糖皮质激素治疗前后AECOPD患者血清IL-13、TNF-a、血浆vWF含量表达及临床意义&#61537;

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题名	糖皮质激素治疗前后AECOPD患者血清IL-13、TNF-a、血浆vWF含量表达及临床意义
其他题名	Changes of IL-13、TNF-a and vWF before and after treatment with systemic Glucocorticoids in Patients with AECOPD
作者	李恒妍
学位类型	硕士
导师	陈少贤 ; 陈彦凡 ; 叶进燕
答辩日期	2010-06-06
学位授予单位	温州医科大学
学位专业	内科学
关键词	慢性阻塞性肺疾病，糖皮质激素， IL-13，TNF-a，vWF
摘要	目的：通过检测AECOPD（慢性阻塞性肺疾病急性加重）患者全身糖皮质激素治疗前后血清TNF-、IL-13、血浆vWF水平变化，探讨糖皮质激素在AECOPD治疗中作用及对各类细胞因子影响，为临床治疗提供实验依据。方法：选择2007年11月至2008年4月收住我院呼吸内科的慢性阻塞性肺疾病急性加重期（AECOPD）患者30例，均符合AECOPD诊断标准，男20例，女10例，年龄54～83（60.33±7.12）岁，其中伴II型呼吸衰竭患者8例。门诊健康体检者30例，男15例，女15例，年龄57～76岁（56.67±6.11）岁，用ELISA法检测治疗组（静脉注射糖皮质激素治疗前、后）及对照组血清IL-13、TNF-及血浆vWF含量。用spss软件分析。结果：1、血清IL-13的测定结果：AECOPD组糖皮质激素治疗前血清IL-13浓度（44.96±5.91 pg/mL）、治疗后血清IL-13浓度（30.62±4.81 pg/mL）显著高于对照组（25.83±3.91 pg/mL）（p<0.01），治疗后血清IL-13浓度（30.62±4.81 pg/mL）较治疗前（44.96±5.91 pg/mL）明显降低(p<0.01)2、血清TNF-的测定结果：AECOPD组糖皮质激素治疗前血清TNF-浓度（38.85±7.01 pg/mL）、治疗后血清TNF-浓度（29.86±5.20 pg/mL）显著高于对照组（9.14±1.60 pg/mL）（p<0.01)，治疗后血清TNF-浓度（29.86±5.20 pg/mL）较治疗前（38.85±7.01 pg/mL）明显降低（p<0.01)3、血浆vWF的测定结果：AECOPD组糖皮质激素治疗前血浆vWF浓度（275.93±20.91%）、治疗后血浆vWF浓度（256.25±30.52）显著高于对照组（171.94±33.94%）(p<0.01)，治疗后血浆vWF浓度（256.25±30.52%）较治疗前（275.93±20.91%）明显降低（p<0.01）结论：COPD急性加重期血清IL-13、TNF-及血浆vWF明显升高，全身糖皮质激素治疗后明显下降，提示多种炎症因子参与急性炎症反应，AECOPD患者内皮细胞损伤加重，存在不同程度的凝血和纤溶系统的激活。糖皮质激素对控制病情进展有一定作用，联合抗炎、抗凝治疗对AECOPD患者预后有指导意义。
其他摘要	Objective: To observe the levels of serum Interleukin-13 (IL-13), Tumor Necrosis Factor-a (TNF-a) and plasma Von Willbrand factor (vWF) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) before and after treatment with systemic Glucocorticoids. Assess the efficacy of glucocorticoids with AECOPD and its influence on cytokines, provide experimental basis for clinical treatment.Methods: Thirty AECOPD hospitalizations were recruited into the study during 2007 November to 2008 April. All were according to the diagnostic standards with the AECOPD，male 20, female 10, age 54 years old ~83 years old，average（60.33±7.12）years old，8 with respiratory failure type II. 30 health people from clinic healthy examination , male 15, female 15, age 57 years old ~76 years old，average（56.67±6.11）years old, IL-13、TNF-a in serum and vWF in plasma were measured by ELISA. The data were analysised among AECOPD group (before and after treatment with systemic glucocorticoids ) and control group. The data were analysised by SPSS softwareResults:1.The concentrations of IL-13 in serum: The level of IL-13 in AECOPD group before treatment（44.96±5.91 pg/mL）and after treatment(30.62±4.81 pg/mL) were significantly higher than these of control group（25.83±3.91 pg/mL）（p<0.01）.The level of IL-13 in AECOPD group after systemic Glucocorticoids（(30.62±4.81 pg/mL）was significantly lower than that group before systemic Glucocorticoids（44.96±5.91 pg/mL）(p<0.01).2. The concentrations of TNF-a in serum: The level of TNF-a in AECOPD group before treatment（38.85±7.01 pg/mL）and after treatment(29.86±5.20 pg/mL) were significantly higher than these of control group（9.14±1.60 pg/mL）（p<0.01）.The level of TNF-a in AECOPD group after systemic Glucocorticoids（29.86±5.20 pg/mL）was significantly lower than that group before systemic Glucocorticoids（38.85±7.01 pg/mL）(p<0.01).3. The concentrations of vWF in plasma: The level of vWF in AECOPD group before treatment（275.93±20.91%）and after treatment(256.25±30.52 %) were significantly higher than these of control group（171.94±33.94%）（p<0.01）.The level of vWF in AECOPD group after systemic Glucocorticoids（256.25±30.52 %）was significantly lower than that group before systemic Glucocorticoids（275.93±20.91%）(p<0.01).Conclusions: IL-13、TNF-a in serum and vWF in plasma express highly in acute exacerbation of chronic obstructive pulmonary disease, and decrease significantly after treatment with systemic Glucocorticoids. It showed various inflammation factors participate and interact together ,vascular endothelial cell injury and activation of coagulation and fibrinolysis existed in AECOPD. Systemic Glucocorticoids has good efficacy on patients. If coagulation and inflammation are treated simultaneously，it can provide a good prognosis for the therapy of AECOPD.
语种	中文
学号	20061094
发布年限	2010-05-27
毕业论文分类号	0R05
原始专题	第一临床学院
学位论文研究方向	呼吸系统疾病
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全文文件名	20061094李恒妍2009内科学.pdf\|20061094李恒妍2009内科学.pdf
文献类型	学位论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/119870
专题	温州医科大学
作者单位	溫州医科大学第一临床学院
推荐引用方式 GB/T 7714	李恒妍. 糖皮质激素治疗前后AECOPD患者血清IL-13、TNF-a、血浆vWF含量表达及临床意义[D]. 温州医科大学,2010.