摘要
目的 探究血浆游离DNA/中性粒细胞胞外诱捕网(Cf-DNA/NETs)水平与重症支气管哮喘合并肺部感染患者肺功能及呼吸动力学指标的关系。方法 选取2019年9月-2020年9月洛阳市中心医院收治的重症支气管哮喘患者87例。按照是否合并肺部感染分为感染组(n=31)和非感染组(n=56)。同时选取健康人64名为对照组。采用免疫荧光染色法检测患者Cf-DNA/NETs水平,对比不同Cf-DNA/NETs水平感染组患者的肺功能、呼吸动力学指标以及相关指标分析。采用单因素和Logistic多因素回归分析影响重症哮喘合并肺部感染患者危险因素。结果 与对照组相比,感染组和非感染组Cf-DNA/NETs、气道阻力(Raw)、气道峰压(PIP)、呼吸做功(WOB)参数水平明显升高,动态顺应性(Cdyn)、肺功能参数水平明显降低,差异有统计学意义(P<0.05);感染组Cf-DNA/NETs、Raw、PIP、WOB参数水平高于非感染组,Cdyn、肺功能参数水平低于非感染组,差异有统计学意义(P<0.05)。Cf-DNA/NETs低水平组患者第1秒用力呼气量(FEV1)、第1秒用力呼气容积占预计肺活量值百分比(FEV1%pred)以及用力肺活量占预计值百分比(FVC%pred)均低于对应高水平的患者,差异有统计学意义(t=3.534、2.648、1.358,P<0.05),Cf-DNA/NETs低水平组患者Raw、PIP以及WOB均低于对应高水平组患者,而Cdyn明显高于对应高水平组患者,差异有统计学意义(t=25.096、9.948、6.683、13.737,P<0.05),高水平组心率、呼吸、平均动脉压、有创机械通气时间均高于低水平组,血氧饱和度低于低水平组,差异均有统计学意义(t=10.122、9.181、8.013、4.147、8.856,P<0.05)。哮喘家族史、Cf-DNA/NETs水平升高均是影响重症哮喘合并肺部感染患者预后的独立危险因素(P<0.05)。结论 Cf-DNA/NETs水平与重症支气管哮喘合并肺部感染患者肺功能及呼吸动力学指标密切相关,为进一步研究重症支气管哮喘合并肺部感染患者病情提供了数据参考。
Objective To explore the relationship between circulating free DNA/neutrophil extracellular traps(Cf-DNA/NETs)levels and the lung function and respiratory dynamics of patients with severe bronchial asthma and lung infection.Methods A total of 87 patients with severe bronchial asthma admitted to our hospital from September 2019 to September2020 were selected.According to whether combined with lung infection,they were divided into infected group(n=31)and non-infected group(n=56).At the same time,64 healthy people were selected as the control group.Immunofluorescence staining method was used to detect the level of Cf-DNA/NETs in patients,and the lung function,respiratory dynamics index and related index analysis of patients with different Cf-DNA/NETs level infection groups were compared.Single factor and Logistic multivariate regression analysis were used to analyze the risk factors of patients with severe asthma and lung infection.Results Compared with the control group,the levels of CF-DNA/NETs,airway resistance(Raw),peak inflation pressure(PIP)and work of breathing(WOB)parameters in the infected group and the non-infected group were significantly increased,while the levels of pulmonary dynamic com pliance(Cdyn) and lung function parameters were significantly decreased,the differences were statistically significant(P<0.05).The levels of Cf-DNA/NETs,Raw,PIP,and WOB parameters in infected group were higher than that in non-infected group,Cdyn and lung function parameters were lower than that in non-infected group,the differences were statistically significant(P<0.05).The forced expiratory volume in onesecond(FEV1),forced expiratory volume in 1 second as a percentage of predicted vital capacity(FEV1% pred)and forced vital capacity as a percentage of predicted(FVC% pred)of the low-level Cf-DNA/NETs group were significantly lower than those of the corresponding high-level patients(t=3.534,2.648,1.358,P<0.05).The Raw,PIP and WOB of the low-level CfDNA/NETs group were lower than those of the high-level group.Cdyn was significantly higher than that of the high-level group(t=25.096,9.948,6.683,13.737,P<0.05).The high-level group’s heart rate,respiration,mean arterial pressure,and invasive mechanical ventilation time were all significantly higher than the low-level group(t=10.122,9.181,8.013,4.147,P<0.05).The blood oxygen saturation of the high-level group was significantly lower than that of the low-level group(t=8.856,P<0.05).Family history of asthma and elevated Cf-DNA/NETs levels were independent risk factors that could affect the prognosis of patients with severe asthma and lung infection(P<0.05).Conclusion The level of Cf-DNA/NETs was closely related to the lung function and respiratory dynamics of patients with severe bronchial asthma and lung infection,which provided a data reference for further research on the condition of patients with severe bronchial asthma and lung infection.
作者
曹义
韩利红
王彤兵
张娜莉
CAO Yi;HAN Li-hong;WANG Tong-bing;ZHANG Na-li(Department of Respiratory and Critical Care Medicine,Luoyang Central Hospital,Luoyang,Henan 471000,China)
出处
《热带医学杂志》
CAS
2022年第2期207-211,共5页
Journal of Tropical Medicine
基金
河南省医学教育研究项目(wjlx2019340)
洛阳市科技计划医疗卫生项目(1721001A-3)。
