中性粒细胞明胶酶相关脂质运载蛋白在AECOPD的表达

发布时间：2019-03-30 15:25

【摘要】：背景慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是以持续性的气流受限为特征的呼吸系统的常见病和多发病,急性加重是慢阻肺患者重要的致死率和病情进展因素,加重患者的经济负担,降低患者的生活质量。慢性气道炎症和气道重塑是慢阻肺重要的病理过程,对于慢阻肺的治疗,特别是急性加重期,迅速控制炎症反应是控制患者症状及改善预后的关键。目前对于慢阻肺中炎症介质的研究众多,关于炎症反应在COPD发展过程中的作用机制尚不明确,经初步研究,中性粒细胞明胶酶相关脂质运载蛋白(NGAL,neutrophil gelatinase-associated lipocalin)作为一种炎症介质,其在慢阻肺中表达上调,可能参与了气道的炎症反应及气道重塑,或可用作控制慢阻肺急性加重时炎症反应的一个标志物。目的分别观察中性粒细胞明胶酶相关脂质运载蛋白在慢性阻塞性肺疾病急性加重(AECOPD,chronic obstructive pulmonary disease acute exacerbation)患者治疗前、后及健康对照中的表达,评价NGAL在评估慢阻肺急性发作期严重程度的价值。方法本实验采用自身前后对照研究,随机选取2015年6月至2016年4月期间于阜阳市人民医院呼吸科因AECOPD住院的病例40例为实验组(初选46例,实验过程中排除6例),选取阜阳市人民医院体检中心体检结果为健康的25人为对照组。应用酶联免疫吸附法(ELISA)测定AECOPD患者治疗前、后及对照组的血NGAL水平,同时采集患者的C-反应蛋白(CRP)、外周血白细胞(WBC)和中性粒细胞百分比(NE%)、PO_2、PCO_2、SpO_2、FEV1%、近一年内急性加重次数、住院时间等资料。结果1、AECOPD患者治疗前后及对照组血NGAL浓度分别为(112.18±20.96)μg/L、(79.02±15.39)μg/L、(64.74±13.20)μg/L,3组间差异具有统计学意义(p0.05)2、慢阻肺急性加重患者治疗后血CRP低于治疗前,但较健康对照组高,差异具有统计学意义(p0.05)。3、慢阻肺患者外周WBC和中性粒细胞百分比治疗后高于治疗前,差异具有统计学意义(p0.05),而治疗后与健康对照组相比无统计学差异(p0.05)4.对NGAL、CRP、WBC、中性粒细胞百分比作ROC曲线,曲线下面积分别为(AUC=0.869,p㩳0.001)、(AUC=0.822,p㩳0.001)、(AUC=0.697,p=0.002)、(AUC=0.799,p㩳0.001),NGAL为92.58μg/L时取截断点,敏感度和特异度分别为80%、80%。5.慢阻肺急性加重患者中频繁加重患者血NGAL高于一般患者。6.不同GOLD分级患者之间NGAL无显著差异。7.AECOPD患者治疗前血NGAL与CRP、中性粒细胞百分比、住院天数呈正相关,与肺功能受损程度(FEV1%)呈负相关,与白细胞计数、PO_2、PCO_2、SpO_2无显著相关性。结论AECOPD患者血NGAL在治疗后显著降低,NGAL可作为NGAL可作协助诊断慢性阻塞性肺疾病急性加重的炎症标志物,评估AECOPD患者病情严重程度的指标。
[Abstract]:Background chronic obstructive pulmonary disease (chronic obstructive pulmonary disease,COPD) is a common and frequently occurring respiratory disease characterized by persistent airflow restriction. Acute exacerbation is an important cause of mortality and progression in patients with chronic obstructive pulmonary disease (COPD). Increase the financial burden of patients, reduce the quality of life of patients. Chronic airway inflammation and airway remodeling are important pathological processes of COPD. For the treatment of COPD, especially in acute exacerbation, rapid control of inflammatory response is the key to control the symptoms and improve the prognosis of the patients. At present, there are many studies on inflammatory mediators in chronic obstructive lung, and the mechanism of inflammatory reaction in the development of COPD is not clear. After preliminary study, neutrophil gelatinase-associated lipid transport protein (NGAL,) has been studied. As an inflammatory medium, neutrophil gelatinase-associated lipocalin may be involved in airway inflammatory reaction and airway remodeling, or may be used as a marker to control the inflammatory response in the acute exacerbation of chronic obstructive lung disease (COPD), which may be involved in airway inflammation and airway remodeling. Objective to observe the expression of neutrophil gelatinase-associated lipid delivery protein in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD,chronic obstructive pulmonary disease acute exacerbation) before and after treatment and in healthy controls. To evaluate the value of NGAL in assessing the severity of acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods from June 2015 to April 2016, 40 cases of AECOPD hospitalized in the respiratory department of Fuyang people's Hospital from June 2015 to April 2016 were randomly selected as the experimental group (46 cases were primary selected, 6 cases were excluded during the experiment), and 40 cases were admitted to the respiratory department of Fuyang people's Hospital from June 2015 to April 2016. 25 healthy controls were selected from the physical examination center of Fuyang people's Hospital. Serum NGAL levels were measured by enzyme-linked immunosorbent assay (ELISA) before and after treatment in patients with AECOPD and in the control group. (WBC) and neutrophil percentage (NE%) of peripheral blood leukocytes and neutrophil percentage (NE%) of patients with C-reactive protein (CRP), were collected at the same time. PO_2, The data of acute exacerbation, length of hospitalization and so on in PCO_2,SpO_2,FEV1%, in recent one year. Results 1Serum NGAL concentrations were (112.18 卤20.96) 渭 g / L, (79.02 卤15.39) 渭 g / L and (64.74 卤13.20) 渭 g / L respectively before and after treatment. The serum CRP in patients with acute exacerbation of chronic obstructive pulmonary disease was lower than that before treatment, but higher than that in healthy control group (p0.05). 3. The percentage of peripheral WBC and neutrophil in patients with chronic obstructive pulmonary disease after treatment was higher than that before treatment. The difference was statistically significant (p0.05), but there was no significant difference between the treatment group and the healthy control group (p0.05) 4. The percentage of neutrophil in NGAL,CRP,WBC, was compared to ROC curve, and the area under the curve was (AUC=0.869,p?0.001), (AUC=0.822,p?0.001), (AUC=0.697,p=0.002), (AUC=0.799,p?0.001). When NGAL was 92.58 渭 g / L, the sensitivity and specificity were 80% and 80% respectively. The serum NGAL in patients with acute exacerbation of chronic obstructive pulmonary disease was higher than that in patients with acute exacerbation of chronic obstructive pulmonary disease. 6. 7. There was a positive correlation between serum NGAL and CRP, neutrophil percentage, length of hospitalization, negative correlation with degree of lung function impairment (FEV1%), white blood cell count and PO_2, before treatment in patients with AECOPD. 7. There was no significant difference in NGAL between patients with different GOLD grades and the percentage of neutrophils in CRP, before treatment. There was no significant correlation between PCO_2,SpO_2. Conclusion the serum NGAL in patients with AECOPD is significantly decreased after treatment. NGAL can be used as a marker of inflammation in the diagnosis of acute exacerbation of chronic obstructive pulmonary disease (COPD) and can be used as a marker to evaluate the severity of AECOPD patients with chronic obstructive pulmonary disease (COPD).
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9

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