肺胀常见三证型与血清ADPN、AQP-5的相关性研究

发布时间：2018-02-28 06:38

本文关键词： 肺胀证型 ADPN AQP-5 相关性　出处：《云南中医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本课题旨在从现代医学理论和中医传统医学辨证的诊疗特点出发,以检测血清脂联素(Adiponectin,ADPN)、水通道蛋白-5(Aquaporin-5,AQP-5)在肺胀肺肾气虚证、阳虚水泛证、痰热郁肺证患者的变化为主要观测内容,辅以中医症状评分及临床血常规、心脏彩色多普勒超声、肺功能等相关检查,探讨血清ADPN、AQP-5水平在肺胀常见三个证型之间的变化规律以及ADPN、AQP-5与肺胀三个证型的相关性,为肺胀的中医临床诊疗提供一定的参考。方法:本课题设计方案采用随机平行对照观察的方法,按病例纳入标准分别纳入肺肾气虚证30例、阳虚水泛30例、痰热郁肺证30例,共90例。根据入院时的临床表现,评估主要症状及临床体征,并于入院第二天采集空腹静脉血进行相关实验室检查包括白细胞(White Blood Cell,WBC)、中性粒细胞百分比(Neutrophilic Granulocyte Percent,NEUT%)、脑钠肽(Brain Natriuretic Peptide,BNP)等,依次进行心脏彩色多普勒超声、肺功能检查,心脏彩色多普勒超声选取右心室舒张末内径(Right Ventricular End-diastolic Diameter,RVEDd)、肺动脉压(Pulmonary Artery Pressure,PAP)为观察指标,肺功能检查选取FEV1/FVC、FEV1占预计值%、FVC占预计值%等相关指标。用双抗体一步夹心酶联免疫吸附法检测血清ADPN、AQP-5水平。评估肺胀阳虚水泛证、肺肾气虚证、痰热郁肺证三个证型的症状评分,并收集记录三个证型的各项辅助检查资料。并对三个证型血清ADPN、AQP-5及各项辅助检查资料、症状评分进行统计分析,探讨血清ADPN、AQP-5、以及相关辅助检查资料在三证型中的差异性及相关性。结果:1.三证型血清ADPN水平比较,阳虚水泛证组、肺肾气虚证组分别与痰热郁肺证组比较,差异均存在显著统计学意义(P0.01);阳虚水泛证组与肺肾气虚证组比较,差异不存在统计学意义(P0.05)。2.三证型血清AQP-5水平比较,肺肾气虚证组与阳虚水泛证组比较,差异有统计学意义(P0.05);痰热郁肺证组与阳虚水泛证组比较,差异有显著统计学意义(P0.01);痰热郁肺证组与肺肾气虚证组比较,差异不存在统计学意义(P0.05)。3.三证型咳嗽、咳痰、气喘、紫绀评分比较,痰热郁肺证组分别与阳虚水泛证组、肺肾气虚证组比较,差异均存在显著统计学意义(P0.01);肺肾气虚证组与阳虚水泛证组比较,差异均无统计学意义(P0.05)。三证型水肿评分比较,阳虚水泛证组分别与肺肾气虚证组、痰热郁肺证组比较,差异均有显著统计学意义(P0.01);肺肾气虚证组与痰热郁肺证组比较,差异无统计学意义(P0.05)。4.FEV1占预计值%、FEV1/FVC、FVC占预计值%分别在三证型之间比较,差异均无统计学意义(P0.05)。5.三证型WBC比较,差异无统计学意义(P0.05)。三证型NEUT%比较,痰热郁肺证组分别与阳虚水泛证组、肺肾气虚证组比较,差异均有显著统计学意义(P0.01);肺肾气虚证组与阳虚水泛证组比较,差异无统计学意义(P0.05)。6.三证型组之间RVEDd两两比较,差异均存在显著统计学意义(P0.01)。7.三证型PAP比较,阳虚水泛证组与痰热郁肺证组比较,差异有显著统计学意义(P0.01);阳虚水泛证组与肺肾气虚证组比较,差异有统计学意义(P0.05);肺肾气虚证组与痰热郁肺证组比较,差异无统计学意义(P0.05)。8.三证型BNP比较,阳虚水泛证组分别与肺肾气虚证组、痰热郁肺证组比较,差异均存在显著统计学意义(P0.01);痰热郁肺证组与肺肾气虚证组比较,差异不存在统计学意义(P0.05)。9.在痰热郁肺证组,ADPN与NEUT%呈正相关,存在显著统计学意义(P0.01),ADPN与WBC无相关性;AQP-5与RVEDd、PAP、BNP无相关性。10.在肺肾气虚证组,ADPN与WBC、NEUT%均无相关性,AQP-5与RVEDd、PAP、BNP无相关性。11.在阳虚水泛证组,ADPN与WBC、NEUT%均无相关性。AQP-5与RVEDd、PAP均呈正相关,均存在显著统计学意义(P0.01);AQP-5与BNP呈正相关,存在统计学意义(P0.05)。结论:1.肺胀痰热郁肺证与血清ADPN存在相关性,在痰热郁肺证组中随着NEUT%的升高ADPN呈上升趋势,ADPN可能参与了肺胀痰热郁肺证的炎症反应过程。2.肺胀阳虚水泛证与血清AQP-5存在相关性,在阳虚水泛证组中随着PAP、BNP的升高、RVEDd的增宽,AQP-5呈上升趋势,AQP-5可能参与了肺胀阳虚水泛证水液代谢失衡的过程。
[Abstract]:Objective: the purpose of this study is to proceed from the characteristics of diagnosis and treatment of traditional Chinese medicine and modern medicine theory of syndrome differentiation, to detect serum adiponectin (Adiponectin, ADPN), aquaporin -5 (Aquaporin-5, AQP-5) in the lungs of lung and kidney qi deficiency, Yang deficiency and water pan card, change of phlegm heat obstructing lung syndrome patients as the main content of observation, supplemented by the TCM symptoms score and clinical blood routine, heart color Doppler ultrasound, pulmonary function examination, serum ADPN, AQP-5 level changes between common in lung distension syndrome type three and ADPN, the correlation between AQP-5 and lung distension syndrome type three, provide a reference for clinical diagnosis and treatment of lung distension. Methods: this topic design scheme using