稳定期慢性阻塞性肺疾病气道炎症的研究  

Study on airway inflammation of stable chronic obstructive pulmonary disease

作　　者：牛颖梅[1] 童朝晖[2] 王辰[2] 庞宝森[2] 杜小玲[3] 王清涛[3] 马力[2] 辛萍[2] 

机构地区：[1]首都医科大学附属北京朝阳医院职业病与中毒医学中心,100020 [2]北京呼吸疾病研究所 [3]首都医科大学附属北京朝阳医院检验科,100020

出　　处：《国际呼吸杂志》2009年第3期132-136,共5页International Journal of Respiration

摘　　要：目的研究稳定期慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）气道炎症和肺功能、下气道细菌定植（lower airway bacterial colonization，LABC）的关系。方法随机入选45例稳定期COPD门诊患者和28名健康志愿者，行肺功能、血常规和胸片检查。采用痰诱导方法留取深部合格痰液，COPD患者的痰液行细菌定量培养，两组研究对象的痰液均行细胞因子检测。结果稳定期COPD组痰液中白介素8（IL-8）、肿瘤坏死因子α（TNF-α）、IL-10、IL-19明显高于对照组（P〈0．05）。第1秒用力呼气容积占预计值百分比（FEV1％pred）〈50％组痰液中IL-8、TNF—α、IL-19明显高于FEV1％pred≥50％组（P〈0．05），而IL-10在两组间比较差异无统计学意义。在本实验中LABC量≥10^7CFU／ml者占总人数的33．33％，主要的下气道定植菌为卡他莫拉菌、副流感嗜血杆菌、肺炎链球菌、流感嗜血杆菌等。LABC量≥10^7CFU／ml组痰液中IL-8、TNF—α、IL-19明显高于LABC〈10^7CFU／ml组（P〈0．05），而IL-10在两组间比较差异无统计学意义。相关性分析显示，IL-19与IL-10呈负相关，相关系数r=-0．548（P〈0．05），IL-19与IL-8、TNF—α呈正相关，相关系数分别为r=0．702（P〈0．05）、r=0．708（P〈0．05）。FEV1％pred〈50％组细菌定植量明显高于FEV1％pred≥50％组（P〈0．05）。FEV1％pred〈50％预计值组的吸烟指数明显高于FEV1％pred≥50％组（P〈0．05）。结论稳定期COPD患者存在气道炎症，既与LABC有关，又与吸烟有关，这种与LABC和吸烟相关的气道炎症可能是导致COPD患者肺功能进行性下降的原因。Objective To investigate the relationship between airway inflammation and pulmonary function, lower airway bacterial colonization （LABC） of stable chronic obstructive pulmonary disease （COPD）. Methods Forty-five outpatients with stable COPD and 28 healthy volunteers were randomly studied,all of which accepted pulmonary function examination, blood routine examination and chest X-ray. The deep qualified sputum samples were obtained from all the subjects through sputum induction, quantitative sputum culture was preformed with the sputum of the patients with COPD and the production of cytokine in sputum of all the subjects analyzed. Results The productions of IL-8,TNF-α,IL-10 and IL-19 in sputum of the patients with stable COPD group were higher than those of control group （ P 〈0.05）. The productions of IL-8,TNF-α and IL-19 in sputum of the patients with FEV1% pred〈50% group were higher than those the patients with FEV1 % pred≥50% group （P 〈0.05）,there was no significant difference of IL-10 between the patients with FEV1%pred〈50% group and the patients with FEV1 %pred≥50% group （ P 〉0.05）. The patients with LABC≥10^7 CFU/ml in the study,accounted for 33.33% of the total patients, the main colonized bacterium were Moraxelle catarrhalis, Haemophilus parainfluenzae, Streptococcus pneumoniae and Hemophilus influenza in lower airway. The productions of IL-8, TNF-αand IL-19 in sputum of the patients with LABC≥10^7 CFU/ml group were higher than those the patients with LABC〈10^7 CFU/ml group （ P 〈0.05） ,there was no significant difference of IL-10 between the patients with LABC≥10^7 CFU/ ml group and the patients with LABCG107 CFU/ml group （P 〉0.05）. There was negative correlation between IL-19 and IL-10, correlation coefficient r = -0. 548 （ P 〈 0.05）, there were positive correlation between IL-19 and IL-8, TNF-α,correlation coefficient r =0. 702（ P 〈0. 05）, r =0. 708（ P 〈0. 05）. The concentration of LABC of the patients with FEV1% pred〈50% group

关 键 词：慢性阻塞性肺疾病 稳定期 气道炎症 肺功能 下气道细菌定植 

分 类 号：R563.9[医药卫生—呼吸系统]