CRP和TNF-α在慢阻肺急性加重期病情严重程度判断中的意义
发布时间：2018-07-14 20:25
【摘要】：研究背景慢性阻塞性肺疾病（chronicobstructivepulmonarydisease，COPD，简称慢阻肺）是以气道、肺实质和肺血管的慢性炎症为特征的疾病。感染是慢阻肺急性加重导致炎症反应的常见诱因。慢性阻塞性肺疾病急性加重（acuteexacerbationofchronicobstructivepulmonarydisease，AECOPD），，是指疾病发展过程中患者的呼吸困难、咳嗽和/或咳痰在基础水平上出现急性改变，超出每天的日常变异，需改变治疗方案。慢阻肺急性加重期，已有研究表明约2/3由感染引起。在感染导致其炎症反应过程中有许多细胞因子的参与，肿瘤坏死因子α（tumornecrosisfactoralpha，TNF-α）作为一种细胞因子近年来被广泛研究。有研究表明TNF-α参与COPD气道炎症的形成,它能诱导炎症反应、促进中性粒细胞黏附、增强对细胞外弹性蛋白的溶解活性，在COPD发生发展过程中起重要作用[1,2]。TNF-α是COPD的一个重要指标,它在COPD发病机制中的作用深受大家重视。C反应蛋白（C-reactiveprotein，CRP）是肝脏产生的一种急性时相蛋白，在伴有炎症和组织坏死疾病的急性期常常升高，并且是一种表明细菌性感染的敏感指标，它优于体温、血沉、白细胞计数及中性粒细胞百分数等[3]。CRP可作为诊断AECOPD的敏感标志和反应AECOPD治疗效果的标志，当出现细菌感染时，CRP值迅速升高，随着患者病情好转，CRP值随之下降,这样有助于我们对疾病的预后判断。 目的通过研究AECOPD患者外周血清CRP和TNF-α水平的变化，探讨二者在AECOPD患者病情严重程度判断中的意义。 方法采用酶联免疫吸附测定法（ELISA）检测58例AECOPD患者治疗前后和60例健康对照者血清CRP和TNF-α的水平，以及常规检测AECOPD患者治疗前白细胞计数（WBC）和中性粒细胞百分数（N%）。根据有无合并呼吸衰竭及肺心病分别分为AECOPD合并呼衰组（31例）、AECOPD无呼衰组（27例）、AECOPD合并肺心病组（25例）和AECOPD无肺心病组（33例）。 结果 1.AECOPD患者治疗前血清中CRP（47.16±49.27）和TNF-α（39.72±8.62）水平与治疗后（5.98±9.17，19.58±2.71）和对照组（1.34±0.75，10.86±1.30）比较，差异具有统计学意义(P均0.001)；治疗后血清TNF-α水平与对照组比较，差异具有统计学意义(P0.001)；治疗后血清CRP水平与对照组比较，差异无统计学意义(P0.05)见表1 2.AECOPD合并呼衰组血清CRP(74.57±48.19)和TNF-α(44.46±8.63)水平与AECOPD无呼衰组(12.83±11.72,34.29±4.40)比较，差异具有统计学意义(P均0.001)见表2 3.AECOPD合并肺心病组TNF-α水平(43.36±9.91)与无肺心病组(36.07±7.77)比较，差异具有统计学意义(P0.01)；而血清CRP水平(41.51±34.04)与无肺心病组(49.10±55.79)比较，差异无统计学意义(P0.05)见表2 4.58例AECOPD患者中治疗前有54例CRP阳性，阳性率为93.10%;21例WBC增高,阳性率为36.2%;39例N%增高,阳性率为67.2%。CRP阳性率显著高于白细胞计数增高和中性粒细胞百分数增高的阳性率。差异有统计学意义(P均0.005)见表3、4 结论CRP对判断COPD急性加重优于血常规；CRP和TNF-α对AECOPD患者病情严重程度的判断有一定的临床意义。
[Abstract]:Background chronic obstructive pulmonary disease (chronicobstructivepulmonarydisease, COPD) is a disease characterized by chronic inflammation of the airway, lung parenchyma and pulmonary vessels. Infection is a common cause of acute exacerbation of chronic obstructive pulmonary disease and acute exacerbation of chronic obstructive pulmonary disease (acuteexacerbationofchronicobstructive Pulmonarydisease, AECOPD) refers to the acute changes in the patient's breathing, coughing and / or phlegm at the basic level during the development of the disease. Beyond daily variation, the treatment needs to be changed. The acute exacerbation of the chronic obstructive pulmonary disease, which has been studied, shows that there are many cells in the process of inflammation that lead to many cells in the process of inflammation. The involvement of factors, tumornecrosisfactoralpha (TNF- alpha), as a cytokine, has been widely studied in recent years. Some studies have shown that TNF- alpha is involved in the formation of airway inflammation in COPD. It can induce inflammatory response, promote neutrophil adhesion, enhance the dissolution of extracellular elastin, and