哮喘-慢性阻塞性肺疾病患者外周血Treg/Th17失衡的研究  

The study on Treg/Th17 imbalance in peripheral blood of patients with asthma-chronic obstructive pulmonary disease overlap

作　　者：时靖峰[1] 韩明锋[1] 滕小宝[1] 张小华 SHI Jing-feng;HAN Ming-feng;TENG Xiao-bao;ZHANG Xiao-hua(Department of Respiration and Critical Care,Fuyang Second People's Hospital,Fuyang236015,China)

机构地区：[1]阜阳市第二人民医院呼吸与危重症科,阜阳236015

出　　处：《现代免疫学》2021年第2期118-123,共6页Current Immunology

基　　金：安徽省卫生厅预防医学与公共卫生科研基金资助项目(2011Y0224)。

摘　　要：为探究哮喘-慢性阻塞性肺疾病(asthma-chronic obstructive pulmonary disease overlap, ACO)患者外周血Treg/Th17失衡对疾病的诊断价值,收集于阜阳市第二人民医院就诊的ACO患者52例(ACO组),哮喘急性发作期患者34例(哮喘组),慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)急性加重期患者45例(COPD组)及健康体检者30例(健康组),FACS检测各组受试者外周血Treg、Th17百分比及Treg/Th17比值;ELISA检测外周血样本IL-17、IL-23、IL-6及TGF-β水平;NIOX NO测定仪检测患者呼出气一氧化氮(fractional exhaled nitric oxide, FeNO)水平和肺功能;受试者工作特征(receiver operator characteristic, ROC)曲线分析Treg/Th17对ACO、哮喘及COPD的诊断价值。结果显示,ACO组Treg百分比,Treg/Th17比值显著低于哮喘组、COPD组和健康组,Th17百分比则显著升高(均P<0.05);外周血IL-17、IL-23、IL-6及TGF-β水平显著高于哮喘组、COPD组和健康组(均P<0.05);ACO组、哮喘组和COPD组FeNO水平显著高于健康组,第1秒用力呼气容积(forced expiratory volume in one second, FEV1)/用力肺活量(forced vital capacity, FVC)百分比、第1秒用力呼气容积占预计值百分比(FEV1 in predicted, FEV1%pred)显著低于健康组(均P<0.05);ROC曲线分析结果显示,Treg/Th17对ACO与哮喘者、ACO与健康者、COPD与哮喘者及COPD与健康者的诊断价值较高(ROC AUC>0.850),但对ACO与COPD者、哮喘与健康者的诊断效能一般(AUC分别为0.726和0.771)。由此,ACO患者存在明显的Treg/Th17失衡,且这一指标对ACO、COPD及哮喘者具有一定的鉴别诊断价值。In order to explore the diagnostic value of Treg/Th17 imbalance in peripheral blood of patients with asthma-chronic obstructive pulmonary disease overlap(ACO), a total of 52 ACO patients(ACO group), 34 asthma patients in acute attack period(asthma group), 45 patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)(COPD group) who were admitted to Fuyang Second People’s Hospital and 30 healthy individuals(healthy group) were enrolled in the study. Treg, Th17 percentages and Treg/Th17 ratio in peripheral blood of each group were detected by FACS;The levels of IL-17, IL-23, IL-6 and TGF-β were detected by ELISA;The level of fractional exhaled nitric oxide(FeNO) and pulmonary function were evaluated by NIOX NO;The diagnostic value of Treg/Th17 ratio in ACO, asthma and COPD was analyzed by ROC curve. The results showed that Treg percentages and Treg/Th17 ratio in ACO group were significantly lower than those in asthma group, COPD group and healthy group, while the Th17 percentages were significantly higher(all P<0.05);The levels of IL-17, IL-23, IL-6 and TGF-β were significantly higher than those in the other three groups(all P<0.05);FeNO in AC, asthma and COPD group were significantly higher than that in healthy group, while forced expiratory volume in one second(FEV1)/forced vital capacity(FVC) percentage and FEV1 in predicted(FEV1% pred) were significantly lower than those in healthy group(all P<0.05);The results of ROC curves showed that the diagnostic value of Treg/Th17 was relatively higher for the differential diagnosis of ACO and asthma group, ACO and healthy group, COPD and asthma group, COPD and healthy group, with all the AUC values greater than 0.850;However, the diagnostic efficiency was ordinary for ACO and COPD group, asthma and healthy group, with AUC being 0.726 and 0.771, respectively. In conclusion, there is significant Treg/Th17 imbalance in ACO patients, and the index could have certain differential diagnosis value among ACO, COPD and asthma patients.

关 键 词：哮喘-慢性阻塞性肺疾病 调节性T细胞/辅助性T细胞17比值 细胞因子 肺功能 诊断价值 

分 类 号：R446.6[医药卫生—诊断学]