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摘要: 目的：本实验通过监测姜黄素干预下百草枯中毒（PQP）患者血清基质金属蛋白酶9（MMP-9），血清基质金属蛋白酶抑制物（TIMP-1）及肺部影像学（肺部HRCT）的变化，研究PQP患者肺部纤维化的可能发生机制及演变过程，初步探讨姜黄素对PQP患者肺纤维化的干预作用。方法：收集2009-03-2011-03我科收治的PQP患者共61例（无原始肺疾病），分为非姜黄素组（n=30）和姜黄素组（n=31），非姜黄素组常规治疗。姜黄素组除给予常规治疗同时予姜黄素胶囊。测定患者血清中MMP-9及TIMP-1水平。同时行肺HRCT，分别比较两组内及两组间MMP-9、TIMP-1、HRCT评分的差异；统计两组患者的入院14d死亡率。结果：①两组组内不同时间段MMP-9、TIMP-1含量差异有统计学意义（P<0.05），两组间比较差异有统计学意义（P<0.05）。②两组间比较，姜黄素组患者各时间点HRCT评分均低于同时间非姜黄组患者（P<0.05），具有统计学意义。③姜黄素组患者于各时间点HRCT评分均低于同时间非姜黄素组患者（P<0.05），纤维化程度较非姜黄素组有所减轻，差异均具有统计学意义。④两组患者的死亡率无明显差异，但姜黄素组患者生存时间明显长于非姜黄素组。结论：①百草枯中毒患者血清中MMP-9、TIMP-1水平升高，这表明MMP-9及TIMP-1可能参与百草枯中毒肺纤维化的启动及进展过程，与肺HRCT评分具有相关性，联合CT等其他检查手段对肺纤维化的程度及预后做出评估。采用姜黄素进行干预治疗可降低循环中MMP-9及TIMP-1水平，减轻中毒患者肺纤维化程度，延缓病情发展，延长生存时间，但不能降低患者死亡率，对预后无明显改善。Abstract: Objective: In this study,by monitoring the content of serum matrix metalloproteinase-9(MMP-9),serum matrix metalloproteinase inhibitor(TIMP-1) and lung imaging(lung HRCT) changes of curcumin intervention paraquat poisoning(PQP) patients,analyse analyzed the possible pulmonary fibrosis mechanism and evolutionary process in patients with PQP.Preliminary research into the intervention effects of curcumin on the pulmonary fibrosis in PQP patients.Method: Collected from March 2009 to March 2011 PQP patients admitted to our department a total of 61 patients(no original pulmonary disease),divided into non-curcumin group(n=30) and curcumin group(n=31),non-curcumin group are treated with conventional treatments.In addition to the conventional treatments above,curcumin group are for curcumin capsules to monitor the content of serum MMP-9 and TIMP-1 levels of the two-group patients with ELASA.Meanwhile,taking the lung HRCT of the two-group patients,Analysis of the 14 th day living conditions of these two groups,curve and depict the survival curve.Result: ①Compared 14 days MMP-9 levels within each group of non-curcumin group and the curcumin group,the differences were statistically significant(P<0.05).Between the two groups were statistically significant(P<0.05).②Compared 14 days TIMP-1 levels within each group of non-curcumin group and the curcumin group,the differences were statistically significant(P<0.05).③Compared 14 days HRCT scores within each group of non-curcumin group and the curcumin group.In curcumin at different time points the patients HRCT scores were lower than at the same time non-curcumin group patients(P<0.05).Fibrosis was slightly reduced compared with non-curcumin group,the differences were statistically significant.④Comparing the 14 th day mortality and living conditions between curcumin group of patients and non-curcumin,two groups no significant difference in mortality,but survival time of patients curcumin group significantly longer than non-curcumin group.Conclusion: Serum MMP-9 and serum TIMP-1 levels of PQP patients,which indicates that the MMP-9 and TIMP-1 may be involved in paraquat induced lung fibrosis and progress of the startup process.Serum MMP-9 and TIMP-1 levels and pulmonary HRCT score of patients with paraquat poisoning correlated,MMP-9 and TIMP-1 can be used as biochemical markers in clinical combining with CT examination and other means of pulmonary fibrosis and to assess the degree and the prognosis of pulmonary fibrosis early intervention treatment with curcumin on paraquat poisoning patients can reduce the cycle of MMP-9 and TIMP-1 levels,reduce pulmonary fibrosis in patients with poisoning,delay the progression of the disease,prolong survival time,but can notcannot reduce mortality,can notcannot improve prognosis.
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Key words:
- Paraquat poisoning /
- MMP-9 /
- curcumin /
- pulmonary fibrosis
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