老年COPD稳定期的营养免疫状况与COPD急性发作关系  

作　　者：江慧娟[1] 徐培杰 谢中秀 陈灵敏 

机构地区：[1]浙江衢化医院,324002 [2]浙江省永康市中医院,321300

出　　处：《浙江临床医学》2021年第4期516-518,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省永康市科技计划项目(【2019】37号-30)。

摘　　要：目的探讨老年慢性阻塞性肺疾病(COPD)稳定期的营养免疫状况与COPD急性发作的关系.方法收集2018年7月至2019年7月本院收治的老年COPD稳定期患者95例,均采用异丙托溴铵气雾剂和沙美特罗替卡松粉吸入剂连续治疗3个月并随访观察至少1年.观察随访期间患者COPD急性发作情况,检测患者的营养免疫、炎症指标水平,统计微型营养得分和6 min步行距离(6MWD),并进行相关性分析.结果23例患者出现COPD急性发作,第1次急性发作的发作时间为76~285 d,平均第1次急性发作的发作时间为(158.66±46.85)d,急性发作发生率为24.21%(23/95).与治疗前比较,治疗后患者的CD3^(+)、CD4^(+)、IgG、Ig A、TB、ALB水平和MNA得分均升高,CD8^(+)、IL-6、TNF-α水平和6MWD均降低(P<0.05).与COPD未急性发作患者比较,COPD急性发作患者CD3^(+)、CD4^(+)、Ig G、Ig A、TB、ALB水平和MNA得分均较低,而CD8^(+)、IL-6、TNF-α水平和6MWD则均较高(P<0.05).CD3^(+)、CD4^(+)、CD8^(+)、Ig G、Ig A、TB、ALB水平和MNA得分与第1次急性发作的发生时间、IL-6、TNF-α水平和6MWD均相关(P<0.05).CD3^(+)、CD4^(+)、CD8^(+)、Ig G、Ig A、TB、ALB水平和MNA得分等营养免疫指标水平均可影响COPD的急性发作(P<0.05).结论老年COPD稳定期患者的营养免疫检测可早期评估急性发作的风险,加强营养免疫干预可有效防治急性发作的发生.Objective To explore the relationship between nutritional and imunity with acute exacerbation of chronic obstructive pulmonary disease(COPD)in the elderly patients.Methods A collection of 95 elderly patients with stable COPD admitted to our hospital from July 2018 to July 2019 were treated with ipratropium bromide aerosol and salmeterol ticasone powder inhalation for 3 consecutive months and follow-up observation at least 1 year.During the follow-up period,the acute onset of COPD of the patients was observed,the nutritional immunity and inflammation index levels of the patients were detected,the mini-nutrition score and the 6-min walking distance were counted,and correlation analysis was performed.Results 23 patients had an acute attack of COPD.The first acute attack lasted from 76 to 285 days.The average first acute attack was(158.66±46.85)days,and the acute attack rate was 24.21%(23/95).Compared with before treatment,the patients'CD3^(+),CD4^(+),IgG,Ig A,TB,ALB levels«md MNA scores all increased after treatment,and CD8^(+),IL-6,TNF-a levels and 6MWD all decreased(P<0.05).Compared with patients with no acute COPD,the CD3^(+),CD4^(+),IgG,IgA,TB,ALB levels and MNA scores of patients with acute COPD are lower,while the levels of CD8^(+),IL-6,TNF-α and 6MWD are higher.(P<0.05).CD3^(+),CD4^(+),CD8^(+),IgG,IgA,TB,ALB levels and MNA scores were correlated with the time of the first acute attack,IL-6,TNF-α levels and 6MWD(P<0.05).CD3^(+),CD4^(+),CD8^(+),IgG,IgA,TB,ALB levels and MNA scores and other nutritional and immune index levels could affect the acute onset of COPD(P<0.05).Conclusion Nutritional immune testing in elderly patients with stable COPD can assess the risk of acute attacks early,and strengthen nutritional immune intervention can effectively prevent the occurrence ot acute attacks.

关 键 词：慢性阻塞性肺疾病 老年患者 稳定期 急性发作 营养 免疫 

分 类 号：R56[医药卫生—呼吸系统]