【作者】 邢晓莉；

【导师】 王燕；

【作者基本信息】 天津医科大学 ， 内科学， 2009， 硕士

【摘要】 目的:慢性阻塞性肺疾病（COPD）是一种全身性疾病,除可引起肺部改变外,还可导致全身性变化,严重危害着人类的健康和生活质量。COPD患者易出现血清钙磷镁及其调节激素1,25—二羟维生素D₃（1,25（OH）₂D₃）代谢紊乱等异常情况,影响疾病的发生发展及预后。我们的研究旨在了解COPD疾病本身、吸烟对这些指标代谢的影响,及这些指标与COPD病情的严重程度及发展预后之间的关系,从而为临床治疗提供新的思路,改善预后,降低致残率。方法:选取COPD确诊患者30人,采用随机自身对照的方法,分别于急性加重期和稳定期取肘静脉血,同时选取30例健康人取肘静脉血作对照研究,并将所有受试者分为吸烟组和非吸烟组,采用放射免疫法测定受试者血清1,25（OH）₂D₃水平,采用终点比色法测定血清钙,采用紫外比色法测定血清磷,采用二甲苯胺蓝法测定血清镁,同时测定所有受试者动脉血气分析指标即动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）、动脉血氧饱和度（SaO₂）、肺泡一动脉氧分压差（AaDO₂）;测定受试者肺功能指标,即第一秒用力呼气流量（FEV₁）占预计值的百分比,第一秒用力呼气流量/用力肺活量（FEV₁/FVC）:测定体重指数（BMI）;对COPD患者进行生活质量调查问卷,应用中国协和医科大学COPD生活质量调查问卷（SGRQ）评分软件进行分析,获得症状部分、活动部分、影响部分分数及总分。分析比较COPD急性加重期、稳定期和对照组三组血清1,25（OH）₂D₃、钙、镁、磷水平变化及吸烟对这些指标的影响,并将这些指标与血气分析、肺功能、BMI及COPD生活质量评分进行相关性分析。结果:1、测定结果:COPD急性加重期血清1,25（OH）₂D₃、钙水平与稳定期相比明显降低,且均明显低于健康对照者,差别有统计学意义（P<0.01）;COPD急性加重期血清磷水平与稳定期、健康对照者相比明显降低,差别有统计学意义（P<0.01）,但稳定期与对照组相比差别无统计学意义（P>0.05）;COPD急性加重期血清镁水平与稳定期相比降低,且均低于健康对照者,但差别无统计学意义（P>0.05）。2、相关性分析结果:①COPD急性加重期,血清1,25（OH）₂D₃水平与血清钙、镁呈正相关;血清1,25（OH）₂D₃、钙水平与肺功能指标FEV₁（%）、FEV₁/FVC呈正相关,与血气分析指标PaO₂、SaO₂呈正相关,与BMI呈正相关;血清磷水平与肺功能指标FEV₁（%）,与血气分子指标PaO₂、SaO₂呈正相关;②COPD稳定期,血清1,25（OH）₂D₃水平与COPD生活质量评分活动评分部分呈负相关;血清钙与血清磷水平呈正相关;血清镁水平与肺功能指标FEV₁/FVC呈正相关;③健康对照者中,血清1,25（OH）₂D₃水平与血清磷水平呈正相关,与肺功能指标FEV₁/FVC呈正相关,与BMI呈正相关;血清钙水平与BMI呈正相关。3、吸烟的影响:①COPD急性加重期,吸烟者FEV₁（%）低于非吸烟者,差别有统计学意义（P<0.05）;②COPD稳定期,吸烟者FEV₁（%）低于非吸烟者,差别有统计学意义（P<0.05）;③健康对照者中,吸烟者血清1,25（OH）₂D₃、钙水平与非吸烟者相比明显降低,差异均有统计学意义（P<0.01）;吸烟者血清磷水平与非吸烟者相比明显降低,差异有统计学意义（P<0.05）,而吸烟者血清镁水平与非吸烟者相比降低,差异无统计学意义（P>0.05）;吸烟者FEV₁（%）低于非吸烟者,差别有统计学意义（P<0.01）,吸烟者FEV₁/FVC低于非吸烟者,差别有统计学意义（P<0.05）;吸烟者BMI低于非吸烟者,差别有统计学意义（P<0.05）。结论:1 COPD患者急性加重期血清1,25（OH）₂D₃、钙、磷水平较稳定期明显降低,且均低于健康对照者,提示这些指标可能与病情严重程度有关,及时发现并予以纠正对COPD感染反复发作的预防和治疗有重要临床意义,同时还有助于减轻COPD的全身效应,为今后干预治疗提供理论依据,以改善预后降低致残率,具有社会效益和经济效益。2 COPD患者急性加重期血清1,25（OH）₂D₃、钙、磷水平与患者动脉血气分析、肺功能指标及BMI之间呈正相关,提示血清1,25（OH）₂D₃、钙、磷水平可能影响COPD患者病情进展,可以作为评估COPD疾病严重程度及预后的指标之一。3 COPD患者稳定期血清1,25（OH）₂D₃水平与患者生活质量评分中活动部分评分呈负相关,提示1,25（OH）₂D₃水平降低可能影响COPD患者的生活质量。4健康吸烟者血清1,25（OH）₂D₃、钙、磷水平及肺功能、BMI均较健康非吸烟者降低,且血清1,25（OH）₂D₃水平与肺功能、BMI呈正相关,血清钙水平与BMI呈正相关,提示吸烟会导致血清1,25（OH）₂D₃、钙、磷代谢紊乱,影响身体健康,我们应大力提倡戒烟,提高人们的生活质量。更多还原

