感染对慢性阻塞性肺疾病系统性炎症反应的影响  

Effects of infection on systemic inflammatory response in patients with chronic obstructive pulmonary disease

作　　者：孙皎琳 曹霞[2] 李婷婷 纪文文 刘佳[1] 崔晨 吕琳 程雪 石志红[1] SUN Jiaolin;CAO Xia;LI Tingting;JI Wenwen;LIU Jia;CUI Chen;LYU Lin;CHENG Xue;SHI Zhihong(Dept.of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Xi’an Jiaotong University,Xi'an710061,Shaanci,China;Dept.of Respiratory and Critical Care Medicine,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]西安交通大学第一附属医院呼吸与危重症医学科,陕西西安710061 [2]武汉大学人民医院呼吸与危重症医学科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2022年第5期768-773,共6页Medical Journal of Wuhan University

基　　金：国家自然基金资助项目(编号:81270094)。

摘　　要：目的:探索感染因素对慢性阻塞性肺疾病(COPD)不同时期系统性炎症的影响。方法:纳入西安交通大学第一附属医院COPD急性加重期(AECOPD)患者30例,治疗后缓解期患者15例,对照组15例,记录患者入院后第一次或出院前检查结果和肺功能,用ELISA检测血浆中干扰素(IFN)-γ、白细胞介素(IL)-2、IL-4、IL-13浓度。结果:COPD组IFN-γ浓度均高于对照组(P<0.05),COPD组IL-2浓度均低于对照组(P<0.01),急性加重期IL-4、IL-13浓度均高于对照组(P<0.05)。当降钙素原小于0.1 ng/mL时,COPD组中性粒细胞数、中性粒细胞百分比、C-反应蛋白(CRP)均高于对照组(分别为P<0.05、P<0.01、P<0.01)。COPD组患者IFN-γ的浓度均高于对照组(P<0.05),IL-2浓度均低于对照组(P<0.01)。结论:去除感染因素后,COPD系统性炎症反应依然存在,其本质依然是T细胞活化向Th1转化,刺激特异性IFN-γ及抑制IL-2释放,这一炎症持续存在于COPD病程的整个过程中,是COPD系统性炎症的核心特征。Objective: To explore the influence of infection on clinical inflammatory indicators in acute exacerbation and remission stage of chronic obstructive pulmonary disease(COPD). Methods: We enrolled 30 cases of acute exacerbation COPD and 15 patients in remission stage, and 15 cases in the control group. The routine blood, C-reactive protein(CRP), procalcitonin levels, and lung function were recorded. The enzyme-linked immunosorbent assay(ELISA) was used to detect the concentration of interferon(IFN)-γ, interleukin(IL)-2, IL-4, and IL-13 in plasma. Results: The concentration of IFN-γ in COPD patients(involved the acute and remission period) was significantly higher than that in control group(P<0. 05). The concentration of IL-2 in COPD patients was significantly lower than that in control group(P<0. 01). The concentration of IL-4 and IL-13 in acute COPD group were higher than those in control group(P<0. 05). When the serum procalcitonin was less than0. 1 ng/mL, the number of neutrophils, percentage of neutrophils, and CRP levels were significantly higher in COPD patients as compared with those in control group, the concentration of IFN-γ in the COPD group was higher than that in control group(P<0. 05), while the concentration of IL-2 was lower than that in control group(P<0. 01). Conclusion: Regardless of the infection factors, systemic inflammatory response to the activation and conversion of T cells in COPD is consistent. The inflammatory state is still the stage of activation of Th1. IFN-γ is stimulated and IL-2 is inhibited. Inflammation exists in the whole process of COPD, which is the core of systemic inflammation of COPD.

关 键 词：慢性阻塞性肺疾病 炎性指标 炎性细胞因子 感染 降钙素原 

分 类 号：R563.3[医药卫生—呼吸系统]