慢阻肺急性加重期患者血浆肿瘤坏死因子-α和可溶性肿瘤坏死因子受体55、75水平及功能意义  

Change of plasma TNF-α and sTNF-R55、75 levels in patients with acute exacerbations of COPD

作　　者：曾勉[1] 王辉[1] 谢灿茂[1] 刘凌云[1] 贺云鹏[1] 严英硕[1] 卢桂芳[1] 

机构地区：[1]中山大学附属第一医院呼吸内科,广州中山二路510080

出　　处：《中国康复医学杂志》2007年第5期418-421,共4页Chinese Journal of Rehabilitation Medicine

基　　金：广东省自然科学基金项目(项目编号:04009385);广东省卫生厅基金项目(项目编号:A2004188)

摘　　要：目的:观察慢性阻塞性肺疾病急性加重期(AECOPD)患者血浆中炎性介质与抗炎介质水平变化,阐明COPD全身炎症与肺功能的关系。方法:检测62例COPD急性加重期患者接受β-内酰胺类或喹诺酮类抗菌药物及平喘祛痰治疗及30例健康志愿者入院第1天和治疗第7天血浆中的肿瘤坏死因子α(TNF-α)和可溶性肿瘤坏死因子受体55、75(sTNF-R55、sTNF-R75)的水平及其肺功能(FEV1,FEV1%pre,FEV1/FVC等)。结果:AECOPD治疗后肺功能明显改善,但仍低于健康组(P<0.05)。AECOPD治疗前后血浆中TNF-α和sTNF-R55、sTNFR-75的水平均高于健康组(P<0.01)。而吸烟健康组TNF-α水平高于不吸烟组。AECOPD患者第7天血浆中的TNF-α浓度较入院第1天明显下降(822.7±353pg/mlvs599.2±456.7pg/ml,P<0.01);sTNF-R55和sTNFR-75水平数值上有上升,但差异无显著性意义(P>0.05);血TNF-α、sTNF-R55和sTNF-R75水平与肺通气功能指标FEV1、FEV1%pre、FEV1/FVC皆无相关性(P>0.05)。结论:AECOPD患者血中炎性介质(TNF-α)及抗炎介质(sTNF-R55、sTNF-R75)的水平均高于健康志愿者,治疗后炎症介质水平降低,抗炎介质水平上升不明显。COPD全身炎症反应与气流受限关系不大。Objective： To test the levels of plasma inflammatory and anti-inflammatory mediators of patients with acute exacerbations of COPD （AECOPD） and illuminate the relationship between these mediators and airflow limitation in AECOPD patients. Method： Levels of the plasma anti-inflammatory mediator soluble tumor necrosis factor receptor 55 and 75 （sTNF-R55 and sTNF-R75）, and inflammatory mediator tumor necrosis factor α （TNF-α） were analyzed in 62 patients with AECOPD and 30 healthy volunteers on admission and the seventh clay after treatment. And the lung function of all the subjects were also measured simultaneously. Changes of these mediators and lung functions were studied during the first 7 days. Result： The lung functions of AECOPD patients improved significantly after treatment but were still worse than healthy subjects （P〈0.05）. The levels of plasma TNF-α, STNF-R55 and STNF-R75 in AECOPD patients were higher than those in healthy subjects before and after treatments （P〈0.01）. The levels of TNF-α of smokers were higher than that of non-smokers in volunteers. On day7, the plasma TNF-α levels of AECOPD patients reduced markedly compared with admission （822.7±353 pg/ml vs 599.2±456pg/ml,P〈0.01）; levels of sTNF-R55 and sTNF-R75 increased compared with day 1, but there was no statistical difference （P〉0.05）. There was no relationship between plasma TNF-α, sTNF-R55 and sTNF-R75 levels and the parameters of lung function such as FEV1 ,FEV1%pre and FEV1/FVC（P〉0.05） in both AECOPD patients and healthy subjects. Conclusion： These datum suggested an imbalance of pro-inflammatory and anti-inflammatory mediators in the plasma of patients with AECOPD. The levels of pro-and anti-inflammatory mediators increased markedly in AECOPD patients compared with those of healthy subjects. And pro-inflammatory levels markedly decreased after treatment, While anti-inflammatory levels were only slightly increased.

关 键 词：慢性阻塞性肺疾病 肿瘤坏死因子 可溶性肿瘤坏死因子受体 

分 类 号：R563.9[医药卫生—呼吸系统]