慢性阻塞性肺疾病患者诱导痰促炎/抗炎介质水平的变化  

Proinflammatory and anti-inflammatory mediator levels in induced sputum of patients with chronic obstructive pulmonary disease at different stages

作　　者：曾勉[1] 关开泮[1] 黄晓梅[1] 卢桂芳[1] 王辉[1] 刘凌云[1] 贺云鹏[1] 黄书然[1] 谢灿茂[1] 

机构地区：[1]中山大学附属第一医院呼吸内科,广东广州510080

出　　处：《中国呼吸与危重监护杂志》2007年第5期373-377,共5页Chinese Journal of Respiratory and Critical Care Medicine

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

摘　　要：目的观察各期慢性阻塞性肺疾病(COPD)患者气道内促炎/抗炎介质的水平变化,阐明COPD气道局部炎症与气流受限的关系。方法检测48例COPD急性加重期患者入院第1d(加重期组)和治疗1周缓解后(缓解期组)、43例COPD稳定期患者(稳定期组),以及28例健康对照者(分为吸烟组和不吸烟组,各14例)诱导痰中肿瘤坏死因子α(TNF-α)和可溶性肿瘤坏死因子受体55、75(sTNF-R55、sTNF-R75)水平,以及肺功能(FEV1、FEV1%pred、FEV1/FVC等)指标的变化。结果COPD缓解期较加重期TNF-α浓度显著下降(P<0.05),sTNF-R55浓度显著上升(P<0.05),sTNF-R75浓度亦上升但差异无统计学意义(P>0.05)。加重期和缓解期诱导痰中TNF-α和sTNF-R55水平均显著高于稳定期患者和对照组(P<0.05)。吸烟组TNF-α水平高于不吸烟组,sTNF-R55水平低于不吸烟组。加重期组痰TNF-α水平与FEV1、FEV1%pred呈显著负相关,而sTNF-R55和sTNF-R75水平与FEV1、FEV1%pred呈显著正相关。稳定期组FEV1与sTNF-R55水平呈显著正相关,与TNF-α无明显相关性。对照组sTNF-R55、sTNF-R75水平与肺功能无明显相关性。结论各期COPD患者气道内存在促炎介质和抗炎介质的失衡,抗炎介质水平增加有利于临床肺功能的改善。Objective To explore the proinflammatory and anti-inflammatory mediator levels in induced sputum of patients with chronic obstructive pulmonary disease （COPD） at different stages and observe the relationship between local airway inflammation and airway obstruction. Methods The tumor necrosis factor-α （TNF-α） and soluble TNF receptor（sTNF-R55, sTNF-R75） levels in induced sputum as well as lung function （FEV1, FEV1 % pred, and FEV1/FVC） of 48 patients with acute exacerbations of COPD（AECOPD）were measured on the first day and the 7th day after admission. The same parameters were measured in 43 stable COPD patients as well as in 28 healthy volunteersserved as controls（ 14 smokers and 14 non-smokers）. The relationships between the changes of mediator levels and lung functions were analyzed. Results After treahnent, the induced sputum＇s TNT-α level was decreased（ P 〈 0.05）, the sTNF-R55 level was increased（ P 〈 0.05）, and the sTNF- R75 level tended to elevate（P〉0.05）. The pre- and post-treatment TNF-α, sTNF-R55, and sTNFR75 levels in the induced sputum of patients with AECOPD were all significantly higher than those in patients with stable COPD and healthy controls. In the healthy controls, the smokers had higher TNF-α levels and lower sTNF-R55 levels than those of non-smokers. In patients with AECOPD, TNF-α level was correlated negatively with FEV1 and FEV1 % pred. However, sTNF-R55 and sTNF-R75 levels were correlated positively with FEV1 and FEV1 % pred. The FEV1 of patients with stable COPD was correlated positively with sTNF-R55 level, but was not correlated with TNF-α. There was no relationship between lung functions and the sTNF-R levels in the healthy controls. Conclusions Patients with COPD have an imbalance of proinflammatory and anti-inflammatory mediators in the airway. The increase of anti-inflammatory mediators has a possibly beneficial effect with respect to lung function improvement.

关 键 词：慢性阻塞性肺疾病 诱导痰 细胞因子 肿瘤坏死因子Α 可溶性肿瘤坏死因子受体 

分 类 号：R563.9[医药卫生—呼吸系统]