【作者】 刘倩；

【导师】 郝青林；

【作者基本信息】 昆明医学院 ， 呼吸内科学， 2011， 硕士

【摘要】 [目的]①通过观察慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)急性加重期轻、中、重三组病人的血清白细胞介素-6 (interleukin-6, IL-6),FKN趋化因子(fractalkine, FKN或CX3CL1)的水平,探讨细胞因子IL-6、FKN在COPD疾病进展中的关系；②通过测量患者的肺功能,探讨患者血清IL-6、FKN的水平与肺功能的关系。[方法]选取79例诊断为COPD的呼吸内科住院病人,且为急性加重期,排除混杂因素后,行肺功能检查后根据第一秒用力呼气容积%预计值(forced expiratory volume in one second% predicted, FEV1%Pre),分为轻、中、重三组,其中轻度患者28例,中度患者28例,重度患者23例。并于住院次日清早空腹抽取患者静脉血,测定血清IL-6和FKN的水平。[结果]①急性加重期的COPD的轻、中、重三组病人血清的IL-6, FKN的水平,经统计学分析后P<0.01,差异有统计学意义,三组病人中血清IL-6、FKN的水平不等；②行两两比较后,三组病人的IL-6的水平都不相同,且重度病人的IL-6的水平最高,中度病人的IL-6的水平次之,轻度病人的IL-6的水平最低,各组间比较,P值小于0.05；轻度组与中度组FKN比较时,P<0.05,差异有统计学意义,中度高于轻度；轻度组与重度组比较时,P<0.05,差异有统计学意义,重度高于轻度；中度组和重度组比较时,P>0.05,差异无统计学意义；③患者血清IL-6、FKN与患者肺功能(FEV1%预计值)的相关性研究发现：FEV1%预计值随着IL-6的水平的升高而降低,P=0.000,r=-0.877,说明IL-6与FEV1%预计值存在负相关关系；FEV1%预计值随着FKN的水平的升高而降低,P=0.000,r=-0.584,说明FKN与FEV1%预计值也存在负相关关系。[结论]1.检测COPD患者血清中细胞因子的水平,有助于进一步研究细胞因子在COPD发病机制中的作用。2. COPD急性加重期轻、中、重三组病人血清IL-6的不同表达、IL-6的水平与FEV1%预计值的相关性可能说明：病情越重,IL-6的水平越高,炎症反应也越严重,患者的肺功能就越低。3. COPD急性加重期轻、中、重三组病人血清FKN的不同表达、FKN的水平与FEV1%预计值的相关性可能说明：FKN与COPD的发展可能有一定的关系,随着FKN的升高,患者肺功能有下降的趋势,但是,在中、重度病人中FKN的差异无统计学意义,可能说明：当COPD发展到一定程度(中、重度)后,FKN的表达无太大的变化,而可能与病人发展为更严重的疾病有关,如：肺动脉高压,肺心病等。更多还原

【Abstract】 [Objectives]①To investigate the changes of serum interleukin -6(IL-6) fractalkine(FKN or CX3CL1) levels in chronic obstructive pulmonary disease(COPD) with acute exacerbation of mild、moderate and severe group of patients,explore the relationship between levels of cytokines IL-6、FKN and disease progression in COPD②By measuring the patient’s lung function of patients, explore the relationship between levels of serum IL-6、FKN and the level of lung function.[Methods] Selected the 79 patients hospitalized in the respiratory department of patients were diagnosed with COPD, and acute exacerbation of.Excludeed confounding factors, lined after the pulmonary function tests forced expiratory volume in one second% predicted (FEV1%Pre) were divided into mild、moderate and severe groups,28 patients with mild,28 patients with moderate,23 patients with severe. And extracted the second day of fasting morning blood of patients, masured serum levels of IL-6 and FKN.[Results]①Acute exacerbation of COPD mild、moderate and severe group of patients serum IL-6、FKN levels, by statistical analysis,P<0.01, there were significant differences, three groups of patients in the serum IL-6 FKN unequal level;②Comparison between two lines, three groups of patients the level of IL-6 is not the same, and severe patients the highest levels of IL-6, patients with moderate levels of IL-6 in the second highest, patients with mild levels of IL-6 minimum, The comparison between groups.P values were less than 0.05; when compared between mild and moderate group of FKN, P<0.05, statistically significant differences,higher than the mild to moderate. when compared between mild group and severe group, the P<0.05, statistically significant differences, higher than the mild to severe, when compared between moderate group and severe group P>0.05, the difference was not statistically significant;③Serum IL-6、FKN of patients correlation with pulmonary function (forced expiratory volume in one second%predicted)findings:FEV1% predicted decrease with the levels of IL-6 increase,P=0.000,r=-0.877, that IL-6 and FEV1% predicted a negative correlation; FEV1% predicted decrease with the level of FKN increase,P=0.000,r=-0.548, that FKN and FEV1% predicted negative correlation exists.[Conclusions]1.Measured of COPD patients levels of serum cycokines, contribute to the further study of cytokines in the pathogenesis of the role of COPD.2. COPD with acute exacerbation of mild, moderate and severe group of patients the difference in serum IL-6 expression,IL-6 levels and FEV1% predicted correlation may indicate:More severe disease, IL-6 levels higher, the more severe inflammatory response,lower lung function in patients.3.COPD with acute exacerbation of mild, moderate and severe groups of different serum FKN expression,FKN levels and FEV1% predicted correlation may indicate: FKN and the development of COPD may have some relationship, with the increase of FKN, a downward trend in pulmonary function, however, in moderate to severe patients no significant differences in FKN, may indicate:when developed to a certain degree of COPD (moderate and severe) after, FKN expression was not much change, and patients may develop more serious diseases,such as:pulmonary hypertension, pulmonary heart disease and so on.更多还原