则停止诱导，必要时吸入支气管扩张剂治疗。超声雾化4.5%的高渗盐水获取诱导痰，显微镜下进行诱导痰白细胞分类计数，分别计算对照组、哮喘组治疗前后的嗜酸粒细胞百分比（EOS%），中性粒细胞百分比（N%），巨噬细胞百分比（M%），淋巴细胞百分比（L%）。测定对照组、哮喘组治疗前后的肺功能指标第一秒用力呼气容积占预计值百分比（FEV1pred%）、第一秒用力呼气容积占用力肺活量百分比（FEV1/FVC%）、最大呼气中期流量占预计值的百分比（MMEFpred%）。哮喘组进行哮喘控制测试（ACT）评分。利用SPSS17.0软件分析对照组与哮喘组之间，哮喘组治疗前后血清hs-CRP的差异性，利用Spearman's相关分析考察血清hs-CRP与诱导痰白细胞分类计数、肺功能指标及ACT评分的相关性。利用ROC曲线（受试者工作特征曲线）分析血清hs-CRP评估支气管哮喘急性发作期炎症水平的效能。 结果：44例研究对象中，，哮喘组2例诱导痰失败，对照组均诱导痰成功，诱导痰成功率为95.45%。哮喘组的血清hs-CRP水平4.18（11.12，2.12）mg/L明显高于对照组1.48（4.81，1.03）mg/L，差异有统计学意义（Z=4.029，P=0.000），哮喘组患者经糖皮质激素治疗后血清hs-CRP水平3.40（8.91，2.02）mg/L较治疗前血清hs-CRP水平4.18（11.12，2.12）mg/L明显下降，差异有统计学意义（Z=-2.755P=0.006）。哮喘组治疗前患者的血清hs-CRP与诱导痰（EOS%）呈正相关（r=0.849,P=0.000），与FEV1pred%、FEV1/FVC%、MMEFpred%均呈负相关(r值分别为-0.617、-0.559、-0.398，P值分别为0.000、0.002、0.036)，与ACT评分呈负相关(r=-0.511, P=0.005)。血清hs-CRP的ROC曲线下面积（AUC）值为0.713，差异有统计学意义（P=0.003）；当血清hs-CRP取最佳临界点（BCOV）为3.65mg/L时，鉴别对照组与哮喘组的敏感度为0.643，特异度为0.667；血清hs-CRP的AUC值（0.713）略低于诱导痰EOS%的AUC值（0.794）。 结论：支气管哮喘急性发作期患者血清hs-CRP与诱导痰嗜酸粒细胞百分比、肺功能、ACT评分具有良好相关性，是评价支气管哮喘系统性炎症水平的潜在标志物。
[Abstract]:Objective : To study the correlation between hypersensitive C - reactive protein ( CRP ) and pulmonary function and asthma control test in patients with acute episode of bronchial asthma .

Methods : From September 2011 to December 2011 , 30 patients with acute episode of bronchial asthma who were hospitalized in the Second Affiliated Hospital of Dalian Medical University were collected , and the criteria for diagnosis of asthma and the severity of acute attack were included .
The levels of serum hs - CRP were measured before and after treatment with systemic glucocorticoid in the control group and in the asthmatic group . The results were as follows : the percentage of pulmonary function ( EOS % ) , the percentage of neutrophil percentage ( N % ) , the percentage of macrophages ( M % ) and the percentage of lymphocytes ( L % ) were measured .

Results : The serum hs - CRP levels in the asthmatic group were significantly higher than those in the control group ( r = - 2.07 55P = 0.006 ) . The serum hs - CRP levels were significantly correlated with those in the control group ( r = 4.29 , P = 0.000 ) . The serum hs - CRP levels in the asthmatic group were significantly correlated with those in the control group ( r = 4.29 , P = 0.000 ) . The levels of serum hs - CRP and induced sputum ( EOS % ) in the asthma group were significantly negative ( r = - 0.617 , - 0.5559 , - 0.398 , P = 0.000 , 0.002 , 0.036 ) , which was negatively correlated with ACT scores ( r = - 0.511 , P = 0.005 ) . The area under ROC curve of serum hs - CRP was 0.713 ( P = 0.003 ) .
When the optimal critical point ( BCOV ) of serum hs - CRP was 3.65 mg / L , the sensitivity of the control group to the asthma group was 0.643 and the specificity was 0.667 ;
The AUC values of serum hs - CRP ( 0.713 ) were slightly lower than the AUC values induced sputum EOS % ( 0.794 ) .

Conclusion : The serum hs - CRP in patients with bronchial asthma has a good correlation with the percentage of induced sputum eosinophils , pulmonary function and ACT score , which is a potential marker for evaluating the systemic inflammatory level of bronchial asthma .
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R562.25

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