【Abstract】 OBJECTIVE:Metabolic disorder of serum 1,25（OH）₂D₃,calcium,magnesium and phosphorus always appears in patients with COPD,and can impact the progression and consequence of COPD.The aim of the investigation is to observe the effect of itself of COPD and smoking on the metabolism of above-mentioned index,and to explore the role and clinical significance of the metabolism of above-mentioned index in the evaluating the severity and progression of COPD.METHODS:30 selected patients with COPD as experiment group,be parted to acute stage group and stable stage group,and 30 collators as control group were investigated.All the subjects were divided into two groups by cigarette.The level of serum 1,25（OH）_D3 of all subjects were measured by radio-immunity method,serum calcium were detected by end-point chromatometry,serum magnesium were determined by xylidine blue assay,serum phosphorus were measured by ultraviolet spectrophotometry.Arterial blood gas indexs（PaO₂,SaO₂,PaCO₂,AaDO₂,PH）,lung function（FEV₁,FEV₁/FVC）,BMI and the St George’s respiratory questionaire（SGRQ） score of the patients were observed simultaneously.We observe the variation of the level of serum 1,25（OH）₂D₃,calcium,magnesium,phosphorus of all subjects,the influence of cigarette on these index,and the correlation between these index with arterial blood gas,lung function,BMI and SGRQ score of patients with COPD.RESULTS:1、the compare result:the level of serum 1,25（OH）₂D₃ and calcium was significantly lower in acute stage COPD group than that in stable stage COPD group and control group（P＜0.01）,the level of serum 1,25（OH）₂D₃ was significantly lower in stable stage COPD group than that in control group（P＜0.01）;The level of serum phosphorus was significantly lower in acute stage COPD group than that in stable stage COPD group and control group（P＜0.01）,the level of serum phosphorus was lower in stable stage COPD group than that in control group（P＞0.05）;The level of serum magnesium was lower in acute stage COPD group than that in stable stage COPD group and control group（P＞0.05）,the level of serum magnesium was lower in stable stage COPD group than that in control group（P＞0.05）.2、correlation analytic result:①In acute stage COPD group,the level of serum 1,25（OH）₂D₃ was positively correlated to the level of serum calcium and magnesium,the level of serum 1,25（OH）₂D₃ and calcium was positively correlated to FEV₁（%）,FEV₁/FVC,PaO₂, SaO₂ and BMI;the level of serum phosphorus was positively correlated to FEV₁（%）, PaO₂and SaO₂;②In stable stage COPD group,the level of serum 1,25（OH）₂D₃ was negtively correlated to the activity score of SGRQ;the level of serum calcium was positively correlated to the level of serum phosphorus;the level of serum magnesium was positively correlated to FEV₁/FVC;③In control group,the level of serum 1,25（OH）₂D₃ was positively correlated to the level of serum phosphours,FEV₁/FVC and BMI;the level of serum calcium was positively correlated to BMI.3、the influence of smoking:①the FEV₁（%） of smoker was significantly lower than non-smoker（P＜0.05） In acute stage COPD group and In stable stage COPD group;②In control group,the level of serum l,25（OH）₂D₃,calcium and phosphorus of smoker was significantly lower than non-smoker（P＜0.01,P＜0.05）,the level of serum magnesium of smoker was lower than non-smoker（P＞0.05）;the FEV₁（%）,FEV₁/FVC and of BMI smoker was significantly lower than non-smoker（P＜0.01,P＜0.05）.CONCLUSIONS:1 the level of serum 1,25（OH）₂D₃,calcium and phosphorus was significantly lower in acute stage COPD group than that in stable stage COPD group and control group,the level of serum 1,25（OH）₂D₃,calcium and phosphorus was significantly lower in stable stage COPD group than that in control group,it suggests that the above-mentioned index were concerned with the severity of COPD.Therefore,it has an important clinical significance to prevent and treatment the infections and recurrent attacks of COPD and relieve systemic effect that the metabolic disorder of serum 1,25（OH）₂D₃,calcium and phosphorus was promptly detected and corrected in time.2 the level of serum 1,25（OH）₂D₃,calcium and phosphorus in acute stage COPD group was positively correlated to arterial blood gas parameters,lung function parameters and BMI,it indicates that the level of serum 1,25（OH）₂D₃,calcium and phosphorus may impact the progression of COPD,and can evaluate the severity and prognosis of COPD.3 the level of serum 1,25（OH）₂D₃ in stable stage COPD group was negtively correlated to the activity score of SGRQ,it means the level of serum 1,25（OH）₂D₃ may influence the quality of life of patients with COPD.4 in control group,the level of serum 1,25（OH）₂D₃,calcium,phosphorus,lung function,and BMI of smokers was significantly lower than that non-smokers;the level of serum 1,25（OH）₂D₃ was positively correlated to lung function parameters and BMI,the level of serum calcium was positively correlated to BMI,it demonstrates that smoking can result in the decrease of the level of serum 1,25（OH）_D3,calcium,and phosphorus,it can also effect health.So we should advocate smoke abatement to increase the the quality of life.更多还原