慢性阻塞性肺疾病急性加重期患者外周血和诱导痰中肿瘤细胞因子的水平  

Levels of tumor necrosis factor(TNF)α and soluble TNF-R55, 75 in plasma and induced sputum in patients with acute exacerbations of chronic obstructive pulmonary disease

作　　者：曾勉[1] 黄建强[1] 卢桂芳[1] 王辉[1] 关开泮[1] 吴健锋[1] 柯彩霞[1] 张国娟[1] 贺云鹏[1] 

机构地区：[1]中山大学附属第一医院呼吸内科,广州510080

出　　处：《中华全科医师杂志》2007年第9期527-530,共4页Chinese Journal of General Practitioners

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

摘　　要：目的观察慢性阻塞性肺疾病(COPD)急性加重期患者治疗前后诱导痰及血浆中肿瘤坏死因子α(TNF-α)和可溶性肿瘤坏死因子受体55、75(sTNF-R55、sTNF-R75)水平的变化。方法检测并分析48例 COPD 急性加重期患者治疗前后(A_1组和 A_2组)及28例健康志愿者诱导痰及血浆中 TNF-α、sTNF-R55、sTNF-R75水平及其肺功能。结果 COPD 急性加重期患者治疗前后诱导痰及血浆中 TNF-α和 sTNF-R55、sTNFR75的水平均高于健康组;治疗前后痰 TNF-α浓度(0.82±0.34)μg/L和(0.48±0.27)μg/L,血(0.82±0.35)μg/L和(0.60±0.46)μg/L,均有明显下降(P<0.01);sTNF-R55、sTNF-R75浓度上升,血中浓度水平与肺功能无相关性(P>0.05),诱导痰中浓度水平与肺功能呈正相关性(P<0.05);TNF-α浓度与第1秒用力呼气容积和其占预计值百分数呈负相关(P=0.000)。结论 COPD 患者急性加重与全身和局部炎性介质和抗炎介质的失衡有关。全身炎症反应与气流受限关系不大,而局部炎症反应与气流受限密切相关。Objective To study changes in levels of tumor necrosis factor-α（TNF-α） and soluble TNF receptor 55 and 75 （sTNF-R55 and sTNF-R75 ） in induced sputum and plasma in patients with acute exacerbations of chronic obstructive pulmonary disease （AECOPD） before and after treatment. Methods Levels of TNF-α, TNF-R55 and sTNF-R75 in induced sputum and plasma, as well as pulmonary function, were examined for 48 patients with AECOPD before and after treatment and 28 voluntary healthy controls. Results Levels of TNF-α, sTNF-R55 and sTNFR75 in patients with AECOPD in induced sputum and plasma either before or after treatment were all significantly higher than those in healthy controls. Levels of TNF-α in sputum and plasma significantly decreased after treatment, as compared to those before treatment （0. 82 ± 0. 34） μg/L vs （0.48 ± 0. 27 ） μg/L, P 〈 0. 001, and （0. 82 ± 0. 35 ） μg/L vs （ 0. 60 ±0.46 ） μg/L, P 〈 0.01, respectively. Levels of sTNF-R55 and sTNF-R75 increased after treatment in both kinds of specimens. But, levels of sTNF-R55 and sTNF-R75 in plasma did not correlate with their pulmonary function （P 〉 0. 05 ）, and levels of those in induced sputum positively correlated with their pulmonary function （P 〈 0. 05 ）, while TNF-α levels in induced sputum correlated negatively with their forced expiratory volume at the first second （ FEV1 ） and FEV1 percentage, P = 0. 000. Conclusions Acute exacerbation of COPD may be correlated to systematic and local imbalance of inflammatory and antiinflammatory mediators. Local inflammatory reactions, rather than systematic one, seem to be closely related to airflow limitation in patients with COPD.

关 键 词：肺疾病 阻塞性 肿瘤坏死因子 受体 肿瘤坏死因子 痰 

分 类 号：R563.9[医药卫生—呼吸系统]