慢性阻塞性肺疾病急性加重期血清皮质醇的表达特征
发布时间：2018-09-10 21:16
【摘要】：目的 通过检测COPD组及非COPD组患者血清皮质醇及血浆促肾上腺皮质激素,了解COPD患者与非COPD患者之间以及AECOPD患者不同病情严重程度的血清皮质醇的表达特征及其与病情的相关性,为之后的干预治疗提供理论及实验依据,从而提高患者的生活质量,减轻社会及经济负担。 方法 随机选取2011年10月至2012年10月在我院住院治疗的AECOPD患者65例为COPD组。根据肺功能结果及第七版《内科学》(人民卫生出版社)COPD的严重程度分级标准分为轻中度组及重度、极重度组。随机选取同期住院的非COPD患者33例为非COPD组。所有研究对象均经病史询问、体格检查、相关实验室检查及辅助检查等排除合并糖尿病及糖尿病家族史、心肝肾疾病、高血压、睡眠呼吸暂停低通气综合征、库欣综合征、肺结核肺纤维化、支气管扩张、支气管哮喘、弥漫性泛细支气管炎及其他代谢障碍等疾病,并且近3个月未曾接受过糖皮质激素治疗。 全部研究对象分别于入院后第二天的8am、4pm及Oam三个时间段各抽取2管肘静脉血,每管2-4ml,每份标本均做好标记。其中一管分离出血清后用电化学发光法检测皮质醇(cortisol, COR)水平,另一管分离出血浆后用电化学发光法检测促肾上腺皮质激素(adrenocor ticotropic hormore, ACTH)水平。 统计学处理：运用SPSS13.0统计分析软件进行数据分析。计量资料以(?)±s表示,多样本均数比较采用单因素方差分析,两两比较方差齐者采用SNK-q检验；偏态资料或方差不齐者采用Games-Howell检验或者秩和检验,以P0.05为差异有统计学意义。 结果 1.三组间皮质醇水平在三个不同时间段比较差异均有显著统计学意义(P0.01)。进一步行两两比较,因方差不齐,采用Games-Howell检验,三个不同时间段轻、中度组及重度、极重度组皮质醇水平与非COPD组之间比较差异有显著统计学意义(P0.01)；8am时段轻、中度组与重度、极重度组之间比较差异有显著统计学意义(P0.01),但在4pm、Oam时间段轻、中度组与重、极重度组之间比较差异无统计学意义(P0.05)。 2.三组间促肾上腺皮质激素水平在8am时间段比较差异有显著统计学意义(P0.01),在4pm、Oam时间段比较差别有统计学意义(P0.05)。进一步行两两比较,因方差不齐,采用Games-Howell检验。三个不同时间段轻、中度组及重度、极重度组肾上腺皮质激素水平与非COPD组之间比较差异有统计学意义(P0.05),但轻、中度组与重、极重度组之间比较差异均无统计学意义(P0.05)。 结论 1. COPD患者在三个不同时间段(8am、4pm、Oam)皮质醇水平均较非COPD患者降低,差异均有显著统计学意义(P0.01),其中早上8时这一时间段重度、极重度患者皮质醇水平又低于轻、重度组,差异有显著统计学意义(P0.01)。 2. COPD患者在下午4时、凌晨0时这两个时间段促肾上腺皮质激素水平较非COPD患者升高,差异具有统计学意义(P0.05)；而在上午8时这个时间段促肾上腺皮质激素水平较非COPD患者升高明显,差异具有显著统计学意义(P0.01)。而在三个不同时间段病情不同程度的AECOPD患者促肾上腺皮质激素水平变化不明显,差异无统计学意义(P0.05)。 3. AECOPD患者可能存在肾上腺皮质代谢紊乱,表现为血清皮质醇水平降低,促肾上腺皮质激素水平升高。
[Abstract]:objective
The serum cortisol and plasma adrenocorticotropic hormone were detected in COPD group and non-COPD group. The expression characteristics of serum cortisol and its correlation with the severity of COPD and non-COPD patients and AECOPD patients were investigated. The results provide theoretical and experimental basis for the subsequent intervention and treatment to improve the patients'condition. Quality of life, reduce social and economic burden.
Method
Sixty-five patients with AECOPD hospitalized in our hospital from October 2011 to October 2012 were randomly selected as COPD group. According to the results of pulmonary function and the severity grading criteria of COPD in the seventh edition of "Internal Medicine" (People's Health Publishing House), they were divided into mild-moderate group and severe-severe group. The subjects were excluded from the family history of diabetes mellitus and diabetes mellitus, heart, liver and kidney disease, hypertension, sleep apnea hypopnea syndrome, Cushing's syndrome, pulmonary tuberculosis, pulmonary fibrosis, bronchiectasis, bronchial asthma, diffuse panbronchiolitis and other metabolites by medical history, physical examination, laboratory examination and auxiliary examination. Disorders such as disorders, and have not received glucocorticoid treatment in the past 3 months.
Two elbow venous blood samples were collected at 8 am, 4 pm and Oam on the second day after admission, and each sample was marked with 2-4 ml. Cortisol (COR) level was detected by electrochemiluminescence after one tube was separated from bleeding serum, and adrenocorticotrophic epithelium was detected by electrochemiluminescence after the other tube was separated from bleeding plasma. Adrenocor ticotropic hormore (ACTH) level.
