【作者】 张扬帆；

【导师】 刘晓菊；

【作者基本信息】 兰州大学 ， 内科学， 2008， 硕士

【摘要】 目的:探讨急性发作期慢性阻塞性肺疾病（AECOPD）患者氧化应激和全身炎症之间的关系。方法:采用乙酸苯酯法检测40例AECOPD患者和30名正常对照者血清对氧磷酶（PON1）活性,用放射免疫法分别测定血清IL-6和IL-8水平;采用免疫投射比浊法测定血清C反应蛋白（CRP）的含量,用比色法分别检测血清丙二醛（MDA）含量、谷胱甘肽过氧化物酶（GSH-Px）活性以及血清总抗氧化能力（TAC）,并分析其相关性。结果:（1）AECOPD组患者FEV₁为（1.34±0.80）L、FEV₁占预计值百分比（FEV₁%）（37.10±13.24）%分别与对照组（2.38±0.57）L、（87.50±16.40）%比较均有显著降低（P＜0.01）;AECOPD组患者FVC（2.29±0.43）L、FVC占预计值百分比（FVC%）为（60.80±10.98）%分别与对照组（2.68±0.52）L、（98.40±11.20）%比较均有降低（P＜0.05）;AECOPD组FEV₁/FVC%（55.23±7.49）%显著低于对照组（90.76±12.20）%（P＜0.01）。（2）AECOPD组患者的体重指数（BMI）（21.90±3.95）kg/m²、理想体重百分比（IBW%）（99.40±8.6）%、臂围（20.78±1.85）cm均小于正常对照组（23.15±3.36）kg/m²、（111.50±9.20）%、（24.88±3.35）cm,差异均有统计学意义（P＜0.05）。AECOPD组患者的三头肌皮皱褶厚度（16.23±3.20）mm明显低于对照组（20.88±4.01）mm（P＜0.01）。（3）AECOPD组患者血清PON1活性[（95.03±57.40）U/mL]、TAC[（9.86±3.19）NU/mL]与正常对照组[（136.0±60.50）U/mL]、[（18.42±8.23）NU/mL]相比较均明显降低（P＜0.01）;GSH-Px活性[（128.46±28.27）U/mL]低于健康对照组[（186.60±39.50）U/mL]（P＜0.05）;血清MDA[（6.25±0.87）nmol/mL]较对照组[（3.65±0.54）nmol/mL]显著增高（P＜0.01）。（4）AECOPD组患者血清CRP含量[（9.25±4.58）mg/L]、IL-6水平[（64.86±20.27）pg/mL]与正常对照组[（3.34±1.29）mg/L]、[（46.32±12.25）pg/mL]相比较显著增高（P＜0.01）;IL-8水平[（2.63±0.75）ng/mL]与正常对照组[（1.82±0.67）ng/mL]比较有增高,差异有统计学意义（P＜0.05）。（5）AECOPD组患者血清IL-6与三头肌皮皱褶厚度、BMI均呈显著相关（r值分别为-0.642、-0.486,P＜0.01）,IL-6与呼吸困难评分呈正相关（r=0.330,P＜0.05）;FEV₁占预计值百分比与C反应蛋白呈显著负相关（r=-0.511,P＜0.01）。（6）AECOPD组患者BMI与GSH-Px呈正相关（r=0.382,P＜0.05）、与MDA呈显著负相关（r=-0.407,P＜0.01）;FEV₁占预计值百分比与PON1活性呈正相关（r=0.434,P＜0.05）,与MDA呈显著负相关（r=-0.800,P＜0.01）,与TAC正相关（r=0.357,P＜0.05）。（7）AECOPD组患者血清PON1活性与IL-8显著负相关（r=-0.589,P＜0.01）;GSH-Px活性与IL-6呈负相关（r=-0.362,P＜0.05）;MDA与CRP呈显著正相关（r=0.512,P＜0.01）;TAC与IL-6呈显著负相关（r=-0.573,P＜0.01）。结论:AECOPD患者存在有营养不良,全身炎症与全身氧化应激,全身炎症、全身氧化应激分别与营养不良以及肺功能恶化间存在相关。全身炎症与全身氧化应激之间存在正相关。更多还原