develop in the process of COPD development. [1,2].TNF- alpha plays an important role in the pathogenesis of COPD, and its role in the pathogenesis of COPD is highly valued as an acute phase protein produced by the.C reactive protein (C-reactiveprotein, CRP), which is often elevated in the acute phase of inflammation and tissue necrosis, and is a sensitive finger indicating bacterial infection. Standard, it is superior to body temperature, blood sedimentation, leukocyte count and neutrophils percentage, such as [3].CRP can be used as a sensitive marker for diagnosis of AECOPD and the marker of response to AECOPD treatment. When bacterial infection occurs, the value of CRP increases rapidly, and as the patient's condition improves, the CRP value decreases, which helps us to judge the prognosis of the disease.
Objective to explore the significance of the two in the judgement of the severity of AECOPD patients by studying the changes of serum CRP and TNF- alpha levels in patients with AECOPD.
Methods the serum levels of CRP and TNF- alpha were detected by enzyme linked immunosorbent assay (ELISA) in 58 patients with AECOPD and 60 healthy controls, and the routine examination of leukocyte count (WBC) and the percentage of neutrophils (N%) before treatment for AECOPD patients were divided into AECOPD combined respiratory failure group, respectively (or without combined respiratory failure and pulmonary heart disease). 31 cases), AECOPD without respiratory failure group (27 cases), AECOPD combined with pulmonary heart disease group (25 cases) and AECOPD without cor pulmonale group (33 cases).
Result
The serum levels of CRP (47.16 + 49.27) and TNF- alpha (39.72 + 8.62) before treatment were compared with the control group (5.98 + 9.17,19.58 + 2.71) and the control group (1.34 + 0.75,10.86 + 1.30), the difference was statistically significant (P 0.001). The serum TNF- alpha level was statistically significant (P0.001) after treatment (P0.001) and serum CRP after treatment. There was no significant difference between the control group and the control group (P0.05) in Table 1.
The levels of serum CRP (74.57 + 48.19) and TNF- alpha (44.46 + 8.63) in the group of 2.AECOPD combined with respiratory failure were compared with that of AECOPD without respiratory failure group (12.83 + 11.72,34.29 4.40). The difference was statistically significant (P 0.001), as shown in Table 2.
The level of TNF- alpha in 3.AECOPD combined with cor pulmonale group (43.36 + 9.91) was compared with that of no cor pulmonale group (36.07 + 7.77), and the difference was statistically significant (P0.01), while the serum CRP level (41.51 + 34.04) was compared with that of cor pulmonale group (49.10 + 55.79), the difference was not statistically significant (P0.05) in Table 2.