random parallel control observation method, according to the inclusion criteria were included in the lung and kidney qi deficiency syndrome in 30 cases, 30 cases of deficiency of Yang, phlegm heat obstructing lung syndrome 30 cases, a total of 90 cases. According to the clinical manifestations of admission, evaluation To clinical symptoms and signs, and fasting venous blood on the second day of admission related laboratory tests including white blood cells (White Blood Cell, WBC), the percentage of neutrophils (Neutrophilic Granulocyte, Percent, NEUT%), brain natriuretic peptide (Brain Natriuretic Peptide, BNP), followed by cardiac color Doppler ultrasound, pulmonary function test and the heart of color Doppler ultrasound selection of right ventricular end diastolic diameter (Right Ventricular End-diastolic Diameter, RVEDd), pulmonary artery pressure (Pulmonary, Artery Pressure, PAP) as observation indexes, pulmonary function tests including FEV1/FVC, FEV1% PRED, FVC% PRED and other related indicators. Using double antibody sandwich enzyme-linked step immunoassay for detection of serum ADPN, AQP-5 levels. Assessment of lung distension edema syndrome due to Yang deficiency, lung qi deficiency symptoms score, phlegm heat obstructing lung syndrome type three, and the collection of the auxiliary examination records of three types Check the information. And the three types of serum ADPN, AQP-5 and the auxiliary examination data, statistical analysis was carried out to investigate the symptom score, serum ADPN, AQP-5, the difference in the three type and correlation and related auxiliary examination data. Results: the serum level of ADPN 1. in water type, Yang Deficiency Syndrome group, lung kidney deficiency syndrome group were compared with the phlegm heat stasis syndrome group, the differences were statistically significant (P0.01); water pan Yang deficiency syndrome group and lung qi deficiency group, the difference was not statistically significant (P0.05) between the level of serum AQP-5.2. syndromes, lung and kidney qi deficiency syndrome group and deficiency of Yang syndrome group. The difference was statistically significant (P0.05); phlegm heat stasis syndrome group and deficiency of Yang syndrome group, the difference was statistically significant (P0.01); phlegm heat stasis syndrome group and lung qi deficiency group, the difference was not statistically significant (P0.05).3. syndromes of cough, expectoration, shortness of breath, Cyanosis scores of phlegm heat obstructing lung syndrome group and deficiency of Yang syndrome group, comparison of lung and kidney qi deficiency group, the differences were statistically significant (P0.01); group of lung and kidney qi deficiency and Yang water pan card group, there were no significant differences (P0.05). Comparing the three patterns of edema scores, Yang pan water C group and lung qi deficiency group, comparison of phlegm heat obstructing lung syndrome group, the difference was statistically significant (P0.01); group comparison of lung and kidney qi deficiency and phlegm heat obstructing lung syndrome group, the difference was not statistically significant (P0.05).4.FEV1% PRED, FEV1/FVC, FVC% predicted respectively in three patterns between comparison, there were no significant differences between the three patterns of.5. (P0.05) WBC, the difference was not statistically significant (P0.05). Three NEUT%, phlegm heat obstructing lung syndrome group and deficiency of Yang syndrome group, comparison of lung and kidney qi deficiency group, the differences were statistically significant (P0.01); lung qi deficiency group Compared with water Yang deficiency syndrome group, the difference was not statistically significant (P0.05) compared to RVEDd 22 among the three patterns of.6. group, the differences were statistically significant (P0.01) compared the three patterns of.7. PAP, comparison of edema syndrome due to Yang deficiency group and phlegm heat stasis syndrome group, the difference was statistically significant (P0.01); Yang water pan lung and kidney qi deficiency syndrome group and the comparison group, the difference was statistically significant (P0.05); group comparison of lung and kidney qi deficiency and phlegm heat obstructing lung syndrome group, there was no significant difference between the three patterns of.8. (P0.05) BNP, edema syndrome due to Yang deficiency group and lung qi deficiency group, comparison of phlegm heat obstructing lung syndrome group. The differences were statistically significant (P0.01); phlegm heat stasis syndrome group and lung qi deficiency group, the difference was not statistically significant (P0.05).9. in phlegm heat stasis syndrome group, ADPN was positively associated with NEUT%, there was statistical significance (P0.01), there is no correlation between ADPN and WBC; AQP-5 and RVEDd. PAP, B There was no correlation between NP.10. in lung and kidney qi deficiency syndrome group, ADPN and WBC, NEUT% had no correlation with RVEDd, AQP-5, PAP, BNP and.11. have no correlation in water Yang deficiency syndrome group, ADPN and WBC, NEUT% showed no correlation between.AQP-5 and RVEDd, PAP were positively correlated, there were statistically significant (P0.01); AQP-5. Associated with BNP, there were statistical significance (P0.05). Conclusion: there is a correlation between the lung heat phlegm obstructing lung 1. and ADPN in serum, phlegm heat obstructing lung syndrome group with the increase of NEUT% ADPN increased, the correlation between ADPN may be involved in the lungs caused by phlegm inflammation.2. during lung distension Yang pan water syndrome and serum AQP-5 in edema syndrome due to Yang deficiency group with PAP, BNP increased, RVEDd widened, AQP-5 showed a rising trend, AQP-5 may be involved in the process of lung edema syndrome due to Yang deficiency water metabolism imbalance.

【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R256.14

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