【Abstract】 Objective:To explore the relationships between oxidative stress and systemic inflammation in patients with AECOPD.Methods:Serum paraoxonase（PON1）activity was measured by phenyl acetate in 40 patients with AECOPD and 30 healthy persons.The IL-6 and IL-8 levels were detected by radioimmunoassay.The level of C-reactive protein（CRP）was measured by immune-reinforced turbidimetry.The malondialdehyde（MDA）level、glutathione peroxidase（GSH-Px）activity and total antioxidant capacity（TAC）were ed by chromatology.Results:（1）FEV₁（1.34±0.80）L、FEV₁ predict（FEV₁%）（37.10±13.24）% in AECOPD group were significantly lower than control group（2.38±0.57）L、（87.50±16.40）%（P＜0.01）;FVC（2.29±0.43）L、FVC predict（FVC%）（60.80±10.98）%in AECOPD group were lower than control group（2.68±0.52）L、（98.20±11.40）% （P＜0.05）;FEV₁/FVC%（55.23±7.49）%in AECOPD group was obviously lower than control group（90.76±12.20）%（P＜0.01）.（2）The body mass index（BMI）（21.90±3.95）kg/m²、Ideal body weight per predict（IBW%）（99.40±8.6）%,mid-arm muscle circumference（20.78±1.85）cm in AECOPD group were lower than control group（23.15±3.36）kg/m²、（111.50±9.20）%、（24.88±3.35）cm（P＜0.05）.The triceps skinfold thickness（16.23±3.20）mm was significantly lower than control group（20.88±4.01）mm（P＜0.01）.（3）The activity of serum PON1[（95.03±57.4）U/mL]、TAC[（9.86±3.19）NU/mL] in AECOPD group were significantly lower than control group[（136.0± 60.50）U/mL]、[（18.42±8.23）NU/mL]（P＜0.01）;The GSH-Px[（128.46±28.27）U/mL] in AECOPD group was lower than control grouop[（186.60±39.50）U/mL]（P＜0.05）. The serum MDA in AECOPD[（6.25±0.87）nmol/mL]was significantly higher than control group[（3.65±0.54）nmol/mL]（P＜0.01）.（4）The level of CRP[（9.25±4.58）mg/L]、IL-6[（64.86±20.27）pg/mL]in AECOPD group were significantly higher than control group[（3.34±1.29）mg/L]、[（46.32±12.25）pg/mL]（P＜0.01）;The concentration of IL-8[（2.63±0.75）ng/mL]in AECOPD group was higher than in control group[（1.82±0.67）ng/mL]（P＜0.05）.（5）In AECOPD group,the level of IL-6 was related to triceps skinfold thickness and BMI（r=-0.642,-0.486,P＜0.01）;IL-6 was positively related to dyspnea scale（r=0.330,P＜0.05）;The FEV₁%was negatively related to CRP （r=-0.511,P＜0.01）.（6）The BMI was related to GSH-Px activity（r=0.382,P＜0.05）and negatively related to MDA（r=-0.407,P＜0.01）;The FEV₁%was positively related to PON1 activity（r=0.434,P＜0.05）and negatively related to MDA（r=-0.800,P＜0.01）, positively related to TAC（r=0.357,P＜0.05）.（7）The PON1 was negatively related to IL-8（r=-0.589,P＜0.01）;Serum GSH-Px activity was negatively related to IL-6（r=-0.362,P＜0.05）;MDA was significantly positively related to C-reactive protein（r=0.512,P＜0.01）;Total antioxidant capacity was negatively related to IL-6 in AECOPD patients（r=-0.573,P＜0.01）.Conclusions:There were malnutritional status、systemic inflammation and systemic oxidative stress in AECOPD group,the systemic inflammation and oxidative stress were both related to malnutritional status and the decrease of lung function in AECOPD.There were positive relationship between systemic inflammation and oxidative stress in patients with AECOPD.更多还原