COPD急性加重期细菌感染对Th17/Treg平衡及炎性因子水平的影响  

Effect of bacterial infection on Th17/Treg balance and inflammatory factors in acute exacerbation of COPD

作　　者：侯英宇[1] 刘晨阳[1] 张丹梅[1] 杨敏[1] Hou Yingyu;Liu Chenyang;Zhang Danmei;Yang Min(The Second Department of Internal Medicine,General Hospital of Heilongjiang Armed Police Force, Harbin 150079,China)

机构地区：[1]武警黑龙江总队医院内二科,哈尔滨150079

出　　处：《疑难病杂志》2020年第8期799-803,共5页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的探讨慢性阻塞性肺疾病(COPD)急性加重期患者发生细菌感染对辅助性T细胞17/调节性T细胞(Th17/Treg)平衡及炎性因子水平的影响。方法收集武警黑龙江总队医院内科2017年6月—2019年6月确诊为下呼吸道细菌感染的COPD患者118例作为研究对象,根据其肺功能及临床症状分为COPD加重期组(n=62)、COPD稳定期组(n=56),另随机选择60例肺功能正常的健康体检者作为健康对照组(n=60)。对患者下呼吸道痰液标本中病原进行鉴定;对患者外周血中的Th17、Treg细胞数量及血清IL-17、IL-22、TGF-β1水平进行检测。结果62例急性加重期患者痰液标本共分离出病原65株,其中革兰阴性菌44株(67.69%),革兰阳性菌21株(32.31%)。加重期组、稳定期组FEV1、FEV1/Pred、FVC、FEV1/FVC均低于健康对照组(P<0.01),而加重期组上述指标均低于稳定期组(P<0.01)。加重期组Th17高于健康对照组,加重期组、稳定期组Treg均低于、Th17/Treg均高于健康对照组,加重期组Th17、Th17/Treg高于稳定期组,Treg低于稳定期组,差异均具有统计学意义(P<0.01)。加重期组、稳定期组IL-17、IL-22、TGF-β1均高于健康对照组,加重期组均高于稳定期组,差异均具有统计学意义(P<0.01)。ROC分析结果表明,Th17、Treg及Th17/Treg水平诊断COPD患者急性加重期发生细菌感染AUC分别为0.835、0.795.0.811(P<0.05)。结论慢性阻塞性肺疾病急性加重期患者发生细菌感染伴明显Th17/Treg失衡及炎性因子水平变化,可作为免疫治疗的靶点。Objective To investigate the effect of bacterial infection on the balance of helper T cell 17/regulatory T cell(Th17/Treg)and the level of inflammatory factors in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods 118 COPD patients with lower respiratory tract bacterial infection from June 2017 to June 2019 in Heilongjiang General Armed Police Hospital were collected and divided into exacerbation group(n=62)and stable COPD group(n=56)according to their pulmonary function and clinical symptoms.Another 60 healthy patients with normal pulmonary function were randomly selected as healthy control group(n=60).The pathogens in sputum samples of lower respiratory tract were identified,the number of Th17 and Treg cells in peripheral blood and the levels of IL-17,IL-22,TGF-β1 in serum were detected.Results A total of 65 pathogens were isolated from sputum samples of 62 patients with acute exacerbation,of which 44(67.69%)were gram negative and 21(32.31%)were gram positive.FEV1,FEV1/PRED,FVC and FEV1/FVC in the exacerbation group and the stable phase group were lower than those in the healthy control group(P<0.01),while the above indexes in the aggravation group were lower than those in the stable phase group(P<0.01);Th17 in the aggravation group was higher than that in the healthy control group,and the Treg in the aggravating and stable phase groups was lower than that in the healthy control group,and the Th17 and Th17/Treg in the aggravation group were higher than those in the stable stage group,and the Treg in the aggravating stage was lower than that in the stable stage The differences were statistically significant(P<0.01);the levels of IL-17,IL-22,TGF-β1 in the exacerbation group and the stable phase group were higher than those in the healthy control group,and the levels of IL-17,IL-22,TGF-β1 in the exacerbation group were higher than those in the stable stage group(P<0.01).The results of ROC analysis showed that the AUC of Th17,Treg and Th17/Treg were 0.835,0.795,0.811 respecti

关 键 词：慢性阻塞性肺疾病 急性加重期 细菌感染 辅助性T细胞17 调节性T细胞:诊断价值 

分 类 号：R56[医药卫生—呼吸系统]