慢性阻塞性肺疾病患者脏层胸膜的病理改变

发布时间：2018-07-25 09:26

【摘要】：研究目的:观察慢性阻塞性肺疾病(COPD)患者脏层胸膜的病理改变,以及该改变与COPD气流受限的关系。研究方法:选取2014年5月—2015年8月于天津市胸科医院胸外科因肺部肿物,行全肺叶或部分肺叶切除手术患者70例。根据患者肺功能检查结果分为COPD组[吸入支气管舒张剂后,第一秒用力呼气容积(FEV1)/用力肺活量(FVC)70%,40例]与对照组(FEV1/FVC≥70%,30例)。并在COPD组内根据FEV1/FEV1预计值(FEV1%pre)对COPD组患者进行严重程度分级,并根据严重程度再次分组。FEV1%pre≥80%为轻度COPD;50%≤FEV1%pre80%为中度COPD;FEV1%pre50%为重度COPD。将轻度COPD患者纳入轻度COPD组(21例),将中度及重度COPD患者纳入中重度COPD组(19例)。对手术所获取肺组织进行取材(取材部位未被病变浸润,距离病变区域2cm)、制作组织切片,使用苏木精—伊红染色法(HE)及弹力纤维染色法(EVG)进行染色;显微镜下观察并计算各标本脏层胸膜的厚度及弹力纤维所占比例。研究结果:1.COPD组与对照组肺上、中叶脏层胸膜厚度均明显小于肺下叶(P0.05)。2.COPD组脏层胸膜厚度以及脏层胸膜中弹力纤维成分所占比例均明显小于对照组(均P0.01)。3.轻度COPD组脏层胸膜厚度以及脏层胸膜中弹力纤维所占比例均明显大于中重度COPD组(均P0.05)。结论:1.肺上、中叶脏层胸膜厚度小于肺下叶。2.COPD患者脏层胸膜变薄,弹力纤维减少。3.COPD患者脏层胸膜变薄以及弹力纤维减少,可能是呼气气流受限的原因之一。
[Abstract]:Objective: To observe the pathological changes of the filthy pleura in patients with chronic obstructive pulmonary disease (COPD) and the relationship between this change and the limitation of COPD airflow. Methods: 70 cases of all pulmonary lobectomy or partial lobectomy were selected from May 2014 to August 2015 in Department of thoracic surgery, Tianjin Thoracic Hospital. The results were divided into COPD Group [after inhaled bronchodilator, the first second forced expiratory volume (FEV1) / forced vital capacity (FVC) 70%, 40 cases] and the control group (FEV1/FVC > 70%, 30 cases). In group COPD, the severity of COPD patients was classified according to the FEV1/FEV1 predicted value (FEV1%pre), and the severity was again divided into.FEV1%pre more than 80% as mild COPD. 50% < FEV1%pre80% as moderate COPD; FEV1%pre50% for severe COPD. and mild COPD patients in a mild COPD group (21 cases), and moderate and severe COPD patients were included in the moderate and severe COPD group (19 cases). The lung tissue obtained from the operation was taken from the lung tissue (the site was not infiltrated by the lesion, apart from the lesion area 2cm), and the tissue section was made, and the hematoxylin Yi Hong was used. Dyeing (HE) and elastic fiber staining (EVG), the thickness of the pleura and the proportion of elastic fibers were observed and calculated under the microscope. The results were as follows: the thickness of the pleura in the lungs of the 1.COPD group and the control group was significantly smaller than that in the lower lobe of the lung (P0.05).2.COPD group, and the elastic fiber in the pleura of the.2.COPD group. The proportion of the components was significantly smaller than that of the control group (P0.01), the thickness of the pleura in the dirty layer of the.3. COPD group and the proportion of the elastic fibers in the pleura of the dirty layer were obviously larger than those in the moderate and severe COPD group (P0.05). Conclusion: on 1. lungs, the thickness of the pleura in the middle lobe of the middle lobe is smaller than the.2.COPD in the lower lobe of the lung, and the elastic fiber reduces the visceral layer of the.3.COPD patients. Thinning of pleural membrane and decrease of elastic fibers may be one of the reasons for expiratory airflow limitation.
【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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