In 4.58 AECOPD patients, 54 cases were positive before treatment, the positive rate was 93.10%, 21 cases of WBC increased, the positive rate was 36.2%, 39 cases of N% increased, the positive rate of 67.2%.CRP positive rate was significantly higher than the increase of white cell count and the increase of neutrophils percentage. The difference was statistically significant (P 0.005) see table 3,4
Conclusion CRP is superior to routine blood test in judging acute exacerbation of COPD. CRP and TNF- alpha have certain clinical significance in judging the severity of AECOPD patients.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.9
本文编号：2122849
[Abstract]:Background chronic obstructive pulmonary disease (chronicobstructivepulmonarydisease, COPD) is a disease characterized by chronic inflammation of the airway, lung parenchyma and pulmonary vessels. Infection is a common cause of acute exacerbation of chronic obstructive pulmonary disease and acute exacerbation of chronic obstructive pulmonary disease (acuteexacerbationofchronicobstructive Pulmonarydisease, AECOPD) refers to the acute changes in the patient's breathing, coughing and / or phlegm at the basic level during the development of the disease. Beyond daily variation, the treatment needs to be changed. The acute exacerbation of the chronic obstructive pulmonary disease, which has been studied, shows that there are many cells in the process of inflammation that lead to many cells in the process of inflammation. The involvement of factors, tumornecrosisfactoralpha (TNF- alpha), as a cytokine, has been widely studied in recent years. Some studies have shown that TNF- alpha is involved in the formation of airway inflammation in COPD. It can induce inflammatory response, promote neutrophil adhesion, enhance the dissolution of extracellular elastin, and develop in the process of COPD development. [1,2].TNF- alpha plays an important role in the pathogenesis of COPD, and its role in the pathogenesis of COPD is highly valued as an acute phase protein produced by the.C reactive protein (C-reactiveprotein, CRP), which is often elevated in the acute phase of inflammation and tissue necrosis, and is a sensitive finger indicating bacterial infection. Standard, it is superior to body temperature, blood sedimentation, leukocyte count and neutrophils percentage, such as [3].CRP can be used as a sensitive marker for diagnosis of AECOPD and the marker of response to AECOPD treatment. When bacterial infection occurs, the value of CRP increases rapidly, and as the patient's condition improves, the CRP value decreases, which helps us to judge the prognosis of the disease.
Objective to explore the significance of the two in the judgement of the severity of AECOPD patients by studying the changes of serum CRP and TNF- alpha levels in patients with AECOPD.
Methods the serum levels of CRP and TNF- alpha were detected by enzyme linked immunosorbent assay (ELISA) in 58 patients with AECOPD and 60 healthy controls, and the routine examination of leukocyte count (WBC) and the percentage of neutrophils (N%) before treatment for AECOPD patients were divided into AECOPD combined respiratory failure group, respectively (or without combined respiratory failure and pulmonary heart disease). 31 cases), AECOPD without respiratory failure group (27 cases), AECOPD combined with pulmonary heart disease group (25 cases) and AECOPD without cor pulmonale group (33 cases).
Result
The serum levels of CRP (47.16 + 49.27) and TNF- alpha (39.72 + 8.62) before treatment were compared with the control group (5.98 + 9.17,19.58 + 2.71) and the control group (1.34 + 0.75,10.86 + 1.30), the difference was statistically significant (P 0.001). The serum TNF- alpha level was statistically significant (P0.001) after treatment (P0.001) and serum CRP after treatment. There was no significant difference between the control group and the control group (P0.05) in Table 1.
The levels of serum CRP (74.57 + 48.19) and TNF- alpha (44.46 + 8.63) in the group of 2.AECOPD combined with respiratory failure were compared with that of AECOPD without respiratory failure group (12.83 + 11.72,34.29 4.40). The difference was statistically significant (P 0.001), as shown in Table 2.
The level of TNF- alpha in 3.AECOPD combined with cor pulmonale group (43.36 + 9.91) was compared with that of no cor pulmonale group (36.07 + 7.77), and the difference was statistically significant (P0.01), while the serum CRP level (41.51 + 34.04) was compared with that of cor pulmonale group (49.10 + 55.79), the difference was not statistically significant (P0.05) in Table 2.
In 4.58 AECOPD patients, 54 cases were positive before treatment, the positive rate was 93.10%, 21 cases of WBC increased, the positive rate was 36.2%, 39 cases of N% increased, the positive rate of 67.2%.CRP positive rate was significantly higher than the increase of white cell count and the increase of neutrophils percentage. The difference was statistically significant (P 0.005) see table 3,4
Conclusion CRP is superior to routine blood test in judging acute exacerbation of COPD. CRP and TNF- alpha have certain clinical significance in judging the severity of AECOPD patients.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.9
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