N-乙酰半胱氨酸对老年慢性阻塞性肺疾病患者血Th17/Treg平衡的影响  

Effects of N-acetylcysteine on Th17/Treg Balance In Elderly Patients With Chronic Obstructive Pulmonary Disease

作　　者：刘晓鹏 胡志雄 周海英 王静 金花 Liu Xiaopeng;Hu Zhixiong;hou Haiying;Wang Jing;Jin Hua(Department of Respiratory Disease,Jinshan Hospital Affiliated to Fudan University,Shanghai,201508,P.R.China)

机构地区：[1]复旦大学附属金山医院呼吸内科,上海201508

出　　处：《老年医学与保健》2020年第3期452-454,467,共4页Geriatrics & Health Care

基　　金：上海市金山区卫健委科研课题青年项目(编号:JSKJKTQN-2018-04);复旦大学附属金山医院院级课题(2018-JSYYKT-01)。

摘　　要：目的分析N-乙酰半胱氨酸(N acetylcysteine,NAC)对老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者Th17/Treg平衡的影响,从免疫调节方面寻找治疗老年COPD的靶点。方法选择2018年9月-2019年6月在复旦大学附属金山医院门诊就诊的老年COPD稳定期患者96例,采用数字表法随机分为观察组和对照组,每组48例。观察组采取常规治疗加口服NAC颗粒(每次用量为0.2g,3次/d),对照组采取常规扩张气道及安慰剂治疗。在治疗前及治疗6个月时,对2组患者进行肺功能检查,采用ELISA方法评估患者外周血血清IL-17、IL-10水平,采用流式细胞术测定患者外周血Th17、Treg占CD4^+T细胞比值,并对2组检测值进行统计分析和比较。结果与治疗前比较,治疗后观察组血清中Th17占CD4^+T细胞比值明显下降(P<0.05),Treg占CD4^+T细胞比例明显上升(P<0.05),Th17/Treg比值明显降低(P<0.05),IL-10水平显著升高(P<0.05);治疗后观察组患者IL-17明显低于对照组(P<0.05),IL-10水平明显高于对照组(P<0.05),IL-17和IL-10水平治疗后与治疗前的差值均明显大于对照组(P<0.01)。对照组治疗前后血清IL-17、10浓度、Th17/CD4^+T细胞、Treg/CD4^+T细胞、Th17/Treg差异均无统计学意义(P>0.05)。结论NAC对老年COPD患者Th17/Treg平衡有着一定的调节效应。Objective To study the effect of N-acetylcysteine(NAC)on Th17/Treg balance in elderly patients with chronic obstructive pulmonary disease(COPD),and to find therapeutic targets of COPD in elderly patients from the aspect of immune regulation.Methods 96 elderly patients with stable COPD were randomly divided into two groups,48 ones in each group.The observation group was treated with oral NAC particles(0.2 g/time,3 times/d)in addition to conventional treatment;The control group was treated with routine airway dilation and placebo.Before and 6 months after the treatment,the lung function of the two groups were examined,the serum levels of IL-17 and IL-10 of two groups were assessed by ELISA,the ratio of Th17 and Treg/CD4^+T cells of two groups was determined by flow cytometry.The above detected results were compared between both groups.Results Compared with before treatment,the ratio of Th17/CD4^+T cells in the serum of the observation group after treatment decreased significantly(P<0.05),the ratio of Treg/CD4^+T cells increased significantly(P<0.05),and the ratio of Th17/Treg decreased significantly(P<0.05),IL-10 levels increased significantly(P<0.05).After the treatment,IL-17 in observation group was significantly lower than that in control group(P<0.05),IL-10 was significantly higher than that in control group(P<0.05),the difference of the levels of IL-17 and IL-10 between after and before the treatment was significantly greater than that in the control group(P<0.01).There was no significant difference in serum IL-17,IL-10,Th17/CD4^+T cells,Treg/CD4^+T cells and Th17/Treg in the control group before and after treatment.Conclusion NAC has a certain regulatory effect on Th17/Treg balance in elderly COPD patients.

关 键 词：老年 慢性阻塞性肺疾病 N-乙酰半胱氨酸 辅助性T细胞17 调节性T细胞 

分 类 号：R563.9[医药卫生—呼吸系统]