术前肺保护对肺组织肺表面活性蛋白A及术后并发症的影响

发布时间：2018-08-22 09:28

【摘要】：目的肺表面活性蛋白A(SP-A)是肺组织中表达最丰富、信号最强烈的肺表面活性物质相关蛋白(约占50%),主要由II型肺泡上皮细胞和气道clara细胞合成和分泌,有维持肺泡稳定性、抗炎杀菌以及调节免疫等功能。在正常条件下,SP-A可以避免烟雾、粉尘、油烟、微生物等各种危险因素引起的肺损伤和肺感染,保护肺组织的作用。肺组织中SP-A表达越多,维持肺内稳态和抵御炎性损伤的能力越强。促进SP-A的表达合成,对保护肺组织有重要意义。作为呼吸科常用药的氨溴索和布地奈德能提高内源性SP-A表达。术前肺保护药物治疗可以有效改善肺功能,肺功能与肺组织中SP-A表达水平有一定相关性。本研究探讨术前肺保护治疗对非小细胞肺癌(NSCLC)合并慢性阻塞性肺疾病(COPD)患者肺组织中SP-A表达及术后并发症的影响。方法入组2015年1月至2016年6月就诊于天津市胸科医院胸外科行手术治疗的非小细胞肺癌合并慢性阻塞性肺疾病患者60例,对照组和肺保护组各30例,对照组予以常规术前准备后行手术治疗,肺保护组在常规术前准备的基础上给予1周术前肺保护治疗后再行手术治疗,肺保护治疗药物包括氨溴索、多索茶碱、布的奈德、异丙托溴铵等,用便携式呼出冷凝液收集装置收集入院及术前呼出气冷凝液(EBC)并复查肺功能,酶联免疫吸附测定(ELISA)法检测EBC中SP-A的含量。术中快速收集肺组织标本,距病灶5cm以上取大小约1cm3肺组织2块,免疫印迹法(Western blotting)测定肺组织SP-A水平。术后予以相关康复治疗,如有并发症及时处理,并记录患者并发症的情况,按照Clavien-Dindo分级系统进行术后并发症分析。比较两组之间肺组织SP-A表达水平及术后并发症情况。结果1.肺保护组中肺组织SP-A水平高于对照组(1.05±0.21 vs 0.93±0.16),差异有统计学意义(P0.05)。2.肺保护组术前EBC中SP-A含量较入院时提高[(5.51±1.48)ng/L vs(4.99±1.32)ng/L],差异有统计学意义(P0.01)。术前EBC中SP-A含量与肺组织中SP-A水平呈正相关(r=0.460,P0.01)。3.经肺保护治疗后,术前肺功能指标FEV1、FEV1%、FEV1/FVC、FVC、FVC%较入院时提高,差异有统计学意义(P0.01)。且入院EBC中SP-A含量同入院肺功能中的FEV1%呈正相关(r=0.343,P=0.007)。4.两组患者术后并发症、Clavien-Dindo并发症分级差异无统计学意义(P0.05),两组患者手术时长、术中出血量、术后带管时长差异无统计学意义(P0.05),肺保护组术后平均住院日少于对照组[(9.2±3.1)d vs(11.6±4.8)d],差异有统计学意义(P0.05)。结论1.术前肺保护能提高肺组织中SP-A表达含量。2.经过术前肺保护治疗,术前EBC中SP-A含量较入院时提高,与肺组织中SP-A变化趋势一致。3.术前肺保护能够改善肺功能和缩短术后住院时间。4.术前肺保护在术后并发症及Clavien-Dindo并发症分级系统并未体现出统计学优势。
[Abstract]:Objective Pulmonary surfactant protein A (SP-A) is the most highly expressed and strongly expressed surfactant associated protein (50%) in lung tissues. It is mainly synthesized and secreted by type II alveolar epithelial cells and airway clara cells. Anti-inflammatory sterilization and regulation of immune function. Under normal conditions, SP-A can avoid lung injury and infection caused by smoke, dust, oil fume and microorganism, and protect lung tissue. The higher the expression of SP-A in lung tissue, the stronger the ability of maintaining stable state and resisting inflammatory injury. Promoting the expression and synthesis of SP-A plays an important role in protecting lung tissue. Ambroxol and budesonide, which are commonly used in respiratory department, can increase endogenous SP-A expression. Preoperative lung protection therapy can effectively improve lung function, and lung function is correlated with the expression of SP-A in lung tissue. This study was to investigate the effect of preoperative lung protection therapy on the expression of SP-A and postoperative complications in patients with (NSCLC) complicated with chronic obstructive pulmonary disease (COPD) in non-small cell lung cancer (NSCLC). Methods from January 2015 to June 2016, 60 patients with non-small cell lung cancer (NSCLC) complicated with chronic obstructive pulmonary disease (COPD), 30 patients in control group and 30 patients in lung protection group were treated by thoracic surgery in Tianjin chest Hospital. The control group was treated with routine preoperative preparation, the lung protection group was treated with preoperative lung protection therapy after 1 week of preoperative lung protection therapy, and the lung protection drugs included ambroxol, doxofylline and bupropion. Ipratropium bromide was used to collect (EBC) from admission and preoperative exhalation condensate with portable exhalation condensate collection device and to examine the pulmonary function. The content of SP-A in EBC was detected by (ELISA) method. The lung tissue samples were collected quickly during the operation. The size of 1cm3 lung tissue was about 2 from the lesion 5cm. The SP-A level of lung tissue was measured by Western blot (Western blotting). The postoperative complications were analyzed according to the Clavien-Dindo grading system. The expression of SP-A and postoperative complications were compared between the two groups. Result 1. The level of SP-A in lung protection group was significantly higher than that in control group (1.05 卤0.21 vs 0.93 卤0.16) (P0.05). In the lung protection group, the level of SP-A in preoperative EBC was significantly higher than that at admission [(5.51 卤1.48) ng/L vs (4.99 卤1.32) ng/L] (P0.01). There was a positive correlation between the content of SP-A in EBC and the level of SP-A in lung tissue before operation (r = 0.460, P 0.01). After lung protection treatment, the preoperative FEV1 / FEV1 / FEV1 / FVC+ FVCU FVC% was significantly higher than that on admission (P0.01). There was a positive correlation between the content of SP-A in EBC and FEV1% in pulmonary function (r = 0.343P0. 007) .4. There was no significant difference in the classification of postoperative complications between the two groups (P0.05). There was no significant difference in the length of the tube after operation (P0.05), and the average length of hospitalization in the lung protection group was less than that in the control group [(9.2 卤3.1) d vs (11.6 卤4.8) days], and the difference was statistically significant (P0.05). Conclusion 1. Preoperative lung protection can increase the expression of SP-A in lung tissue. 2. 2. After preoperative lung protection therapy, the content of SP-A in preoperative EBC was higher than that in admission, which was consistent with the trend of SP-A in lung tissue. 3. Preoperative lung protection can improve lung function and shorten postoperative hospitalization time. 4. 4. Preoperative lung protection did not show statistical advantage in postoperative complications and Clavien-Dindo complication classification system.
【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】：R734.2;R563.9

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