慢性阻塞性肺疾病和阻塞性睡眠呼吸暂停低通气综合征患者外周血单个核细胞TNF—α、IL-8mRNA表达的研究

目的分析慢性阻塞性肺疾病（COPD）、阻塞性睡眠呼吸暂停低通气综合征（OSAHS）及重叠综合征（overlap syndrome）患者单个核细胞TNF-α和IL-8mRNA表达的特点，从炎症反应方面探讨重叠综合征的发病机制。方法选取已确诊为COPD11例、OSAHS15例和重叠综合征4例各为一组，所有研究对象均行夜间多导睡眠图监测和肺功能检查，用半定量RT-PCR法检测外周血单个核细胞TNF-α、IL-8的mRNA水平。结果外周血单个核细胞在TNF-α的mRNA表达水平中，OSAHS组〈COPD组〈重叠组，差异均具有统计学意义（P均〈0．05）；在IL-8的mRNA表达水平中，COPD组和重叠组均高于OSAHS组，差异具有统计学意义（P均〈0．05），而COPD组和重叠组之间无显著性差异（P〉0．05）。COPD患者单个核细胞TNF—αmRNA表达水平与第一秒用力呼气容积（FEVI／Pre％）呈负相关（r=-0．894，P〈0．01），与低氧时间呈正相关（r=0．781，P〈0．01）；IL-8mRNA表达水平与FEVI／Pre％呈负相关（r=-0．859，P〈0．01），与低氧时间呈正相关（r=0．862，P〈0．01）。OSAHS患者单个核细胞TNF-αmRNA表达水平与呼吸暂停和低通气指数（AHI）、低氧时间均呈正相关（r=0．833、0．742，P均〈0．01）；IL-8mRNA表达水平与AHI、低氧时间均呈正相关（r=0．825、0．882，P均〈0．01）。结论COPD患者和重叠综合征患者的IL-8和TNF-α的mRNA表达高于OSAHS患者，且IL-8和TNF-α的mRNA表达与FEVI／Pre％、AHI和低氧时间均有较好的相关性，提示炎症反应也可能在重叠综合征的发病机制和发展中起着较为重要的作用。

Features and significance of mRNA expression of TNF-a and IL-8 between COPD and OSAHS patients

Objective To investigate the clinical features and treatment methods of pheochromotocyto-ma in multiple endocrine neoplasia type 2A patients. Methods Three unrelated families, among of which 8 were clinically diagnosed MEN2A patients, pheochromocytoma was found in all( 100% )of the 8 MEN2A patients. We analysis the clinical feature of blood pressure, the result of 24 hour urine vanillyl mandelic acid (VMA) and adre-nal CT, the treatment methods of pheochromocytoma. Results Medullary thyroid carcinoma(MTC) was found in 7(87.5% )patients,and pheochromocytoma was found in all(100%)of the 8 MEN2A patients. Hyperplasia or adenoma of the parathyroid gland was not found in any of these cases. Among them, pheochromocytoma was the initial demonstration of the syndrome in 6 patients(75%) ,and bilateral phoochromocytomas were found in 7 of them (87.5 %). 3 (37.5 %)patients present as sustained hypertension and 5 (62.5 %)patients present as parox-ysmal hypertension,75% of VMA was elevated and another 25% VMA/Cr was elevated. 4 (50%) patients were operated by open method and 4 (50%) patients were operated by video-assisted laparoscopic method. Conclu-sion The study indicated that pheochromocytomns was usually bilateral in MEN2A patients. The hypertension may be sustained or paroxysmal, the examinations of biology, imaging and RET gene mutation were useful for early diagnosis and treatment of pheochromotocytoma in MEN2A patients. Laparoscopic surgery was the best choice of treatment.