Statistical analysis: SPSS13.0 statistical analysis software was used for data analysis. The measurement data was (?) + s. The mean of multiple samples was analyzed by one-way ANOVA. The SNK-q test was used for the two-way ANOVA. Game-Howell test or rank sum test were used for the skewed data or the uneven variance, and the difference was statistically significant (P 0.05).
Result
1. There were significant differences in cortisol levels among the three groups at three different times (P 0.01). There was a significant difference between the mild, moderate, severe and very severe groups (P 0.01), but there was no significant difference between the mild, moderate and severe groups (P 0.05).
2. There was a significant difference in the levels of corticotrophin between the three groups at 8 am (P 0.01). There was a significant difference at 4 pm and Oam time intervals (P 0.05). Further, two-to-two comparisons were performed, and games-Howell test was used because of uneven variance. There were significant differences in serum levels between non-COPD and mild, moderate and severe groups (P 0.05).
conclusion
1. Cortisol levels of COPD patients in three different time periods (8 am, 4 pm, Oam) were lower than those of non-COPD patients, the difference was statistically significant (P 0.01). Cortisol levels of severe COPD patients at 8 am were lower than those of light COPD patients and severe COPD patients, the difference was statistically significant (P 0.01).
2. The levels of adrenocorticotropic hormone in COPD patients were significantly higher than those in non-COPD patients at 4 pm and 0 am (P 0.05), while the levels of adrenocorticotropic hormone in 8 am were significantly higher than those in non-COPD patients (P 0.01). There was no significant difference in the levels of adrenocorticotropic hormone between AECOPD patients with different degrees of interval disease (P 0.05).
3. AECOPD patients may have adrenocortical metabolic disorders, characterized by decreased serum cortisol levels and elevated corticotropic hormone levels.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.9
本文编号：2235632
[Abstract]:objective
The serum cortisol and plasma adrenocorticotropic hormone were detected in COPD group and non-COPD group. The expression characteristics of serum cortisol and its correlation with the severity of COPD and non-COPD patients and AECOPD patients were investigated. The results provide theoretical and experimental basis for the subsequent intervention and treatment to improve the patients'condition. Quality of life, reduce social and economic burden.
Method
Sixty-five patients with AECOPD hospitalized in our hospital from October 2011 to October 2012 were randomly selected as COPD group. According to the results of pulmonary function and the severity grading criteria of COPD in the seventh edition of "Internal Medicine" (People's Health Publishing House), they were divided into mild-moderate group and severe-severe group. The subjects were excluded from the family history of diabetes mellitus and diabetes mellitus, heart, liver and kidney disease, hypertension, sleep apnea hypopnea syndrome, Cushing's syndrome, pulmonary tuberculosis, pulmonary fibrosis, bronchiectasis, bronchial asthma, diffuse panbronchiolitis and other metabolites by medical history, physical examination, laboratory examination and auxiliary examination. Disorders such as disorders, and have not received glucocorticoid treatment in the past 3 months.
Two elbow venous blood samples were collected at 8 am, 4 pm and Oam on the second day after admission, and each sample was marked with 2-4 ml. Cortisol (COR) level was detected by electrochemiluminescence after one tube was separated from bleeding serum, and adrenocorticotrophic epithelium was detected by electrochemiluminescence after the other tube was separated from bleeding plasma. Adrenocor ticotropic hormore (ACTH) level.
Statistical analysis: SPSS13.0 statistical analysis software was used for data analysis. The measurement data was (?) + s. The mean of multiple samples was analyzed by one-way ANOVA. The SNK-q test was used for the two-way ANOVA. Game-Howell test or rank sum test were used for the skewed data or the uneven variance, and the difference was statistically significant (P 0.05).
Result
1. There were significant differences in cortisol levels among the three groups at three different times (P 0.01). There was a significant difference between the mild, moderate, severe and very severe groups (P 0.01), but there was no significant difference between the mild, moderate and severe groups (P 0.05).
2. There was a significant difference in the levels of corticotrophin between the three groups at 8 am (P 0.01). There was a significant difference at 4 pm and Oam time intervals (P 0.05). Further, two-to-two comparisons were performed, and games-Howell test was used because of uneven variance. There were significant differences in serum levels between non-COPD and mild, moderate and severe groups (P 0.05).
conclusion
1. Cortisol levels of COPD patients in three different time periods (8 am, 4 pm, Oam) were lower than those of non-COPD patients, the difference was statistically significant (P 0.01). Cortisol levels of severe COPD patients at 8 am were lower than those of light COPD patients and severe COPD patients, the difference was statistically significant (P 0.01).
2. The levels of adrenocorticotropic hormone in COPD patients were significantly higher than those in non-COPD patients at 4 pm and 0 am (P 0.05), while the levels of adrenocorticotropic hormone in 8 am were significantly higher than those in non-COPD patients (P 0.01). There was no significant difference in the levels of adrenocorticotropic hormone between AECOPD patients with different degrees of interval disease (P 0.05).
3. AECOPD patients may have adrenocortical metabolic disorders, characterized by decreased serum cortisol levels and elevated corticotropic hormone levels.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.9
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