高血糖对慢性阻塞性肺疾病患者免疫功能的影响  

Effect of hyperglycemia on immune function in patients with chronic obstructive pulmonary disease

作　　者：吕侯强[1] 崔淑芬 谢轩[1] 范素芳 杨丛丽[1] LV Houqiang;CUI Shufen;XIE Xuan;FAN Sufang;YANG Congli(The Second Hospital of Shijiazhuang,Shijiazhuang 050051,Hebei,China;Hospital of Guchong County,Gucheng 253800,Hbei,China)

机构地区：[1]河北省石家庄市第二医院,河北石家庄050051 [2]河北省故城县医院,河北故城253800

出　　处：《现代中西医结合杂志》2018年第20期2175-2177,2181,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：河北省医学科学研究重点课题(20181037)

摘　　要：目的探讨高血糖对于慢性阻塞性肺疾病急性加重期患者免疫功能的影响与其作用机制。方法选择慢性阻塞性肺疾病急性加重期患者150例,依入院后24 h内患者空腹血糖水平分为正常血糖组97例和血糖升高组53例。比较2组T淋巴细胞亚群各指标、血清中转化生长因子-β(TGF-β)、白细胞介素-17(IL-17)、IL-6与干扰素-γ(IFN-γ)、降钙素原(PCT)水平,肺部感染、呼吸衰竭发生情况,有创机械通气比例、抗生素应用时间等临床指标的差异。结果与正常血糖组比较,血糖升高组患者CD3^+、CD4^+、CD4^+/CD8^+比值差异均无统计学意义(P均>0.05),Th1/Th2、Th17/Treg比值显著下降(P均<0.05),血清中TGF-β、IL-6、PCT水平均显著升高而IL-17、IFN-γ水平均下降(P均<0.05),肺部感染、呼吸衰竭、有创机械通气发生率均显著升高(P均<0.05),抗生素应用时间显著延长(P<0.05),住院费用显著增加(P<0.05)。结论高血糖可以导致慢性阻塞性肺疾病急性加重期患者体内免疫功能紊乱,表现为Th1/Th2漂移,机体内处于免疫抑制状态,增加患者继发肺部感染等不良临床事件发生率,延长患者住院抗生素应用时间,增加医疗费用。Objective It is to explore the effect and mechanism of hyperglycemia on immune function in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods 150 patients with AECOPD were divided into normal blood sugar group （97 cases） and high blood sugar group （53 cases） according to the FPG levels within 24 hours after admission. The differences in indexes of T lymphocyte subsets, serum levels of TGF-β, IL-17,IL-6, TNF-γ, PCT, pulmonary infection, respiratory failure, invasive mechanical ventilation, antibiotic application time between the two groups were compared. Results There was no significant difference in CD3^＋,CD4^＋, CD4^＋/CD8^＋ ratio between the two groups （ P 〉0.05）. Compared with normal blood sugar group, the serum levels of TGF-β, IL-6 and PCT, the incidence of pulmonary infection, respiratory failure, invasive mechanical ventilation were significantly higher, the levels of IL-17, TNF-γ were lower, antibiotic application time was longer, hospitalization costs were more in high blood sugar group （all P 〈 0.05）. Conclusion Hyperglycemia can lead to immune dysfunction in patients with AECOPD, manifested as Th1/Th2 shift, body immunosuppressed state, increase the incidence of adverse clinical events such as secondary pulmonary infections, prolong the application time of hospitalized antibiotics, and increase medical expenses.

关 键 词：高血糖 慢性阻塞性肺疾病 免疫功能 感染 

分 类 号：R563[医药卫生—呼吸系统]