COPD流行病学调查与EBC检测在气道炎症监测中的应用意义

发布时间：2018-09-13 16:05

【摘要】：目的：了解湖北省浩口地区农村慢性阻塞性肺病患病率及危险因素；评价呼出气冷凝水检测(EBC)这一新的检测手段在监测慢性阻塞性肺病稳定期患者气道炎症中的可行性和意义；并分析氧化应激相关基因CYBA中第四号外显子中242位点单核基因多态性与慢性阻塞性肺病易感性之间的关系。方法：以多阶段抽样方法,抽取浩口地区非干预村年龄≥40岁的农村居民1554人进行调查,采用统一的流行病学调查表格,并进行体检和肺功能检测,以支气管舒张试验后(FEV1/FVC)×100%70%作为慢性阻塞性肺病的诊断标准。其中118名慢性阻塞性肺病患者及65名健康对照者进行静脉血、诱导痰及呼出气冷凝水的采集,并用ELISA及EIA等方法检测三种标本中白细胞介素8、肿瘤坏死因子α、白三烯B4、8-异前列腺素以及瘦素的含量,评价慢性阻塞性肺病稳定期患者气道炎症的程度、与全身性炎症的关系以呼出气冷凝水检测的可行性。最后,提取两组受试者的DNA,并利用限制性片段长度多态性技术对NADPH氧化酶P22PHOX亚基编码基因CYBA的C242T的基因型和等位基因分布进行检测。结果：共检出慢性阻塞性肺病患者173例,总患病率为11.13%.男性患病率为13.57%,女性患病率为7.44%,男性高于女性。随年龄增高患病率逐渐上升。慢性阻塞性肺病患者以轻中度者为主(78.98%)。单因素分析表明,性别、年龄、吸烟、用生物燃料做饭、体重指数降低等5项因素与慢性阻塞性肺病有关。多因素logistic分析发现,性别、年龄、吸烟为慢性阻塞性肺病的危险因素。慢性阻塞性肺病患者气道炎症标志物及特异性的氧化应激标准升高明显,提示慢性阻塞性肺病稳定期患者有慢性气道炎症存在。EBC检测可以反应患者气道炎症情况,但检测方法尚待标准化。P22PHOX亚基编码基因CYBA的C242T的单核苷酸基因多态性与慢性阻塞性肺病的易感性无关。结论：浩口地区农村非干预村慢性阻塞性肺病患病率较高,防治意识及戒烟率差,亟需加强农村地区人群的防治工作。EBC对于慢性阻塞性肺病患者气道炎症监测有潜力,但检测方法尚需进一步优化和规范。此外,慢性阻塞性肺病稳定期患者的气道炎症过程明显,应给予规范的缓解期治疗,以利于气道炎症的控制。P22PHOX亚基编码基因CYBA的C242T的单核苷酸基因多态性与慢性阻塞性肺病的易感性无关。
[Abstract]:Objective: to investigate the prevalence and risk factors of chronic obstructive pulmonary disease (COPD) in rural areas of Haokou, Hubei Province, and to evaluate the feasibility and significance of detecting (EBC) in patients with chronic obstructive pulmonary disease (COPD) at stable stage. The relationship between the polymorphisms at locus 242in exon 4 of oxidative stress-related gene CYBA and the susceptibility to chronic obstructive pulmonary disease (COPD) was analyzed. Methods: 1554 rural residents aged more than 40 years old in non-interventional villages in Haokou area were selected by multi-stage sampling method. A unified epidemiological investigation form was used and physical examination and pulmonary function test were performed. Bronchodiastolic test (FEV1/FVC) 脳 100p% was used as diagnostic criteria for chronic obstructive pulmonary disease (COPD). Among them, 118 patients with chronic obstructive pulmonary disease and 65 healthy controls received venous blood, induced sputum and exhaled condensed water. The levels of interleukin-8 (IL-8), tumor necrosis factor 伪 (TNF- 伪), leukotriene B4-isoprostaglandin and leptin were measured by ELISA and EIA to evaluate the degree of airway inflammation in stable patients with chronic obstructive pulmonary disease (COPD). Relationship with systemic inflammation to detect the feasibility of exhaling condensate. Finally, DNA, was extracted from two groups of subjects and the genotypes and alleles of C242T of P22PHOX subunit encoding gene CYBA of NADPH oxidase were detected by restriction fragment length polymorphism (RFLP). Results: 173 cases of chronic obstructive pulmonary disease (COPD) were detected, the total prevalence rate was 11.13%. The prevalence rate of male was 13.57 and that of female was 7.44. The rate of male was higher than that of female. The prevalence rate increased with age. Patients with chronic obstructive pulmonary disease (COPD) were mainly mild to moderate (78.98%). Univariate analysis showed that 5 factors, such as sex, age, smoking, cooking with biofuel and lower body mass index, were associated with chronic obstructive pulmonary disease (COPD). Multivariate logistic analysis showed that sex, age and smoking were risk factors for chronic obstructive pulmonary disease (COPD). In patients with chronic obstructive pulmonary disease (COPD), markers of airway inflammation and specific oxidative stress criteria were significantly increased, indicating that chronic airway inflammation exists in patients with chronic obstructive pulmonary disease at stable stage. EBC detection can reflect the airway inflammation in patients with chronic obstructive pulmonary disease. However, the single nucleotide polymorphisms of C242T of P22PHOX subunit encoding gene CYBA were not associated with the susceptibility to chronic obstructive pulmonary disease (COPD). Conclusion: the prevalence rate of chronic obstructive pulmonary disease (COPD) in rural non-intervention villages in Haokou area is high, and the prevention and cure consciousness and smoking cessation rate are poor. It is urgent to strengthen the prevention and treatment of rural population. EBC has potential for monitoring airway inflammation in patients with chronic obstructive pulmonary disease (COPD). However, the detection method still needs to be optimized and standardized. In addition, chronic obstructive pulmonary disease patients with stable airway inflammation process is obvious, should be given standard remission treatment, The single nucleotide polymorphisms of C242T in P22 PHOX subunit coding gene CYBA were not associated with the susceptibility to chronic obstructive pulmonary disease (COPD).
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R563.9

【共引文献】